HESI RN
HESI RN Fundamentals II Questions
Extract:
Question 1 of 5
The nurse is preparing to give an emergency sedative injection to an agitated client. Which action by the nurse comprises a tort?
Correct Answer: C
Rationale: Deceiving the client violates trust and consent.
Question 2 of 5
A child has experienced several episodes of vomiting. After the nurse reviews the need to provide only clear liquids, the parent of the child reports making clear liquid popsicles out of flavored gelatin for the child. Which information should the nurse obtain about the popsicles?
Correct Answer: D
Rationale: Pulp or fruit is not suitable for clear liquid diet.
Question 3 of 5
The nurse is teaching a client how to do active range of motion (ROM) exercises. To exercise the hinge joints, which action should the nurse instruct the client to perform?
Correct Answer: B
Rationale: Elbow flexion targets hinge joints.
Extract:
History and Physical
The client is an 81-year-old male with a history of hypertension, heart failure, and seasonal allergies. He was admitted for pneumonia 3 days ago and is currently in the intermediate care unit. He lives with his daughter and her family. She reports that he is active and compliant with his medication regime. He walks the dog every morning and has no signs of cognitive decline at home.
Nurses' Notes
0800
Received report. The client is awake and alert. Upon assessment, found a 0.7 in by 1.6 in (2 cm by 4 cm) partial thickness abrasion behind the client's right ear where the strap holding the continuous positive airway pressure (CPAP) mask was positioned.
Orders
• Continuous positive airway pressure (CPAP) 10 cm H2O with supplemental oxygen 55%
• Adjust oxygen as needed to keep oxygen saturation greater than 91%
• Activity as tolerated
• Vital signs every 2 hours
• Diet as tolerated
• Lactated Ringers IV infusion at 90 mL/hr
Question 4 of 5
Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: Condition: Stage 1 pressure injury; Actions: Clean the area with sterile saline or wound cleanser and dry, Place a hydrocolloid dressing over the area; Parameters: Temperature, Skin integrity
Rationale: Cleaning and dressing prevent progression; temperature and skin monitor infection.
Extract:
Question 5 of 5
A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?
Correct Answer: D
Rationale: Diminished lung sounds indicate abnormality.