HESI FUNDAMENTALS EXAM 2 ACTUAL EXAM
QUESTIONS WITH DETAILED VERIFIED CORRECT
ANSWERS (GRADED A+)
A nurse is assessing a client's nails and finds a slight convex curve at the angle from the
skin to nail base of about 160 degrees. Which condition does the nurse suspect?
Normal Finding
The client's nail, which has a slight convex curve at the angle from the skin to nail base of
about 160 degrees, is normal. In clubbing, there is a change in the angle between the nail and
the nail base that is larger than 180 degrees. Paronychia is the inflammation of the skin at the
base of nail. Koilonychia is the concave curves on the nail.
When assessing a client's fluid and electrolyte status, the nurse recalls that the regulator
of extracellular osmolarity is what?
Sodium
Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular)
osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major
intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and
conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction.
Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular
cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac
conduction, transmission of nerve impulses, and muscle contraction.
Which intervention reflects the nurse's approach of "family as a context"?
Trying to meet the client's comfort
,In the "family as context" approach, the focus is on the client. The nursing care aims at
meeting the client's comfort, hygiene, and nutritional needs. The "family as a client" approach
focuses on the family's needs as a whole to determine their coping skills. This approach also
includes assessment of the family's energy level to determine if the family would be able to
meet the client's needs. In addition, the approach "family as a client" involves assessment of
the family's nutritional needs.
A registered nurse is educating a nursing student about the process of resolving an ethical
dilemma. What information should the nurse provide regarding negotiation of outcomes?
"A nurse should provide a personal point of view."
During the process of negotiating outcomes, the nurse is required to provide a personal point
of view. Negotiations may take place informally at the client's bedside or in a formal setting.
After gathering relevant information regarding an ethical dilemma, the nurse is required to
examine his or her own values and formulate an opinion regarding the matter. When
verbalizing the problem, the group agrees to a statement of the problem to begin discussions.
This step is performed before negotiating outcomes. Negotiations take place after determining
all possible courses of action.
Which statement regarding Roy's theory of nursing needs correction?
All individuals must adapt to the following demands: meeting basic physiological needs,
developing a positive self-concept, performing social roles, and achieving a balance between
dependence and independence.
Which nursing process involves delegation and verbal discussion with the healthcare team?
,Implementation
The implementation process involves delegation and verbal discussion with the
healthcare team. Planning involves interpersonal or small group healthcare team sessions.
Evaluation involves the acquisition of verbal and nonverbal feedback. Assessment involves
verbal interviewing and a history of talking with the clients.
Which psychophysiologic factors can influence communication between a nurse and a
client? Select all that apply.
Emotional Status and Growth and Development
Growth and development and emotional status are two psychophysiologic factors that
influence communication between a nurse and a client. Privacy level is an environmental factor.
Information exchange is a situational factor. Level of caring expressed is a relational factor.
Which fine-motor skills may be observed in an 8 to 10 month-old infant? Select all that apply.
Using Pincer Grasp well
Picking up small objects
Showing hand preference
The fine-motor skills evident in 8 to 10 month-old infants include the accurate use of the pincer
grasp. It also involves picking up small objects. At this stage, the infants may also demonstrate a
hand preference. Crawling on hands and knees and pulling oneself to standing or sitting
position are considered gross motor skills.
While performing a physical assessment, the nurse notices a minute, nonpalpable change
in the skin color of a client. What might be the type of skin lesion involved?
Macule
, While performing a physical assessment, the nurse notices a minute, nonpalpable change in the
skin color of a client. What might be the type of skin lesion involved?
Which nursing action indicates that the nurse is actively listening to the client?
The nurse interprets what the client is saying and reiterates in his or her own words.
The nurse is listening actively if he or she is able to take in what the client says. A nurse who is
listens attentively interprets and reiterates what the client is saying in his or her own words. A
nurse who states his or her own opinions when the client is speaking is being judgmental. A
good listener should be able to reach out by exchanging his or her own stories with the client. If
a nurse reads the client's health record during the conversation, it is an indication that the
nurse is not really interested in the conversation.
registered nurse is educating a nursing student about the stages of changes in a
client's health behavior. Which statement describes the stage of contemplation?
The client considers a change within the next 6 months.
In the contemplation stage, the client considers a change within the next 6 months. In the
precontemplation stage, the client does not intend to make changes within the next 6 months. In
the action stage, the client is actively engaged in strategies to change behavior. This stage lasts up
to 6 months. When sustained change is noticed over time and begins 6 months after action has
started and continues indefinitely, the client has reached the maintenance stage.
A client is placed on a stretcher and restrained with straps while being transported to the x-
ray department. A strap breaks, and the client falls to the floor, sustaining a fractured arm.
Later the client shows the strap to the nurse manager, stating, "See, the strap is worn just
at the spot where it snapped." What is the nurse's accountability regarding this incident?
Liable, along with the employer, for misapplication of equipment or use of defective
equipment that harms the client
QUESTIONS WITH DETAILED VERIFIED CORRECT
ANSWERS (GRADED A+)
A nurse is assessing a client's nails and finds a slight convex curve at the angle from the
skin to nail base of about 160 degrees. Which condition does the nurse suspect?
Normal Finding
The client's nail, which has a slight convex curve at the angle from the skin to nail base of
about 160 degrees, is normal. In clubbing, there is a change in the angle between the nail and
the nail base that is larger than 180 degrees. Paronychia is the inflammation of the skin at the
base of nail. Koilonychia is the concave curves on the nail.
When assessing a client's fluid and electrolyte status, the nurse recalls that the regulator
of extracellular osmolarity is what?
Sodium
Sodium is the most abundant extracellular fluid cation and regulates serum (extracellular)
osmolarity, as well as nerve impulse transmission and acid-base balance. Potassium is the major
intracellular osmolarity regulator, and it also regulates metabolic activities, transmission and
conduction of nerve impulses, cardiac conduction, and smooth and skeletal muscle contraction.
Chloride is a major extracellular fluid anion and follows sodium. Calcium is an extracellular
cation necessary for bone and teeth formation, blood clotting, hormone secretion, cardiac
conduction, transmission of nerve impulses, and muscle contraction.
Which intervention reflects the nurse's approach of "family as a context"?
Trying to meet the client's comfort
,In the "family as context" approach, the focus is on the client. The nursing care aims at
meeting the client's comfort, hygiene, and nutritional needs. The "family as a client" approach
focuses on the family's needs as a whole to determine their coping skills. This approach also
includes assessment of the family's energy level to determine if the family would be able to
meet the client's needs. In addition, the approach "family as a client" involves assessment of
the family's nutritional needs.
A registered nurse is educating a nursing student about the process of resolving an ethical
dilemma. What information should the nurse provide regarding negotiation of outcomes?
"A nurse should provide a personal point of view."
During the process of negotiating outcomes, the nurse is required to provide a personal point
of view. Negotiations may take place informally at the client's bedside or in a formal setting.
After gathering relevant information regarding an ethical dilemma, the nurse is required to
examine his or her own values and formulate an opinion regarding the matter. When
verbalizing the problem, the group agrees to a statement of the problem to begin discussions.
This step is performed before negotiating outcomes. Negotiations take place after determining
all possible courses of action.
Which statement regarding Roy's theory of nursing needs correction?
All individuals must adapt to the following demands: meeting basic physiological needs,
developing a positive self-concept, performing social roles, and achieving a balance between
dependence and independence.
Which nursing process involves delegation and verbal discussion with the healthcare team?
,Implementation
The implementation process involves delegation and verbal discussion with the
healthcare team. Planning involves interpersonal or small group healthcare team sessions.
Evaluation involves the acquisition of verbal and nonverbal feedback. Assessment involves
verbal interviewing and a history of talking with the clients.
Which psychophysiologic factors can influence communication between a nurse and a
client? Select all that apply.
Emotional Status and Growth and Development
Growth and development and emotional status are two psychophysiologic factors that
influence communication between a nurse and a client. Privacy level is an environmental factor.
Information exchange is a situational factor. Level of caring expressed is a relational factor.
Which fine-motor skills may be observed in an 8 to 10 month-old infant? Select all that apply.
Using Pincer Grasp well
Picking up small objects
Showing hand preference
The fine-motor skills evident in 8 to 10 month-old infants include the accurate use of the pincer
grasp. It also involves picking up small objects. At this stage, the infants may also demonstrate a
hand preference. Crawling on hands and knees and pulling oneself to standing or sitting
position are considered gross motor skills.
While performing a physical assessment, the nurse notices a minute, nonpalpable change
in the skin color of a client. What might be the type of skin lesion involved?
Macule
, While performing a physical assessment, the nurse notices a minute, nonpalpable change in the
skin color of a client. What might be the type of skin lesion involved?
Which nursing action indicates that the nurse is actively listening to the client?
The nurse interprets what the client is saying and reiterates in his or her own words.
The nurse is listening actively if he or she is able to take in what the client says. A nurse who is
listens attentively interprets and reiterates what the client is saying in his or her own words. A
nurse who states his or her own opinions when the client is speaking is being judgmental. A
good listener should be able to reach out by exchanging his or her own stories with the client. If
a nurse reads the client's health record during the conversation, it is an indication that the
nurse is not really interested in the conversation.
registered nurse is educating a nursing student about the stages of changes in a
client's health behavior. Which statement describes the stage of contemplation?
The client considers a change within the next 6 months.
In the contemplation stage, the client considers a change within the next 6 months. In the
precontemplation stage, the client does not intend to make changes within the next 6 months. In
the action stage, the client is actively engaged in strategies to change behavior. This stage lasts up
to 6 months. When sustained change is noticed over time and begins 6 months after action has
started and continues indefinitely, the client has reached the maintenance stage.
A client is placed on a stretcher and restrained with straps while being transported to the x-
ray department. A strap breaks, and the client falls to the floor, sustaining a fractured arm.
Later the client shows the strap to the nurse manager, stating, "See, the strap is worn just
at the spot where it snapped." What is the nurse's accountability regarding this incident?
Liable, along with the employer, for misapplication of equipment or use of defective
equipment that harms the client
