HESI RN
HESI Fundamentals Practice Exam
1. During the insertion of a nasogastric tube (NGT), the client begins to cough and gag. What action should the healthcare professional take?
- A. Stop advancing the tube and allow the client to rest
- B. Remove the tube and try again after a few minutes
- C. Continue inserting the tube while the client sips water
- D. Withdraw the tube slightly and pause before continuing
Correct answer: D
Rationale: When a client begins to cough and gag during the insertion of a nasogastric tube, withdrawing the tube slightly and pausing is the appropriate action. This technique helps prevent further irritation, gives the client a moment to recover, and allows for a smoother continuation of the insertion process. Choice A is incorrect because allowing the client to rest without adjusting the tube position might not address the issue. Choice B is incorrect as removing the tube without addressing the cause of coughing and gagging may lead to repeated discomfort. Choice C is incorrect as continuing to insert the tube while the client is experiencing difficulties can increase discomfort and potential complications.
2. Practices such as female genital mutilation and unsafe male circumcision are categorized as:
- A. Harmful traditional practices
- B. Encouraged in rural Zambia
- C. Recommended in modern surgery and IRH
- D. Safer sex practices
Correct answer: A
Rationale: Practices like female genital mutilation and unsafe male circumcision are considered harmful traditional practices due to the physical and psychological harm they cause. Choice A is correct as these practices are not safe or recommended. Choice B is incorrect, as harmful traditional practices are not encouraged anywhere. Choice C is incorrect as modern surgery and organizations like IRH aim to eliminate such practices, not recommend them. Choice D is incorrect as these practices are not related to safer sex practices but rather harmful practices that need to be eradicated.
3. A client with a history of myocardial infarction is experiencing chest pain. Which intervention should the nurse implement first?
- A. Administer oxygen therapy as prescribed.
- B. Administer aspirin as prescribed.
- C. Administer nitroglycerin sublingually as prescribed.
- D. Obtain an electrocardiogram (ECG).
Correct answer: A
Rationale: Administering oxygen therapy is the initial priority in managing chest pain in a client with a history of myocardial infarction. Oxygen therapy helps improve oxygenation, which is crucial in reducing myocardial damage. While administering aspirin and nitroglycerin are essential interventions in the treatment of myocardial infarction, oxygen therapy takes precedence because it addresses the immediate need for oxygen supply to the heart muscle. Obtaining an ECG is important but can be done after ensuring adequate oxygenation.
4. The client is being taught how to self-administer a subcutaneous injection. To ensure sterility of the procedure, which subject is most important for the instructor to include in the teaching plan?
- A. Hand washing before preparing the injection.
- B. Technique for drawing medication from a vial.
- C. Selection and rotation of injection sites.
- D. Proper disposal of injection equipment.
Correct answer: B
Rationale: To maintain the sterility of the procedure, it is crucial to teach the client the correct technique for drawing medication from a vial. This ensures that the medication remains sterile during preparation and administration. While hand washing, injection site selection, and equipment disposal are important aspects of injection safety, the key focus should be on maintaining the sterility of the medication itself to prevent infections and ensure the effectiveness of the treatment.
5. A client with a history of atrial fibrillation is admitted with a new onset of confusion. Which intervention should the nurse implement first?
- A. Obtain a blood glucose level.
- B. Administer an anticoagulant as prescribed.
- C. Perform a neurological assessment.
- D. Administer aspirin as prescribed.
Correct answer: C
Rationale: Performing a neurological assessment is the priority in this situation as it helps in evaluating the cause of the new onset of confusion in a client with atrial fibrillation. This assessment will provide crucial information about the client's neurological status, which can guide further interventions. Obtaining a blood glucose level (Choice A) is important but should not be the first step when dealing with a new onset of confusion. Administering an anticoagulant (Choice B) or aspirin (Choice D) may be necessary depending on the underlying cause, but assessing the neurological status comes first to determine the appropriate course of action.