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HESI Fundamentals Practice Exam #1 Questions With Correct Answers Latest Update

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HESI Fundamentals Practice Exam #1 Questions With Correct Answers Latest Update A 35y/o client with cancer refuses to allow a nurse to insert an IV for scheduled chemo & states that she's ready to go home to die. What intervention should the nurse initiate? - ANSWER-Evaluate the client's mental st...

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HESI Fundamentals Practice
Exam #1 Questions With
Correct Answers Latest
Update




A 35y/o client with cancer refuses to allow a nurse to insert an IV for scheduled
chemo & states that she's ready to go home to die. What intervention should the
nurse initiate? - ✔✔✔ANSWER-Evaluate the client's mental status for competence
to refuse treatment


Rationale: Competent clients have the right to refuse treatment. The nurse cannot
document until the HCP is notified of the patient's wishes & a d/c RX is obtained.
Advance directives & DNR are not necessary for competent client to refuse care.


A 4y/o boy who is scheduled for a tonsillectomy & adenoidectomy asks the nurse,
"Will it hurt to have my tonsils & adenoids taken out?" Which response is best for

,the nurse to provide? - ✔✔✔ANSWER-"It may hurt, but we'll give you medicine
to help you feel better."


A 73y/o Hispanic client is seen with a history of protein malnutrition. What
information should the nurse obtain first? - ✔✔✔ANSWER-Foods & liquids
consumed during past 24 hrs


Rationale: Client's dietary habits should be determined first through dietary recall
before suggesting protein sources or supplements as options in client's diet.


A 75y/o client who has a history of end stage renal failure & advancing lung
cancer, recently had a stroke. 2 days ago, the HCP d/c the client's dialysis
treatments, stating that death is inevitable, but the client is disoriented & will not
sign a DNR directive. What is the priority nursing intervention? - ✔✔✔ANSWER-
Determine who is legally empowered to make decisions


To obtain the most complete assessment for a client with chronic pain, which
information should the nurse obtain? - ✔✔✔ANSWER-Which activities during a
routine day are impacted by your pain?


What action by the nurse demonstrates culturally sensitive care? -
✔✔✔ANSWER-Asks permission before touching a client


What action should the nurse implement to prevent the formation of a sacral ulcer
for a client who is immobile? - ✔✔✔ANSWER-Position prone with a small pillow
below the diaphragm

, What action should the nurse implement when adding sterile liquids to a sterile
field? - ✔✔✔ANSWER-Consider the sterile field contaminated if it becomes wet
during the procedure


What activity should the nurse use in the evaluation phase of the nursing process? -
✔✔✔ANSWER-Examine the effectiveness of nursing interventions toward
meeting client outcomes


What client statement indicates to the nurse that the client requires assistance with
bathing? - ✔✔✔ANSWER-"I don't understand why I'm so weak & tired."


What intervention should the nurse include in the care plan for a client who is
being treated with an Unna's paste boot for leg ulcers due to chronic venous
insufficiency? - ✔✔✔ANSWER-Check capillary refill of toes on lower extremity
with Unna's paste boot


Rationale: Boot becomes rigid after it dries, so it is important to check distally for
adequate circulation. No bandage should be put under it. Should be applied from
foot & wrapped towards knee. Acts as a sterile dressing & should not be removed
q8h. Weekly removal is reasonable.


What is most important for the nurse to implement when placing a client in the
Sim's position? - ✔✔✔ANSWER-Raise the bed to a wasit-high working level


What is the rationale in using the nursing process in planning care for clients? -
✔✔✔ANSWER-As a tool to organize thinking & clinical decision making about
clients' healthcare needs

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