HESI Fundamentals Practice Exam

HESI Fundamentals Practice Exam Related

Review HESI Fundamentals Practice Exam related questions and content

In completing a client's preoperative routine, the nurse finds that the operative permit is not signed. The client begins to ask more questions about the surgical procedure. Which action should the nurse take next?

  • A. Witness the client's signature on the permit.
  • B. Answer the client's questions about the surgery.
  • C. Inform the surgeon that the operative permit is not signed and the client has questions about the surgery.
  • D. Reassure the client that the surgeon will answer any questions before the anesthesia is administered.
Correct Answer: C

Rationale: The nurse should inform the surgeon promptly that the operative permit is not signed and the client has questions about the surgery. It is crucial for the surgeon to be aware of these issues as it is their responsibility to explain the procedure to the client and ensure that the necessary consent is obtained before proceeding with the surgery. Answering the client's questions directly (choice B) may not be appropriate as the surgeon is the one responsible for providing detailed information about the procedure. Witnessing the client's signature (choice A) is premature since the permit is not signed. Reassuring the client (choice D) is not the most appropriate action at this point; the priority is to involve the surgeon in addressing the unsigned permit and the client's questions.

You may also like to solve these questions

A client is admitted with a diagnosis of left-sided heart failure. Which assessment finding is most consistent with this diagnosis?

  • A. Dependent edema.
  • B. Ascites.
  • C. Nocturia.
  • D. Orthopnea.
Correct Answer: D

Rationale: Orthopnea (D) is most consistent with left-sided heart failure. It is characterized by difficulty breathing when lying flat and is relieved by sitting up or standing. Dependent edema (A), ascites (B), and nocturia (C) are more commonly associated with right-sided heart failure. Dependent edema refers to swelling due to fluid accumulation, ascites is the accumulation of fluid in the peritoneal cavity, and nocturia is the excessive need to urinate during the night, all of which are more indicative of right-sided heart failure.

A client with a history of coronary artery disease (CAD) is admitted with chest pain. Which intervention should the nurse implement first?

  • A. Administer sublingual nitroglycerin
  • B. Obtain a 12-lead electrocardiogram (ECG)
  • C. Apply oxygen via nasal cannula
  • D. Initiate continuous cardiac monitoring
Correct Answer: C

Rationale: In a client with a history of coronary artery disease (CAD) experiencing chest pain, the priority intervention for the nurse to implement first is to apply oxygen via nasal cannula. Oxygenation is crucial to ensure adequate oxygen supply to the tissues and the heart. This intervention takes precedence over administering sublingual nitroglycerin, obtaining an ECG, or initiating continuous cardiac monitoring. While these interventions are important, ensuring adequate oxygenation is the initial priority in the management of a client with chest pain.

To avoid nerve injury, what location should the nurse select to administer a 3 mL IM injection?

  • A. Ventrogluteal
  • B. Outer upper quadrant of the buttock
  • C. Two inches below the acromion process
  • D. Vastus lateralis
Correct Answer: A

Rationale: The ventrogluteal site is the preferred location for administering large volume IM injections to avoid nerve injury. This site is situated away from major nerves and blood vessels, reducing the risk of complications associated with injecting into other areas. The ventrogluteal site allows for deep muscle penetration and is recommended for injections over 2 mL in volume to ensure proper dispersion and absorption of the medication. Choices B, C, and D are incorrect because the outer upper quadrant of the buttock is not the recommended site for large volume injections, two inches below the acromion process is a location for a deltoid injection, and the vastus lateralis is typically used for smaller volume injections.

Which assessment data indicates the need for the nurse to include the problem 'Risk for falls' in a client's plan of care?

  • A. Recent serum hemoglobin level of 16 g/dL
  • B. Opioid analgesic received one hour ago
  • C. Stooped posture with an unsteady gait
  • D. Expressed feelings of depression
Correct Answer: B

Rationale: The correct answer is B. The administration of opioid analgesics can impair balance and increase the risk of falls, justifying the inclusion of 'Risk for falls' in the client's care plan. Choice A, a recent serum hemoglobin level of 16 g/dL, is not directly related to the risk of falls. Choice C, stooped posture with an unsteady gait, may indicate a risk for falls, but the direct influence of opioid analgesics on balance is more immediate. Choice D, expressed feelings of depression, while important, is not a direct indicator of the immediate risk for falls associated with opioid analgesic use.

A client with a diagnosis of hyperkalemia is receiving sodium polystyrene sulfonate (Kayexalate). Which laboratory value should the nurse monitor to evaluate the effectiveness of this medication?

  • A. Serum sodium level.
  • B. Serum potassium level.
  • C. Serum calcium level.
  • D. Serum glucose level.
Correct Answer: B

Rationale: The correct answer is B: Serum potassium level. Sodium polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, leading to potassium removal from the body. Monitoring the serum potassium level allows the nurse to assess the effectiveness of this medication in lowering the elevated potassium levels. Serum sodium (A), calcium (C), and glucose (D) levels are not directly impacted by the action of sodium polystyrene sulfonate.

Copyright © 2025 Nokea. All rights reserved.