HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
An adult woman with primary Raynaud's phenomenon develops pallor and then cyanosis of her fingers. After warming her hands, the fingers turn red and the client reports a burning sensation. Which action should the nurse take?
- A Secure a pulse oximeter to monitor the client's oxygen saturation.
- B Continue to monitor the fingers until color returns to normal.
- C Apply a cool compress to the affected fingers for 20 minutes.
- D Report the finding to the healthcare provider (HCP) as soon as possible.
Explanation
The client is exhibiting the classic triphasic color change seen in Raynaud’s phenomenon: pallor → cyanosis → redness, followed by a burning sensation as blood flow returns. This sequence is expected during an episode triggered by cold or stress. After the warming intervention, reactive hyperemia occurs, causing redness and discomfort, both of which indicate recovery of circulation. No emergency action is needed unless symptoms persist, worsen, or become frequent. The appropriate nursing response is to continue monitoring until normal color and sensation fully return, while educating the client about prevention strategies such as avoiding cold exposure, managing stress, and using protective gloves.
Correct Answer Is:
B
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, DPatient Data
History and Physical
A 22-year-old female presents to the emergency department (ED) by ambulance and reports lower-extremity numbness, tingling, and weakness that have progressed over the past week from bilateral feet up to her knees. She says that she is now unable to walk. Has a history of gastroenteritis with watery diarrhea 2 weeks ago that lasted 4 days. A stool sample sent by the primary healthcare provider (HCP) at time of illness which came back as campylobacter jejuni. Medications include drospirenone/ethinyl estradiol 3 mg/0.02 mg by mouth (PO) daily. Surgical history includes an appendectomy at age 10.
Nurses' Notes
0700
Assessment
. Cardiovascular: Normal heart tones. Radial and pedal purses 2+. Capillary refill 2 seconds.
· Gastrointestinal: Abdomen soft and non-tender, bowel sounds present.
. Genitourinary: Last menstrual period 4 days ago. Voided small amount this morning.
. Respiratory: Clear to auscultation, no increased respiratory effort noted.
· Musculoskeletal: Hypotonic tone bilateral lower extremities, unable to move feet. Client states they normally ambulate without difficulty.
. Neurological: Awake and oriented, mildly anxious, reports increasing fatigue. No signs of neck stiffness, no cranial nerve involvement. Reflexes on lower limbs 0 out of 4, sensation intact globally.
. Integumentary: Skin intact, diaphoretic.
Flow Sheet
0700
Vital signs
· Temperature: 97.8° F (36.5° C) orally
. Heart rate: 86 beats/minute
. Respiratory rate: 17 breaths/minute
. Blood pressure: 144/82 mm Hg
· Oxygen saturation: 98% on room air
. Pain: rated 3 on a 0 to 10 scale, bilateral feet
. Weight: 142 pounds (64.54 kg)
. Height: 5 feet, 7 inches (170.2 cm)
1000
Vital signs
· Temperature: 97.4° F (36.3° C) orally
. Heart rate: 76 beats/minute
. Respiratory rate: 18 breaths/minute
· Blood pressure: 128/78 mm Hg
· Oxygen saturation: 97% on room air
. Pain: rated 2 on a 0 to 10 scale, bilateral feet and calf
1400
Vital signs
· Temperature: 97.8° F (36.5° C) orally
. Heart rate: 72 beats/minute
· Respiratory rate: 19 breaths/minute
. Blood pressure: 138/76 mm Hg
· Oxygen saturation: 94% on room air
· Oxygen saturation: 97% on 2 liters oxygen per minute via nasal canula
. Pain: rated 4 on a 0 to 10 scale, bilateral lower extremities
Orders
0800
· Complete blood count (CBC)
· Comprehensive metabolic panel (CMP)
· C-reactive protein
0900
· Admit to neurology progressive care unit
· Oxygen via nasal cannula at 2 to 4 L/minute to maintain oxygen saturation greater than 97%
· Sodium chloride lock peripheral intravenous (IV) access
· Acetaminophen 650 mg by mouth (PO) x 1 now
. Acetaminophen 650 mg by mouth (PO) every 4 hours as needed (PRN) for pain; not to exceed 3000 mg in a 24-hour
period
. Lumbar puncture
· Enoxaparin 30 mg subcutaneous (SQ) twice daily (BID)
. Atenolol 50 mg by mouth (PO) daily; hold for heart rate less than 50 beats/minute
. Physical therapy evaluation and treatment
1500
· Intravenous immunoglobulin (IVIG) 0.4 g/kg IV daily x 5 days
· Hydrocodone/acetaminophen 5 mg/300 mg, 2 tablets by mouth (PO) every 6 hours as needed (PRN) for moderate pain;
not to exceed 4000 mg acetaminophen in 24 hours
· Docusate sodium 250 mg by mouth (PO) daily, at bedtime
· Occupational therapy evaluation and treatment
The nurse identifies care plans for the client.
Which musculoskeletal interventions are appropriate for this client with rapidly progressing lower-extremity weakness? (Select all that apply.)
- A Range-of-motion (ROM) exercises every 8 hours
- B Educate client on mobility status and need for assistance
- C Reposition client every 4 hours
- D Ambulate client every shift
Explanation
A. Range-of-motion (ROM) exercises every 8 hours
The client has lower-extremity paralysis due to probable Guillain-Barré syndrome. ROM exercises maintain joint flexibility, prevent contractures, and reduce muscle atrophy during periods of immobility. Because the weakness is ascending and progressive, preservation of musculoskeletal function is essential to prevent long-term impairment.
B. Educate client on mobility status and need for assistance
Because the client is unable to ambulate and has hypotonic lower extremities, attempting independent mobility poses a high fall risk. Education ensures the client understands their limitations, preventing injury and promoting safe movement with staff assistance.
C. Reposition client every 4 hours
The client’s immobility increases risk for pressure injuries. Regular repositioning improves circulation, reduces pressure over bony prominences, and prevents skin breakdown. This intervention is critical as paralysis progresses and the client becomes unable to shift weight independently.
Correct Answer Is:
A, B, C
Following a total thyroidectomy, the nurse plans to observe a client for complications. Which finding indicates that the client has developed a complication?
- A Diaphoretic, but denies any headache.
- B Reports of muscle twitching in hands and feet.
- C Denies muscle spasms in extremities.
- 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
A client with Cushing's syndrome is recovering from an elective laparoscopic procedure. Which assessment finding warrants immediate intervention by the nurse?
- A Pitting ankle edema.
- B Purple marks on skin of the abdomen.
- C Irregular apical heart rate.
- D Quarter-size blood spot on dressing.
Explanation
An irregular apical heart rate is the most urgent finding because clients with Cushing’s syndrome are at increased risk for cardiac dysrhythmias, electrolyte imbalances (especially hypokalemia), hypertension, and fluid overload. An irregular heart rhythm can indicate life-threatening dysrhythmias, requiring immediate assessment, cardiac monitoring, and electrolyte evaluation.
The other findings—edema, purple abdominal striae, and minimal surgical drainage—are expected with Cushing’s syndrome or postoperative recovery and do not indicate acute deterioration.
Correct Answer Is:
C
A client with an arterial ischemic leg injury is being discharged from the hospital. Which instruction is most important for the nurse to include in this client's discharge teaching plan?
- A Trim toenails straight across.
- B Wear shoes and socks while awake.
- C Inspect feet daily for skin breakdown.
- D Keep legs elevated as much as possible.
Explanation
Clients with arterial ischemic leg disease have significantly decreased blood flow to the extremities. Because of poor perfusion, even small wounds can progress rapidly to ulcers, infection, or gangrene. Daily foot inspection is essential because it allows early detection of skin breakdown, color changes, or injuries that the client may not feel due to neuropathy or impaired circulation. Identifying problems early is the most important strategy to prevent limb-threatening complications.
Correct Answer Is:
C
The nurse is planning care for an older adult client who experienced a cerebrovascular accident (CVA) several weeks ago. The client has expressive aphasia and often becomes frustrated with the nursing staff. Which intervention should the nurse implement?
- A Ask the client simple questions.
- B Encourage client's use of picture charts.
- C Teach the client use of basic sign language.
- D Speak slowly to the client.
Explanation
Expressive aphasia impairs a client's ability to form words, but comprehension is usually intact. Frustration commonly occurs when the client cannot communicate needs clearly. Using picture charts provides an alternative communication method that reduces anxiety, supports autonomy, and allows the client to express needs effectively without relying on speech. This approach is evidence-based, practical for daily care, and minimizes communication-related frustration.
Correct Answer Is:
B
After teaching a male client with chronic kidney disease (CKD) about therapeutic diet for his condition, the nurse provides the client with a menu to make breakfast selections. Which food choice(s) by the client indicate that the teaching was effective? Select all that apply.
- A Four strips of well-done bacon
- B A slice of whole-grain toast
- C Ham, cheese, and egg omelet
- D A bowl of cream of wheat
- E Banana and orange slices
Explanation
B. A slice of whole-grain toast
This choice is appropriate for a client with chronic kidney disease because it is low in potassium and phosphorus compared to other breakfast options. Whole-grain toast provides needed carbohydrates and fiber without adding excessive sodium or protein, both of which must be moderated in CKD to reduce kidney workload.
D. A bowl of cream of wheat
Cream of wheat is a low-potassium, low-phosphorus cereal that fits well within kidney-friendly dietary restrictions. It offers energy-providing carbohydrates while avoiding high-protein or high-sodium ingredients that could worsen kidney function. This makes it a safe and effective breakfast selection for someone managing CKD.
Correct Answer Is:
B, D
The nurse is caring for a client with urolithiasis who reports severe flank and abdominal pain. Which action should the nurse implement?
- A Strain all urine.
- B Limit fluid intake.
- C Encourage a high-calcium diet.
- D Maintain client on strict bedrest.
Explanation
Straining all urine is essential for clients with urolithiasis because it allows the nurse to collect any passed stones for laboratory analysis. Identifying the stone’s composition guides treatment decisions and helps determine preventive dietary or medication strategies. This intervention also ensures the healthcare team can monitor the progression of stone passage. Limiting fluids, encouraging high-calcium intake, or maintaining strict bedrest are not appropriate and do not support the therapeutic goals for urolithiasis management.
Correct Answer Is:
A
During spring break, a young adult client presents to the urgent care clinic and reports a stiff neck, a fever for the past 6 hours, and a headache. Which intervention should the nurse implement first?
- A Administer an antipyretic.
- B Initiate isolation precautions.
- C Prepare for a lumbar puncture.
- D Draw blood cultures.
Explanation
A client with fever, severe headache, and nuchal rigidity must be treated as a suspected case of bacterial meningitis, which is highly contagious and spreads rapidly through respiratory droplets. The FIRST nursing action is to place the client on droplet isolation precautions to protect healthcare workers and other clients.
After isolation, the nurse can obtain blood cultures, prepare for lumbar puncture, and administer medications—but infection control must occur before all other interventions.
Correct Answer Is:
B
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