HESI Practice Test B
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) Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
D. Applies knowledge of a cultural group unless a client embraces Western customs.
,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 Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
D. Grains and legume combinations used by the client.
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 Correct Answer: 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.
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 Correct Answer: 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.
Healthy middle-aged adults focus on establishing the next generation by nurturing and guiding, which is
describe by Erikson as the developmental stage of generativity (A), and is characteristic of middle
adulthood. (B, C and D) are not stages of this age group according to Erickson's psychosocial
developmental theory.
Correct Answer: A Correct Answer: 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.
The durable power of attorney is a legal document or a form of advance directive that designates
another person to voice healthcare decisions when the client is unable to do so. A durable power of
attorney for health directives is legally binding (A). (B, C and D) do not include the legal parameters that
must be determined by the client in the event the client is unable to make a healthcare decision, which
can be changed by the client at any time.
Correct Answer: A Correct Answer: Which statement best describes durable power of attorney for
health care?
A. The client signs a document that designates another person to make legally binding healthcare
decisions if client is unable to do so.
B. The healthcare decisions made by another person designated by the client are not legally binding.
C. Instructions about actions to be taken in the event of a client's terminal or irreversible condition are
not legally binding.
D. Directions regarding care in the event of a terminal or irreversible condition must be documented to
ensure that they are legally binding.
A macrobiotic diet is high in whole-grain cereals, vegetables, sea vegetables, beans, and vegetarian
soups, and the client needs essential amino acids to provide complete proteins to heal the infected
wound. Although a macrobiotic diet contains no source of animal protein, essential amino acids should
be obtained by combining plant (incomplete) proteins to provide complete (all essential amino acids)
proteins (B) for anabolic processes. (A, C, and D) do not provide the client with food choices consistent
with a macrobiotic diet and protein needs.
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) Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
D. Applies knowledge of a cultural group unless a client embraces Western customs.
,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 Correct Answer: 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.
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 Correct Answer: 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.
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 Correct Answer: 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.
D. Grains and legume combinations used by the client.
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 Correct Answer: 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.
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 Correct Answer: 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.
Healthy middle-aged adults focus on establishing the next generation by nurturing and guiding, which is
describe by Erikson as the developmental stage of generativity (A), and is characteristic of middle
adulthood. (B, C and D) are not stages of this age group according to Erickson's psychosocial
developmental theory.
Correct Answer: A Correct Answer: 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.
The durable power of attorney is a legal document or a form of advance directive that designates
another person to voice healthcare decisions when the client is unable to do so. A durable power of
attorney for health directives is legally binding (A). (B, C and D) do not include the legal parameters that
must be determined by the client in the event the client is unable to make a healthcare decision, which
can be changed by the client at any time.
Correct Answer: A Correct Answer: Which statement best describes durable power of attorney for
health care?
A. The client signs a document that designates another person to make legally binding healthcare
decisions if client is unable to do so.
B. The healthcare decisions made by another person designated by the client are not legally binding.
C. Instructions about actions to be taken in the event of a client's terminal or irreversible condition are
not legally binding.
D. Directions regarding care in the event of a terminal or irreversible condition must be documented to
ensure that they are legally binding.
A macrobiotic diet is high in whole-grain cereals, vegetables, sea vegetables, beans, and vegetarian
soups, and the client needs essential amino acids to provide complete proteins to heal the infected
wound. Although a macrobiotic diet contains no source of animal protein, essential amino acids should
be obtained by combining plant (incomplete) proteins to provide complete (all essential amino acids)
proteins (B) for anabolic processes. (A, C, and D) do not provide the client with food choices consistent
with a macrobiotic diet and protein needs.
