HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
The nurse is assessing a group of older adult clients. Which factor in a client's history places the client at greatest risk for developing colon cancer?
- Has intestinal polyps.
- Is excessively exposed to sunlight.
- Smokes cigars.
- Eats a high-fat diet.
Explanation
The presence of intestinal (colorectal) polyps is the greatest risk factor for developing colon cancer. Polyps are benign growths on the lining of the colon that can undergo malignant transformation over time if left untreated. Clients with a history of polyps require regular colonoscopy screenings to detect and remove precancerous lesions early, significantly reducing the risk of colon cancer.
The nurse reviews the client’s assessment findings. Based on the clinical data, which disease process do these findings indicate?
- Bronchitis
- Asthma exacerbation
- Pneumonia
- 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.
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?
- Take the client to emergency department (ED).
- Ensure that the client avoids salt intake for the rest of the day.
- Apply the client's home oxygen.
- 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.
A client with diabetes mellitus is admitted with an upper respiratory infection (URI). Which changes in blood glucose management should the nurse tell the client to expect?
- Restriction of caloric intake.
- Higher doses of insulin.
- Fewer fingerstick glucose checks.
- Increased oral fluid intake.
Explanation
During an infection or illness, the body releases stress hormones such as cortisol and epinephrine, which increase blood glucose levels and lead to insulin resistance. Therefore, clients with diabetes often require higher doses of insulin or adjustments to their regimen, even if they have reduced appetite. This helps prevent hyperglycemia and diabetic ketoacidosis (DKA). The nurse should teach the client to monitor glucose closely and continue insulin therapy as prescribed during illness.
Based on the client’s symptoms and clinical presentation, which potential condition, nursing actions, and parameters to monitor are most appropriate for this client?
-
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 -
Potential Condition: Pulmonary Embolism
Actions to Take: Administer oxygen; Prepare to give anticoagulants
Parameters to Monitor: Oxygen saturation, Respiratory rate -
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 -
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.
A nurse is caring for a client with diabetes insipidus (DI). Which data warrants the most immediate intervention by the nurse?
- Apical heart rate of 110 beats/minute.
- Serum sodium of 185 mEq/L (185 mmol/L).
- Polyuria and excessive thirst.
- Dry skin with inelastic turgor.
Explanation
A serum sodium of 185 mEq/L indicates severe hypernatremia, a life-threatening complication of diabetes insipidus. It reflects profound water loss leading to dehydration, increased serum osmolality, and potential neurological impairment such as seizures, altered mental status, or coma. Immediate intervention is required to restore fluid balance, typically through IV hypotonic fluids and monitoring for cerebral edema during correction.
The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?
- Platelet count.
- White blood cell count.
- Red blood cell count.
- Hemoglobin levels.
Explanation
Petechiae (small pinpoint spots) and ecchymosis (bruising) are classic signs of impaired platelet function or thrombocytopenia—a low platelet count. Platelets are essential for blood clot formation and vascular integrity. When platelet levels drop significantly, spontaneous bleeding under the skin can occur, leading to these visible findings. The nurse should review the platelet count to assess the severity of thrombocytopenia and report critically low values immediately, as they increase the risk of internal or external hemorrhage.
The nurse is preparing a client for an outpatient thoracentesis. Which statement made by the client should the nurse recognize as needing additional education?
- Expect a persistent cough after the procedure.
- Limit activity for a day or two after returning home.
- Prepare to sit forward with arms propped on a table.
- Anticipate a stinging feeling during needle insertion.
Explanation
A persistent cough after a thoracentesis is not expected and may indicate lung injury, pneumothorax, or re-expansion pulmonary edema, all of which are potential complications that require immediate medical attention. The client should be instructed to report continuous coughing, shortness of breath, or chest pain immediately following the procedure.
While caring for a client with amyotrophic lateral sclerosis (ALS), the nurse performs a neurological assessment every four hours. Which assessment finding warrants immediate intervention by the nurse?
- Increasing anxiety.
- Inappropriate laughter.
- Weakened cough effort.
- Asymmetrical weakness.
Explanation
A weakened cough effort in a client with amyotrophic lateral sclerosis (ALS) indicates respiratory muscle weakness, which can quickly lead to inadequate airway clearance, hypoventilation, and respiratory failure. Because ALS progressively affects the motor neurons controlling voluntary muscles, declining respiratory function is the most life-threatening complication. This finding requires immediate intervention, such as airway support, suctioning, or notifying the healthcare provider for possible ventilatory assistance.
During a preoperative assessment phone call, a client reports taking several "pills" every day. Which response should the office nurse provide?
- Bring copies of all your prescriptions to your preoperative appointment.
- Obtain a copy of your medication records from your healthcare provider (HCP).
- Bring all of your medication containers to your preoperative appointment.
- Discuss with your healthcare provider (HCP) which medications to take before surgery.
Explanation
Asking the client to bring all medication containers ensures an accurate medication reconciliation, allowing the nurse and surgical team to verify exact dosages, over-the-counter products, and herbal supplements. This step prevents potential drug interactions, duplication, or contraindications before surgery and helps determine which medications should be continued or held.
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