HESI RN
HESI Fundamentals Questions
Question 1 of 5
The healthcare provider is conducting an initial admission assessment for a woman who is Mexican-American and who is scheduled to deliver a baby by C-section in the next 24 hours. What should the healthcare provider include in the assessment?
Correct Answer: D
Rationale: In this scenario, the correct answer is D) Rely on cultural norms as the basis for providing healthcare for this client. This is the most appropriate action because it acknowledges the importance of cultural competence in nursing care. Understanding and respecting the cultural background of a patient is essential in providing effective and holistic healthcare. Option A is incorrect because just providing an interpreter does not address the broader cultural considerations that should be taken into account. While language translation is important, it is not sufficient to ensure culturally sensitive care. Option B is incorrect as commending the client for patience does not directly address the cultural aspects that may impact the patient's care and experience during the admission process. Option C is incorrect as assuming the need for a chaplain based solely on the patient's cultural background is not appropriate. It is important to respect the client's beliefs and preferences regarding spiritual care rather than making assumptions based on ethnicity. In an educational context, it is crucial for nursing students to understand the significance of cultural competence in nursing practice. Providing culturally sensitive care leads to better patient outcomes, increased trust between the healthcare provider and patient, and overall improved quality of care. Nurses should be equipped with the knowledge and skills to effectively assess and address the cultural needs of diverse patient populations to deliver patient-centered care.
Question 2 of 5
A client with a suspected kidney infection is admitted to the hospital for observation. Which action should the nurse implement to assess the client's kidney function?
Correct Answer: A
Rationale: Monitoring urine output is the most direct way to assess kidney function as it provides crucial information about the kidneys' ability to filter waste and produce urine. Changes in urine output can indicate potential issues with kidney function, such as decreased filtration or impaired excretion of waste products.
Question 3 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 4 of 5
During a home visit, an elderly female client who had a brain attack three months ago and can now ambulate with a quad cane is assessed by the nurse. Which assessment finding has the greatest implications for this client's care?
Correct Answer: C
Rationale: The presence of numerous scatter rugs throughout the house poses a significant safety hazard to the client who is ambulating with a quad cane. These rugs increase the risk of tripping and falling, making it the most critical finding that needs immediate attention to prevent potential injuries and ensure the client's safety during ambulation.
Question 5 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.