HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
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.
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Recurrence of chest pain
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Prothrombin time (PT)
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Groin access site
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Electrocardiographic changes
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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.
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?
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Take the client to emergency department (ED).
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Ensure that the client avoids salt intake for the rest of the day.
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Apply the client's home oxygen.
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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.
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?
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Has intestinal polyps.
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Is excessively exposed to sunlight.
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Smokes cigars.
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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.
A client with stage IV bone cancer is admitted to the hospital for pain control. The client verbalizes continuous, severe pain of 8 on a 0 to 10 scale. Which intervention should the nurse implement?
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Administer opioid and non-opioid medication simultaneously.
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Give maximum dosage when score reaches 10.
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Educate client on signs and symptoms of narcotic dependency.
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Alternate IV and IM analgesic medications.
Explanation
For a client with stage IV bone cancer and severe, continuous pain, the most effective intervention is administering opioid and non-opioid medications together using a multimodal approach. This method enhances pain control by acting on different pain pathways, allowing for better relief with fewer side effects. According to the WHO analgesic ladder, combination therapy is recommended for cancer-related pain and should be administered around the clock, not just when pain becomes unbearable.
Four days following an abdominal aortic aneurysm (AAA) repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?
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Evaluate edema for pitting.
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Elevate extremities on pillows.
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Wrap the feet with warmed blankets.
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Assess pulses with a vascular doppler.
Explanation
After an abdominal aortic aneurysm (AAA) repair, the loss of palpable pedal pulses may indicate arterial occlusion or graft thrombosis, which is a surgical emergency. The nurse’s first action should be to verify circulation using a vascular Doppler to confirm the presence or absence of blood flow. Prompt detection of impaired perfusion is critical to prevent tissue ischemia or limb loss, and findings should be reported immediately to the healthcare provider.
Select the 3 areas of teaching that should be included when providing education to the client with symptomatic benign prostate hyperplasia.
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A Avoid cough or cold remedies that contain pseudoephedrine or phenylephrine.
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B Urinate every 4 to 6 hours or when you first feel the urge.
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C Refrain from exercise because it can lead to incontinence.
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D Limit your intake of alcohol and caffeine.
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E Schedule yearly prostate-specific antigen blood test.
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F Decrease fluid intake to lessen the severity of symptoms.
Explanation
A. Avoid cough or cold remedies that contain pseudoephedrine or phenylephrine
These decongestants can cause urinary retention by tightening smooth muscles in the bladder neck and prostate. Clients with BPH should avoid these medications to prevent worsening urinary obstruction.
D. Limit your intake of alcohol and caffeine
Both alcohol and caffeine act as bladder irritants and diuretics, increasing urinary frequency and urgency. Reducing intake helps minimize nocturia and incontinence episodes.
E. Schedule yearly prostate-specific antigen (PSA) blood test
Although PSA is not diagnostic of BPH, annual monitoring is recommended to screen for prostate cancer, which can coexist with BPH and present with similar urinary symptoms.
The nurse obtains a fingerstick blood glucose utilizing a bedside glucose meter for a client with a prescribed sliding scale insulin protocol. The meter indicates 56 mg/dL (3.12 mmol/L). At this time, which intervention should the nurse implement first?
Reference Range:
Glucose: 74–106 mg/dL (4.1–5.9 mmol/L)
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Collect a blood specimen by venipuncture to send to the laboratory for serum glucose analysis.
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Prepare the prescribed dose of rapid-acting insulin from the sliding scale instructions.
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Give the client six ounces (180 mL) of non-diet carbonated soda and instruct the client to drink it entirely.
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Document the glucose reading in the electronic medical record (EMR) as the only action needed.
Explanation
A glucose reading of 56 mg/dL indicates hypoglycemia, a potentially life-threatening emergency that requires immediate correction to prevent neurological complications such as seizures or loss of consciousness. The nurse should follow the “15–15 rule”: administer 15 grams of fast-acting carbohydrates (such as 6 oz of regular soda, 4 oz of fruit juice, or glucose tablets), then recheck the glucose in 15 minutes. Rapid intervention restores blood sugar quickly and safely, preventing further decline.
The nurse is providing discharge instructions to a client who is receiving prednisone 5 mg PO daily for a rash due to contact with poison ivy. Which symptom should the nurse tell the client to report to the healthcare provider?
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Gastric irritation.
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Rapid weight gain.
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Abdominal striae.
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Moon facies.
Explanation
Rapid weight gain may indicate fluid retention and sodium imbalance, a serious adverse effect of prednisone, suggesting Cushingoid changes or early corticosteroid-induced fluid overload. This can lead to hypertension, edema, and potential heart complications if unaddressed. Because prednisone alters metabolism and electrolyte balance, sudden weight changes can signal systemic effects requiring dosage adjustment or further evaluation by the healthcare provider.
A client with heart failure (HF) is receiving IV fluids at 125 mL/hour. The nurse observes an increase in jugular vein distention (JVD) and pedal edema. Which additional assessment should the nurse make before reporting to the healthcare provider (HCP)?
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Inspect for distention of peripheral veins.
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Assess for inflammation of the calves.
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Observe for change in breathing pattern.
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Palpate the volume of pedal pulses.
Explanation
In a client with heart failure, increased JVD and pedal edema indicate fluid volume overload. The next most important assessment is to observe for changes in breathing pattern, such as dyspnea, crackles, orthopnea, or decreased oxygen saturation, which suggest pulmonary congestion or acute decompensation. Assessing respiratory status provides critical information about worsening heart failure and guides urgent intervention, such as slowing or stopping the IV infusion and notifying the HCP.
Following a motor vehicle collision, a client with chest trauma receives a chest tube to relieve a hemothorax. Two hours following the chest tube insertion, the nurse observes the water level in the water-seal chamber is rising during inspiration and falling during expiration. Which action should the nurse implement?
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Auscultate lungs for unequal breath sounds.
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Continue to monitor the drainage system.
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Inspect the tube insertion site for leaking.
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Lift and clear drainage from the chest tube.
Explanation
The rising and falling (tidaling) of the water level in the water-seal chamber with inspiration and expiration is a normal finding after chest tube insertion. It indicates that the chest tube is patent and functioning properly, allowing air or fluid to escape from the pleural space and the lung to re-expand. Therefore, the nurse should continue to monitor the drainage system for ongoing tidaling, drainage amount, and any signs of air leak or blockage.
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