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HESI Fundamentals of Nursing Test Bank 2025–2026 |
120+ NCLEX-Style Questions with Answers & Rationales
| Verified A+ Study Pack
Question 1
A nurse is caring for an older adult patient who is recovering from
abdominal surgery. The patient reports feeling dizzy and lightheaded upon
standing. The nurse notes a blood pressure of 110/70 mm Hg while lying
down, and 88/60 mm Hg while standing. Which nursing intervention is the
most appropriate?
A. Encourage the patient to ambulate immediately to prevent immobility
complications
B. Instruct the patient to sit at the edge of the bed before standing
C. Increase fluid intake to correct the blood pressure imbalance
D. Notify the physician immediately of the drop in blood pressure
Correct Answer: B. Instruct the patient to sit at the edge of the bed
before standing
Rationale: Orthostatic hypotension is common after surgery, especially in
older adults. The nurse should use safety measures such as dangling legs at
, 2
the bedside before ambulation to allow the cardiovascular system to adjust.
This intervention prevents sudden drops in blood pressure and reduces fall
risk. Immediate ambulation (A) can cause injury, and while fluids (C) may
help, they're not the first response. Notifying the physician (D) is appropriate
only if symptoms persist or worsen despite nursing interventions.
Question 2
A nurse prepares to administer a medication via a nasogastric (NG) tube.
Which action is most appropriate to ensure the correct placement of the tube
before giving the drug?
A. Inject air into the tube and listen over the stomach
B. Measure pH of aspirated stomach contents
C. Ask the patient if they feel the tube in their throat
D. Rely on the external tube length to confirm placement
Correct Answer: B. Measure pH of aspirated stomach contents
Rationale: Measuring gastric pH (typically <5) is the most reliable bedside
method to confirm NG placement before administering medication or
feedings. Auscultation (A) is outdated and unreliable. Patient feedback (C)
and tube length (D) are not safe indicators of placement. Incorrect placement
can lead to aspiration or ineffective drug delivery.
Question 3
During a bed bath, a confused elderly patient becomes agitated and attempts
to hit the nurse. What is the most appropriate nursing response?
A. Apply wrist restraints to prevent injury
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B. Complete the bath quickly before the patient escalates
C. Stop the bath and return later when the patient is calmer
D. Call security for assistance immediately
Correct Answer: C. Stop the bath and return later when the patient is
calmer
Rationale: The nurse should prioritize patient dignity and safety. Agitation
can escalate if the patient feels threatened or overwhelmed. By stopping and
returning later, the nurse respects autonomy and reduces stress. Restraints
(A) should be a last resort. Rushing (B) may worsen agitation, and security
(D) is only for immediate danger.
Question 4
Which action by the nurse best demonstrates the principle of patient
autonomy during care planning?
A. Documenting the patient’s refusal of medication
B. Telling the patient what treatment is best
C. Allowing the patient to choose between approved treatment options
D. Explaining why the doctor’s order must be followed
Correct Answer: C. Allowing the patient to choose between approved
treatment options
Rationale: Autonomy involves empowering patients to make informed
decisions about their care. Offering choices promotes involvement and
respects independence. While documenting refusal (A) is ethical, it's not a
proactive support of autonomy. Telling (B) or insisting (D) limits patient
participation.
, 4
Question 5
A nurse is teaching a newly diagnosed diabetic client about foot care. Which
instruction is most appropriate?
A. Soak feet in warm water daily
B. Cut toenails straight across
C. Use a heating pad to warm cold feet
D. Walk barefoot at home to air feet
Correct Answer: B. Cut toenails straight across
Rationale: Diabetic patients should avoid foot injuries to reduce the risk of
infection. Cutting toenails straight prevents ingrown nails. Soaking (A)
increases skin breakdown risk. Heating pads (C) can cause burns due to
neuropathy. Barefoot walking (D) increases injury risk.
Question 6
A nurse delegates the task of obtaining a routine blood pressure to a UAP
(unlicensed assistive personnel). Which patient is appropriate for delegation?
A. A patient experiencing chest pain
B. A patient who is post-op from carotid surgery
C. A patient on antihypertensives being monitored
D. A patient admitted with syncope
Correct Answer: C. A patient on antihypertensives being monitored
Rationale: Delegation is appropriate when the task is routine, predictable,
and safe. A stable patient on medication monitoring fits this. Acute
HESI Fundamentals of Nursing Test Bank 2025–2026 |
120+ NCLEX-Style Questions with Answers & Rationales
| Verified A+ Study Pack
Question 1
A nurse is caring for an older adult patient who is recovering from
abdominal surgery. The patient reports feeling dizzy and lightheaded upon
standing. The nurse notes a blood pressure of 110/70 mm Hg while lying
down, and 88/60 mm Hg while standing. Which nursing intervention is the
most appropriate?
A. Encourage the patient to ambulate immediately to prevent immobility
complications
B. Instruct the patient to sit at the edge of the bed before standing
C. Increase fluid intake to correct the blood pressure imbalance
D. Notify the physician immediately of the drop in blood pressure
Correct Answer: B. Instruct the patient to sit at the edge of the bed
before standing
Rationale: Orthostatic hypotension is common after surgery, especially in
older adults. The nurse should use safety measures such as dangling legs at
, 2
the bedside before ambulation to allow the cardiovascular system to adjust.
This intervention prevents sudden drops in blood pressure and reduces fall
risk. Immediate ambulation (A) can cause injury, and while fluids (C) may
help, they're not the first response. Notifying the physician (D) is appropriate
only if symptoms persist or worsen despite nursing interventions.
Question 2
A nurse prepares to administer a medication via a nasogastric (NG) tube.
Which action is most appropriate to ensure the correct placement of the tube
before giving the drug?
A. Inject air into the tube and listen over the stomach
B. Measure pH of aspirated stomach contents
C. Ask the patient if they feel the tube in their throat
D. Rely on the external tube length to confirm placement
Correct Answer: B. Measure pH of aspirated stomach contents
Rationale: Measuring gastric pH (typically <5) is the most reliable bedside
method to confirm NG placement before administering medication or
feedings. Auscultation (A) is outdated and unreliable. Patient feedback (C)
and tube length (D) are not safe indicators of placement. Incorrect placement
can lead to aspiration or ineffective drug delivery.
Question 3
During a bed bath, a confused elderly patient becomes agitated and attempts
to hit the nurse. What is the most appropriate nursing response?
A. Apply wrist restraints to prevent injury
, 3
B. Complete the bath quickly before the patient escalates
C. Stop the bath and return later when the patient is calmer
D. Call security for assistance immediately
Correct Answer: C. Stop the bath and return later when the patient is
calmer
Rationale: The nurse should prioritize patient dignity and safety. Agitation
can escalate if the patient feels threatened or overwhelmed. By stopping and
returning later, the nurse respects autonomy and reduces stress. Restraints
(A) should be a last resort. Rushing (B) may worsen agitation, and security
(D) is only for immediate danger.
Question 4
Which action by the nurse best demonstrates the principle of patient
autonomy during care planning?
A. Documenting the patient’s refusal of medication
B. Telling the patient what treatment is best
C. Allowing the patient to choose between approved treatment options
D. Explaining why the doctor’s order must be followed
Correct Answer: C. Allowing the patient to choose between approved
treatment options
Rationale: Autonomy involves empowering patients to make informed
decisions about their care. Offering choices promotes involvement and
respects independence. While documenting refusal (A) is ethical, it's not a
proactive support of autonomy. Telling (B) or insisting (D) limits patient
participation.
, 4
Question 5
A nurse is teaching a newly diagnosed diabetic client about foot care. Which
instruction is most appropriate?
A. Soak feet in warm water daily
B. Cut toenails straight across
C. Use a heating pad to warm cold feet
D. Walk barefoot at home to air feet
Correct Answer: B. Cut toenails straight across
Rationale: Diabetic patients should avoid foot injuries to reduce the risk of
infection. Cutting toenails straight prevents ingrown nails. Soaking (A)
increases skin breakdown risk. Heating pads (C) can cause burns due to
neuropathy. Barefoot walking (D) increases injury risk.
Question 6
A nurse delegates the task of obtaining a routine blood pressure to a UAP
(unlicensed assistive personnel). Which patient is appropriate for delegation?
A. A patient experiencing chest pain
B. A patient who is post-op from carotid surgery
C. A patient on antihypertensives being monitored
D. A patient admitted with syncope
Correct Answer: C. A patient on antihypertensives being monitored
Rationale: Delegation is appropriate when the task is routine, predictable,
and safe. A stable patient on medication monitoring fits this. Acute
