HESI Fundamentals Exam Test Bank

Question 1 of 5

The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin administration. Which statement by the client indicates a need for further teaching?

A. I will rotate my injection sites to avoid lipodystrophy. B. I will check my blood sugar before meals and at bedtime. C. I will use the same needle for 3 days if I keep it clean. D. I will keep my insulin refrigerated until I need it.

Correct Answer: C

Rationale: The correct answer is C because insulin needles should be disposed of after a single use to prevent infection. Reusing the same needle for three days can lead to infection and is not a safe practice.

Choices A, B, and D demonstrate good understanding of insulin administration and diabetes management, so they do not indicate a need for further teaching.

Question 2 of 5

When applying an ice bag to a client's ankle following a sports injury, which of the following actions should the nurse take?

A. Fill the bag two-thirds full with ice. B. Apply the ice bag directly to the skin with a barrier. C. Keep the ice bag on for more than 30 minutes at a time. D. Use a frozen gel pack instead of ice.

Correct Answer: A

Rationale: Filling the ice bag two-thirds full is the correct action as it ensures the effectiveness of the ice application while allowing some space for the ice to move and conform to the injury.
Choice B is incorrect because the ice bag should be applied with a barrier like a cloth to prevent direct contact with the skin, which can lead to ice burns.
Choice C is wrong as ice should typically be applied for 20 minutes at a time to avoid tissue damage.
Choice D is also incorrect as ice is preferred over frozen gel packs for immediate sports injury management.

Question 3 of 5

The patient has the nursing diagnosis of Impaired physical mobility related to pain in the left shoulder. Which priority action will the nurse take?

A. Encourage the patient to engage in self-care. B. Promote mobility in the patient. C. Encourage the patient to perform range of motion exercises. D. Assist the patient with comfort measures.

Correct Answer: D

Rationale: The priority action for a patient with Impaired physical mobility related to pain is to assist the patient with comfort measures. By addressing pain through comfort measures, the patient will be more willing and able to move. Encouraging self-care (
Choice
A) may be important but addressing pain first is crucial in improving mobility. Promoting mobility (
Choice
B) and encouraging range of motion exercises (
Choice
C) are important but addressing the pain and providing comfort measures take precedence to improve the patient's physical mobility.

Question 4 of 5

Following surgery on the neck, the client asks the LPN why the head of the bed is up so high. The LPN should tell the client that the high-Fowler position is preferred for what reason?

A. To reduce strain on the incision B. To promote drainage of the wound C. To provide stimulation for the client D. To reduce edema at the operative site

Correct Answer: D

Rationale: The high-Fowler position is preferred after neck surgery to reduce edema at the operative site. Elevating the head of the bed promotes venous return and drainage, aiding in decreasing swelling and fluid accumulation, which helps reduce edema at the operative site.
Choice A is incorrect as the main purpose is not solely about reducing strain on the incision.
Choice B is incorrect because while drainage may occur, it is not the primary reason for maintaining the high-Fowler position.
Choice C is incorrect as providing stimulation is not the primary rationale for positioning the client in high-Fowler.

Question 5 of 5

A nurse on a med-surg unit is teaching a newly licensed nurse about tasks to delegate to APs. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

A. An AP may take orthostatic blood pressure measurements from a client who reports dizziness. B. An AP may monitor the peripheral IV insertion site of a client who is receiving replacement fluids. C. An AP may perform a central line dressing change for a client who is ready for discharge. D. An AP may ambulate a client who had a stroke 2 days ago.

Correct Answer: D

Rationale: The correct answer is D. Delegating the task of ambulating a client who had a stroke 2 days ago to an AP is appropriate. This task falls within the scope of practice for an AP and can help promote mobility and prevent complications.

Choices A, B, and C involve more complex nursing assessments or procedures that require a higher level of training and expertise. Taking orthostatic blood pressure measurements, monitoring a peripheral IV insertion site, and performing a central line dressing change should be tasks performed by licensed nurses to ensure proper assessment and management of the client's condition.

Nurselytic

HESI LPN

HESI LPN