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Keiser University NUR-1023C HESI Fundamentals
& Clinical Skills Performance Review Latest
(2026/2027) Blueprint
Question 1 A nurse is assessing a client admitted with fluid volume deficit. Which combination of findings is consistent with this diagnosis? A. Bounding pulse, hypertension, and peripheral edema. B. Decreased urine output, dry mucous membranes, and elevated heart rate. - Correct answer C. Bradycardia, increased urine output, and moist skin turgor. D. Low-grade fever, hypertension, and jugular vein distension. Decreased urine output, dry mucous membranes, and tachycardia are classic signs of fluid volume deficit resulting from inadequate fluid intake or excessive fluid loss. NCLEX Client Need: Physiological Adaptation — Fluid and Electrolyte Imbalances. Question 2 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is preparing to administer medications to a client through a nasogastric tube (NGT). Which actions should the nurse perform? Select all that apply. A. Verify tube placement before administering any medications. ✅ - Correct answer B. Flush the NGT with 30 ml of water before the first medication. ✅ - Correct answer C. Mix all medications together in one syringe to save time. D. Flush the NGT with 15 ml of water between each medication. ✅ - Correct answer E. Clamp the NGT for 30 minutes after all medications are administered. ✅ - Correct answer F. Crush all medications including enteric-coated tablets before administration. Verifying tube placement, flushing before and between medications, and clamping after administration are all essential steps for safe NGT medication delivery. Mixing medications together risks chemical incompatibilities, and enteric-coated tablets must never be crushed as this destroys their protective coating.
NCLEX Client Need: Pharmacological and Parenteral Therapies — Medication Administration. Question 3 A nurse is caring for a postoperative client who reports pain rated 7 out of 10. The client's blood pressure is 158/92 mmHg and heart rate is 102 beats per minute. Which nursing action has the highest priority? A. Notify the healthcare provider of the elevated blood pressure immediately. B. Document the vital signs and reassess in 30 minutes. C. Administer the prescribed analgesic and reassess vital signs after 30 minutes. - Correct answer D. Apply a cold compress to the incision site to reduce inflammation and pain. Elevated blood pressure and tachycardia in a postoperative client are frequently caused by uncontrolled pain. Addressing pain first with prescribed analgesia is the priority intervention before treating the secondary cardiovascular responses. NCLEX Client Need: Physiological Adaptation — Pharmacological Pain Management. Question 4 A nurse is teaching a client with type 2 diabetes mellitus about proper foot care. Which statement by the client indicates that additional teaching is needed? A. I will inspect my feet every day for cuts, blisters, and redness. B. I will soak my feet in hot water each evening to improve circulation. - Correct answer C. I will wear properly fitted shoes and cotton socks at all times. D. I will notify my healthcare provider if I notice any wounds that are slow to heal. Soaking feet in hot water is contraindicated for diabetic clients due to peripheral neuropathy, which impairs the ability to detect dangerously high temperatures, placing the client at high risk for thermal burns. NCLEX Client Need: Health Promotion and Maintenance — Self-Care and Disease Management. Question 5 ⭐ NEXT GENERATION — MATRIX GRID
Question 7 A nurse is providing care to a client with a newly created colostomy. The client refuses to look at the stoma and states they feel disgusted by their body. Which nursing response is most therapeutic? A. Reassure the client that the stoma will become less noticeable over time. B. Encourage the client to look at the stoma and begin learning self-care immediately. C. Acknowledge the client's feelings and allow time to adjust before introducing stoma education. - Correct answer D. Contact the healthcare provider to discuss the client's psychological adjustment difficulties. Acknowledging the client's emotional response validates feelings and demonstrates therapeutic communication. Forcing stoma education before the client is psychologically ready is counterproductive and damages the therapeutic nurse-client relationship. NCLEX Client Need: Psychosocial Integrity — Therapeutic Communication and Coping. Question 8 A nurse is preparing to perform hand hygiene using an alcohol-based hand rub. Which situation requires the nurse to use soap and water instead? A. After removing sterile gloves following a dressing change. B. Before administering oral medications to a client. C. After caring for a client with a Clostridium difficile infection. - Correct answer D. Before performing a routine physical assessment on a client. Alcohol-based hand sanitizers are not effective against Clostridium difficile spores. Hand hygiene with soap and water is mandatory after caring for clients with C. diff infection to physically remove spores from the hands and prevent transmission. NCLEX Client Need: Safety and Infection Control — Standard Precautions and Hand Hygiene. Question 9 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is assessing a client for signs and symptoms of pulmonary embolism. Which findings are consistent with this diagnosis? Select all that apply.
A. Sudden onset of dyspnea. ✅ - Correct answer B. Bradycardia and hypotension. C. Pleuritic chest pain that worsens with inspiration. ✅ - Correct answer D. Tachycardia and restlessness. ✅ - Correct answer E. Hemoptysis. ✅ - Correct answer F. Gradual onset of bilateral lower extremity edema. Pulmonary embolism presents with sudden dyspnea, pleuritic chest pain, tachycardia, restlessness, and hemoptysis due to obstruction of pulmonary blood flow. Bradycardia and gradual bilateral edema are not characteristic findings of acute pulmonary embolism. NCLEX Client Need: Physiological Adaptation — Acute and Chronic Conditions. Question 10 A nurse is educating a client about warfarin (Coumadin) therapy. Which food should the nurse instruct the client to consume consistently rather than avoid entirely? A. Grapefruit juice. B. Leafy green vegetables. - Correct answer C. Aged cheeses and cured meats. D. Foods high in sodium and saturated fat. Leafy green vegetables contain vitamin K which affects warfarin's anticoagulant activity. Clients should consume these foods in consistent amounts rather than eliminating them entirely, as sudden changes in vitamin K intake cause significant fluctuations in INR levels. NCLEX Client Need: Pharmacological and Parenteral Therapies — Medication and Food Interactions. Question 11 A nurse is assessing a client's surgical wound on postoperative day two and notes the wound edges are well approximated with mild surrounding erythema and a small amount of serous drainage. How should the nurse interpret these findings? A. The wound is showing early signs of infection requiring immediate intervention. B. The wound is healing by secondary intention with granulation tissue present. C. The wound demonstrates normal primary intention healing during the inflammatory phase. - Correct answer D. The wound is dehiscing and requires immediate surgical consultation.
Client and Intervention Appropriate Requires Modification Client with dysphagia — nurse offers thin liquids and crackers for snacks
Orange juice is high in potassium and is contraindicated for clients with chronic renal failure. Increased protein is appropriate for lactating women. Limiting beef supports cholesterol reduction. Clients with dysphagia require thickened liquids and soft foods rather than thin liquids and crackers which increase aspiration risk. NCLEX Client Need: Physiological Adaptation — Nutrition and Oral Hydration. Question 14 A nurse is donning personal protective equipment (PPE) before entering the room of a client on contact precautions. Which is the correct sequence for donning PPE? A. Mask, gown, gloves, goggles. B. Gloves, gown, mask, goggles. C. Gown, mask, goggles, gloves. - Correct answer D. Goggles, gloves, gown, mask. The correct sequence for donning PPE is gown first, followed by mask, then goggles or face shield, and finally gloves. This sequence ensures that all mucous membranes and skin surfaces are protected before the hands are gloved and contact with the client occurs. NCLEX Client Need: Safety and Infection Control — Use of Personal Protective Equipment. Question 15 A nurse is caring for a client receiving mechanical ventilation. Which intervention is most important in preventing ventilator-associated pneumonia (VAP)? A. Administer prophylactic antibiotics every 24 hours as prescribed. B. Perform comprehensive oral hygiene including tooth brushing every two hours. - Correct answer C. Suction the endotracheal tube every hour regardless of secretion presence. D. Keep the head of the bed flat to prevent aspiration of gastric contents.
Comprehensive oral hygiene every two hours significantly reduces the bacterial load in the oropharynx, which is a primary source of organisms that cause ventilator-associated pneumonia through microaspiration into the lower airways. NCLEX Client Need: Safety and Infection Control — Healthcare-Associated Infection Prevention. Question 16 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is reviewing fall prevention strategies for an elderly client admitted following a fall at home. Which interventions should be included in the fall prevention plan? Select all that apply. A. Keep the bed in the lowest position with brakes locked at all times. ✅ - Correct answer B. Ensure the call light is within the client's reach at all times. ✅ - Correct answer C. Apply bilateral wrist restraints to prevent the client from getting out of bed unsupervised. D. Encourage the client to wear non-skid footwear when ambulating. ✅ - Correct answer E. Perform hourly rounding to assess the client's needs proactively. ✅ - Correct answer F. Keep all four side rails raised at all times to prevent the client from falling out of bed. Evidence-based fall prevention includes keeping the bed low with brakes locked, ensuring call light accessibility, encouraging non-skid footwear, and performing hourly rounding. Restraints are not a first-line fall prevention strategy and require a specific order. Keeping all four rails raised is considered a restraint and is not appropriate without justification. NCLEX Client Need: Safety and Infection Control — Accident and Injury Prevention. Question 17 A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who requires supplemental oxygen. Which oxygen delivery method and flow rate is most appropriate? A. Non-rebreather mask at 15 L/min. B. Simple face mask at 8 to 10 L/min. C. Nasal cannula at 1 to 2 L/min. - Correct answer D. Venturi mask at 10 L/min. Clients with COPD depend on a hypoxic drive to stimulate breathing. Administering oxygen at low flow rates of 1 to 2 L/min via nasal cannula maintains adequate oxygenation without eliminating the hypoxic respiratory drive that controls ventilation in these clients.
Question 20 A nurse is caring for a client who is postoperative following abdominal surgery and has a Jackson-Pratt drain in place. Which nursing action is correct when emptying the drain? A. Leave the drain bulb fully expanded after emptying to allow passive gravity drainage. B. Irrigate the drain with normal saline after each emptying to maintain patency. C. Remove the drain if output is less than 10 ml in an eight-hour period. D. Compress the drain bulb completely after emptying and replace the cap to maintain suction. - Correct answer After emptying a Jackson-Pratt drain, the bulb must be fully compressed before replacing the cap to reestablish negative pressure suction, which is necessary for the drain to function effectively and collect wound drainage. NCLEX Client Need: Physiological Adaptation — Postoperative Care and Drain Management. Question 21 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is preparing to perform a sterile dressing change on a client's abdominal surgical wound. Which actions represent correct sterile technique? Select all that apply. A. Open sterile packages by peeling back the edges away from the sterile field. ✅ - Correct answer B. Place sterile items at the center of the sterile drape during setup. ✅ - Correct answer C. Reach across the sterile field to retrieve instruments on the opposite side. D. Keep sterile gloved hands above waist level at all times during the procedure. ✅ - Correct answer E. Consider the one-inch border around the sterile drape as non-sterile. ✅ - Correct answer F. Apply sterile gloves before touching any items on the sterile field. ✅ - Correct answer Correct sterile technique requires opening packages away from the sterile field, placing items at the center of the drape, keeping gloved hands above the waist, recognizing the one- inch border as non-sterile, and gloving before touching sterile items. Reaching across the sterile field contaminates both the field and the gloves. NCLEX Client Need: Safety and Infection Control — Surgical Asepsis and Sterile Technique. Question 22
A nurse is teaching a client with hypertension about lifestyle modifications. Which client statement indicates that teaching has been effective? A. I will exercise vigorously once per week for two hours to lower my blood pressure. B. I can have up to three alcoholic drinks per day since moderate drinking is heart healthy. C. I will reduce my sodium intake to less than 2,300 mg per day and exercise regularly. - Correct answer D. I only need to take my antihypertensive medication when my blood pressure feels high. Reducing dietary sodium intake to less than 2,300 mg per day combined with regular physical activity are the most evidence-based lifestyle modifications proven to significantly reduce blood pressure in clients with hypertension. NCLEX Client Need: Health Promotion and Maintenance — Disease Prevention and Lifestyle Modification. Question 23 A nurse is providing care for a client who is in the terminal stage of illness and experiencing air hunger. Which nursing intervention is most appropriate? A. Administer high-flow oxygen at 15 L/min via non-rebreather mask. B. Position the client supine and encourage slow deep breathing exercises. C. Administer a prescribed low dose of morphine sulfate to reduce air hunger. - Correct answer D. Apply a simple face mask and titrate oxygen to maintain saturation above 98%. Low-dose morphine sulfate is the most effective pharmacological intervention for relieving dyspnea in terminal clients by reducing the perception of air hunger, decreasing respiratory rate, and improving overall comfort without significantly hastening death. NCLEX Client Need: Psychosocial Integrity — End-of-Life Care and Comfort Measures. Question 24 A nurse is performing a focused respiratory assessment on a client with pneumonia. Which auscultation finding is most consistent with this diagnosis? A. High-pitched musical wheezing bilaterally on expiration. B. Coarse crackles and diminished breath sounds in the affected lobe. - Correct answer C. Pleural friction rub heard over the lateral chest wall bilaterally. D. Vesicular breath sounds heard throughout all lung fields equally.
A. Administer the digoxin and document the heart rate in the medication record. B. Administer half the prescribed dose and reassess the heart rate in 30 minutes. C. Withhold the digoxin and notify the healthcare provider of the heart rate finding. - Correct answer D. Administer the digoxin since a heart rate of 54 is expected in clients with heart failure. Digoxin should be withheld and the healthcare provider notified when the apical heart rate falls below 60 beats per minute in adults, as administering digoxin in the presence of bradycardia increases the risk of life-threatening digoxin toxicity and cardiac dysrhythmias. NCLEX Client Need: Pharmacological and Parenteral Therapies — Medication Safety and Toxicity. Question 27 A nurse is caring for a client receiving IV heparin therapy for deep vein thrombosis. Which laboratory value is most important for the nurse to monitor to evaluate the effectiveness of therapy? A. Prothrombin time and International Normalized Ratio. B. Platelet count and complete blood count with differential. C. Serum fibrinogen level and D-dimer concentration. D. Activated partial thromboplastin time. - Correct answer The activated partial thromboplastin time (aPTT) is the primary laboratory value used to monitor IV heparin therapy. The therapeutic range is 1.5 to 2.5 times the normal control value, and results must be assessed regularly to ensure safe and effective anticoagulation. NCLEX Client Need: Pharmacological and Parenteral Therapies — Anticoagulant Therapy Monitoring. Question 28 A nurse is assessing a client's skin during a head-to-toe physical examination and notes a reddened area over the sacrum that does not blanch when pressure is applied. How should the nurse classify this finding? A. Stage I pressure injury. B. Stage II pressure injury. - Correct answer C. Deep tissue pressure injury. D. Unstageable pressure injury.
A Stage II pressure injury involves partial thickness skin loss presenting as a shallow open wound with a pink or red wound bed, or as an intact or ruptured serum-filled blister. Non- blanchable redness of intact skin represents a Stage I pressure injury. NCLEX Client Need: Physiological Adaptation — Skin Integrity and Wound Care. Question 29 A nurse is teaching a client how to use a metered-dose inhaler correctly. Which instruction should the nurse include? A. Exhale forcefully into the inhaler before activating it to clear the airway. B. Activate the inhaler at the beginning of a rapid deep inhalation. C. Activate the inhaler during a slow steady inhalation and hold the breath for 10 seconds afterward. - Correct answer D. Take three rapid consecutive puffs to ensure the full dose of medication is delivered. The client should activate the inhaler during a slow steady inhalation to carry the medication deep into the airways, then hold the breath for 10 seconds to allow maximum medication deposition and absorption in the bronchial tissues. NCLEX Client Need: Pharmacological and Parenteral Therapies — Inhaler Medication Administration. Question 30 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is caring for a client who is receiving a blood transfusion and develops fever, chills, lower back pain, and dark red urine 20 minutes after the transfusion began. Which actions should the nurse take? Select all that apply. A. Stop the blood transfusion immediately. ✅ - Correct answer B. Slow the transfusion rate and continue monitoring the client closely. C. Maintain IV access and infuse normal saline through new IV tubing. ✅ - Correct answer D. Notify the healthcare provider and the blood bank immediately. ✅ - Correct answer E. Obtain a urine specimen and blood samples for laboratory analysis. ✅ - Correct answer F. Return the blood bag and administration tubing to the blood bank. ✅ - Correct answer The described symptoms are consistent with an acute hemolytic transfusion reaction, which is a life-threatening emergency. The transfusion must be stopped immediately, IV access
Question 33 A nurse is assessing a client with a chest tube connected to a water-seal drainage system. Which finding requires the nurse's immediate intervention? A. Gentle tidaling in the water-seal chamber during respirations. B. Serosanguineous drainage of 30 ml in the collection chamber. C. Cessation of bubbling in the water-seal chamber 48 hours post-insertion. D. Continuous vigorous bubbling in the water-seal chamber at all times. - Correct answer Continuous vigorous bubbling in the water-seal chamber indicates an air leak in the chest tube system caused by a loose connection, crack in tubing, or incomplete lung re-expansion, requiring immediate nursing assessment and intervention to restore system integrity. NCLEX Client Need: Physiological Adaptation — Chest Tube Management and Respiratory Care. Question 34 A nurse is preparing to perform nasopharyngeal suctioning on a client with retained secretions. What is the maximum duration the nurse should apply suction during each suctioning pass? A. 5 seconds. B. 10 to 15 seconds. - Correct answer C. 20 to 25 seconds. D. 30 seconds. Each suctioning pass must not exceed 10 to 15 seconds to prevent hypoxia, mucosal trauma, and vagal stimulation that can cause dangerous cardiac dysrhythmias including bradycardia during the suctioning procedure. NCLEX Client Need: Physiological Adaptation — Airway Management and Suctioning. Question 35 ⭐ NEXT GENERATION — MATRIX GRID A nurse is evaluating the pain management plans for four clients. For each client situation, indicate whether the current pain management approach is effective or requires modification.
Client Situation Effective Requires Modification Hospice client receiving around-the-clock scheduled opioid analgesics ✅ Postoperative client receiving analgesics only when pain reaches a level of 9 out of 10
Client with chronic pain receiving analgesic 30 minutes before physical therapy
Terminal client kept fully sedated and unaware of all stimuli for comfort
Around-the-clock analgesic scheduling is the most effective approach for hospice and chronic pain clients. Waiting until pain reaches a severe level before medicating is ineffective as analgesics work less effectively at pain peaks. Pre-medicating before therapy optimizes participation. Excessive sedation that eliminates the client's ability to interact and experience remaining life should be minimized in terminal care. NCLEX Client Need: Physiological Adaptation — Pain Management and Comfort Care. Question 36 A nurse is caring for an elderly client on strict bedrest following a left hip fracture. Which nursing intervention is highest priority to prevent skin breakdown? A. Apply a thick layer of moisturizing lotion over all bony prominences every shift. B. Massage reddened areas vigorously over bony prominences to stimulate circulation. C. Reposition the client every two hours using proper lifting technique to avoid shearing. - Correct answer D. Place the client in a high Fowler's position continuously to reduce sacral pressure. Repositioning every two hours using proper lifting technique to avoid shearing forces is the highest priority intervention for preventing pressure injury formation in immobile elderly clients with limited ability to reposition independently. NCLEX Client Need: Physiological Adaptation — Skin Integrity and Pressure Injury Prevention.
A nurse is performing a complete physical assessment and prepares to examine the client's abdomen. Which assessment technique should the nurse perform first? A. Percussion to assess organ size and presence of fluid or gas. B. Deep palpation to detect masses, tenderness, and organ enlargement. C. Light palpation to assess superficial tenderness and muscle guarding. D. Auscultation to assess bowel sounds before disturbing the abdomen. - Correct answer Auscultation must be performed before percussion and palpation during abdominal assessment because manual manipulation of the abdomen alters bowel motility and can artificially change the frequency and character of bowel sounds, producing inaccurate findings. NCLEX Client Need: Health Promotion and Maintenance — Physical Assessment Techniques. Question 40 ⭐ NEXT GENERATION — SELECT ALL THAT APPLY (SATA) A nurse is reviewing discharge instructions with a client who has been prescribed warfarin (Coumadin) following deep vein thrombosis treatment. Which instructions should the nurse include? Select all that apply. A. Have your INR levels checked regularly as scheduled by your healthcare provider. ✅ - Correct answer B. Avoid aspirin and NSAIDs unless specifically prescribed by your healthcare provider. ✅ - Correct answer C. Consume vitamin K-containing foods in consistent amounts rather than eliminating them entirely. ✅ - Correct answer D. Take a double dose of warfarin if you accidentally miss a scheduled dose. E. Notify your healthcare provider immediately if you notice unusual bleeding or bruising. ✅ - Correct answer F. Wear a medical alert bracelet identifying yourself as an anticoagulant therapy client. ✅ - Correct answer Regular INR monitoring, avoiding medications that increase bleeding risk, consuming consistent amounts of vitamin K, reporting unusual bleeding, and wearing medical alert identification are all essential discharge instructions for clients on warfarin therapy. Double dosing after a missed dose is dangerous and can cause life-threatening hemorrhage. NCLEX Client Need: Pharmacological and Parenteral Therapies — Anticoagulant Therapy Patient Education.
Question 41 A nurse is caring for a client with chronic kidney disease who is on a potassium-restricted diet. The client's lunch tray arrives containing orange juice, a banana, and tomato soup. What is the nurse's most appropriate action? A. Allow the client to consume the meal since fruits and vegetables are universally healthy. B. Remove only the orange juice since it contains the highest concentration of potassium. C. Educate the client about potassium restrictions and allow them to decide what to eat. D. Contact the dietary department and replace the entire tray with an appropriate low-potassium meal. - Correct answer Orange juice, bananas, and tomato-based products are all high in potassium and are contraindicated for clients with chronic kidney disease. The nurse must ensure the client receives a nutritionally appropriate meal by contacting the dietary department to replace the entire tray. NCLEX Client Need: Physiological Adaptation — Renal Disease and Dietary Management. Question 42 A nurse is educating a client recovering from a myocardial infarction about cardiac rehabilitation and dietary modifications. Which statement by the client requires clarification? A. I will limit my intake of saturated fats and increase my consumption of omega-3 fatty acids. B. I will exercise at a moderate intensity for at least 30 minutes on most days of the week. C. I can eat as much lean protein as I want since protein does not affect my heart health. - Correct answer D. I will reduce my sodium intake and maintain a healthy body weight to protect my heart. While lean protein is generally healthy, excessive protein intake can contribute to increased saturated fat consumption and place additional strain on the kidneys. Clients with cardiac disease should consume moderate portions of lean protein as part of a balanced heart- healthy diet. NCLEX Client Need: Health Promotion and Maintenance — Cardiac Disease and Dietary Modification. Question 43
