HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
A client with benign prostatic hyperplasia (BPH) is preparing for discharge following a transurethral needle ablation (TUNA).
Which information should the nurse include in the discharge instructions?
- A Monitor urinary stream for decrease in output.
- B Use incentive spirometer.
- C Report when hematuria becomes pink tinged.
- D Restrict physical activities.
Explanation
After a TUNA procedure, the prostate tissue has been heated and partially destroyed, leaving the surrounding area highly vascular and easily irritated. To prevent postoperative bleeding and allow proper healing, clients must avoid strenuous activity, heavy lifting, vigorous exercise, and sexual activity for a prescribed period—typically one to two weeks. Increased physical exertion can trigger bleeding, worsen swelling, or impair urinary flow. Teaching activity restrictions is therefore essential for reducing complications and promoting a smooth recovery.
Correct Answer Is:
D
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 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)?
Reference Range:
Potassium: 3.5 to 5 mEq/L (3.5 to 5 mmol/L)
Magnesium: 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L)
Calcium: 9 to 10.5 mg/dL (2.3 to 2.6 mmol/L)
Sodium: 136 to 145 mEq/L (136 to 145 mmol/L)
- 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:
B
The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema and ascites in clients with cirrhosis?
- A Hyperaldosteronism causing an increased sodium reabsorption in renal tubules.
- B Decreased renin-angiotensin response related to an increase in renal blood flow.
- C Decreased portacaval pressure with greater collateral circulation.
- D Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
Explanation
Cirrhosis impairs the liver’s ability to synthesize albumin, leading to hypoalbuminemia. Albumin plays a critical role in maintaining colloidal oncotic pressure, which keeps fluid within the vascular system. When albumin levels fall, oncotic pressure drops, allowing fluid to leak from the bloodstream into interstitial tissues and body cavities. This results in peripheral edema and ascites, hallmark manifestations of advanced liver disease. Without adequate albumin, circulating plasma volume decreases while third-spacing increases, worsening fluid accumulation and contributing to hemodynamic instability, sodium retention, and activation of compensatory mechanisms that further exacerbate fluid imbalance.
Correct Answer Is:
D
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?
Reference Range:
Sodium: 136 to 145 mEq/L
Urine Specific Gravity: 1.005 to 1.030
- A Fremitus over the chest wall.
- B Weight gain of 2 lb (0.91 kg) in one day.
- C Serum sodium of 150 mEq/L (150 mmol/L).
- 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:
B
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
An older adult client recently diagnosed with chronic obstructive pulmonary disease (COPD) is admitted with shortness of breath. The nurse observes the client sitting upright and leaning over the bedside table, using accessory muscles to assist in breathing. Which action should the nurse take?
- A Assist the client to a high Fowler's position in bed.
- B Instruct the client in pursed lip breathing techniques.
- C Prepare to transfer the client to a critical care unit.
- D Observe the client for the presence of a barrel chest.
Explanation
The client is exhibiting tripod positioning and accessory muscle use, clear signs of respiratory distress associated with COPD. Pursed lip breathing is an immediate, effective intervention that helps prolong exhalation, prevent airway collapse, improve carbon dioxide elimination, and reduce dyspnea. This technique increases ventilation efficiency by maintaining positive airway pressure and decreasing air trapping. Teaching the client pursed lip breathing provides rapid relief, enhances oxygen exchange, and improves overall respiratory control during acute shortness of breath.
Correct Answer Is:
B
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 urinary tract infection (UTI)? (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
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:
B
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 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
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