HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
An adult client who had bariatric surgery two months ago has developed a postoperative stricture. For the past week, the client has experienced nausea, vomiting, and anorexia, and is admitted to the hospital for fluid resuscitation. At this time the client denies feeling any pain. Which intervention should the nurse implement?
- A Keep the client NPO.
- B Encourage small frequent meals.
- C Provide protein-enriched shakes.
- D Administer daily vitamin supplements.
Explanation
A postoperative stricture following bariatric surgery can cause gastric outlet obstruction, leading to persistent nausea, vomiting, and inability to tolerate intake. The safest and most appropriate intervention is to keep the client NPO to prevent further vomiting, aspiration risk, and worsening obstruction. NPO status also prepares the client for possible endoscopic dilation, which is the typical treatment.
Oral intake—including small meals, shakes, or supplements—is contraindicated until the stricture is evaluated and treated.
Correct Answer Is:
A
A client receives a prescription for ciprofloxacin 400 mg IV every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D5W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)
- A 100
- B 150
- C 200
- D 250
Explanation
The infusion must run over one hour, and the total volume in the IV bag is 200 mL. To determine the pump rate in mL/hr, divide the total volume by the infusion time. Since 200 mL is to infuse over 1 hour, the correct rate is 200 mL/hr. This ensures the medication is delivered safely and at the prescribed rate.
Correct Answer Is:
C
Based on the client's history, physical, and laboratory findings, her priority need will be to treat __________, and she may need interventions to manage complications, especially __________.
- Fluid status; electrolyte imbalance
- Low pulse oximetry; respiratory acidosis
- Erythrocytosis; infection
- Respiratory acidosis; fluid status
Explanation
The client presents with heart failure–related fluid overload, evidenced by jugular vein distention, S3 and S4 heart sounds, pleural effusions, cardiomegaly, and worsening respiratory symptoms. Managing fluid status is therefore essential to reduce cardiac workload and improve respiratory function. In addition, clients with heart failure often develop electrolyte imbalances, especially when diuretics are used or when renal function is compromised. Monitoring and correcting these imbalances is necessary to prevent arrhythmias, neuromuscular disturbances, and worsening cardiac instability.
Correct Answer Is:
AA client with obstructive sleep apnea (OSA) calls the clinic to report difficulty wearing the continuous positive airway pressure (CPAP) mask because it is uncomfortable. The client asks the nurse for an alternative way to manage sleep apnea. Which recommendation should the nurse provide?
- A Begin a weight loss program.
- B Sleep with the head of the bed flat.
- C Take sedatives prior to sleep.
- D Drink 1 to 2 glasses of wine at bedtime.
Explanation
Weight loss is one of the most effective non-CPAP interventions for obstructive sleep apnea. Excess body weight, particularly around the neck and upper airway, contributes to airway collapse during sleep by increasing soft tissue pressure and reducing airway diameter. Losing weight decreases airway obstruction, improves breathing patterns, reduces apnea–hypopnea episodes, and can significantly improve daytime fatigue and cardiovascular risks associated with OSA. When CPAP use is difficult or inconsistent, counseling on weight reduction is a safe, evidence-based alternative that directly targets the underlying physiological cause of the disorder.
Correct Answer Is:
A
The nurse observes that a newly admitted client with Parkinson's disease exhibits a mask-like facial appearance. Which additional nursing assessment takes priority in response to this finding?
- A Respiratory rate.
- B Swallowing ability.
- C Neck flexion.
- D Speech patterns.
Explanation
A mask-like facial expression in Parkinson’s disease occurs due to rigidity and decreased facial muscle movement. This same rigidity can significantly impair swallowing, placing the client at high risk for aspiration, choking, and inadequate nutrition. Because airway protection is a priority, assessing swallowing ability becomes essential. Early identification allows prompt interventions such as modified diets, swallowing precautions, or speech-language pathology referral to reduce aspiration risk and support safe intake.
Correct Answer Is:
B
The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?
- A Pain rating of 8 on a scale of 0 to 10.
- B High-pitched sound heard upon inspiration.
- C Redness and edema noted at the incision site.
- D Apical heart rate of 100 to 110 beats/minute.
Explanation
A high-pitched sound on inspiration suggests stridor, an ominous sign of upper airway obstruction. This can develop suddenly after surgery due to laryngeal edema, airway trauma, secretions, or a reaction to anesthesia. Stridor is a medical emergency because it can progress rapidly to complete airway obstruction. Immediate interventions are required—such as notifying the provider, preparing for airway support, and administering oxygen—to prevent respiratory failure. Airway compromise always takes priority over pain, incision changes, or mild tachycardia.
Correct Answer Is:
B
Patient Data
History and Physical
A 68-year-old male, with a history of bilateral total hip arthroplasty two years ago, presents to the emergency department (ED) by ambulance. The client reports he simply slipped today and did not feel lightheaded or dizzy before the fall. The client reports he returned home from the store and was putting his groceries away. He dropped a can and bent over to pick it up.
He lost his balance and fell face-forward, hitting his head on the wall and his left shoulder on the floor. Reports pain mainly in his shoulder. However, he also notes pain in his right knee. Additionally, the client reports he feels nauseated and tired.
Nurses' Notes
1820
Client is resting in bed, grimacing. Vital signs assessed. Reports intense pain and the inability to move his left arm. He is guarded. Shoulder swelling and bruising are present. Left arm is cool to the touch. Collarbone appears out of alignment on the left side.
Flow Sheet
1820
· Temperature: 98.1° F (36.7° C) orally
. Heart rate: 88 beats/minute
· Respirations: 18 breaths/minute
· Blood pressure: 136/90 mm Hg
· Oxygen saturation: 95% on room air
· Pain: 10 on a 0 to 10 scale, sharp, constant
pain in the left arm; pain rating of 3 on a 0
to 10 scale, dull, achy pain in the right knee
. Weight: 344 lb (156.1 kg)
. Height: 6 ft 2 in (182.8 cm)
. Body mass index (BMI) is 46.67
kg/m2 (normal 18 to 24.9 kg/m2)
1835
Peripheral IV (PIV) access is initiated, 20 gauge, in the client's right forearm. Assessment completed.
Assessment
· Neurological: Pupils equal, round, reactive to light accommodations (PERRLA). Oriented to person, place, time, and
situation. Decreased sensation noted in left forearm to fingertips.
· Cardiovascular: Normal heart sounds of S1 and S2. Bilateral pedal pulses and right radial pulse are 2+ while left radial is
1+.
. Respiratory: Clear lung sounds in all fields.
. Musculoskeletal: Normal strength observed in lower extremities. Minimal pain on palpation noted in right knee. The
client can still flex and extend his right leg. 1+ strength noted in the left upper extremity and 3+ strength noted in the
right upper extremity. Diffuse pain noted with and without palpation on the left shoulder, and pain reported extending
from the left shoulder into the neck. 3+ swelling is noted on the left shoulder and 1+ swelling on the right knee. No pain
noted upon assessment of right shoulder and left knee.
· Gastrointestinal: Abdomen is soft, nondistended and nontender.
. Genitourinary: Last bowel movement reported today. The client denies difficulty with urination.
. Integumentary: The left arm is cool to touch. Bruising is noted on the left upper arm; bruise area is 0.79 in (3 cm) by 1.18 in (2 cm). Right knee skin is intact and dry.
1845
The client is taken via stretcher for imaging studies.
Flow Sheet
1820
. Temperature: 98.1° F (36.7° C) orally
. Heart rate: 88 beats/minute
· Respirations: 18 breaths/minute
. Blood pressure: 136/90 mm Hg
· Oxygen saturation: 95% on room air
. Pain: 10 on a 0 to 10 scale, sharp, constant pain in the left arm; pain rating of 3 on a 0 to 10 scale, dull, achy pain in the
right knee
· Weight: 344 lb (156.1 kg)
. Height: 6 ft 2 in (182.8 cm)
· Body mass index (BMI) is 46.67 kg/m2 (normal 18 to 24.9 kg/m2)
Orders
1830
· Initiate peripheral IV (PIV) access
. X-ray of left shoulder and right knee, STAT
. Computed tomography (CT) of brain, STAT
A nurse is reviewing the client’s assessment findings after a fall. Based on the clinical presentation, which findings are MOST consistent with a humeral fracture rather than a rotator cuff injury? (Select all that apply.)
- Reduced pulse distal to the injury
- 1+ strength in the left upper extremity
- Decreased range of motion
- Coolness of the skin
- Pain with movement
Explanation
A. Reduced pulse distal to the injury
A diminished pulse (left radial 1+ compared to 2+ on the right) suggests vascular compromise, which is far more characteristic of a humeral fracture than a rotator cuff tear. Fractures can compress or injure nearby vessels, making this a concerning, fracture-specific finding requiring urgent evaluation.
B. 1+ strength in the left upper extremity
Severely reduced arm strength after trauma may occur in both conditions but is more severe in fractures where pain, structural instability, and possible nerve involvement decrease motor ability. In this case, the client cannot move the left arm and is guarding, consistent with a possible humeral fracture.
D. Coolness of the skin
A cool extremity indicates compromised perfusion, a complication associated with fractures where swelling or displacement may impair circulation. This is not typical of isolated rotator cuff injuries, making this finding strongly indicative of humeral fracture.
Correct Answer Is:
A, B, D
Patient Data
History and Physical
54-year-old female is brought to the emergency department (ED) by private vehicle. She reports difficulty breathing which has significantly worsened in the past two days, and a moist cough producing thick, yellow sputum. Client reports home oxygen use of 1 liter/minute via nasal cannula; however, she has increased her use to 2 liters/minute due to difficulty
breathing. She has a medical history of heart failure (HF), hypertension, stage 2 kidney disease, and chronic obstructive pulmonary disease (COPD) with multiple exacerbations. Two weeks ago, client had a viral upper respiratory infection for which she was started on stress dose steroids. She has no known allergies.
Nurses' Notes
2005
Healthcare assessment completed by healthcare provider (HCP).
Assessment
. General observation: Is leaning forward, resting her arms in front of her on the pillows. Hair is unkempt, poor oral hygiene, and body odor are noted.
· Neurological: Alert and oriented x 3.
· Cardiovascular: Heart sounds of S1, S2, S3, S4, and a systolic murmur. Jugular vein distention.
. Respiratory: Shallow respirations. Expiratory wheezing and crackles in bilateral upper lobes and diminished bilateral bases. Intercostal retractions.
· Musculoskeletal: Generalized weakness and easily fatigued.
· Gastrointestinal and genitourinary: Increased thirst. Last bowel movement 2 days ago. Increased urinary frequency.
. Integumentary: Skin is warm and diaphoretic. Bilateral finger clubbing. Dry mucous membranes. Poor skin turgor.
Flow Sheet
2005
Vital signs
· Temperature: 100.2° F (37.9° C) Axillary
. Heart rate: 124 beats/minute
. Respiration: 38 breaths/minute
· Blood pressure: 164/94 mm Hg
. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
. Height: 5 feet, 11 inches (180.3 cm)
· Weight: 155 pounds (70.3 kg)
. Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
For each of the findings listed, click to indicate which are consistent with the disease process of chronic obstructive pulmonary disease (COPD), heart failure (HF), or urinary tract infection (UTI). Each column must have at least one response option selected.
For each finding listed below, which findings are consistent with the disease process of heart failure (HF)? (Select all that apply.)
- A Pain: heaviness in the chest, rated 6 out of 10
- B Temperature: 100.2° F (37.9° C)
- C Oxygen saturation: 87% on 2 liters/minute via nasal cannula
- D Heart sounds of S1, S2, S3, S4
- E Respiration: 38 breaths/minute
- F Jugular vein distention
- G Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Explanation
D. Heart sounds of S1, S2, S3, S4
The presence of both an S3 and S4 is strongly associated with impaired ventricular compliance and volume overload in HF. This is a classic indicator of a worsening heart failure condition.
F. Jugular vein distention
JVD reflects increased central venous pressure caused by right-sided heart failure or fluid overload. This is a key assessment finding in HF patients.
G. Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Crackles indicate fluid in the alveoli, consistent with pulmonary congestion from HF. Wheezing can occur due to "cardiac asthma" when pulmonary edema irritates airways.
Correct Answer Is:
D, F, G
A client has an absolute neutrophil count (ANC) of 500/mm³ (0.5 × 10⁹/L) after completing chemotherapy. Which intervention is most important for the nurse to implement?
- A Place the client in protective isolation.
- B Assess vital signs every 4 hours.
- C Implement bleeding precautions.
- D Review need for pneumococcal vaccine.
Explanation
An ANC of 500/mm³ indicates severe neutropenia, placing the client at extremely high risk for life-threatening infection because the immune system cannot mount an adequate response. Protective (reverse) isolation is the most important priority intervention to reduce exposure to pathogens. This includes a private room, strict hand hygiene, limiting visitors, and avoiding fresh flowers or raw foods. Infection prevention becomes the nurse’s highest priority until neutrophil counts recover.
Correct Answer Is:
AWhen assessing a client for a potential diagnosis of lung cancer, the nurse should review the history for which condition?
- A Night sweats.
- B Hemoptysis.
- C Productive cough.
- D Dyspnea.
Explanation
Hemoptysis—coughing up blood—is a classic and highly significant symptom associated with lung cancer. Tumors within the airway can erode or irritate bronchial blood vessels, leading to bleeding that appears as blood-streaked sputum or frank bloody mucus. This finding warrants prompt evaluation because it often signals advanced or centrally located lesions. While other respiratory symptoms may occur with many lung conditions, hemoptysis is particularly concerning for malignancy and is therefore a key historical cue the nurse should assess when lung cancer is suspected.
Correct Answer Is:
B
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