HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
The nurse reviews the client’s assessment findings. Based on the clinical data, which disease process do these findings indicate?
- A. Bronchitis
- B. Asthma exacerbation
- C. Pneumonia
- D. Pulmonary embolism
Explanation
This client’s presentation—wheezing, prolonged expiration, tachypnea, dyspnea, restlessness, diaphoresis, and hypoxemia—is characteristic of an acute asthma exacerbation triggered by environmental smoke exposure. The client’s history of asthma, recent noncompliance with inhaled corticosteroid therapy, and improvement with oxygen therapy confirm the diagnosis. In asthma, airway inflammation and bronchoconstriction cause increased airway resistance, leading to prolonged expiration and use of accessory muscles.
The healthcare provider (HCP) prescribes diagnostic tests for a client whose chest x-ray indicates pneumonia. Which diagnostic test should the nurse review for implementation in the most therapeutic treatment of the pneumonia?
- A. Sputum culture and sensitivity
- B. Arterial blood gas (ABG)
- C. Blood cultures
- D. Computerized tomography (CT) of the chest
Explanation
A sputum culture and sensitivity identifies the specific organism causing the pneumonia and determines which antibiotics are most effective against it. This information guides targeted antimicrobial therapy, ensuring the client receives the most therapeutic and appropriate treatment rather than broad-spectrum antibiotics alone. Accurate identification of the pathogen improves outcomes, prevents antibiotic resistance, and promotes recovery.
Ten hours after successful thrombolysis for ST elevation myocardial infarction (STEMI), a client is receiving lidocaine and heparin infusions. Which assessment(s) should the nurse monitor regularly during the reperfusion period? Select all that apply.
- A. Recurrence of chest pain
- B. Prothrombin time (PT)
- C. Groin access site
- D. Electrocardiographic changes
- E. Activated partial thromboplastin time (aPTT)
Explanation
A. Recurrence of chest pain
After thrombolytic therapy, monitoring for return of chest pain is critical because it may signal reocclusion or reinfarction. Persistent or recurrent ischemic pain requires immediate evaluation and potential reintervention.
C. Groin access site
Thrombolytics and heparin increase the risk of bleeding and hematoma formation, especially at vascular access sites used during catheterization or monitoring. Frequent inspection of the groin site helps identify early signs of bleeding or hematoma.
D. Electrocardiographic changes
Continuous ECG monitoring is essential to detect reperfusion arrhythmias (such as accelerated idioventricular rhythm) or recurrent ST-segment elevation, which can indicate reinfarction or inadequate reperfusion.
E. Activated partial thromboplastin time (aPTT)
Since the client is receiving heparin infusion, the aPTT must be monitored regularly to ensure therapeutic anticoagulation (typically 1.5–2.5 times control) and prevent hemorrhage.
Based on the client’s symptoms and clinical presentation, which potential condition, nursing actions, and parameters to monitor are most appropriate for this client?
-
A. Potential Condition: Dumping Syndrome
Actions to Take: Elevate the head of the bed after meals; Offer small, frequent meals
Parameters to Monitor: Blood glucose levels, Gastrointestinal symptoms -
B. Potential Condition: Pulmonary Embolism
Actions to Take: Administer oxygen; Prepare to give anticoagulants
Parameters to Monitor: Oxygen saturation, Respiratory rate -
C. Potential Condition: Anastomosis Leak
Actions to Take: Initiate continuous cardiac monitoring; Prepare client to return to the operating room
Parameters to Monitor: Vital signs; Signs and symptoms of peritonitis -
D. Potential Condition: Deep Vein Thrombosis (DVT)
Actions to Take: Apply sequential compression devices; Encourage ambulation
Parameters to Monitor: Calf circumference, Pain and swelling in lower extremities
Explanation
The client’s sudden onset of severe back and shoulder pain, fever, tachycardia, restlessness, and elevated temperature several hours after bariatric surgery strongly indicates an anastomosis leak, a surgical emergency. This complication occurs when gastric or intestinal contents leak into the peritoneal cavity, leading to peritonitis and sepsis if not promptly treated.
Actions to Take:
Initiate continuous cardiac monitoring to detect tachycardia, arrhythmias, or signs of shock caused by systemic infection or internal bleeding. Prepare the client to return to the operating room for urgent surgical repair and management of the leak to prevent further contamination and deterioration.
Parameters to Monitor:
Monitor vital signs (blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation) closely to assess for hemodynamic instability. Observe for signs and symptoms of peritonitis, such as increasing abdominal pain, rigidity, distention, fever, and guarding. Prompt identification and intervention are essential to prevent septic shock and multi-organ failure.
While assisting a client to the toilet, the client begins to have a seizure and the nurse eases the client to the floor. The nurse calls for help and monitors the client until the seizing stops. Which intervention should the nurse implement first?
- A. Observe for prolonged periods of apnea.
- B. Evaluate for evidence of incontinence.
- C. Observe for lacerations to the tongue.
- D. Document details of the seizure activity.
Explanation
Immediately after a seizure, the priority nursing action is to assess airway, breathing, and circulation (ABCs). During the postictal phase, apnea or respiratory compromise can occur due to relaxation of the respiratory muscles or obstruction from the tongue. Observing for prolonged apnea ensures timely intervention—such as repositioning the airway, providing oxygen, or initiating resuscitation if necessary. This step directly addresses life-threatening complications.
The nurse reports that a client is at risk for a stroke based on which assessment finding?
- A. Jugular vein distention
- B. Carotid bruit
- C. Nuchal rigidity
- D. Palpable cervical lymph node
Explanation
A carotid bruit is an abnormal swishing sound heard over the carotid artery with a stethoscope, caused by turbulent blood flow due to carotid artery narrowing or atherosclerosis. This finding indicates reduced cerebral perfusion and an increased risk for stroke (cerebrovascular accident). Early identification of a carotid bruit allows for further evaluation, such as a carotid Doppler ultrasound, and potential interventions to prevent thromboembolic events.
A client has a leg cast following an open reduction for a fractured tibia. Approximately two hours after returning to the unit, the client reports severe pain in the affected extremity, and the nurse observes that the limb is blue and blanched. Which action should the nurse perform first?
- A. Record the observations and check the limb every 15 minutes.
- B. Notify the healthcare provider of the assessment findings.
- C. Release the traction and notify the healthcare provider.
- D. Administer a PRN pain medication routinely as prescribed.
Explanation
The client’s symptoms—severe pain unrelieved by medication, pallor, cyanosis, and coolness of the limb—indicate compartment syndrome, a surgical emergency caused by increased pressure within the muscle compartments that restricts blood flow. Immediate notification of the healthcare provider is critical so the cast can be loosened or a fasciotomy performed to prevent permanent tissue and nerve damage, or even limb loss.
A client receives a prescription for 2 liters of lactated Ringer's IV to be infused over 12 hours. The IV administration set delivers 20 gtt/mL. How many gtt/min should the nurse regulate the infusion?
- A. 48 gtt/min
- B. 56 gtt/min
- C. 62 gtt/min
- D. 72 gtt/min
Explanation
Convert volume and time, then apply drop factor: 2 L = 2000 mL; 12 hr = 720 min.
mL/min = 2000 ÷ 720 = 2.78 mL/min.
gtt/min = 2.78 × 20 = 55.6 → round to nearest whole number = 56 gtt/min.
When caring for a client with nephrotic syndrome, which assessment is most important for the nurse to obtain?
- A. Vital signs.
- B. Bowel sounds.
- C. Daily weight.
- D. Level of consciousness.
Explanation
In nephrotic syndrome, large amounts of protein are lost in the urine due to glomerular damage, leading to hypoalbuminemia and massive fluid retention (edema). The most important assessment to monitor fluid status accurately is obtaining a daily weight under consistent conditions. Weight changes reflect even small fluid shifts that may not yet be visible as edema, helping evaluate the effectiveness of diuretics, diet, or corticosteroid therapy and detect worsening renal function early.
A client with chronic kidney disease (CKD) missed dialysis yesterday to attend a funeral. The client's spouse calls the home health nurse and reports that the client is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?
- A. Take the client to emergency department (ED).
- B. Ensure that the client avoids salt intake for the rest of the day.
- C. Apply the client's home oxygen.
- D. Check for a thrill and bruit at the client's dialysis access site.
Explanation
A client with chronic kidney disease who missed a dialysis session and is now lethargic and difficult to arouse is exhibiting signs of uremic encephalopathy or severe electrolyte imbalance (especially hyperkalemia). These conditions can rapidly become life-threatening. The priority nursing action is to instruct the spouse to take the client to the emergency department immediately for urgent assessment and possible emergency dialysis. Delay can lead to cardiac arrhythmias, coma, or death.
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