HESI RN
HESI Fundamentals Practice Test
1. The nurse is providing discharge teaching to a client with a new diagnosis of osteoporosis. Which instruction should the nurse include?
- A. Increase dietary intake of calcium-rich foods.
- B. Avoid activities that increase the risk of falls.
- C. Avoid prolonged exposure to sunlight.
- D. Increase intake of vitamin D supplements.
Correct answer: B
Rationale: Avoiding activities that increase the risk of falls (B) is the most crucial instruction for a client with osteoporosis to prevent fractures. Osteoporosis weakens bones, making them more susceptible to fractures from falls. While increasing calcium intake (A) is important for bone health, avoiding falls takes precedence to prevent immediate harm. Avoiding prolonged exposure to sunlight (C) is not directly related to osteoporosis management. Increasing vitamin D supplements (D) is beneficial for bone health, but fall prevention is more critical in this scenario.
2. Oxygen at liters/min per nasal cannula PRN difficult breathing is prescribed for a client with pneumonia. Which nursing intervention is effective in preventing oxygen toxicity?
- A. Avoiding the administration of high levels of oxygen for extended periods.
- B. Administering a sedative at bedtime to slow the client's respiratory rate.
- C. Removing the nasal cannula during the night to prevent oxygen buildup.
- D. Running oxygen through a hydration source prior to administration.
Correct answer: A
Rationale: The correct answer is A: Avoiding the administration of high levels of oxygen for extended periods. Oxygen toxicity can occur when high levels of oxygen are given for a prolonged period. It is important to monitor and adjust the oxygen levels as needed to prevent toxicity. Choice B is incorrect because administering a sedative to slow the respiratory rate does not directly prevent oxygen toxicity. Choice C is incorrect as removing the nasal cannula during the night can compromise the client's oxygenation. Choice D is incorrect as running oxygen through a hydration source does not prevent oxygen toxicity; instead, it may introduce risks associated with the hydration source.
3. Which of the following best describes the nurse's role in maintaining patient dignity?
- A. The nurse ensures that the patient is treated with respect and that their personal beliefs and values are considered in their care.
- B. The nurse maintains the patient's dignity by ensuring privacy during personal care activities.
- C. The nurse ensures that the patient's personal information is kept private and only shared with those directly involved in their care.
- D. The nurse ensures that the patient is involved in decisions about their care and that their preferences are respected.
Correct answer: A
Rationale: The correct answer is A. The nurse's role in maintaining patient dignity goes beyond just privacy during personal care activities. It involves treating the patient with respect, considering their personal beliefs and values in their care. While privacy is important for dignity, respecting personal beliefs and values is equally crucial. Choice B focuses solely on privacy, overlooking the broader aspects of dignity maintenance. Choices C and D, although important in patient care, do not fully capture the comprehensive approach needed for maintaining patient dignity as described in choice A.
4. A male client with rheumatoid arthritis is scheduled for a procedure in the morning. The procedure cannot be completed due to early morning stiffness. Which intervention should the nurse implement?
- A. Assign a UAP to assist the client with a warm shower early in the morning.
- B. Administer anti-inflammatory medication before the procedure.
- C. Encourage the client to perform range-of-motion exercises.
- D. Reschedule the procedure for later in the day.
Correct answer: A
Rationale: A warm shower can help alleviate stiffness, allowing the client to be more comfortable and mobile before the procedure. This intervention promotes increased comfort and mobility, which may help the client proceed with the procedure later in the day. Administering anti-inflammatory medication (Choice B) may be helpful but may take time to be effective, while range-of-motion exercises (Choice C) may be challenging for the client due to stiffness. Rescheduling the procedure (Choice D) does not address the immediate need to alleviate stiffness.
5. The nurse is caring for a client who requires a mechanical ventilator for breathing. The high-pressure alarm goes off on the ventilator. What is the first action the nurse should perform?
- A. Disconnect the client from the ventilator and use a manual resuscitation bag
- B. Perform a quick assessment of the client's condition
- C. Call the respiratory therapist for help
- D. Press the alarm reset button on the ventilator
Correct answer: B
Rationale: The correct answer is to perform a quick assessment of the client's condition when the high-pressure alarm goes off on the ventilator. This assessment is crucial to determine the cause of the alarm and the client's current status. Option A is incorrect because disconnecting the client from the ventilator without assessing the situation can be harmful. Option C is incorrect as the nurse should first assess the client before seeking additional help. Option D is incorrect because resetting the alarm without understanding the underlying issue may lead to potential risks to the client.