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HESI Fundamentals Exam 2025: Full Guide to
Content Areas, Scoring, and Test-Taking
Strategies
Question 1: During evacuation of a group of clients from a medical unit because of a fire, the nurse observes an ambulatory client walking alone toward the stairway at the end of the hall. Which action should the nurse take? A) Direct the client toward the nearest elevator for quicker evacuation. B) Instruct the client to wait in a safe area until assisted by staff. C) Remind the client to walk carefully down the stairs until reaching a lower floor. D) Provide the client with a wheelchair for safer transport down the stairs. Rationale: The correct answer is C. Ambulatory clients should use the stairs during a fire evacuation, and the nurse's role is to ensure they do so safely. Elevators (A) should not be used during a fire. Asking the client to wait (B) delays evacuation. Wheelchairs (D) are unnecessary for ambulatory clients and can hinder evacuation flow. Question 2: An older client who had abdominal surgery 3 days earlier was given a barbiturate for sleep and is now requesting to go to the bathroom. Which action should the nurse implement? A) Offer the client a bedpan or urinal to use in bed. B) Assist the client to walk to the bathroom and do not leave the client alone. C) Instruct the client to call for assistance after reaching the bathroom. D) Ask the client if they feel steady enough to go to the bathroom independently. Rationale: The correct answer is B. Postoperative clients, especially older adults who have received sedatives, are at increased risk for falls. The nurse should assist the client to the bathroom and remain with them to ensure safety due to potential weakness or altered sensorium from the barbiturate. Question 3:
Which step(s) should the nurse take when administering ear drops to an adult client? (Select all that apply.) A) Warm the ear drops to room temperature before instillation. B) Place the client in a side-lying position with the affected ear facing up. C) Pull the auricle downward and backward. D) Hold the dropper directly inside the ear canal. E) Pull the auricle upward and outward. Rationale: The correct answers are A, B, and E.
- A) Warm the ear drops to room temperature before instillation: This helps prevent dizziness and discomfort.
- B) Place the client in a side-lying position with the affected ear facing up: This allows gravity to assist the medication in flowing into the ear canal and helps the client remain still.
- E) Pull the auricle upward and outward: This straightens the ear canal in adults, allowing the drops to reach the eardrum more effectively. Incorrect Options:
- C) Pull the auricle downward and backward: This technique is used for children younger than 3 years old.
- D) Hold the dropper directly inside the ear canal: The dropper should be held about 1 cm (½ inch) above the ear canal to prevent contamination. Question 4: The mental health nurse plans to discuss a client's depression with the health care provider in the emergency department. There are two clients sitting across from the emergency department desk. Which nursing action is best? A) Briefly state the client's need for a medication refill. B) Ask the health care provider to step into a private examination room. C) Discuss the client's situation in a low voice to maintain confidentiality. D) Discuss the client another time. Rationale: The correct answer is D. Discussing a client's mental health condition in a public area like the emergency department desk, even in a low voice, compromises the client's privacy and confidentiality. The best course of action is to postpone the discussion until a more private
The nurse is using the Glasgow Coma Scale to perform a neurologic assessment. A comatose client winces and pulls away from a painful stimulus. Which action should the nurse take next? A) Apply a stronger painful stimulus to elicit a more definitive response. B) Document that the client responds to painful stimulus. C) Assign a numerical score of 2 for motor response on the Glasgow Coma Scale. D) Reassess the client's pupillary response and verbal response. Rationale: The correct answer is B. The client's withdrawal from a painful stimulus is a motor response that should be documented. Applying a stronger stimulus (A) is unnecessary and could be harmful. Assigning a GCS score (C) requires evaluating all three components (eye opening, verbal response, motor response), and the verbal response cannot be assessed in a comatose client. Reassessing other components (D) is part of a complete neurological assessment but the immediate next step after observing the motor response is to document it. Question 8: The nurse assesses a 2-year-old who is admitted for dehydration and finds that the peripheral IV rate by gravity has slowed, even though the venous access site is healthy. What should the nurse do next? A) Gently milk the IV tubing to dislodge any potential clots. B) Flush the IV catheter with a small amount of normal saline. C) Check for kinks in the tubing and raise the IV pole. D) Apply a warm compress to the IV insertion site. Rationale: The correct answer is C. The most common reasons for a slowed gravity-flow IV rate with a healthy insertion site are mechanical issues such as kinks in the tubing or insufficient height of the IV pole. These should be checked and corrected first. Milking the tubing (A) could dislodge clots but is not the initial action. Flushing the catheter (B) might be necessary if an obstruction is suspected but should be done cautiously in a dehydrated child and after checking for simpler causes. A warm compress (D) would be indicated for infiltration or phlebitis, which are stated as not present. Question 9: The nurse prepares to insert a nasogastric tube in a client with hyperemesis who is awake and alert. Which intervention(s) is(are) correct? (Select all that apply.)
A) Lubricate the distal 10-15 cm (4-6 inches) of the nasogastric tube with a water-soluble lubricant. B) Place the client in a semi-Fowler position with the head slightly hyperextended. C) Instruct the client to swallow after the tube has passed the pharynx. D) Advance the tube while the client holds their breath. E) Use a small-bore, flexible nasogastric tube. Rationale: The correct answers are A, C, and E.
- A) Lubricate the distal 10-15 cm (4-6 inches) of the nasogastric tube with a water-soluble lubricant: Lubrication facilitates easier passage of the tube and reduces friction.
- C) Instruct the client to swallow after the tube has passed the pharynx: Swallowing helps to close the epiglottis and guide the tube into the esophagus.
- E) Use a small-bore, flexible nasogastric tube: These tubes are generally more comfortable for the client and are effective for feeding and medication administration. Incorrect Options:
- B) Place the client in a semi-Fowler position with the head slightly hyperextended: The client should be in high Fowler's position with the head slightly flexed forward to close the trachea and open the esophagus. Hyperextension can increase the risk of the tube entering the trachea.
- D) Advance the tube while the client holds their breath: The client should be instructed to swallow, not hold their breath, as the tube is advanced past the pharynx. Question 10: After receiving written and verbal instructions from a clinic nurse about a newly prescribed medication, a client asks the nurse what to do if questions arise about the medication after getting home. How should the nurse respond? A) "Look up the medication online for more information." B) "Ask your pharmacist when you pick up your next refill." C) "Encourage the client to call the clinic nurse or health care provider if any questions arise." D) "Try to remember everything we discussed today." Rationale: The correct answer is C. The nurse should provide the client with clear instructions on how to seek clarification if they have questions or concerns after leaving the clinic. Calling the clinic nurse or health care provider ensures they receive accurate and timely information
B) Taking anticoagulants for the past year. C) Recent upper respiratory infection. D) Allergy to latex. Rationale: The correct answer is B. Anticoagulants increase the risk of bleeding during and after surgery, which can lead to significant complications. While controlled asthma (A), a recent upper respiratory infection (C), and a latex allergy (D) require careful consideration and management, the potential for hemorrhage with anticoagulant use poses the greatest immediate threat during the surgical procedure. Question 14 A low-sodium, low-protein diet is prescribed for a 45-year-old client with renal insufficiency and hypertension, who gained 3 pounds in the last month. The nurse determines that the client has been noncompliant with the diet, based on which report from the 24 - hour dietary recall? (Select all that apply.) A. Snack of potato chips and diet soda. B. Lunch of tuna fish sandwich, carrot sticks, fresh fruit, and coffee. C. Breakfast of eggs, bacon, toast, and coffee. D. Bedtime snack of crackers and milk. Rationale: Potato chips are high in sodium. Bacon is high in sodium and protein. Tuna fish (especially canned) can be high in sodium, and eggs are high in protein. These choices indicate noncompliance with a low-sodium, low-protein diet. Question 15 While preparing to insert a rectal suppository in a male adult client, the nurse observes that the client is holding his breath while bearing down. What action should the nurse implement? A. Instruct the client to take slow deep breaths and stop bearing down. B. Proceed with the insertion quickly to minimize discomfort. C. Ask the client to try to bear down harder. D. Administer a fast-acting sedative before insertion. Rationale: During administration of a rectal suppository, the client is asked to take slow deep breaths through the mouth to relax the anal sphincter.
Question 16 A female client who has breast cancer with metastasis to the liver and spine is admitted with constant, severe pain despite around-the-clock use of oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home. During the admission assessment, which information is most important for the nurse to obtain? A. Previous pain medication dosages and schedules. B. The client's preferred pain scale (e.g., 0-10). C. Sensory pattern, area, intensity, and nature of the pain. D. The family's understanding of the client's pain level. Rationale: The components of every pain assessment should include sensory patterns, area, intensity, and nature (P.A.I.N.). Question 17 Which statement best describes durable power of attorney for health care? A. The client signs a document that dictates their wishes for organ donation. B. The client signs a document that designates another person to make legally binding healthcare decisions if the client is unable to do so. C. It is a verbal agreement made with the healthcare provider about future medical treatments. D. It allows the client to refuse all medical treatment, regardless of their mental capacity. Rationale: The durable power of attorney is a legal document or a form of advance directive that designates another person to voice healthcare decisions when the client is unable to do so. Question 18 A client provides the nurse with information about the reason for seeking care. The nurse realizes that some information about past hospitalizations is missing. How should the nurse obtain this information? A. Wait for the client to spontaneously volunteer the information later in the assessment. B. Elicit specific facts about past hospitalizations with direct questions. C. Ask the family members to provide the missing information.
B. Provide additional blankets to increase body temperature. C. Turn the client q2h. D. Increase oral fluid intake. Rationale: Turning the client every 2 hours will help to move and drain respiratory secretions and prevent pneumonia from occurring, so this intervention has the highest priority. Older adults often have an increased BP, and a PRN antihypertensive medication is usually prescribed for a BP over 140 systolic and 90 diastolic. Question 22 A male client arrives at the outpatient surgery center for a scheduled needle aspiration of the knee. He tells the nurse that he has already given verbal consent for the procedure to the healthcare provider. What action should the nurse implement? A. Proceed with the procedure as verbal consent is sufficient for minor procedures. B. Notify the healthcare provider that the client is refusing to sign the consent form. C. Witness the client's signature on the consent form. D. Explain the procedure again to ensure the client's understanding. Rationale: Written informed consent is required prior to any invasive procedure. The healthcare provider must explain the procedure to the client, but the nurse can witness the client's signature on a consent form. Question 23 The nurse is administering an intermittent infusion of an antibiotic to a client whose intravenous (IV) access is an antecubital saline lock. After the nurse opens the roller clamp on the IV tubing, the alarm on the infusion pump indicates an obstruction. What action should the nurse take first? A. Flush the saline lock with normal saline. B. Reposition the client's arm. C. Check for kinks in the IV tubing. D. Discontinue the IV and restart it in a new location. Rationale: If the client's elbow is bent, the IV may be unable to infuse, resulting in an obstruction alarm, so the nurse should first attempt to reposition the client's arm to alleviate any obstruction.
Question 24 The nurse is preparing to irrigate a client's indwelling urinary catheter using an open technique. What action should the nurse take after applying gloves? A. Clamp the catheter tubing below the port. B. Draw up the irrigating solution into the syringe. C. Cleanse the catheter port with an antiseptic wipe. D. Insert the syringe into the catheter port. Rationale: After applying gloves, the next step in open catheter irrigation is to draw up the irrigating solution into the syringe. This prepares the solution for immediate use once the catheter port is accessed. Question 25 A male client with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis and tells the nurse he does not want to be resuscitated if his breathing stops. What action should the nurse implement? A. Document the client's wishes in the medical record. B. Ask the client if this decision has been discussed with his healthcare provider. C. Immediately place a "Do Not Resuscitate" (DNR) order on the chart. D. Inform the client that he cannot refuse life-sustaining treatment. Rationale: Advance directives are written statements of a person's wishes regarding medical care, and verbal directives may be given to a healthcare provider with specific instructions in the presence of two witnesses. Question 26 The nurse is caring for a client who is weak from inactivity because of a 2-week hospitalization. In planning care for the client, the nurse should include which range of motion (ROM) exercises? A. Passive ROM exercises to both arms and legs once a day. B. Active ROM exercises to both arms and legs two or three times a day. C. Continuous passive motion (CPM) machine for lower extremities only.
D. Develop a plan of care with specific nursing interventions. Rationale: In the nursing process, the evaluation component examines the effectiveness of nursing interventions in achieving client outcomes. Question 30 A 75-year-old client who has a history of end-stage renal failure and advanced lung cancer, recently had a stroke. Two days ago the healthcare provider discontinued the client's dialysis treatments, stating that death is inevitable, but the client is disoriented and will not sign a DNR directive. What is the priority nursing intervention? A. Continue dialysis treatments until a DNR is signed. B. Determine who is legally empowered to make decisions. C. Inform the client's family that a DNR is required. D. Provide comfort measures only, as death is inevitable. Rationale: When death is impending, it is essential for the nurse to determine who is legally empowered to make decisions regarding the use of life-saving measures for the client. Question 31 When assessing a client with an indwelling urinary catheter, which observation requires the most immediate intervention by the nurse? A. The client reports mild discomfort at the insertion site. B. The urinary drainage bag is less than half full. C. The urine in the tubing is cloudy. D. The clamp on the urinary drainage bag is open. Rationale: Maintaining a closed urinary drainage system is important to prevent infection, so the most immediate priority is to close the clamp. Question 32 A client with Raynaud's disease asks the nurse about using biofeedback for self-management of symptoms. What response is best for the nurse to provide? A. "Biofeedback involves using electrical currents to stimulate circulation."
B. "Biofeedback allows the client to control involuntary responses to promote peripheral vasodilation." C. "Biofeedback is a form of deep tissue massage that improves blood flow." D. "Biofeedback teaches you to ignore the symptoms of your disease." Rationale: Biofeedback involves the use of various monitoring devices that help people become more aware and able to control their own physiologic responses, such as heart rate, body temperature, muscle tension, and brain waves. Question 33 When the nurse enters a client's room to do an initial assessment, the client shouts, "Get out of my room! I'm tired of being bothered!" How should the nurse respond? A. "I will come back later when you are feeling more cooperative." B. "What is concerning you this morning?" C. "You need to calm down so I can do my job." D. "I understand you're upset, but I have to do my assessment." Rationale: An open-ended question that encourages the client to discuss personal feelings. Question 34 The nurse notes that a client consistently coughs while eating and drinking. Which nursing diagnosis is most important for the nurse to include in this client's plan of care? A. Imbalanced nutrition: Less than body requirements. B. Risk for aspiration. C. Deficient fluid volume. D. Impaired oral mucous membrane. Rationale: Coughing during or after meals is a manifestation of dysphagia, or difficulty swallowing, which places the client at risk for aspiration. Question 35
Question 38 The nurse encounters resistance when inserting the tubing into a client's rectum for a tap water enema. What action should the nurse implement? A. Increase the pressure on the tubing to overcome the resistance. B. Remove the tubing immediately and notify the healthcare provider. C. Ask the client to relax and run a small amount of fluid into the rectum. D. Reposition the client to the left lateral Sim's position. Rationale: If resistance is encountered during the initial insertion of an enema tube, the client should be instructed to relax while a small amount of solution runs through the tube into the rectum. Question 39 The nurse removes the dressing on a client's heel that is covering a pressure sore one-inch in diameter and finds that there is straw-colored drainage seeping from the wound. What description of this finding should the nurse include in the client's record? A. One-inch pressure sore with purulent drainage. B. One-inch pressure sore draining serous fluid. C. One-inch pressure sore with sanguineous drainage. D. One-inch pressure sore with serosanguineous drainage. Rationale: Serous drainage is clear watery plasma, which matches the description of straw- colored drainage. Question 40 When preparing to administer an intravenous medication through a central venous catheter, the nurse aspirates a blood return in one of the lumens of the triple lumen catheter. Which action should the nurse implement? A. Discontinue the use of that lumen and use another. B. Flush the lumen with the saline solution and administer the medication through the lumen. C. Notify the healthcare provider of possible catheter displacement.
D. Aspirate again to confirm the blood return before proceeding. Rationale: Aspiration of a blood return in the lumen of a central venous catheter indicates that the catheter is in place and the medication can be administered. The nurse should flush the tubing with the saline solution, administer the medication. Question 41 Before administering a client's medication, the nurse assesses a change in the client's condition and decides to withhold the medication until consulting with the healthcare provider. After consultation with the healthcare provider, the dose of the medication is changed and the nurse administers the newly prescribed dose an hour later than the originally scheduled time. What action should the nurse implement in response to this situation? A. Apologize to the client for the delay in medication administration. B. Document the events that occurred in the nurses' notes. C. Fill out an incident report regarding the medication delay. D. Inform the charge nurse about the change in the medication order. Rationale: The nurse took the correct action and should document the events that occurred in the nurses' notes. Question 42 When making the bed of a client who needs a bed cradle, which action should the nurse include? A. Secure the top sheet and blankets tightly around the client's feet. B. Drape the top sheet and covers loosely over the bed cradle. C. Remove all top covers to prevent pressure on the client. D. Place the bed cradle under the client's legs. Rationale: A bed cradle is used to keep the top bedclothes off the client, so the nurse should drape the top sheet and covers loosely over the cradle. Question 43 How should the nurse handle linens that are soiled with incontinent feces? A. Shake the feces into the toilet before placing linens in the hamper.
Question 46 After a client has been premedicated for surgery with an opioid analgesic, the nurse discovers that the operative permit has not been signed. What action should the nurse implement? A. Have the client sign the consent form immediately. B. Notify the surgeon that the consent form has not been signed. C. Allow the client to go to surgery, and the surgeon can obtain consent there. D. Ask the client's family to sign the consent form. Rationale: Once a client has been premedicated for surgery with any type of sedative, legal informed consent is not possible, so the nurse must notify the surgeon. Question 47 The nurse is preparing to give a client dehydration IV fluids delivered at a continuous rate of 175 ml/hour. Which infusion device should the nurse use? A. Gravity drip set. B. Cassette infusion pump. C. Syringe pump. D. Volume control set. Rationale: A cassette pump (B) should be used to accurately deliver large volumes of fluid over longer periods of time with extreme precision, such as ml/hour. Question 48 A 73-year-old Hispanic client is seen at the community health clinic with a history of protein malnutrition. What information should the nurse obtain first? A. The client's preferred protein sources. B. Foods and liquids consumed during the past 24 hours. C. The client's financial ability to purchase protein-rich foods. D. Availability of culturally appropriate protein supplements.
Rationale: A client's dietary habits should be determined first by the client's dietary recall (B) before suggesting protein sources or supplements. Question 49 A client in hospice care develops audible gurgling sounds on inspiration. Which nursing action has the highest priority? A. Turn the client to a side-lying position to promote drainage. B. Administer a PRN antiemetic medication. C. Inform the family that death is imminent. D. Increase the room's humidity to loosen secretions. Rationale: An audible gurgling sound produced by a dying client is characteristic of ineffective clearance of secretions from the lungs or upper airways, causing a "rattling" sound as air moves through the accumulated fluid. The nursing priority in this situation is to convey to the family that the client's death is imminent. Question 50 A middle-aged woman who enjoys being a teacher and mentor feels that she should pass down her legacy of knowledge and skills to the younger generation. According to Erikson she is involved in what developmental stage? A. Intimacy vs. Isolation B. Generativity vs. Stagnation C. Ego Integrity vs. Despair D. Identity vs. Role Confusion Rationale: Healthy middle-aged adults focus on establishing the next generation by nurturing and guiding, which is described by Erikson as the developmental stage of generativity. Question 51 The nurse is digitally removing a fecal impaction for a client. The nurse should stop the procedure and take corrective action if which client reaction is noted? A. Temperature increases from 98.8 to 99.0 F. B. Pulse rate decreases from 78 to 52 beats/min.
