HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
Following a total knee arthroplasty, the client is discharged from the hospital with a prescription for warfarin. In reviewing discharge teaching, the client recounts to the nurse the need to avoid eating foods high in potassium, such as bananas and melon. How should the nurse respond?
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Explain that no dietary restrictions are needed with warfarin.
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Provide a written list of additional foods high in potassium.
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Review teaching about the effects of foods rich in Vitamin K.
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Discuss necessary fluid restrictions as well as food restrictions.
Explanation
Correct Answer: C. Review teaching about the effects of foods rich in Vitamin K.
The client has demonstrated a misunderstanding of the dietary teaching related to warfarin. Warfarin is an anticoagulant whose effectiveness is directly affected by Vitamin K intake — not potassium. Foods high in Vitamin K, such as leafy green vegetables (spinach, kale, broccoli), can decrease warfarin's anticoagulant effect and must be kept consistent in the diet. The nurse must correct this misconception by reviewing the relationship between Vitamin K and warfarin, not potassium. There are no fluid restrictions associated with warfarin therapy.
For each finding listed below, which findings are consistent with the disease process of urinary tract infection (UTI)? (Select all that apply.)
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A Pain: heaviness in the chest, rated 6 out of 10
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B Temperature: 100.2° F (37.9° C)
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C Oxygen saturation: 87% on 2 liters/minute via nasal cannula
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D Heart sounds of S1, S2, S3, S4
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E Respiration: 38 breaths/minute
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F Jugular vein distention
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G Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Explanation
B. Temperature: 100.2° F (37.9° C)
While the fever may also be related to COPD or HF complications, low-grade fever is commonly seen in UTIs, especially in older adults. Increased urinary frequency mentioned in the case also supports the possibility of UTI as a comorbidity.
Correct Answer Is:
BWhich neurologic interventions are appropriate for this client with suspected Guillain-Barré syndrome? (Select all that apply.)
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A Neurologic checks every 2 hours
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B Obtain nerve conduction study
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C Daily MRI of brain and spine
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D Administer lorazepam 2 mg PO every 8 hours
Explanation
A. Neurologic checks every 2 hours
Guillain-Barré syndrome can progress rapidly, and frequent neurologic assessments allow early identification of worsening paralysis, absent reflexes, or cranial nerve involvement. This is essential for anticipating respiratory compromise and ensuring timely intervention should deterioration occur.
B. Obtain nerve conduction study
A nerve conduction study is one of the primary diagnostic tools for confirming Guillain-Barré syndrome. It detects slowed or blocked nerve signals caused by demyelination. Early diagnostic confirmation is critical for initiating treatment such as IVIG and predicting clinical progression.
Correct Answer Is:
A, BThe nurse administers an antibiotic to a client with a respiratory tract infection. To evaluate the medication's effectiveness, which laboratory value(s) should the nurse monitor? Select all that apply.
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Urinalysis.
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Blood urea nitrogen (BUN).
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Serum potassium.
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Red blood cell (RBC) count.
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White blood cell (WBC) count.
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Sputum culture and sensitivity.
Explanation
Correct Answers: E and F.
To evaluate the effectiveness of an antibiotic in treating a respiratory tract infection, the nurse should monitor the WBC count (E) and sputum culture and sensitivity (F). An elevated WBC count indicates active infection, and a downward trend toward normal confirms the antibiotic is working. Sputum culture and sensitivity identifies the causative organism and confirms the antibiotic is appropriate for that specific pathogen. Urinalysis, BUN, serum potassium, and RBC count reflect renal function, electrolyte balance, and red cell status — these are not direct indicators of antibiotic effectiveness against a respiratory infection.
Vital Signs: 1800 — HR: 76, RR: 17, BP: 100/68, SpO2: 99% on 2L NC 1900 — HR: 103, RR: 18, BP: 96/51, SpO2: 98% on 2L NC
Flow Sheet (I&O): IV fluid intake remains at 100 mL/hr each hour. Urine output: 1600 = 89 mL, 1700 = 100 mL, 1800 = 450 mL, 1900 = 420 mL.
Based on the trending vital signs and intake and output data, which condition is the nurse most likely observing in this client?
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Fluid volume overload.
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Hypertensive urgency.
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Hypovolemic shock.
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Septic shock.
Explanation
Correct Answer: C. Hypovolemic shock.
The client's vital sign trend from 1800 to 1900 shows a rising heart rate (76 to 103), falling blood pressure (100/68 to 96/51), and a narrowing pulse pressure — classic early signs of hypovolemic shock. Despite receiving 100 mL/hr of IV fluids, the client's blood pressure continues to drop and heart rate is compensatorily rising, suggesting the body is not maintaining adequate circulating volume.
The sudden large spike in urine output at 1800 and 1900 (450 mL and 420 mL respectively) compared to minimal output earlier suggests a possible fluid shift or pathological loss, contributing to intravascular depletion. Fluid overload would present with elevated BP and decreased urine output. Hypertensive urgency involves severely elevated BP, and septic shock, while possible, is not specifically supported by the data provided here without signs of infection.
Following a total thyroidectomy, the nurse plans to observe a client for complications. Which finding indicates that the client has developed a complication?
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A Diaphoretic, but denies any headache.
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B Reports of muscle twitching in hands and feet.
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C Denies muscle spasms in extremities.
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D Troubled with back and joint tenderness and pain.
Explanation
Muscle twitching in the hands and feet after a total thyroidectomy is a classic early sign of hypocalcemia, a serious postoperative complication. During surgery, the parathyroid glands may be inadvertently damaged or removed, leading to decreased parathyroid hormone and rapid drops in serum calcium. Hypocalcemia causes neuromuscular excitability, manifesting as tingling, twitching, and tetany. Prompt recognition is critical because severe hypocalcemia can lead to laryngospasm, cardiac dysrhythmias, and airway obstruction.
Correct Answer Is:
B
The healthcare provider prescribes streptomycin 300 mg IM every 12 hours for a client with tuberculosis. The available vial is labeled Streptomycin 1 gram/2.5 mL. How many milliliters should the nurse administer? (Enter the numerical value only. If rounding is required, round to the nearest tenth.)
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A 0.5 mL
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B 0.8 mL
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C 1.0 mL
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D 1.2 mL
Explanation
First convert 1 gram to milligrams: 1 g = 1000 mg. The concentration is therefore 1000 mg in 2.5 mL. To determine how many milliliters contain 300 mg, set up the proportion: 300 mg ÷ 1000 mg × 2.5 mL = 0.75 mL. When rounded to the nearest tenth as required, the dose becomes 0.8 mL.
Correct Answer Is:
B
A client with a closed head injury demonstrates signs of syndrome of inappropriate antidiuretic hormone (SIADH). Which additional finding should the nurse expect to obtain?
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A Fremitus over the chest wall.
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B Weight gain of 2 lb (0.91 kg) in one day.
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C Serum sodium of 150 mEq/L (150 mmol/L).
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D Urine specific gravity of 1.004.
Explanation
SIADH causes excessive release of antidiuretic hormone, leading to water retention, dilutional hyponatremia, and decreased urine output. As free water accumulates, the client gains weight rapidly, often within hours, making sudden weight gain a key clinical indicator. Because excess fluid is retained rather than excreted, daily weight is one of the most sensitive and early measures of worsening SIADH. This finding aligns with the pathophysiology of fluid overload associated with increased ADH activity.
Correct Answer Is:
BReference Range: Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)] Hemoglobin A1C [Good diabetic control is less than 7%]
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The client's hemoglobin A1C will be less than 7% in 6 months.
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The client will self administer all prescribed medications as directed.
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The client will keep a detailed diary of food consumed each day.
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The client's random fasting glucose will be less than 140 mg/dL (7.77 mmol/L).
Explanation
Correct Answer: A. The client's hemoglobin A1C will be less than 7% in 6 months.
A well-written nursing outcome must be client-centered, measurable, realistic, and time-bound. Option A meets all of these criteria — it identifies a specific, measurable laboratory goal (A1C less than 7%) within a defined timeframe (6 months), which reflects good long-term glycemic control. The client's blurred vision is likely related to poor glucose control, making glycemic management the priority outcome. Option B describes a nursing intervention, Option C is a behavioral action rather than an outcome, and Option D uses an incorrect threshold — random glucose under 140 mg/dL is not the standard goal for fasting glucose management in type 2 diabetes.
The nurse reviews the physical assessment and vital signs to determine the initial care needs of the client. Click to highlight the findings that require follow-up by the nurse. Select all that apply.
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A Bilateral finger clubbing
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B Temperature: 100.2° F (37.9° C)
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C Poor oral hygiene
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D Heart sounds of S1, S2, S3, S4
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E Generalized weakness and easily fatigued
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F Intercostal retractions
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G Respiration: 38 breaths/minute
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H Increased thirst
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I Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
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J Oxygen saturation: 87% on 2 liters/minute via nasal cannula
Explanation
B. Temperature: 100.2° F (37.9° C)
Even a low-grade fever in a client with COPD, productive yellow sputum, and recent viral illness suggests an evolving respiratory infection such as pneumonia. This requires follow-up because infection can rapidly worsen gas exchange in COPD and HF patients.
D. Heart sounds of S1, S2, S3, S4
The presence of both S3 and S4 indicates impaired ventricular function and elevated filling pressures, strongly suggesting a heart failure exacerbation, which can worsen respiratory distress. This finding requires timely evaluation.
F. Intercostal retractions
Retractions signal severe respiratory effort and impending fatigue. In a COPD patient already hypoxic, this is a priority finding indicating significant respiratory compromise that requires immediate intervention.
G. Respiration: 38 breaths/minute
A respiratory rate of 38/min shows acute respiratory distress and ineffective ventilation. This degree of tachypnea is unsafe and requires rapid assessment and escalation of respiratory support.
I. Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
Chest heaviness in a tachycardic, hypoxic client raises concerns for cardiac ischemia or HF strain. This symptom requires prompt follow-up to rule out an evolving cardiac event.
J. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
An SpO₂ of 87% despite increased oxygen use indicates acute hypoxemia, signaling inadequate gas exchange. This must be addressed urgently to prevent respiratory failure.
Correct Answer Is:
B, D, F, G, I, JHow to Order
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