CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
1. A 35y/o client with cancer refuses to
Evaluate the client's mental
allow a nurse to insert an IV for
status for competence to refuse
scheduled chemo & states that she's
treatment
ready to go home to die. What
intervention should the nurse initiate?
Rationale: Competent clients
have the right to refuse
treatment. The nurse cannot
document until the HCP is
notified of the patient's wish- es
& a d/c RX is obtained. Advance
directives & DNR are not
2. A client with chronic renal disease is necessary for competent client to
admitted to the hospital for evaluation refuse care.
prior to a surgi- cal procedure. Which
laboratory test indicates client's protein Serum albumin
status for the longest length of time?
Rationale: Serum albumin has a
3. What client statement indicates to the long half-life.
nurse
"I don't understand why I'm so
weak
that the client requires assistance with bathing? & tired."
4. How should the nurse handle linens elderly male
that are soiled with incontinent feces? client &
determines that
his blood
5. When caring for an immobile client, what pressure is
nurs- ing diagnosis has the highest 138/60, his
priority? temperature is
95.8F & his
6. The nurse assesses an immobile,
output is 100 mL
,HESI FUNDAMENTALS PRACTICE EXAM #1 WITH ALL
CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
of concentrated urine during the last Place the soiled linens in a
hour. He has wet sounding lungs & pillow case & deposit them in the
increased respiratory secretions. Based
dirty linen hamper
on these assess-
Impaired gas exchange
Turn the client q2h
Rationale: It will help move
&
drain respiratory secretions & pre-
vent pneumonia from
occurring.
, HESI FUNDAMENTALS PRACTICE EXAM #1 WITH ALL
CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
ment findings , what nursing action is
most im- portant for the nurse to
implement?
11.
7. The home health nurse visits an elderly
female client who had a brain attack 3
months ago & is now able to ambulate
with the assistance of a quad cane.
Which assessment finding has the
greatest implications for this client's
care?
8. The nurse removes the dressing on a
client's heel that is cover a pressure
sore 1" in diame- ter & finds that there
is straw-colored drainage seeping from
the wound. What description of this
finding should the nurse include in the
client's record?
9. Medication is prescribed to be given QID.
What schedule should the nurse use to
administer this Rx?
10. The nurse working in the ED is
assessing 4 clients' ability to tolerate
pain. Which client is likely to tolerate a
higher level of pain?
, HESI FUNDAMENTALS PRACTICE EXAM #1 WITH ALL
CORRECT & VERIFIED ANSWERS (UPDATED TO PASS)
The nurse notes there are numerous scatter rugs throughout the
house
One-inch pressure sore draining serous fluid
0800, 1200, 1600, 2000
1 55y/o woman who has had mod- erate low back pain for 3 months
Rationale: Experiences with the same type of pain that has
success- fully been relieved makes it easier for the client to
interpret the pain sensation and, as a result, the client is better
prepared to take steps to relieve the pain. All other clients are
having new experiences with pain.