HESI FUNDAMENTALS EXAM – UPDATED RETAKE GUIDE
1) A client who is in hospice care complains of increasing amounts of pain.
The healthcare provider prescribes an analgesic every four hours as
needed. Which action should the nurse implement?
A. Give an around-the-clock schedule for administration of analgesics. B..
Administer analgesic medication as needed when the pain is severe.
C. Provide medication to keep the client sedated and unaware of stimuli.
D. Offer a medication-free period so that the client can do daily activities.
Correct Answer: A
2) When assessing a client with wrist restraints, the nurse observes that the
fingers on the right hand are blue. What action should the nurse
implement first?
A. Loosen the right wrist restraint.
B. Apply a pulse oximeter to the right hand.
C. Compare hand color bilaterally.
D. Palpate the right radial pulse.
Correct Answer: A
3) The nurse is assessing the nutritional status of several clients. Which
client has the greatest nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle.
B. A lactating woman nursing her 3-day-old infant.
C. A school-aged child with Type 2 diabetes.
D. An elderly man being treated for a peptic ulcer.
, Correct Answer: B
4) A client is in the radiology department at 0900 when the prescription
levofloxacin (Levaquin) 500 mg IV q24h is scheduled to be administered.
The client returns to the unit at 1300. What is the best intervention for the
nurse to implement?
A. Contact the healthcare provider and complete a medication variance form.
B. Administer the Levaquin at 1300 and resume the 0900 schedule in
the morning.
C. Notify the charge nurse and complete an incident report to explain the
missed dose.
D. Give the missed dose at 1300 and change the schedule to administer daily
at 1300.
Correct Answer: D
5) While instructing a male client's wife in the performance of passive
rangeof-motion exercises to his contracted shoulder, the nurse observes
that
she is holding his arm above and below the elbow. What nursing action should
the nurse implement?
A. Acknowledge that she is supporting the arm correctly.
B. Encourage her to keep the joint covered to maintain warmth.
C. Reinforce the need to grip directly under the joint for better support.
D. Instruct her to grip directly over the joint for better motion.
Correct Answer: A
6) What is the most important reason for starting intravenous infusions in
the upper extremities rather than the lower extremities of adults?
A. It is more difficult to find a superficial vein in the feet and ankles.
, B. A decreased flow rate could result in the formation of a thrombosis.
C. A cannulated extremity is more difficult to move when the leg or foot is used.
D. Veins are located deep in the feet and ankles, resulting in a more
painful procedure.
Correct Answer: B
7) The nurse observes an unlicensed assistive personnel (UAP) taking a
client's blood pressure with a cuff that is too small, but the blood
pressure reading obtained is within the client's usual range. What action
is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure.
Correct Answer: B
8) A client is to receive cimetidine (Tagamet) 300 mg q6h IVPB. The
preparation arrives from the pharmacy diluted in 50 ml of 0.9% NaCl. The
nurse plans to administer the IVPB dose over 20 minutes. For how many
ml/ hr should the infusion pump be set to deliver the secondary infusion?
Correct Answer: 150
9) Twenty minutes after beginning a heat application, the client states that
the heating pad no longer feels warm enough. What is the best response by
the nurse?
A. That means you have derived the maximum benefit, and the heat can
be removed.
1) A client who is in hospice care complains of increasing amounts of pain.
The healthcare provider prescribes an analgesic every four hours as
needed. Which action should the nurse implement?
A. Give an around-the-clock schedule for administration of analgesics. B..
Administer analgesic medication as needed when the pain is severe.
C. Provide medication to keep the client sedated and unaware of stimuli.
D. Offer a medication-free period so that the client can do daily activities.
Correct Answer: A
2) When assessing a client with wrist restraints, the nurse observes that the
fingers on the right hand are blue. What action should the nurse
implement first?
A. Loosen the right wrist restraint.
B. Apply a pulse oximeter to the right hand.
C. Compare hand color bilaterally.
D. Palpate the right radial pulse.
Correct Answer: A
3) The nurse is assessing the nutritional status of several clients. Which
client has the greatest nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle.
B. A lactating woman nursing her 3-day-old infant.
C. A school-aged child with Type 2 diabetes.
D. An elderly man being treated for a peptic ulcer.
, Correct Answer: B
4) A client is in the radiology department at 0900 when the prescription
levofloxacin (Levaquin) 500 mg IV q24h is scheduled to be administered.
The client returns to the unit at 1300. What is the best intervention for the
nurse to implement?
A. Contact the healthcare provider and complete a medication variance form.
B. Administer the Levaquin at 1300 and resume the 0900 schedule in
the morning.
C. Notify the charge nurse and complete an incident report to explain the
missed dose.
D. Give the missed dose at 1300 and change the schedule to administer daily
at 1300.
Correct Answer: D
5) While instructing a male client's wife in the performance of passive
rangeof-motion exercises to his contracted shoulder, the nurse observes
that
she is holding his arm above and below the elbow. What nursing action should
the nurse implement?
A. Acknowledge that she is supporting the arm correctly.
B. Encourage her to keep the joint covered to maintain warmth.
C. Reinforce the need to grip directly under the joint for better support.
D. Instruct her to grip directly over the joint for better motion.
Correct Answer: A
6) What is the most important reason for starting intravenous infusions in
the upper extremities rather than the lower extremities of adults?
A. It is more difficult to find a superficial vein in the feet and ankles.
, B. A decreased flow rate could result in the formation of a thrombosis.
C. A cannulated extremity is more difficult to move when the leg or foot is used.
D. Veins are located deep in the feet and ankles, resulting in a more
painful procedure.
Correct Answer: B
7) The nurse observes an unlicensed assistive personnel (UAP) taking a
client's blood pressure with a cuff that is too small, but the blood
pressure reading obtained is within the client's usual range. What action
is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure.
Correct Answer: B
8) A client is to receive cimetidine (Tagamet) 300 mg q6h IVPB. The
preparation arrives from the pharmacy diluted in 50 ml of 0.9% NaCl. The
nurse plans to administer the IVPB dose over 20 minutes. For how many
ml/ hr should the infusion pump be set to deliver the secondary infusion?
Correct Answer: 150
9) Twenty minutes after beginning a heat application, the client states that
the heating pad no longer feels warm enough. What is the best response by
the nurse?
A. That means you have derived the maximum benefit, and the heat can
be removed.
