HESI RN
Summer 2025 BSN 225 RN FUNDAMENTALS 38660 Questions
Question 1 of 5
A client, who speaks very little English, is being seen in the emergency department following an automobile accident. The client's sibling offers to act as an interpreter and asks about the laboratory results. Which response is best for the nurse to provide?
Correct Answer: C
Rationale: Using family members as interpreters violates patient confidentiality and can lead to errors in translation. Professional interpreters are trained to accurately convey medical information while maintaining privacy. Option A is dismissive and damages the therapeutic relationship. Option B inappropriately agrees to share confidential information. Option D passes responsibility to the healthcare provider without addressing the confidentiality issue directly.
Question 2 of 5
The nurse observes the unlicensed assistive personnel (UAP) securing a client’s wrist restraints to the bedside rails. Which action is most important for the nurse to implement?
Correct Answer: C
Rationale: Patient safety is the priority. Restraints that are too tight can compromise circulation and cause tissue damage, nerve injury, or skin breakdown. The nurse must immediately assess for proper fit before addressing documentation or education. While initiating a flow sheet and proper education are important components of restraint use, they do not address the immediate safety risk. An incident report is not indicated unless injury has occurred.
Question 3 of 5
A client diagnosed with primary open angle glaucoma received a prescription for middle eye drops. Which instruction should the nurse plan to include in this client’s teaching?
Correct Answer: A
Rationale:
Touching the dropper to the eye can contaminate the bottle and introduce pathogens, leading to infection. While hand hygiene is important, it should be performed *before* administration. Squeezing the eyes closed can force the medication out of the eye, reducing its effectiveness. Administering drops directly onto the cornea can cause injury and discomfort; drops should be instilled into the conjunctival sac.
Question 4 of 5
When administering 0900 medications to four clients, which prescription should the nurse administer first?
Correct Answer: C
Rationale: Time-critical medications, like antibiotics, must be administered at the scheduled time to maintain consistent therapeutic blood levels and ensure effectiveness. Delaying the first dose of an antibiotic could compromise treatment. Diuretics are often given earlier in the day to prevent nocturia, but this is not as critical as the antibiotic schedule. Antianxiety agents and topical patches have more flexible administration windows.
Question 5 of 5
The nurse assists a client who has obstructive sleep apnea (OSA) with evening care. Which intervention is most important for the nurse to implement before leaving the client alone?
Correct Answer: B
Rationale: The positive airway pressure device is the primary treatment for OSA and prevents airway obstruction during sleep, reducing the risk of hypoxia and other complications. While elevating the head of the bed can help, it is not a substitute for the prescribed device. Side rails are a safety measure but do not address the primary respiratory problem. Removing dentures is not specifically indicated for OSA and may be uncomfortable for the client.