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HESI Fundamentals Exam 2025: Updated
Format, Question Count, and Must-Know
Topics forNursing Students
Question 1: Which client is most likely to tolerate a higher level of pain? A. A 10-year-old who was burned by a campfire earlier today. B. A 70-year-old who has a postoperative infection from a surgery one week ago. C. A 23-year-old woman who sprained her knee bicycling. D. A 55-year-old woman who has had moderate low back pain for 3 months that has been successfully managed with medication. Rationale: The correct answer is D. The client with chronic pain that has been successfully relieved in the past is likely to tolerate a higher level of pain. Prior successful pain management allows the client to interpret the pain sensation with a degree of understanding and equips them with coping mechanisms and a belief in potential relief. Acute pain, such as burns (A), postoperative infection (B), or a new sprain (C), is often less tolerated due to its novelty and the body's immediate stress response. Question 2: A signed consent form indicated a client should have an electromyogram, but a myelogram was performed instead. Though the myelogram revealed the cause of the client's back pain, which was subsequently treated, the client filed a lawsuit against the nurse and the healthcare provider for performing the incorrect procedure. The court is likely to rule in favor of the plaintiff because these events represent what? A. Negligence B. Malpractice C. Assault and Battery D. Invasion of Privacy
Rationale: The correct answer is C. Performing a procedure without the client's informed consent constitutes battery (intentional touching without consent). Even though the myelogram was medically beneficial, it was not the procedure the client agreed to. Assault is the threat of unlawful touching, and battery is the actual unlawful touching. Negligence is a failure to exercise the care that a reasonably prudent person would exercise in similar circumstances, and malpractice is professional negligence. Invasion of privacy involves the wrongful intrusion into a person's private affairs. Question 3: Which of the following best describes a quasi-intentional tort? A. An unintentional act resulting in harm, such as a medication error. B. Physical contact without the client's consent. C. Injury to a person's reputation or emotional well-being through actions like defamation or breach of confidentiality. D. Failure to provide the standard of care that a reasonably prudent nurse would provide. Rationale: The correct answer is C. Quasi-intentional torts involve voluntary acts that directly cause injury to a person's economic interests or personal dignity. Examples include invasion of privacy and defamation of character (libel or slander). Unintentional torts (A and D) involve negligence or malpractice. Physical contact without consent (B) is battery, an intentional tort. Question 4: Which of the following is a key characteristic of the "related to" clause in a nursing diagnosis statement? A. It should identify the medical diagnosis that is contributing to the client's problem. B. It should describe the defining characteristics or symptoms exhibited by the client. C. It should indicate the etiological or contributing factors that cause or influence the nursing diagnosis. D. It should suggest the specific nursing interventions that will address the client's problem. Rationale: The correct answer is C. The "related to" (etiology) part of a nursing diagnosis statement aims to identify the factors that are causing or contributing to the client's health problem. This clause guides the nurse in selecting appropriate interventions aimed at addressing the underlying cause. The diagnostic label describes the client's response (A is incorrect as it shouldn't be a medical diagnosis, B describes defining characteristics), and the interventions are developed after the diagnosis is formulated (D is incorrect).
C. A diet high in whole-grain cereals, vegetables, sea vegetables, beans, and vegetarian soups. D. A diet that eliminates all processed foods and focuses on single food items. Rationale: The correct answer is C. A macrobiotic diet is characterized by a high intake of whole grains, vegetables, sea vegetables, beans, and vegetarian soups. It typically minimizes or excludes animal products, refined sugars, and processed foods. While it emphasizes plant-based proteins, careful combination of incomplete proteins is necessary to ensure intake of all essential amino acids. Question 8: What is the fundamental principle behind biofeedback therapy? A. Using guided imagery to promote relaxation and reduce stress. B. Employing meditation techniques to alter physiological responses. C. Utilizing monitoring devices to increase a person's awareness and control over their own physiological responses. D. Administering small electrical currents to stimulate nerve pathways and reduce pain. Rationale: The correct answer is C. Biofeedback involves using various instruments to provide real-time feedback on physiological functions like heart rate, temperature, muscle tension, and brain waves. This awareness allows individuals to learn to consciously control these responses through relaxation techniques, cognitive strategies, and behavioral modifications. Question 9: Which of the following is a key component of every comprehensive pain assessment, as indicated by the mnemonic PAIN? A. Patient's age, allergies, insurance, and nursing history. B. Presence, absence, intensity, and need for medication. C. Sensory patterns, area, intensity, and nature of the pain. D. Provoking factors, alleviating factors, impact on ADLs, and non-pharmacological measures used. Rationale: The correct answer is C. The mnemonic PAIN specifically stands for:
- P - Sensory Patterns (how the pain feels)
- A - Area (location of the pain)
- I - Intensity (severity of the pain)
- N - Nature (characteristics of the pain) While the other options include important aspects of pain assessment, they do not align with the specific components of the PAIN mnemonic as defined in the provided information. Question 10: What is the primary distinction between advance directives and verbal directives regarding a person's wishes for medical care? A. Advance directives are legally binding, while verbal directives are not. B. Advance directives must be communicated to the healthcare provider by the client, while verbal directives can be relayed by family. C. Advance directives are written statements, while verbal directives are spoken instructions given to a healthcare provider with witnesses. D. Advance directives outline financial decisions, while verbal directives address medical care. Rationale: The correct answer is C. Advance directives are written documents that communicate a person's wishes regarding medical treatment in the event they become unable to do so. Verbal directives, on the other hand, are spoken instructions given directly to a healthcare provider, typically in the presence of two witnesses to ensure their validity. While both aim to convey the client's preferences, the key difference lies in their form (written vs. spoken). Question 11: Which of the following positions is best described as a side-lying position? A. Supine position B. Prone position C. Fowler's position D. Sim's position Rationale: The correct answer is D. Sim's position is a specific type of side-lying position where the client lies on their left side with the lower arm extended behind the back and the upper arm flexed at the shoulder and elbow. The lower leg is slightly flexed at the hip and knee, and the upper leg is flexed at a greater angle and drawn forward. Question 12:
Rationale: The correct answer is B. The immediate priority is to correct the dangerously high infusion rate to prevent fluid overload. Slowing the infusion to a KVO rate (a very slow rate to maintain patency of the IV line) is the initial action to reduce the infusion volume while the situation is further assessed. Determining when the IV started (A) and assessing the site (C) are important follow-up actions. Reporting to the provider (D) is also necessary but should occur after the immediate action to slow the infusion. Question 15 Which laboratory test indicates the client's protein status for the longest length of time? A. Blood urea nitrogen (BUN) B. Prealbumin C. Serum albumin D. C-reactive protein Rationale: Serum albumin has a long half-life and is the best long-term indicator of the body's entry into a catabolic state following protein depletion from malnutrition or stress of chronic illness. Question 16 What is the normal serum protein range? A. 2.0-4.0 g/dL B. 4.5-6.0 g/dL C. 6.4-8.3 g/dL D. 9.0-11.0 g/dL Rationale: Normal serum protein range is 6.4-8.3 g/dL. Question 17 What do the "ABCs" of client care stand for? A. Assessment, Baseline, Comfort B. Airway, Breathing, Circulation C. Activity, Bedrest, Communication
D. Ambulation, Bowel, Consciousness Rationale: A-Airway, B-Breathing, C-Circulation. Question 18 When caring for an immobile client, which nursing diagnosis has the highest priority? A. Risk for fluid volume deficit B. Impaired gas exchange C. Risk for impaired skin integrity D. Altered tissue perfusion Rationale: Impaired gas exchange is the highest priority because it directly impacts a vital physiological function, potentially leading to immediate life-threatening complications like atelectasis or pneumonia in immobile clients. While the other options are important, they represent risks that are generally not as immediately life-threatening. Question 19 What type of drainage is described as clear, watery plasma? A. Sero-sanguineous drainage B. Purulent drainage C. Exudate D. Serous drainage Rationale: Serous drainage is clear watery plasma. Question 20 What type of drainage is pale and watery, containing plasma and red blood cells? A. Serous drainage B. Purulent drainage C. Sero-sanguineous drainage D. Exudate
Rationale: The first action taken by the nurse should be to assess the skin for any possible thermal injury. If no injury to the skin has occurred, the nurse can take the other actions. Question 24 The nurse mixes 50 mg of Nipride in 250 mL of D5W and plans to administer the solution at a rate of 5 mcg/kg/min to a client weighing 182 lbs. Using a drip factor of 60 gtt/mL, how many drops per minute should the client receive? A. 62 gtt/min B. 98 gtt/min C. 124 gtt/min D. 156 gtt/min Rationale: 124 gtt/min Convert client weight to kg: 182 lbs / 2.2 lbs/kg = 82.73 kg Calculate total mcg/min needed: 5 mcg/kg/min * 82.73 kg = 413.65 mcg/min Convert Nipride to mcg: 50 mg * 1000 mcg/mg = 50,000 mcg Calculate concentration of Nipride: 50,000 mcg / 250 mL = 200 mcg/mL Calculate mL/min: 413.65 mcg/min / 200 mcg/mL = 2.068 mL/min Calculate gtt/min: 2.068 mL/min * 60 gtt/mL = 124.08 gtt/min (round to 124 gtt/min) Question 25 The healthcare provider prescribes an IV infusion of 1000 ml of Ringer's Lactate w/ 30 units of Pitocin to run in over 4 hours for a client who has just delivered a 10 pound infant by cesarean section. The tubing has been changed to a 20 gtt/ml administration set. The nurse plans to set the flow rate at how many gtt/min? A. 42 gtt/min B. 60 gtt/min C. 83 gtt/min D. 125 gtt/min Rationale: 83 gtt/min Calculate total minutes: 4 hours * 60 minutes/hour = 240 minutes Calculate gtt/min: (1000 mL * 20 gtt/mL) / 240 minutes = 20000 / 240 = 83.33 gtt/min (round to 83 gtt/min)
Question 26 Which assessment data provides the most accurate determination of proper placement of a nasogastric tube? A. Auscultating air injected into the tube over the epigastrium. B. Aspirating gastric contents and checking their pH. C. Examining a chest x-ray obtained after the tubing was inserted. D. Observing for signs of respiratory distress after insertion. Rationale: Examining a chest x-ray obtained after the tubing was inserted is the most accurate method to confirm proper placement of a nasogastric tube, especially for long-term feeding or medication administration, as it directly visualizes the tube's location. Question 27 Three days following a surgery, a male client observes his colostomy for the first time. He becomes quite upset and tells the nurse that it is much bigger than he expected. What is the best response by the nurse? A. Reassure the client that he will become accustomed to the stoma appearance in time. B. Instruct the client that the stoma will become much smaller when the initial swelling diminishes. C. Offer to contact a member of the local ostomy support group to help him with his concerns. D. Encourage the client to handle the stoma equipment to gain confidence with the procedure. Rationale: Postoperative swelling causes enlargement of the stoma. The nurse can teach the client that the stoma will become smaller when swelling is diminished. This will help reduce the client's anxiety and promote acceptance of the colostomy. Question 28 A female client with a nasogastric tube attached to low suction states that she is nauseated. The nurse assesses that there has been no drainage through the nasogastric tube in the last two hours. What action should the nurse take first? A. Irrigate the nasogastric tube with sterile normal saline. B. Reposition the client on her side. C. Advance the nasogastric tube an additional five centimeters.
A client with chronic kidney disease (CKD) selects a scrambled egg for his breakfast. What action should the nurse take? A. Commend the client for selecting a high biologic value protein. B. Remind the client that protein in the diet should be avoided. C. Suggest that the client also select orange juice, to promote absorption. D. Encourage the client to attend classes on dietary management of CKD. Rationale: Foods such as eggs and milk (A) are high biologic proteins which are allowed because they are complete proteins and supply the essential amino acids that are necessary for growth and cell repair. Orange juice is rich in potassium and should not be encouraged. The client has made a good diet choice so (D) is not necessary. Question 32 When assisting an 82-year-old client to ambulate, it is important for the nurse to realize that the center of gravity for an elderly person is the: A. Hips B. Upper torso C. Knees D. Feet Rationale: The center of gravity for adults is the hips. However, as the person grows older, a stooped posture is common because of the changes from osteoporosis and normal bone degeneration, and the knees, hips, and elbows flex. This stooped posture results in the upper torso becoming the center of gravity for older persons. Question 33 In developing a plan of care for a client with dementia, the nurse should remember that confusion in the elderly: A. Is to be expected, and progresses with age. B. Often follows relocation to new surroundings. C. Is a result of irreversible brain pathology. D. Can be prevented with adequate sleep.
Rationale: Relocation (B) often results in confusion among elderly clients-- moving is stressful for anyone. (A) is stereotypical judgement. Stress in the elderly often manifests itself as confusion, so (C) is wrong. Adequate sleep is not a prevention (D) for confusion. Question 34 A postoperative client will need to perform daily dressing changes after discharge. Which outcome statement best demonstrates the client's readiness to manage his wound care after discharge? The client: A. Asks relevant questions regarding the dressing change. B. States he will be able to complete the wound care regimen. C. Demonstrates the wound care procedure correctly. D. Has all the necessary supplies for wound care. Rationale: A return demonstration of a procedure (C) provides an objective assessment of the client's ability to perform a task, while (A and B) are subjective measures. (D) is important, but is less of a priority than the nurse's assessment of the client's ability to complete wound care. Question 35 A client who is 5'5" tall and weighs 200 pounds is scheduled for surgery the next day. What question is most important for the nurse to include during the preoperative assessment? A. "What is your daily calorie consumption?" B. "What vitamin and mineral supplements do you take?" C. "Do you feel that you are overweight?" D. "Will a clear liquid diet be okay after surgery?" Rationale: Vitamin and mineral supplements (B) may impact medications used during the operative period. (A and C) are appropriate questions for long-term dietary counseling. The nature of the surgery and anesthesia will determine the need for a clear liquid diet (D), rather than the client's preference. Question 36 During the initial morning assessment, a male client denies dysuria but reports that his urine appears dark amber. Which intervention should the nurse implement?
Question 39 A male client being discharged with a prescription for the bronchodilator theophylline tells the nurse that he understands he is to take three doses of the medication each day. Since, at the time of discharge, time-released capsules are not available, which dosing schedule should the nurse advise the client to follow? A. 8 AM, 12 PM, 4 PM B. 9 AM, 5 PM, 1 AM C. 8 AM, 4 PM, and midnight D. 7 AM, 3 PM, 11 PM Rationale: Theophylline should be administered on a regular around the clock schedule to provide the best bronchodilating effect and reduce the potential for adverse effects. Question 40 A client is to receive 10 mEq of KCl diluted in 250 mL of normal saline over 4 hours. At what rate should the nurse set the client's intravenous infusion pump? A. 25 mL/hr B. 50 mL/hr C. 63 mL/hr D. 75 mL/hr Rationale: 63 mL/hr Calculate mL/hr: 250 mL / 4 hours = 62.5 mL/hr (round to 63 mL/hr) Question 41 When evaluating a client's plan of care, the nurse determines that a desired outcome was not achieved. Which action should the nurse implement first? A. Establish a new nursing diagnosis. B. Note which actions were not implemented. C. Add additional nursing orders to the plan.
D. Collaborate with the HCP to make changes. Rationale: First, the nurse should review which actions in the original plan were not implemented (B) in order to determine why the original plan did not produce the desired outcome. Appropriate revisions can then be made, which may include revising the expected outcome, or identifying a new nursing diagnosis (A). (C) may be needed if the nursing actions were unsuccessful, or were unable to be implemented. (D) other members of the healthcare team may be necessary to collaborate changes once the nurse determines why the original plan did not produce the desired outcome. Question 42 Which snack food is best for the nurse to provide a client with myasthenia gravis who is at risk for altered nutritional status? A. Chocolate pudding B. Graham crackers C. Sugar-free gelatin D. Apple slices Rationale: The client with myasthenia gravis is at high risk for altered nutrition because of fatigue and muscle weakness resulting in dysphagia. Snacks that are semisolid, such as pudding (A) are easy to swallow and require minimal chewing effort, and provide calories and protein. (C) does not provide any nutritional value. (B and D) require energy to chew and are more difficult to swallow than pudding. Question 43 The nurse is instructing a client with high cholesterol about diet and lifestyle modification. What comment from the client indicates that the teaching has been effective? A. "If I exercise at least two times weekly for one hour, I will lower my cholesterol." B. "I need to avoid eating proteins, including red meat." C. "I will limit my intake of beef to 4 ounces per week." D. "My blood level of low-density lipoproteins needs to increase." Rationale: Limiting saturated fat from animal food sources to no more than 4 ounces per week (C) is an important diet modification for lowering cholesterol. To be effective in reducing cholesterol, the client should exercise 30 minutes per day, or at least 4 to 6 times per week (A). Red meat and all proteins do not need to be eliminated (B) to lower cholesterol, but should be
An IV infusion of terbutaline sulfate 5 mg in 500 mL of D5W, infusing at a rate of 30 mcg/min, is prescribed for a client in premature labor. How many ml/hr should the nurse set the infusion pump? A. 90 mL/hr B. 120 mL/hr C. 180 mL/hr D. 240 mL/hr Rationale: 180 mL/hr Convert mg to mcg: 5 mg * 1000 mcg/mg = 5000 mcg Calculate concentration: 5000 mcg / 500 mL = 10 mcg/mL Calculate mL/min: 30 mcg/min / 10 mcg/mL = 3 mL/min Calculate mL/hr: 3 mL/min * 60 min/hr = 180 mL/hr Question 47 The healthcare provider prescribes the diuretic metolazone (Zaroxolyn) 7.5 mg PO. Zaroxolyn is available in 5 mg tablets. How much should the nurse plan to administer? A. 1 tablet B. 1 1/2 tablets C. 2 tablets D. 2 1/2 tablets Rationale: 1 1/2 tablets Calculation: 7.5 mg / 5 mg/tablet = 1.5 tablets Question 48 The healthcare provider prescribes furosemide (Lasix) 15 mg IV stat. On hand is Lasix 20 mg/2ml. How many milliliters should the nurse administer? A. 0.75 mL B. 1.0 mL C. 1.5 mL
D. 2.0 mL Rationale: 1.5 mL Calculation: (15 mg / 20 mg) * 2 mL = 0.75 * 2 mL = 1.5 mL Question 49 Heparin 20,000 units in 500 mL D5W at 50 mL/hour has been infusing for 5.5 hours. How much heparin has the client received? A. 5,500 units B. 8,000 units C. 11,000 units D. 15,000 units Rationale: 11,000 units Calculate total mL infused: 50 mL/hour * 5.5 hours = 275 mL Calculate units per mL: 20,000 units / 500 mL = 40 units/mL Calculate total units received: 275 mL * 40 units/mL = 11,000 units Question 50 The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN) via a central line at 54 mL/hr. When initially assessing the client, the nurse notes that the TPN solution has run out and the next TPN solution is not available. What immediate action should the nurse take? A. Infuse normal saline at a keep vein open rate. B. Discontinue the IV and flush the port with heparin. C. Infuse 10% dextrose and water at 54 mL/hour. D. Obtain a stat blood glucose level and notify the HCP. Rationale: TPN is discontinued gradually to allow the client to adjust decreased levels of glucose. Administering 10% dextrose in water at the prescribed rate (C) will keep the client from experiencing hypoglycemia until the next TPN solution is available. The client could experience a hypoglycemic reaction if the current level of glucose (A) is not maintained or if the TPN is discontinued abruptly (B). There is no reason to obtain a stat blood-glucose level (D) and the HCP cannot do anything about this situation.
