HESI RN
HESI Fundamentals Questions
Question 1 of 5
A client is scheduled for a colonoscopy. What instruction should the nurse provide to prepare the client for the procedure?
Correct Answer: A
Rationale: In preparing a client for a colonoscopy, the nurse should instruct them to drink clear liquids for 24 hours before the procedure. This is essential to ensure that the colon is adequately cleansed for a clear visualization during the colonoscopy. Clear liquids help to prevent dehydration and provide essential hydration without leaving residue that could obstruct the view. Option B, taking a laxative the morning of the procedure, is incorrect because a laxative alone is not sufficient to adequately clean the colon within a short timeframe. Option C, eating a light meal before the procedure, is incorrect as solid foods can leave residue in the colon, hindering the effectiveness of the examination. Option D, avoiding drinking fluids for 4 hours before the procedure, is incorrect as dehydration can be a risk and clear liquids are necessary for colon cleansing. In an educational context, understanding the rationale behind the preparation instructions for a colonoscopy is crucial for nurses to provide safe and effective care to their clients. By comprehending the importance of clear liquid intake for colon cleansing, nurses can ensure that the procedure is conducted successfully and accurate results are obtained.
Question 2 of 5
Which client care task requires the nurse to wear barrier gloves as mandated by the Standard Precautions protocol?
Correct Answer: D
Rationale: In the context of nursing practice and infection control, the correct answer is option D) Emptying the urinary catheter drainage bag for a client with Alzheimer's disease. Wearing barrier gloves during this task is essential because it involves contact with bodily fluids, which can potentially harbor pathogens that may be transmitted to the nurse or other individuals if proper precautions are not taken. Option A) Removing the empty food tray from a client with a urinary catheter does not require the use of barrier gloves unless there is a spill or contamination with bodily fluids. Washing and combing the hair of a client with a fractured leg in traction (option B) does not involve direct contact with bodily fluids that necessitate barrier gloves. Administering oral medications to a cooperative client with a wound infection (option C) also does not require barrier gloves unless there is a risk of exposure to contaminated fluids. In the educational context of nursing fundamentals, understanding and adhering to Standard Precautions, including the use of barrier protection like gloves, is crucial to prevent the spread of infections in healthcare settings. Nurses must always assess the level of risk involved in each care task to determine the appropriate use of personal protective equipment, ensuring the safety of both themselves and their patients.
Question 3 of 5
A male client is on contact precautions due to an infected draining wound and is being discharged home. The client lives at home with his wife and their adolescent daughter. What discharge instruction should the nurse include for the client?
Correct Answer: C
Rationale: When a client is on contact precautions due to an infected draining wound, it is important to prevent contact with wound secretions. Therefore, disposing of soiled dressings in securely closed plastic bags helps contain and prevent the spread of infectious material, reducing the risk of transmission to others in the household.
Question 4 of 5
When making the bed of a client who needs a bed cradle, which action should the nurse include?
Correct Answer: D
Rationale: In this scenario, the correct action for the nurse to include when making the bed of a client who needs a bed cradle is to drape the top sheet and covers loosely over the bed cradle (Option D). This is important because the bed cradle is used to keep the weight of the top linens off the client's lower extremities, providing comfort and preventing pressure ulcers. Option A is incorrect as teaching the client to call for help before getting out of bed is important for safety but not directly related to bed making with a bed cradle. Option B is incorrect because keeping both the upper and lower side rails in a raised position is not necessary when using a bed cradle. Option C is also incorrect as keeping the bed in the lowest position while changing the sheets does not directly address the specific need of accommodating a bed cradle. Educationally, understanding the purpose and proper use of bed cradles in caring for clients is essential for nursing students. It ensures they provide appropriate and individualized care to clients with specific needs, promoting comfort and preventing complications associated with immobility. Learning these details enhances students' clinical skills and critical thinking in executing nursing interventions effectively.
Question 5 of 5
The healthcare provider obtains a BP reading of 100/88 in the right arm of a client whose blood pressure is typically 120/60 in the same arm. What action should the healthcare provider implement first?
Correct Answer: B
Rationale: The healthcare provider should first retake the blood pressure in the right arm, deflating the cuff slowly, because a low systolic and high diastolic blood pressure measurement is often the result of deflating the cuff too rapidly. Taking the BP in the same arm ensures consistency and accuracy of the measurement.