HESI Fundamentals Practice Test B
GRADED A.
1.What is the rationale for using the nursing process in planning care for clients?
A. As a scientific process to identify nursing diagnoses of a clients' healthcare problems.
B. To establish nursing theory that incorporates the biopsychosocial nature of humans.
C. As a tool to organize thinking and clinical decision making about clients' healthcare
needs.
D. To promote the management of client care in collaboration with other healthcare
professionals. - answer C (The nursing process is a problem-solving approach that
provides an organized, systematic, decision making process to effectively address the
client's needs and problems. The nursing process includes an organized framework
using knowledge, judgments, and actions by the nurse as the client's plan of care is
determined, and encompasses assessment, analysis, planning, implementation, and
evaluation of client care (C). (A, B, and D) do not support the basis for using the nursing
process.
Correct Answer: C)
2.What activity should the nurse use in the evaluation phase of the nursing process?
A. Ask a client to evaluate the nursing care provided.
B. Document the nursing care plan in the progress notes.
C. Determine whether a client's health problems have been alleviated.
D. Examine the effectiveness of nursing interventions toward meeting client outcomes. -
answer In the nursing process, the evaluation component examines the effectiveness of
nursing interventions in achieving client outcomes (D). (A) is an evaluation of client
satisfaction, not outcomes. (B) is a written record of the plan of care. Although (C) may
occur when client outcomes are achieved, evaluation is best determined by attainment
of measurable client outcomes.
Correct Answer: D
3.Which statement is an example of a correctly written nursing diagnosis statement?
A. Altered tissue perfusion related to congestive heart failure.
B. Altered urinary elimination related to urinary tract infection.
C. Risk for impaired tissue integrity related to client's refusal to turn.
D. Ineffective coping related to response to positive biopsy test results. - answer The
first part of the nursing diagnosis statement is the diagnostic label and is followed by
related to the cause, which should direct the nurse to the appropriate interventions. (D)
best fits this criteria. (A and B) contain a medical diagnosis. (C) includes an observable
cause, but (D) focuses on the client's response, which the nurse can provide support,
reflection, and dialogue.
Correct Answer: D
4.What action by the nurse demonstrates culturally sensitive care?
A. Asks permission before touching a client.
B. Avoids questions about male-female relationships.
C. Explains the differences between Western medical care and cultural folk remedies.
,HESI Fundamentals Practice Test B
GRADED A.
D. Applies knowledge of a cultural group unless a client embraces Western customs. -
answer Physical contact, such as touching the head, in some cultures is a sign of
respect, whereas in others, it is strictly forbidden. So asking permission before touching
a client (A) demonstrates culturally sensitive care. (B, C, and D) do not demonstrate
cultural awareness.
Correct Answer: A
5.A nurse is becoming increasingly frustrated by the family members' efforts to
participate in the care of a hospitalized client. What action should the nurse implement
to cope with these feelings of frustration?
A. Suggest that other cultural practices be substituted by the family members.
B. Examine one's own culturally based values, beliefs, attitudes, and practices.
C. Explain to the family that multiple visitors are exhausting to the client.
D. Allow the situation to continue until a family member's action may harm the client. -
answer Acknowledging a client's beliefs and customs related to sickness and health
care are valuable components in the plan of care that prevents conflict between the
goals of nursing and the client's cultural practices. Cultural sensitivity begins with
examining one's own cultural values (B) to compare, recognize, and acknowledge
cultural bias. (A and C) do not consider the family's needs to care for the client and are
not the best ways to cope with the nurse's frustration. Although (D) may be an option,
examining one's cultural differences allows the nurse to cope, empathize, and
implement culturally specific interventions pertaining to the needs of the client and the
family.
Correct Answer: B
6.Which technique is most important for the nurse to implement when performing a
physical assessment?
A. A head-to-toe approach.
B. The medical systems model.
C. A consistent, systematic approach.
D. An approach related to a nursing model. - answer The most important factor in
performing a physical assessment is following a consistent and systematic technique
(C) each time an assessment is performed to minimize variation in sequence which may
increase the likelihood of omitting a step or exam of an isolated area. The method of
completing a physical assessment (A, B, and D) may be at the discretion of the
examiner, but a consistent sequence by the examiner provides a reliable method to
ensure thorough review of the clients' history, complaints, or body systems.
Correct Answer: C
7.A 73-year-old Hispanic client is seen at the community health clinic with a history of
protein malnutrition. What information should the nurse obtain first?
A. Amount of liquid protein supplements consumed daily.
B. Foods and liquids consumed during the past 24 hours.
C. Usual weekly intake of milk products and red meats.
, HESI Fundamentals Practice Test B
GRADED A.
D. Grains and legume combinations used by the client. - answer A client's dietary
habits should be determined first by the client's dietary recall (B) before suggesting
protein sources or supplements (A and C) as options in the client's diet. Although grains
and legumes (D) contain incomplete proteins that reduces the essential amino acid
pools inside the cells, the client's cultural preferences should be illicited after confirming
the client's dietary history.
Correct Answer: B
8.The nurse formulates the nursing diagnosis of, "Ineffective health maintenance related
to lack of motivation" for a client with Type 2 diabetes. Which finding supports this
nursing diagnosis?
A. Does not check capillary blood glucose as directed.
B. Occasionally forgets to take daily prescribed medication.
C. Cannot identify signs or symptoms of high and low blood glucose.
D. Eats anything and does not think diet makes a difference in health. - answer The
nursing diagnosis of ineffective health maintenance refers to an inability to identify,
manage, and/or seek out help to maintain health, and is best exemplified in the client
belief or understanding about diet and health maintenance (D). (A) indicates
noncompliance with an action to be done in the management of diabetes. (B)
represents inattentiveness. (C) reflects knowledge deficit.
Correct Answer: D
9.Which statement correctly identifies a written learning objective for a client with
peripheral vascular disease?
A. The nurse will provide client instruction for daily foot care.
B. The client will demonstrate proper trimming toenail technique.
C. Upon discharge, the client will list three ways to protect the feet from injury.
D. After instruction, the nurse will ensure the client understands foot care rationale. -
answer An objective should contain four elements: who will perform the activity or
acquire the desired behavior, the actual behavior that the learner will exhibit, the
condition under which the behavior is to be demonstrated, and the specific criteria to be
used to measure success. (C) is a concise statement that is a learning objective that
defines exactly how the client will demonstrate mastery of the content. (A, B, and D)
lack one or more of these elements.
Correct Answer: C
10.A middle-aged woman who enjoys being a teacher and mentor feels that she should
pass down her legacy of knowledge and skills to the younger generation. According to
Erikson, she is involved in what developmental stage?
A. Generativity.
B. Ego integrity.
C. Identification.
D. Valuing wisdom. - answer Healthy middle-aged adults focus on establishing the next
generation by nurturing and guiding, which is describe by Erikson as the developmental
GRADED A.
1.What is the rationale for using the nursing process in planning care for clients?
A. As a scientific process to identify nursing diagnoses of a clients' healthcare problems.
B. To establish nursing theory that incorporates the biopsychosocial nature of humans.
C. As a tool to organize thinking and clinical decision making about clients' healthcare
needs.
D. To promote the management of client care in collaboration with other healthcare
professionals. - answer C (The nursing process is a problem-solving approach that
provides an organized, systematic, decision making process to effectively address the
client's needs and problems. The nursing process includes an organized framework
using knowledge, judgments, and actions by the nurse as the client's plan of care is
determined, and encompasses assessment, analysis, planning, implementation, and
evaluation of client care (C). (A, B, and D) do not support the basis for using the nursing
process.
Correct Answer: C)
2.What activity should the nurse use in the evaluation phase of the nursing process?
A. Ask a client to evaluate the nursing care provided.
B. Document the nursing care plan in the progress notes.
C. Determine whether a client's health problems have been alleviated.
D. Examine the effectiveness of nursing interventions toward meeting client outcomes. -
answer In the nursing process, the evaluation component examines the effectiveness of
nursing interventions in achieving client outcomes (D). (A) is an evaluation of client
satisfaction, not outcomes. (B) is a written record of the plan of care. Although (C) may
occur when client outcomes are achieved, evaluation is best determined by attainment
of measurable client outcomes.
Correct Answer: D
3.Which statement is an example of a correctly written nursing diagnosis statement?
A. Altered tissue perfusion related to congestive heart failure.
B. Altered urinary elimination related to urinary tract infection.
C. Risk for impaired tissue integrity related to client's refusal to turn.
D. Ineffective coping related to response to positive biopsy test results. - answer The
first part of the nursing diagnosis statement is the diagnostic label and is followed by
related to the cause, which should direct the nurse to the appropriate interventions. (D)
best fits this criteria. (A and B) contain a medical diagnosis. (C) includes an observable
cause, but (D) focuses on the client's response, which the nurse can provide support,
reflection, and dialogue.
Correct Answer: D
4.What action by the nurse demonstrates culturally sensitive care?
A. Asks permission before touching a client.
B. Avoids questions about male-female relationships.
C. Explains the differences between Western medical care and cultural folk remedies.
,HESI Fundamentals Practice Test B
GRADED A.
D. Applies knowledge of a cultural group unless a client embraces Western customs. -
answer Physical contact, such as touching the head, in some cultures is a sign of
respect, whereas in others, it is strictly forbidden. So asking permission before touching
a client (A) demonstrates culturally sensitive care. (B, C, and D) do not demonstrate
cultural awareness.
Correct Answer: A
5.A nurse is becoming increasingly frustrated by the family members' efforts to
participate in the care of a hospitalized client. What action should the nurse implement
to cope with these feelings of frustration?
A. Suggest that other cultural practices be substituted by the family members.
B. Examine one's own culturally based values, beliefs, attitudes, and practices.
C. Explain to the family that multiple visitors are exhausting to the client.
D. Allow the situation to continue until a family member's action may harm the client. -
answer Acknowledging a client's beliefs and customs related to sickness and health
care are valuable components in the plan of care that prevents conflict between the
goals of nursing and the client's cultural practices. Cultural sensitivity begins with
examining one's own cultural values (B) to compare, recognize, and acknowledge
cultural bias. (A and C) do not consider the family's needs to care for the client and are
not the best ways to cope with the nurse's frustration. Although (D) may be an option,
examining one's cultural differences allows the nurse to cope, empathize, and
implement culturally specific interventions pertaining to the needs of the client and the
family.
Correct Answer: B
6.Which technique is most important for the nurse to implement when performing a
physical assessment?
A. A head-to-toe approach.
B. The medical systems model.
C. A consistent, systematic approach.
D. An approach related to a nursing model. - answer The most important factor in
performing a physical assessment is following a consistent and systematic technique
(C) each time an assessment is performed to minimize variation in sequence which may
increase the likelihood of omitting a step or exam of an isolated area. The method of
completing a physical assessment (A, B, and D) may be at the discretion of the
examiner, but a consistent sequence by the examiner provides a reliable method to
ensure thorough review of the clients' history, complaints, or body systems.
Correct Answer: C
7.A 73-year-old Hispanic client is seen at the community health clinic with a history of
protein malnutrition. What information should the nurse obtain first?
A. Amount of liquid protein supplements consumed daily.
B. Foods and liquids consumed during the past 24 hours.
C. Usual weekly intake of milk products and red meats.
, HESI Fundamentals Practice Test B
GRADED A.
D. Grains and legume combinations used by the client. - answer A client's dietary
habits should be determined first by the client's dietary recall (B) before suggesting
protein sources or supplements (A and C) as options in the client's diet. Although grains
and legumes (D) contain incomplete proteins that reduces the essential amino acid
pools inside the cells, the client's cultural preferences should be illicited after confirming
the client's dietary history.
Correct Answer: B
8.The nurse formulates the nursing diagnosis of, "Ineffective health maintenance related
to lack of motivation" for a client with Type 2 diabetes. Which finding supports this
nursing diagnosis?
A. Does not check capillary blood glucose as directed.
B. Occasionally forgets to take daily prescribed medication.
C. Cannot identify signs or symptoms of high and low blood glucose.
D. Eats anything and does not think diet makes a difference in health. - answer The
nursing diagnosis of ineffective health maintenance refers to an inability to identify,
manage, and/or seek out help to maintain health, and is best exemplified in the client
belief or understanding about diet and health maintenance (D). (A) indicates
noncompliance with an action to be done in the management of diabetes. (B)
represents inattentiveness. (C) reflects knowledge deficit.
Correct Answer: D
9.Which statement correctly identifies a written learning objective for a client with
peripheral vascular disease?
A. The nurse will provide client instruction for daily foot care.
B. The client will demonstrate proper trimming toenail technique.
C. Upon discharge, the client will list three ways to protect the feet from injury.
D. After instruction, the nurse will ensure the client understands foot care rationale. -
answer An objective should contain four elements: who will perform the activity or
acquire the desired behavior, the actual behavior that the learner will exhibit, the
condition under which the behavior is to be demonstrated, and the specific criteria to be
used to measure success. (C) is a concise statement that is a learning objective that
defines exactly how the client will demonstrate mastery of the content. (A, B, and D)
lack one or more of these elements.
Correct Answer: C
10.A middle-aged woman who enjoys being a teacher and mentor feels that she should
pass down her legacy of knowledge and skills to the younger generation. According to
Erikson, she is involved in what developmental stage?
A. Generativity.
B. Ego integrity.
C. Identification.
D. Valuing wisdom. - answer Healthy middle-aged adults focus on establishing the next
generation by nurturing and guiding, which is describe by Erikson as the developmental
