HESI-HU NSG122 Nursing Fundamental Concepts Exam 1
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Free HESI-HU NSG122 Nursing Fundamental Concepts Exam 1 Questions
1. The nurse implements a change in the approach to client care after gathering evidence in support of the new approach. Which action should the nurse take next?
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Engage staff in evidence based practice.
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Consult with a clinical nursing expert.
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Evaluate effectiveness of the change.
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Revise clinical practice guidelines.
Explanation
Explanation
After implementing a change in clinical practice, the next step in the evidence-based practice process is to evaluate whether the change achieved the desired outcome. Evaluation is essential to determine if the new approach is effective, safe, and beneficial for client care. This step follows implementation and precedes any decision to adopt, modify, or abandon the change.
Why the other options are incorrect:
A. Engage staff in evidence based practice — Staff engagement in evidence-based practice is an important step that occurs before implementation, during the education and preparation phase. It has already been addressed prior to implementing the change.
B. Consult with a clinical nursing expert — Expert consultation is a step that occurs earlier in the process, during evidence gathering and planning, not after implementation has already taken place.
D. Revise clinical practice guidelines — Revising guidelines is a step that follows successful evaluation of the change. Guidelines are updated only after the effectiveness of the new approach has been confirmed through evaluation.
After implementing a change in clinical practice, the next step in the evidence-based practice process is to evaluate whether the change achieved the desired outcome. Evaluation is essential to determine if the new approach is effective, safe, and beneficial for client care. This step follows implementation and precedes any decision to adopt, modify, or abandon the change.
Why the other options are incorrect:
A. Engage staff in evidence based practice — Staff engagement in evidence-based practice is an important step that occurs before implementation, during the education and preparation phase. It has already been addressed prior to implementing the change.
B. Consult with a clinical nursing expert — Expert consultation is a step that occurs earlier in the process, during evidence gathering and planning, not after implementation has already taken place.
D. Revise clinical practice guidelines — Revising guidelines is a step that follows successful evaluation of the change. Guidelines are updated only after the effectiveness of the new approach has been confirmed through evaluation.
2. The nurse is caring for a client who wears bilateral hearing aids. Which action should the nurse take when communicating with the client?
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Increase volume on the hearing aid.
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Maintain eye contact.
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Lean away from the client.
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Emphasize word enunciation.
Explanation
Explanation
Correct Answer: (B) Maintain eye contact.
Maintaining eye contact when communicating with a client who wears hearing aids is essential as it allows the client to use visual cues such as lip reading and facial expressions to supplement what they hear. This enhances understanding and shows respectful, attentive communication.
Why the other options are incorrect:
A. Increase volume on the hearing aid — The nurse should not adjust a client's hearing aid without proper training or the client's direction, as improper volume changes can cause discomfort or damage.
C. Lean away from the client — Leaning away reduces the client's ability to see facial expressions and lip movements, making communication more difficult.
D. Emphasize word enunciation — While speaking clearly is helpful, over-enunciating can distort lip movements and actually make lip reading harder for the client.
Correct Answer: (B) Maintain eye contact.
Maintaining eye contact when communicating with a client who wears hearing aids is essential as it allows the client to use visual cues such as lip reading and facial expressions to supplement what they hear. This enhances understanding and shows respectful, attentive communication.
Why the other options are incorrect:
A. Increase volume on the hearing aid — The nurse should not adjust a client's hearing aid without proper training or the client's direction, as improper volume changes can cause discomfort or damage.
C. Lean away from the client — Leaning away reduces the client's ability to see facial expressions and lip movements, making communication more difficult.
D. Emphasize word enunciation — While speaking clearly is helpful, over-enunciating can distort lip movements and actually make lip reading harder for the client.
3. Which outcome statement can be used in the planning stage of the nursing process?
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The client's breath sounds will be auscultated by the nurse every 4 hours.
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The client informs she has tried to inject her own insulin but cannot stick herself.
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The client will adhere to the medication regimen after discharge.
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The client will demonstrate ability to change the ostomy bag in two days.
Explanation
Explanation
A proper outcome statement in the planning stage must be client-centered, measurable, realistic, and time-bound. Option D meets all these criteria — it identifies what the client will do, is observable and measurable, and includes a specific timeframe (two days).
Why the other options are incorrect:
A. The client's breath sounds will be auscultated by the nurse every 4 hours — This describes a nursing intervention, not a client outcome. Outcome statements focus on what the client will achieve, not what the nurse will do.
B. The client informs she has tried to inject her own insulin but cannot stick herself — This is an assessment finding or subjective data, not a planned outcome statement.
C. The client will adhere to the medication regimen after discharge — While client-centered, this statement lacks a specific, measurable timeframe and is too vague to be an actionable outcome in the planning stage.
A proper outcome statement in the planning stage must be client-centered, measurable, realistic, and time-bound. Option D meets all these criteria — it identifies what the client will do, is observable and measurable, and includes a specific timeframe (two days).
Why the other options are incorrect:
A. The client's breath sounds will be auscultated by the nurse every 4 hours — This describes a nursing intervention, not a client outcome. Outcome statements focus on what the client will achieve, not what the nurse will do.
B. The client informs she has tried to inject her own insulin but cannot stick herself — This is an assessment finding or subjective data, not a planned outcome statement.
C. The client will adhere to the medication regimen after discharge — While client-centered, this statement lacks a specific, measurable timeframe and is too vague to be an actionable outcome in the planning stage.
4. An older adult male is brought to the emergency department (ED) by ambulance after a neighbor found him confused and unable to walk. The client is hypotensive, tachycardic, febrile, and incontinent of foul-smelling urine. After the client is admitted to the intensive care unit for septic shock, his daughter arrives and tells the nurse that her father does not want to be resuscitated. To include a "do not resuscitate" (DNR) form in the client's record, which information should the nurse obtain?
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Other family members support of the daughter's report regarding the client's end-of-life wishes.
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The healthcare provider verifies the client's DNR status.
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The daughter is the client's durable power of attorney for health care.
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A DNR form, signed by the client during a previous hospitalization is available from Medical Records.
Explanation
Explanation
Correct Answer: (D) A DNR form, signed by the client during a previous hospitalization is available from Medical Records.
The most legally sound way to honor a DNR request is to obtain a previously signed, legally valid DNR document. A DNR form signed by the client himself during a prior hospitalization constitutes documented, direct evidence of the client's own wishes and can be legally placed in the current medical record to guide care decisions.
Why Other Options are Incorrect:
A. Other family members supporting the daughter's report — Family consensus does not constitute a legal DNR order. Multiple family members agreeing does not replace a formal, signed legal document from the client.
B. The healthcare provider verifies the DNR status — While a provider must write a DNR order, verbal verification alone is insufficient without a legal document or direct order based on confirmed patient wishes.
C. The daughter is the durable power of attorney — While durable power of attorney for healthcare does grant decision-making authority, the daughter's word alone without legal documentation on file is insufficient to immediately place a DNR in the record, especially in an acute emergency setting.
Correct Answer: (D) A DNR form, signed by the client during a previous hospitalization is available from Medical Records.
The most legally sound way to honor a DNR request is to obtain a previously signed, legally valid DNR document. A DNR form signed by the client himself during a prior hospitalization constitutes documented, direct evidence of the client's own wishes and can be legally placed in the current medical record to guide care decisions.
Why Other Options are Incorrect:
A. Other family members supporting the daughter's report — Family consensus does not constitute a legal DNR order. Multiple family members agreeing does not replace a formal, signed legal document from the client.
B. The healthcare provider verifies the DNR status — While a provider must write a DNR order, verbal verification alone is insufficient without a legal document or direct order based on confirmed patient wishes.
C. The daughter is the durable power of attorney — While durable power of attorney for healthcare does grant decision-making authority, the daughter's word alone without legal documentation on file is insufficient to immediately place a DNR in the record, especially in an acute emergency setting.
5. The nurse is educating a client on how to self-administer an injection. Which method should the nurse use to evaluate the teaching?
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Discuss with the client the latest update about self injection.
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Ask the client to show how the injection will be performed.
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Provide client with a video demonstrating how to self inject.
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Ask the client to repeat the information that was provided.
Explanation
Explanation
The most effective method to evaluate teaching of a psychomotor skill such as self-injection is return demonstration. By asking the client to physically show how they will perform the injection, the nurse can directly observe and verify that the client has correctly learned the technique, identify any errors in hand placement, site selection, or technique, and provide immediate corrective feedback. Return demonstration is the gold standard for evaluating skill-based learning.
Why the other options are incorrect:
A. Discuss with the client the latest update about self injection — Discussion evaluates knowledge at a cognitive level but does not confirm that the client can correctly perform the physical skill of self-injection.
C. Provide client with a video demonstrating how to self inject — Showing a video is a teaching strategy, not an evaluation method. It provides instruction but does not assess whether the client has learned and can correctly perform the skill.
D. Ask the client to repeat the information that was provided — This method, known as the teach-back method, evaluates cognitive understanding and recall of verbal information. For a procedural skill like self-injection, observing actual performance through return demonstration is a more complete and accurate evaluation method.
The most effective method to evaluate teaching of a psychomotor skill such as self-injection is return demonstration. By asking the client to physically show how they will perform the injection, the nurse can directly observe and verify that the client has correctly learned the technique, identify any errors in hand placement, site selection, or technique, and provide immediate corrective feedback. Return demonstration is the gold standard for evaluating skill-based learning.
Why the other options are incorrect:
A. Discuss with the client the latest update about self injection — Discussion evaluates knowledge at a cognitive level but does not confirm that the client can correctly perform the physical skill of self-injection.
C. Provide client with a video demonstrating how to self inject — Showing a video is a teaching strategy, not an evaluation method. It provides instruction but does not assess whether the client has learned and can correctly perform the skill.
D. Ask the client to repeat the information that was provided — This method, known as the teach-back method, evaluates cognitive understanding and recall of verbal information. For a procedural skill like self-injection, observing actual performance through return demonstration is a more complete and accurate evaluation method.
6. The nurse wants to use role playing as a teaching technique. Which group is most likely to benefit from this teaching method?
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Adolescents who are learning to abstain from recreational drug use.
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Men who are willing to admit that they have a drinking problem.
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Newly pregnant women who are attending a well-baby seminar.
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Older adults who are preparing to retire from the workforce.
Explanation
Explanation
Correct Answer: (A) Adolescents who are learning to abstain from recreational drug use.
Role playing is most effective when the learning goal involves practicing responses to real-life social situations. Adolescents learning to resist peer pressure around drug use benefit greatly from rehearsing refusal skills in a simulated, safe environment. This method builds confidence and prepares them to respond effectively when faced with actual social pressure.
Why Other Options are Incorrect:
B. Men willing to admit they have a drinking problem — This group may benefit more from group discussion or motivational interviewing, as they are already in the acknowledgment stage and need support rather than behavioral rehearsal.
C. Newly pregnant women at a well-baby seminar — This group primarily needs informational and demonstrative teaching methods for infant care, not role playing to practice interpersonal responses.
D. Older adults preparing to retire — Retirement preparation involves informational and reflective learning strategies rather than the interactive behavioral rehearsal that role playing provides.
Correct Answer: (A) Adolescents who are learning to abstain from recreational drug use.
Role playing is most effective when the learning goal involves practicing responses to real-life social situations. Adolescents learning to resist peer pressure around drug use benefit greatly from rehearsing refusal skills in a simulated, safe environment. This method builds confidence and prepares them to respond effectively when faced with actual social pressure.
Why Other Options are Incorrect:
B. Men willing to admit they have a drinking problem — This group may benefit more from group discussion or motivational interviewing, as they are already in the acknowledgment stage and need support rather than behavioral rehearsal.
C. Newly pregnant women at a well-baby seminar — This group primarily needs informational and demonstrative teaching methods for infant care, not role playing to practice interpersonal responses.
D. Older adults preparing to retire — Retirement preparation involves informational and reflective learning strategies rather than the interactive behavioral rehearsal that role playing provides.
7. Which activity by the nurse best describes the adoption of an evidence-based practice in the delivery of client care?
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Postanesthesia, the client's first dose of a narcotic is halved to maintain respiratory effort.
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Vital signs are recorded every shift on stable clients per current hospital-wide policy.
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Certain antimicrobials were discarded after being linked to increased nosocomial infection rates.
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Dependent clients on a medical unit are bathed every other day instead of daily by the staff.
Explanation
Explanation
This option best describes evidence-based practice because it demonstrates a change in clinical practice that was directly driven by research evidence. When data showed that specific antimicrobials were associated with increased hospital-acquired infection rates, the clinical decision to discontinue their use was made based on that evidence, which is the core principle of evidence-based practice — integrating the best available research evidence into clinical decision-making to improve client outcomes.
Why the other options are incorrect:
A. Postanesthesia, the client's first dose of a narcotic is halved to maintain respiratory effort — While this may reflect a safety consideration, it describes a prescribing adjustment rather than a practice change based on systematically gathered and applied research evidence.
B. Vital signs are recorded every shift on stable clients per current hospital-wide policy — Following an existing institutional policy is a standard of care practice, not an example of adopting a new evidence-based change. It does not demonstrate the application of new research evidence to modify practice.
D. Dependent clients on a medical unit are bathed every other day instead of daily by the staff — While bathing frequency may be informed by some evidence, this example appears to reflect a staffing convenience decision rather than a change driven by research evidence to improve client outcomes.
This option best describes evidence-based practice because it demonstrates a change in clinical practice that was directly driven by research evidence. When data showed that specific antimicrobials were associated with increased hospital-acquired infection rates, the clinical decision to discontinue their use was made based on that evidence, which is the core principle of evidence-based practice — integrating the best available research evidence into clinical decision-making to improve client outcomes.
Why the other options are incorrect:
A. Postanesthesia, the client's first dose of a narcotic is halved to maintain respiratory effort — While this may reflect a safety consideration, it describes a prescribing adjustment rather than a practice change based on systematically gathered and applied research evidence.
B. Vital signs are recorded every shift on stable clients per current hospital-wide policy — Following an existing institutional policy is a standard of care practice, not an example of adopting a new evidence-based change. It does not demonstrate the application of new research evidence to modify practice.
D. Dependent clients on a medical unit are bathed every other day instead of daily by the staff — While bathing frequency may be informed by some evidence, this example appears to reflect a staffing convenience decision rather than a change driven by research evidence to improve client outcomes.
8. A nurse-manager is describing the process for IV insertions on the surgical unit. She states, "We began requiring RNs to cleanse all peripheral insertion sites with both alcohol and an iodine-based cleanser before starting an IV because several multi-institutional studies found a statistically significant decrease in IV-related septicemia rates for surgical clients when both alcohol and iodine were used as cleansers as compared with those who had alcohol only cleansing prior to IV insertions." Which statement best describes this unit's client care requirements?
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Standards-related process.
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Theory-based practice.
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Outcome-oriented process.
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Evidence-based practice.
Explanation
Explanation
Correct Answer: (D) Evidence-based practice.
The nurse-manager explicitly states that the change in practice was driven by findings from multiple institutional research studies demonstrating a significant decrease in infection rates. This is the definition of evidence-based practice — integrating the best available research evidence to guide clinical decision-making and improve patient outcomes.
Why the other options are incorrect:
A. Standards-related process — Standards of care are established guidelines or benchmarks, but the nurse-manager's rationale was based on research findings, not pre-existing standards.
B. Theory-based practice — Theory-based practice is guided by nursing or behavioral theories rather than direct research evidence, which is not what is described here.
C. Outcome-oriented process — While improved outcomes resulted from the change, the driving force behind the practice change was research evidence, making evidence-based practice the more precise and accurate descriptor.
Correct Answer: (D) Evidence-based practice.
The nurse-manager explicitly states that the change in practice was driven by findings from multiple institutional research studies demonstrating a significant decrease in infection rates. This is the definition of evidence-based practice — integrating the best available research evidence to guide clinical decision-making and improve patient outcomes.
Why the other options are incorrect:
A. Standards-related process — Standards of care are established guidelines or benchmarks, but the nurse-manager's rationale was based on research findings, not pre-existing standards.
B. Theory-based practice — Theory-based practice is guided by nursing or behavioral theories rather than direct research evidence, which is not what is described here.
C. Outcome-oriented process — While improved outcomes resulted from the change, the driving force behind the practice change was research evidence, making evidence-based practice the more precise and accurate descriptor.
9. The nurse is preparing a client for surgery and notices that the signed consent form has an error. The form states that the client is to have the left leg amputated. However, the client's right leg is marked for the surgery. The nurse administered the preoperative opioid medication 10 minutes ago and there are no family members present. Which action should the nurse implement?
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Call the healthcare provider (HCP) to have the procedure rescheduled.
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Have the client sign another form before surgery.
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Call the nearest relative to come in and sign a new form.
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Cross out the error and initial the consent form.
Explanation
Explanation
This is a serious informed consent and patient safety issue. The consent form contains a critical error regarding which limb is to be amputated, and the client has already received preoperative opioid medication, which means they are no longer legally capable of providing informed consent. Since no family members are present to consent on the client's behalf, the safest and most appropriate action is to notify the HCP and have the procedure rescheduled until a corrected, properly signed consent form can be obtained from a competent client or authorized representative.
Why the other options are incorrect:
B. Have the client sign another form before surgery — The client received opioid premedication 10 minutes ago and is therefore legally impaired and unable to provide valid informed consent. Having the client sign a new form under these circumstances is not legally or ethically acceptable.
C. Call the nearest relative to come in and sign a new form — While family members can provide consent in certain circumstances, the situation involves a discrepancy between the consent form and the surgical site marking, which is a Never Event requiring full surgical team review and rescheduling, not simply a new signature.
D. Cross out the error and initial the consent form — Altering a legal consent document by crossing out errors and initialing without proper process is not an acceptable or legally valid method of correcting an informed consent form. This does not meet the standard for valid informed consent.
This is a serious informed consent and patient safety issue. The consent form contains a critical error regarding which limb is to be amputated, and the client has already received preoperative opioid medication, which means they are no longer legally capable of providing informed consent. Since no family members are present to consent on the client's behalf, the safest and most appropriate action is to notify the HCP and have the procedure rescheduled until a corrected, properly signed consent form can be obtained from a competent client or authorized representative.
Why the other options are incorrect:
B. Have the client sign another form before surgery — The client received opioid premedication 10 minutes ago and is therefore legally impaired and unable to provide valid informed consent. Having the client sign a new form under these circumstances is not legally or ethically acceptable.
C. Call the nearest relative to come in and sign a new form — While family members can provide consent in certain circumstances, the situation involves a discrepancy between the consent form and the surgical site marking, which is a Never Event requiring full surgical team review and rescheduling, not simply a new signature.
D. Cross out the error and initial the consent form — Altering a legal consent document by crossing out errors and initialing without proper process is not an acceptable or legally valid method of correcting an informed consent form. This does not meet the standard for valid informed consent.
10. When providing health teaching to older adult clients, which action is most important for the nurse to implement?
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Speak loudly and face the client.
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Underline key words on the written information.
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Use everyday language when explaining issues.
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Provide a very well lit meeting space.
Explanation
Explanation
Correct Answer: (C) Use everyday language when explaining issues.
Using everyday, plain language is the most important health teaching strategy for older adult clients because it directly supports health literacy and comprehension. Medical jargon and complex terminology create barriers to understanding, which can lead to poor adherence and adverse outcomes. Using simple, familiar language ensures the client clearly understands the information being taught, regardless of educational background or cognitive changes associated with aging.
Why the other options are incorrect:
A. Speak loudly and face the client — While speaking clearly and facing the client supports communication, especially for those with hearing impairment, speaking loudly is not universally appropriate and can be perceived as condescending. It is also not the most important overarching teaching strategy.
B. Underline key words on the written information — Highlighting key information in written materials is a supportive strategy but is secondary to ensuring that the spoken explanation itself is delivered in plain, understandable language.
D. Provide a very well lit meeting space — Good lighting is a helpful environmental accommodation for older adults with visual changes, but it is an environmental factor rather than a communication or teaching strategy and is not the most important action.
Correct Answer: (C) Use everyday language when explaining issues.
Using everyday, plain language is the most important health teaching strategy for older adult clients because it directly supports health literacy and comprehension. Medical jargon and complex terminology create barriers to understanding, which can lead to poor adherence and adverse outcomes. Using simple, familiar language ensures the client clearly understands the information being taught, regardless of educational background or cognitive changes associated with aging.
Why the other options are incorrect:
A. Speak loudly and face the client — While speaking clearly and facing the client supports communication, especially for those with hearing impairment, speaking loudly is not universally appropriate and can be perceived as condescending. It is also not the most important overarching teaching strategy.
B. Underline key words on the written information — Highlighting key information in written materials is a supportive strategy but is secondary to ensuring that the spoken explanation itself is delivered in plain, understandable language.
D. Provide a very well lit meeting space — Good lighting is a helpful environmental accommodation for older adults with visual changes, but it is an environmental factor rather than a communication or teaching strategy and is not the most important action.
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