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2020 HESI Fundamentals

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2020 HESI Fundamentals A policy requiring the removal of acrylic nails by all nursing personnel was implemented 6 months ago. Which assessment measure best determines if the intended outcome of the policy is being achieved. Number of staff induced injury Client satisfaction survey Health care-...

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  • January 31, 2022
  • 8
  • 2021/2022
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2020 HESI Fundamentals
A policy requiring the removal of acrylic nails by all nursing personnel was
implemented 6 months ago. Which assessment measure best determines
if the intended outcome of the policy is being achieved.
Number of staff induced injury
Client satisfaction survey
Health care-associated infection rate.
Rate of needle-stick injuries by nurse.
The nurse is preparing to assist a newly admitted client with personal hygiene
measures. The client...the client’s gag reflex. Which action should the
nurse include?
Offer smalls sips of water through a straw
Place tongue blade on back half of tongue
Use a penlight to observe back of oral cavity
Auscultate breath sounds after client swallows
The father of an 11-year-old boy….
inform the father that it is most important to let the son that nocturnal emissions are normal
The nurse explains to an older adult male the procedure for collecting a 24-hour
urine specimen for creatinine clearance.
Assess the client for confusion and reteach the procedure
Check the urine for color and texture
Empty the urinal contents into the 24-hour collection container
Discard the contents of the urinal
5. A 54-year-old male client and his wife were informed this morning that he has terminal cancer.
Which nursing intervention is likely to be most
Ask her how she would like to participate in the client’s care
Provide the wife with information about hospice
Encourage the wife to visit after painful treatments are completed
Refer her to support group for family members of those dying of cancer
6. A client who has a body mass index (BMI) of 30 is requesting information on the initial approach to a weight loss plan. Which action
s Plan low carbohydrate and high protein meals
h Engage in strenuous activity for an hour daily
o Keep a record of food and drinks consumed
u daily
l Participated in a group exercise class 3 times a
d cannula delivering oxygen at 2 L/min. To assess
7. T he nurse assesses a client who has a nasal week for skin damage related to the cannula, which

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https://www.coursehero.com/file/99874857/2020HESIFundamentalsdoc/

, nostrils
T Over the cheeks
o Across the forehead
p personnel (UAP) who is providing a total bed bath for a confused and lethargic client. The
8. T he nurse observes an unlicensed assistive
UAP is soaking the client’s foot in a basin of
s warm water placed on the bed. WhatRemove thethebasin
action should of water from the client’s
nurse take?
bed immediately
o Remind the UAP to dry between the client’s
f toes completely
Advise the UAP that this procedure is
t damaging to the skin
h Add skin cream to the basin of water while
e
9. T he nurse in the emergency department observes therecord
a colleague viewing the electronic health foot(EHR)
is soaking
of a client who holds an elected

position in the community. The client is notea part of the colleague’s assignment. Communicate
Which action shouldthe colleague’s
the nurse implement?actions to the
a unit charge nurse
r Send an email to facility administration
B reporting the action
r Write an anonymous complaint to a
i professional website
d Post a comment about the action on a staff
g
10. At 0100 on a male client’s second postoperative night, the client states he is unstable to discussion
sleep and plansboard
to read until feeling sleepy. What
e
action should the nurse implement? Leave the room and close the door to the
o client’s room
f Assess the appearance of the client’s surgical
dressing
t Bring the client a prescribed PRN sedative-
h hypnotic
e Discuss symptoms of sleep deprivation with
11. T he nursing staff in the cardiovascular intensive care unit are creating a continuous qualitytheimprovement
client project on social media that
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addresses coronary artery disease (CAD). Which action should the nurse
implement to protect client privacy?
Remove identifying information of the clients who participated
Recall that authored content may be legally discoverable
Share material from credible, peer reviewed sources only
Respect all copyright laws when adding website content
A male client with unstable angina needs a cardiac catheterization, so the
healthcare provider explains the risks and benefits of the procedure, and
then leaves to set up for the procedure. When the nurse presents the
consent form for signature, the client hesitates and asks how the wires
will keep his heart going. Which action should the nurse take?
Answer the client’s specific questions with a short understandable explanation
Postpone the procedure until the client understands the risks and benefits
Call the client’s next of kin and ask them to provide verbal consent
Page the healthcare provider to return and provide additional explanation
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?
Tilt the pelvis forwards and backwards



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