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Ultimate 2025 HESI Fundamentals Exam Guide:
Structure, Key Concepts, and Proven Study
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Question 1: Which of the following is a basic contact precaution for clients in protective environments (e.g., those with neutropenia or severe immunosuppression)? A. Wearing sterile gloves and gowns for all interactions. B. Placing the client in a room with positive airflow and HEPA filtration. C. Hand hygiene before and after entering the room. D. Limiting visitors and prohibiting fresh flowers or live plants. Rationale: The correct answer is C. Basic contact precautions, even in protective environments, include meticulous hand hygiene before and after any contact with the client or their environment. While sterile attire (A), positive airflow (B), and limiting visitors/plants (D) are often implemented in protective environments, hand hygiene is a fundamental contact precaution in all settings. Question 2: Which of the following is a crucial guideline to follow when applying heat therapy to a client? A. Allow the client to adjust the temperature of the heat application for comfort. B. Apply heat directly to open wounds to promote healing. C. Ensure a healthcare provider's order is obtained before applying heat. D. Leave the heat application in place for extended periods to maximize therapeutic effect. Rationale: The correct answer is C. Heat application can have physiological effects and potential risks, so a healthcare provider's order is necessary to ensure it is appropriate for the client's condition. Clients should not adjust the temperature (A) due to the risk of burns. Heat should not be applied directly to open wounds (B) without specific orders and precautions. Application time should be within safe limits (D) to prevent injury. Question 3:
Which of the following is a "do" for the nurse when applying heat or cold therapy? A. Allow the client to move the application if they feel discomfort. B. Avoid explaining the sensations the client might feel during the therapy. C. Provide the client with a timer and a call light. D. Assume the client can feel temperature changes regardless of their condition. Rationale: The correct answer is C. Providing a timer allows the client to participate in their care and helps prevent prolonged exposure. A call light ensures they can immediately report any adverse changes. Explaining sensations (a "do" mentioned in the original information) helps the client understand what to expect. Clients should not move the application (a "don't"), and the nurse should not assume they can feel temperature changes (a "don't"). Question 4: Which of the following is a "don't" for the nurse when applying heat or cold therapy? A. Report any changes in the client's condition immediately. B. Look up the safe temperature range for the application. C. Ensure the client can move away from the temperature source if needed. D. Allow a client with sensory impairment to manage the application. Rationale: The correct answer is D. Clients who cannot feel temperature changes (e.g., due to neuropathy, altered mental status) should not be left unattended with heat or cold applications, as they are at high risk for burns or tissue damage without being aware of it. Reporting changes (A), checking safe temperatures (B), and ensuring the client can move away (C) are all important "do's." Question 5: What is the maximum duration for a restraint order for an adult client in most healthcare settings? A. 1 hour B. 2 hours C. 4 hours D. 8 hours
C. 10 - 20 mL D. Less than 0.5 mL Rationale: The correct answer is B. Syringe sizes commonly used for IM and subcutaneous injections typically range from 1 to 3 mL, depending on the volume of medication to be administered and the injection site. Question 9: When are syringes larger than 5 mL typically used in clinical practice? A. For administering routine intramuscular vaccinations. B. For subcutaneous injections of insulin. C. For administering intravenous medications, adding medications to IV solutions, or irrigating wounds. D. For intradermal injections for allergy testing. Rationale: The correct answer is C. Syringes larger than 5 mL are generally used for tasks involving larger volumes, such as administering IV medications (often diluted), adding medications to IV bags or solutions, and irrigating wounds. Smaller syringes (1-3 mL) are used for IM and subQ injections, and tuberculin syringes (1 mL) are used for intradermal or small subQ volumes. Question 10: What is the typical volume capacity of most standard insulin syringes? A. 0.3-0.5 mL (calibrated in units) B. 1 - 3 mL (calibrated in milliliters) C. 5 mL (calibrated in units) D. 0.3-1 mL (calibrated in units), with most being 100 U. Rationale: The correct answer is D. Insulin syringes are specifically calibrated in units to measure insulin doses accurately. They typically range in size from 0.3 to 1 mL, with the most common type being a 1 mL syringe calibrated for up to 100 units of insulin. Question 11: What are tuberculin syringes primarily used for due to their fine calibration?
A. Intramuscular injections requiring precise measurement of larger volumes. B. Subcutaneous injections of large doses of medication. C. Intradermal injections (e.g., for TB skin tests) or subcutaneous injections requiring small, precise volumes. D. Intravenous bolus administration of medications. Rationale: The correct answer is C. Tuberculin syringes have a small capacity (typically 1 mL) and are finely calibrated in hundredths of a milliliter and sixteenths of a minim, making them ideal for administering small, precise volumes required for intradermal injections (like tuberculin skin tests) and some subcutaneous injections. Question 12: Which type of pain is predictable and often elicited by specific activities like physical therapy or wound dressing changes? A. Spontaneous pain B. End-of-dose failure pain C. Incident pain D. Neuropathic pain Rationale: The correct answer is C. Incident pain is defined as pain that is predictable and triggered by specific movements or procedures, such as physical therapy exercises or wound dressing changes. Question 13: What is end-of-dose failure pain characterized by? A. Sudden, unpredictable pain unrelated to any specific activity. B. Pain that intensifies during a specific procedure or movement. C. Pain that occurs towards the end of the usual dosing interval of a regularly scheduled analgesic. D. Chronic pain that persists despite consistent analgesic use. Rationale: The correct answer is C. End-of-dose failure pain occurs when the analgesic effect of a regularly scheduled pain medication wears off before the next dose is due, leading to a recurrence of pain.
Question 17: Generally, what percentage should a client's oxygen saturation (O2 sats) be maintained above to ensure adequate oxygenation? A. 85% B. 90% C. 95% D. 80% Rationale: The correct answer is B. For most clients, the target oxygen saturation level is typically maintained above 90% to ensure adequate tissue oxygenation. However, the specific target range may vary depending on the client's underlying medical conditions. Question 18: What is the primary therapeutic use of prune juice in patient care? A. To provide a concentrated source of potassium. B. To aid in bowel stimulation and relieve constipation. C. To increase urinary output and prevent urinary tract infections. D. To provide a readily digestible source of carbohydrates for energy. Rationale: The correct answer is B. Prune juice is well-known for its natural laxative properties due to its high sorbitol content and fiber, making it useful for bowel stimulation and the relief of constipation. Question 19: When formulating a nursing diagnosis related to diarrhea, what is the standard format? A. Potential for diarrhea related to... B. Diarrhea as evidenced by... C. Diarrhea related to... D. Risk for diarrhea due to...
Rationale: The correct answer is C. The standard format for an actual nursing diagnosis includes the problem (in this case, Diarrhea) followed by the etiology or related factors, connected by the phrase "related to..." This identifies the contributing factors to the client's current diarrheal condition. Question 20: Which of the following statements is accurate regarding nasogastric (NG) tubes and their management? A. The skill of NG tube insertion can be delegated to unlicensed assistive personnel (UAP). B. Encouraging the patient to sip water during NG tube insertion can help facilitate passage. C. NG tubes, when properly placed, cannot enter the lungs. D. Clients with an impaired level of consciousness have a decreased risk of aspiration with NG tubes. Rationale: The correct answer is B. Having the patient sip water during NG tube insertion can help facilitate the tube's passage down the esophagus. NG tube insertion cannot be delegated to UAP (A). NG tubes can be misplaced into the lungs, especially if the patient coughs or moves (C). Clients with impaired LOC are at increased risk for aspiration with NG tubes (D). Question 21: What characterizes intermittent tube feedings? A. A large volume of feeding administered rapidly over a short period (20-30 minutes). B. A continuous infusion of feeding solution at a consistent rate. C. Feedings administered periodically throughout the day, often mimicking a normal meal schedule. D. A small volume of feeding administered as a supplement to oral intake. Rationale: The correct answer is C. Intermittent tube feedings involve administering a prescribed amount of feeding solution at regular intervals throughout the day, often several times a day, similar to a normal eating pattern. Question 22: What characterizes a bolus tube feeding? A. A slow, continuous infusion of nutrient-rich formula.
Correct Answer: B. To allow the client autonomy to make choices when appropriate Rationale: Therapeutic interaction aims to empower clients by fostering autonomy in decision- making while maintaining a value-free, advice-free, and reassurance-free approach. This promotes client independence and self-efficacy.
25. A client with schizophrenia reports chest pain during a psychiatric session. What should the nurse do first? A. Administer an antipsychotic medication B. Assess the client’s physical condition, such as taking blood pressure C. Ignore the complaint as it may be a delusion D. Refer the client to a psychiatrist immediately Correct Answer: B. Assess the client’s physical condition, such as taking blood pressure Rationale: When a client reports a physical problem, the nurse must first assess to rule out a medical emergency, especially in clients with psychiatric conditions like schizophrenia, where symptoms may be misinterpreted. Taking vital signs, such as blood pressure, is a critical initial step.
26. Which of the following is a basic communication principle in psychiatric nursing? A. Offering unsolicited advice to guide the client B. Maintaining a judgmental attitude to correct behavior C. Establishing trust and using active listening D. Minimizing client interaction to reduce anxiety Correct Answer: C. Establishing trust and using active listening
Rationale: Basic communication principles include establishing trust, active listening, maintaining a nonjudgmental attitude, and validating the client’s feelings. These foster a therapeutic relationship and support effective communication.
27. After electroconvulsive therapy (ECT), a client experiences nausea. Why is this a concern? A. It indicates the treatment was ineffective B. Vomiting by an unconscious client can lead to aspiration C. It suggests the client has an allergic reaction D. It requires immediate administration of antiemetics Correct Answer: B. Vomiting by an unconscious client can lead to aspiration Rationale: Nausea post-ECT is concerning because vomiting in an unconscious or semi-conscious client can lead to aspiration, a life-threatening complication. Maintaining a patent airway is critical.
28. Which of the following is a common physiological response to anxiety? A. Decreased heart rate and relaxed muscles B. Increased heart rate and palmar sweating C. Improved appetite and restful sleep D. Slow, deep respirations Correct Answer: B. Increased heart rate and palmar sweating Rationale: Anxiety triggers the sympathetic nervous system, leading to physiological responses such as increased heart rate, rapid shallow respirations, palmar sweating, and muscle tension.
31. Where should a nurse place an anxious client to minimize environmental stimuli? A. Near the nurse’s station for close monitoring B. In a quiet area of the unit away from the nurse’s station C. In a group therapy room with other clients D. In a brightly lit common area Correct Answer: B. In a quiet area of the unit away from the nurse’s station Rationale: A quiet environment with reduced stimuli helps lower anxiety levels, as excessive noise or activity can exacerbate the client’s condition.
32. When is the best time to interact with a client who performs compulsive rituals? A. During the ritual to interrupt the behavior B. Immediately before the ritual to prevent it C. At the completion of the ritual when anxiety is lowest D. Randomly throughout the day to distract the client Correct Answer: C. At the completion of the ritual when anxiety is lowest Rationale: After completing a ritual, the client’s anxiety is at its lowest, making it an optimal time for therapeutic interaction and learning.
33. How should a nurse respond to a client with obsessive-compulsive disorder (OCD) performing non-violent rituals? A. Interrupt the rituals to reduce anxiety B. Actively listen to the client’s obsessive themes and demonstrate empathy C. Criticize the rituals to encourage change D. Ignore the rituals completely Correct Answer: B. Actively listen to the client’s obsessive themes and demonstrate empathy Rationale: As long as the rituals are non-violent, the nurse should listen actively, acknowledge the impact of the rituals, show empathy, and avoid judgment to build trust and support the client.
34. What should the nurse do when caring for a client with post-traumatic stress disorder (PTSD)? A. Discourage the client from discussing the traumatic event B. Actively listen to the client’s stories and assess suicide risk C. Avoid group therapy to prevent triggering memories D. Focus solely on medication management Correct Answer: B. Actively listen to the client’s stories and assess suicide risk Rationale: For PTSD, nurses should listen to the client’s experiences, assess for suicide risk, help develop coping strategies, and encourage group therapy with others who share similar experiences to promote healing.
35. When caring for a client with a somatoform disorder, what should the nurse be aware of?
B. It reinforces their perception of self-control C. It increases their anxiety about food D. It leads to weight gain in others Correct Answer: B. It reinforces their perception of self-control Rationale: Allowing clients with anorexia to prepare food for others reinforces their sense of control over food and eating, which is a core feature of the disorder and can hinder recovery.
38. A client with bulimia uses syrup of ipecac to induce vomiting. What is a potential complication? A. Severe dehydration B. Cardiotoxicity causing conduction disturbances C. Chronic constipation D. Elevated blood pressure Correct Answer: B. Cardiotoxicity causing conduction disturbances Rationale: If ipecac is absorbed rather than vomited, it can cause cardiotoxicity, leading to conduction disturbances, dysrhythmias, myocarditis, or circulatory failure, which may be overlooked in young clients.
39. What is the most important sign of depression in a client? A. Increased appetite and weight gain B. Depressed mood with loss of interest in pleasures C. Excessive energy and talkativeness
D. Improved concentration and decision-making Correct Answer: B. Depressed mood with loss of interest in pleasures Rationale: The hallmark of depression is a sustained depressed mood and anhedonia (loss of interest in pleasurable activities), which significantly impact the client’s quality of life.
40. How can a nurse tell if a depressed client is improving? A. The client expresses more hopelessness B. The client takes an interest in their appearance C. The client avoids social interactions D. The client sleeps excessively Correct Answer: B. The client takes an interest in their appearance Rationale: Improvement in depression is indicated by increased engagement in self-care activities, such as grooming or taking interest in appearance, reflecting a rise in self-esteem and energy.
41. A depressed client suddenly appears happier. What should the nurse suspect? A. The client is fully recovered B. The client may be planning a suicide attempt C. The client is experiencing mania D. The client is denying their depression
44. A client with mania is placed on the unit. Where should the nurse place them? A. In a busy area near the nurse’s station B. In a quiet part of the unit to reduce stimuli C. In a group therapy room with others D. In an isolation room for safety Correct Answer: B. In a quiet part of the unit to reduce stimuli Rationale: Manic clients are sensitive to environmental stimuli, which can escalate their symptoms. A quiet area helps reduce overstimulation and promotes calmer behavior.
45. Which of Bleuler’s 4 A’s is characterized by difficulty making decisions in schizophrenia? A. Autism B. Affect C. Associations D. Ambivalence Correct Answer: D. Ambivalence Rationale: Bleuler’s 4 A’s for schizophrenia include ambivalence (difficulty making decisions), autism (preoccupation with self), affect (flat), and associations (loose).
46. What should the nurse do if a client with schizophrenia is experiencing increased command hallucinations? A. Argue with the client about the hallucinations B. Observe for increased motor activity and erratic behavior C. Administer a sedative immediately D. Encourage the client to focus on the hallucinations Correct Answer: B. Observe for increased motor activity and erratic behavior Rationale: Increased command hallucinations may lead to aggressive behavior. Observing for signs like increased motor activity or erratic responses helps the nurse assess risk and intervene appropriately.
47. What medication is commonly administered to clients with alcohol dependence during withdrawal? A. Antabuse or Librium B. Lithium or Phenothiazines C. MAO inhibitors or SSRIs D. Clozaril or Ativan Correct Answer: A. Antabuse or Librium Rationale: Librium (chlordiazepoxide) is used to manage alcohol withdrawal symptoms, while Antabuse (disulfiram) is used to deter alcohol consumption by causing adverse reactions if alcohol is ingested.
