HESI Fundamentals of Nursing

Free preview · Original latest version

Sample questions from HESI Fundamentals of Nursing

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A nurse enters a client's room and finds the client lying on the floor beside the bed. What should the nurse do first?

   • A.Assess the client for injury and level of consciousness
   • B.Notify the health care provider
   • C.Complete an incident report
   • D.Ask the client why the fall occurred

   Rationale: The nurse first assesses the client for injury, responsiveness, and immediate threats to life. Notifying the provider and completing an incident report are important but follow the initial assessment and necessary care. Asking about the cause can wait until the client's condition is stable; the exam takeaway is to assess before documenting or investigating.

2. 2.A nurse is preparing to administer a medication and finds that the medication administration record lists a dose that differs from the dose on the medication label. What is the nurse's best action?

   • A.Administer the dose on the label because it is more current
   • B.Hold the medication and clarify the discrepancy
   • C.Ask another nurse to choose which dose is correct
   • D.Document that the medication was unavailable

   Rationale: The nurse should withhold the medication until the discrepancy is clarified with an appropriate prescriber or pharmacist. The label does not independently supersede the current order, and asking a colleague to choose does not resolve the order safely. Documenting unavailability would be inaccurate; the takeaway is to question unclear or conflicting orders before administration.

3. 3.Which action by a nurse best demonstrates the use of standard precautions?

   • A.Wearing gloves only when a client has a documented infection
   • B.Performing hand hygiene and selecting personal protective equipment based on anticipated exposure
   • C.Using a mask for every client interaction
   • D.Keeping the same gloves on when moving between tasks for one client

   Rationale: Standard precautions apply to all clients and include hand hygiene and risk-based selection of personal protective equipment. Gloves are not limited to clients with known infections, and masks are not required for every routine interaction. Gloves must be changed between tasks when contaminated and removed when care is complete; they do not replace hand hygiene.

4. 4.A nurse is caring for a client with a suspected airborne infection. Which action is appropriate?

   • A.Place the client in a negative-pressure room and wear a fit-tested respirator
   • B.Place the client in a positive-pressure room and wear a surgical mask
   • C.Use contact precautions only
   • D.Keep the room door open to improve ventilation

   Answer and rationale are in the full material.

5. 5.A client with weakness on the left side is learning to walk with a cane. Which instruction should the nurse provide?

   • A.Hold the cane in the left hand and move it after the left leg
   • B.Hold the cane in the right hand and move it with the left leg
   • C.Hold the cane in the left hand and move it with the right leg
   • D.Hold the cane in the right hand and move it after the right leg

   Answer and rationale are in the full material.