ALL HESI Fundamentals Exam Test Bank updated 2024
HESI Fundamentals Exam, Answered
An \elderly \client \with \a \fractured \left \hip \is \on \strict \bedrest. \Which \nursing \measure
\is\essential \to \the \client's \nursing \care?
A. Massage \any \reddened \areas \for \at \least \five \minutes.
B. Encourage \active \range \of \motion \exercises \on \extremities.
C. Position \the \client \laterally, \prone, \and \dorsally \in \sequence.
D. Gently \lift \the \client \when \moving \into \a \desired \position. \- \To \avoid \shearing
\forces\when \repositioning, \the \client \should \be \lifted \gently \across \a \surface \(D).
\Reddened \areas \should \not \be \massaged \(A) \since \this \may \increase \the \damage \to
\already \traumatized \skin. \To \control \pain \and \muscle \spasms, \active \range \of
\motion \(B) \may \be \limited \on \the \affected \leg. \The \position \described \in \(C) \is
\contraindicated \for \a \client \with \a \fractured \left \hip.
Correct \Answer: \D
The \nurse \is \administering \medications \through \a \nasogastric \tube \(NGT) \which
\is \connected \to \suction. \After \ensuring \correct \tube \placement, \what \action
\should \the\nurse \take \next?
A. Clamp \the \tube \for \20 \minutes.
,B. Flush \the \tube \with \water.
,C. Administer \the \medications \as \prescribed.
D. Crush \the \tablets \and \dissolve \in \sterile \water. \- \The \NGT \should \be \flushed
\before,\after \and \in \between \each \medication \administered \(B). \Once \all
\medications \are \administered, \the \NGT \should \be \clamped \for \20 \minutes \(A). \(C
\and \D) \may \be \implemented \only \after \the \tubing \has \been \flushed.
Correct \Answer: \B
A \client \who \is \in \hospice \care \complains \of \increasing \amounts \of \pain. \The
\healthcare\provider \prescribes \an \analgesic \every \four \hours \as \needed. \Which \action
\should \the \nurse \implement?
A. Give \an \around-the-clock \schedule \for \administration \of \analgesics.
B. Administer \analgesic \medication \as \needed \when \the \pain \is \severe.
C. Provide \medication \to \keep \the \client \sedated \and \unaware \of \stimuli.
D. Offer \a \medication-free \period \so \that \the \client \can \do \daily \activities. \- \The
\most \effective \management \of \pain \is \achieved \using \an \around-the-clock \schedule
\that \provides \analgesic \medications \on \a \regular \basis \(A) \and \in \a \timely \manner.
\Analgesics \are \less \effective \if \pain \persists \until \it \is \severe, \so \an \analgesic
\medication\should \be \administered \before \the \client's \pain \peaks \ (B). \Providing
\comfort \is \a \priority \for \the \client \who \is \dying, \but \sedation \that \impairs \the \client's
\ability \to \interact \and \experience \the \time \before \life \ends \should \be \minimized \(C).
\Offering \a \medication-free \period \allows \the \serum \drug \level \to \fall, \which \is \not
\an \effective \method \to \manage \chronic \pain \(D).
, Correct \Answer: \A
When \assessing \a \client \with \wrist \restraints, \the \nurse \observes \that \the \fingers \on
\the\right \hand \are \blue. \What \action \should \the \nurse \implement \first?
A. Loosen \the \right \wrist \restraint.
B. Apply \a \pulse \oximeter \to \the \right \hand.
C. Compare \hand \color \bilaterally.
D. Palpate \the \right \radial \pulse. \- \The \priority \nursing \action \is \to \restore \circulation
\by\loosening \the \restraint \(A), \because \blue \fingers \(cyanosis) \indicates \decreased
\circulation. \(C \and \D) \are \also \important \nursing \interventions, \but \do \not \have \the
\priority \of \(A). \Pulse \oximetry \(B) \measures \the \saturation \of \hemoglobin \with
\oxygen \and \is \not \indicated \in \situations \where \the \cyanosis \is \related \to \mechanical
\compression \(the \restraints).
Correct \Answer: \A
The \nurse \is \assessing \the \nutritional \status \of \several \clients. \Which \client \has
\the\greatest \nutritional \need \for \additional \intake \of \protein?
A. A \college-age \track \runner \with \a \sprained \ankle.
B. A \lactating \woman \nursing \her \3-day-old \infant.
C. A \school-aged \child \with \Type \2 \diabetes.
HESI Fundamentals Exam, Answered
An \elderly \client \with \a \fractured \left \hip \is \on \strict \bedrest. \Which \nursing \measure
\is\essential \to \the \client's \nursing \care?
A. Massage \any \reddened \areas \for \at \least \five \minutes.
B. Encourage \active \range \of \motion \exercises \on \extremities.
C. Position \the \client \laterally, \prone, \and \dorsally \in \sequence.
D. Gently \lift \the \client \when \moving \into \a \desired \position. \- \To \avoid \shearing
\forces\when \repositioning, \the \client \should \be \lifted \gently \across \a \surface \(D).
\Reddened \areas \should \not \be \massaged \(A) \since \this \may \increase \the \damage \to
\already \traumatized \skin. \To \control \pain \and \muscle \spasms, \active \range \of
\motion \(B) \may \be \limited \on \the \affected \leg. \The \position \described \in \(C) \is
\contraindicated \for \a \client \with \a \fractured \left \hip.
Correct \Answer: \D
The \nurse \is \administering \medications \through \a \nasogastric \tube \(NGT) \which
\is \connected \to \suction. \After \ensuring \correct \tube \placement, \what \action
\should \the\nurse \take \next?
A. Clamp \the \tube \for \20 \minutes.
,B. Flush \the \tube \with \water.
,C. Administer \the \medications \as \prescribed.
D. Crush \the \tablets \and \dissolve \in \sterile \water. \- \The \NGT \should \be \flushed
\before,\after \and \in \between \each \medication \administered \(B). \Once \all
\medications \are \administered, \the \NGT \should \be \clamped \for \20 \minutes \(A). \(C
\and \D) \may \be \implemented \only \after \the \tubing \has \been \flushed.
Correct \Answer: \B
A \client \who \is \in \hospice \care \complains \of \increasing \amounts \of \pain. \The
\healthcare\provider \prescribes \an \analgesic \every \four \hours \as \needed. \Which \action
\should \the \nurse \implement?
A. Give \an \around-the-clock \schedule \for \administration \of \analgesics.
B. Administer \analgesic \medication \as \needed \when \the \pain \is \severe.
C. Provide \medication \to \keep \the \client \sedated \and \unaware \of \stimuli.
D. Offer \a \medication-free \period \so \that \the \client \can \do \daily \activities. \- \The
\most \effective \management \of \pain \is \achieved \using \an \around-the-clock \schedule
\that \provides \analgesic \medications \on \a \regular \basis \(A) \and \in \a \timely \manner.
\Analgesics \are \less \effective \if \pain \persists \until \it \is \severe, \so \an \analgesic
\medication\should \be \administered \before \the \client's \pain \peaks \ (B). \Providing
\comfort \is \a \priority \for \the \client \who \is \dying, \but \sedation \that \impairs \the \client's
\ability \to \interact \and \experience \the \time \before \life \ends \should \be \minimized \(C).
\Offering \a \medication-free \period \allows \the \serum \drug \level \to \fall, \which \is \not
\an \effective \method \to \manage \chronic \pain \(D).
, Correct \Answer: \A
When \assessing \a \client \with \wrist \restraints, \the \nurse \observes \that \the \fingers \on
\the\right \hand \are \blue. \What \action \should \the \nurse \implement \first?
A. Loosen \the \right \wrist \restraint.
B. Apply \a \pulse \oximeter \to \the \right \hand.
C. Compare \hand \color \bilaterally.
D. Palpate \the \right \radial \pulse. \- \The \priority \nursing \action \is \to \restore \circulation
\by\loosening \the \restraint \(A), \because \blue \fingers \(cyanosis) \indicates \decreased
\circulation. \(C \and \D) \are \also \important \nursing \interventions, \but \do \not \have \the
\priority \of \(A). \Pulse \oximetry \(B) \measures \the \saturation \of \hemoglobin \with
\oxygen \and \is \not \indicated \in \situations \where \the \cyanosis \is \related \to \mechanical
\compression \(the \restraints).
Correct \Answer: \A
The \nurse \is \assessing \the \nutritional \status \of \several \clients. \Which \client \has
\the\greatest \nutritional \need \for \additional \intake \of \protein?
A. A \college-age \track \runner \with \a \sprained \ankle.
B. A \lactating \woman \nursing \her \3-day-old \infant.
C. A \school-aged \child \with \Type \2 \diabetes.
