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Practice Question

The nurse is planning to provide mouth care for an unconscious client. Which statement is accurate in regard to implementing mouth care for this client?

Answer Choices:

Correct Answer:

Positioning the unconscious client with the head turned to the side is the key to providing safety during mouth care.

Rationale:

🟦 Turning the head to the side prevents aspiration of secretions during mouth care.

🟦 Unconscious clients lack a gag reflex, making airway protection essential.

🟦 Side positioning allows saliva and fluids to drain safely from the mouth.

🟦 This is the safest strategy to prevent aspiration pneumonia.

🟦 Proper positioning maintains airway patency throughout the procedure.

Unconscious clients need less frequent care

🟦 They need more frequent care due to lack of swallowing.

🟦 Increased oral dryness raises infection and breakdown risk.

Glycerin swabs are best

🟦 Glycerin causes drying and mucosal irritation.

🟦 Not recommended for routine oral care.

Brushing should be avoided

🟦 Brushing improves oral hygiene and prevents infection.

🟦 Safe with proper suctioning and positioning.

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This question is from HESI BSN 225-RN Fundamentals Fall-2025 which contains 59 questions.

More Questions from This Exam
The client is a 48-year-old male in the hospital for cellulitis to the left leg.

Answer Choices:

A. Implement seizure precautions
B. Lower the head of the bed
C. Encourage fluid intake
D. Retake vital signs
E. Call the rapid response team
F. Administer angiotensin converting enzyme (ACE) inhibitor
G. Teach the client relaxation techniques
H. Assess the client
When preparing a sterile field, which action(s) by the nurse would compromise the sterility? Select all that apply.

Answer Choices:

A. Set up the sterile field immediately prior to use.
B. Inspect the sterile package for punctures.
C. Use of sterile gloves to touch items in the field.
D. Open the sterile field facing the body.
E. Leave the sterile field to gather additional supplies.
A client with unstable angina needs a cardiac catheterization, so the healthcare provider (HCP) 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 the heart going. Which action should the nurse take?

Answer Choices:

A. Answer the client's specific question with a short understandable explanation.
B. Call the client's next of kin and ask them to provide verbal consent.
C. Postpone the procedure until the client understands the risks and benefits.
D. Call the HCP to return and provide additional explanation.
A client tells the nurse about doing a high intensity workout program to help with losing weight but now describes having difficulty getting to sleep at night. Which action should the nurse implement?

Answer Choices:

A. Ask the client for a description of the exercise schedule that is being followed.
B. Determine the amount of weight the client has lost since increasing activity.
C. Encourage the client to exercise every day to eliminate bedtime wakefulness.
D. Advise the client that lifestyle changes often take several weeks to be effective.
From Exam
HESI BSN 225-RN Fundamentals Fall-2025

59 Questions

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Question Details
  • Category: RN Nursing Exam(s)
  • Subcategory: HESI Exam(s)
  • Domain: Hesi Fundamentals of Nursing
  • Answer Choices: 4
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