NEW!! REVISED 2024 ALL HESI
FUNDAMENTALS EXAM TEST-BANK
WITH RATIONALES AND UPDATED
ANSWERS
MULTIPLE QUESTIONS:
The nurse is caring for a client
... [Show More] 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 percent dextrose and water at 54 ml/hr.
D. Obtain a stat blood glucose level and notify the healthcare provider. - TPN is discontinued
gradually to allow the client to adjust to 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 healthcare provider cannot do anything about this
situation.
Correct Answer: C
NEW!! REVISED 2024 ALL HESI FUNDAMENTALS EXAM TEST-BANK WITH RATIONALES AND UPDATED ANSWERS
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. Arms.
B. Upper torso.
C. Head.
D. Feet. - 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 (B) becoming the center of gravity for older persons. Although
(A) is a part, or an extension of the upper torso, this is not the best and most complete answer.
Correct Answer: B
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. - Relocation (B) often results in confusion among
elderly clients--moving is stressful for anyone. (A) is a stereotypical judgment.
NEW!! REVISED 2024 ALL HESI FUNDAMENTALS EXAM TEST-BANK WITH RATIONALES AND UPDATED ANSWERS
Stress in the elderly often manifests itself as confusion, so (C) is wrong. Adequate sleep is not a
prevention (D) for confusion.
Correct Answer: B
An elderly male client who suffered a cerebral vascular accident is receiving tube feedings via a
gastrostomy tube. The nurse knows that the best position for this client during administration of
the feedings is
A. prone.
B. Fowler's.
C. Sims'.
D. supine. - The client should be positioned in a semi-sitting or Fowler's (B) position during
feeding, in order to decrease the chance of aspiration. A gastrostomy tube, often referred to as a
PEG tube, is inserted directly into the stomach through an incision in the abdomen and is used
when long-term tube feedings are needed. In (A and/or C) positions, the client would be lying on
his abdomen and on the tubing. In (D), the client would be lying flat on his back which would
increase the chance of aspiration. [Show Less]