HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
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.
- A Bilateral finger clubbing
- B Temperature: 100.2° F (37.9° C)
- C Poor oral hygiene
- D Heart sounds of S1, S2, S3, S4
- E Generalized weakness and easily fatigued
- F Intercostal retractions
- G Respiration: 38 breaths/minute
- H Increased thirst
- I Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
- 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, JPatient 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 chronic obstructive pulmonary disease (COPD)? (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
C. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
Severe hypoxemia is a hallmark of COPD exacerbation. This client’s oxygen requirement has increased from 1 L/min to 2 L/min at home and still remains low at 87%, indicating poor gas exchange due to airflow obstruction or infection.
E. Respiration: 38 breaths/minute
Tachypnea occurs during COPD exacerbations due to increased work of breathing, air trapping, and impaired ventilation. A respiratory rate of 38 is critically high and consistent with acute COPD distress.
G. Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bases
Wheezing indicates airway narrowing and inflammation, while diminished breath sounds reflect air trapping or hyperinflation. Crackles may appear when a COPD patient also has an acute infection such as pneumonia.
Correct Answer Is:
C, E, G
Which intervention should the nurse include in the teaching plan for a client with pruritus?
- A Discourage the use of any type of skin lubricant.
- B Encourage the client to keep a warm sleeping environment.
- C Explain the importance of not taking any type of tub bath.
- D Instruct the client to keep fingernails trimmed short.
Explanation
Pruritus increases the risk of skin damage due to scratching, which can lead to excoriation, secondary infection, and delayed healing. Keeping fingernails trimmed short reduces the potential for skin injury when the urge to scratch becomes difficult to control. Even gentle or unconscious scratching during sleep can cause significant trauma. This intervention is a simple, essential component of pruritus management and complements other comfort strategies such as using moisturizers, cool environments, and gentle cleansing routines.
Correct Answer Is:
D
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 with a C-7 spinal cord injury (SCI) is experiencing autonomic dysreflexia. The nurse should first assess the client for which precipitating factor?
- A An acutely distended bladder.
- B Skeletal traction misalignment.
- C A severe pounding headache.
- D Profuse forehead diaphoresis.
Explanation
The most common cause of autonomic dysreflexia is a distended bladder, responsible for up to 85% of episodes. In clients with SCI at or above T6, any noxious stimulus below the injury level can trigger a life-threatening hypertensive crisis. The nurse must immediately assess the bladder for kinks, obstruction, or overfilling of the catheter or for urinary retention. Removing the bladder stimulus rapidly relieves the dysreflexic episode and prevents complications such as stroke or seizures.
Correct Answer Is:
A
After three days of persistent epigastric pain, a female client presents to the clinic. She has been taking oral antacids without relief. Her vital signs are heart rate 122 beats/minute, respirations 16 breaths/minute, blood pressure 116/70 mm Hg, and oxygen saturation 96%. The nurse obtains a 12-lead electrocardiogram (ECG). Which assessment finding is most critical?
- A ST elevation in three leads.
- B Bile colored emesis.
- C Irregular heart rate.
- D Reports of radiating jaw pain.
Explanation
ST elevation in multiple ECG leads is the most critical finding because it indicates an acute ST-segment elevation myocardial infarction (STEMI), a life-threatening emergency requiring immediate intervention to restore coronary perfusion. Women often present with atypical symptoms such as epigastric discomfort rather than classic chest pain, which increases the risk of missed diagnosis. Persistent epigastric pain unrelieved by antacids combined with ST elevation strongly suggests myocardial ischemia. Rapid activation of emergency cardiac protocols—including oxygen as needed, aspirin, nitroglycerin if appropriate, and preparation for reperfusion therapy—is essential to minimize myocardial damage and decrease mortality.
Correct Answer Is:
A
Which neurologic interventions are appropriate for this client with suspected Guillain-Barré syndrome? (Select all that apply.)
- A Neurologic checks every 2 hours
- B Obtain nerve conduction study
- C Daily MRI of brain and spine
- 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, BA client who received 6 units of packed red blood cells (PRBCs) 3 days ago for a lower gastrointestinal (GI) bleed is now displaying shortness of breath with occasional stridor and is reporting muscle cramping. Which serum laboratory value should the nurse immediately report to the healthcare provider (HCP)?
- A Sodium 135 mEq/L (135 mmol/L).
- B Calcium 6.5 mg/dL (1.63 mmol/L).
- C Magnesium 2.1 mEq/L (0.86 mmol/L).
- D Potassium 4.7 mEq/L (4.70 mmol/L).
Explanation
Normal calcium levels range from 9 to 10.5 mg/dL, and a value of 6.5 mg/dL represents severe hypocalcemia, which is a medical emergency. After multiple PRBC transfusions, the citrate preservative can bind to calcium, causing a dangerous drop in serum levels. This client’s symptoms—muscle cramping, shortness of breath, and stridor—are hallmark findings of neuromuscular irritability caused by acute hypocalcemia. If not treated immediately, the client is at risk for laryngospasm, tetany, seizures, and life-threatening cardiac dysrhythmias.
Correct Answer Is:
BThe nurse is caring for a client who tests positive for the sexually transmitted infection (STI) gonorrhea. The client reports having sex with someone who has many partners. Which response should the nurse provide?
- A Teach importance of medication regimen and follow up protocol.
- B Emphasize that using safe sex practices removes the risk of STIs.
- C Discuss that partners without similar symptoms may not be infected.
- D Clarify that all STIs are transmitted through sexual intercourse.
Explanation
When a client is diagnosed with gonorrhea, the immediate priority is ensuring they understand the prescribed treatment plan, the importance of completing all antibiotics, and the need for follow-up testing to confirm cure. The nurse should also emphasize partner notification and treatment to prevent reinfection. This response directly addresses safety, reduces transmission risk, and aligns with evidence-based STI management guidelines.
Correct Answer Is:
A
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.)
- A. Reduced pulse distal to the injury
- B. 1+ strength in the left upper extremity
- C. Decreased range of motion
- D. Coolness of the skin
- E. 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
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