HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
A client is recovering from the surgical removal of glass in the right eye. Which intervention should the nurse implement immediately following the procedure?
- A. Teach a family member to administer eye drops.
- B. Obtain vital signs every 2 hours during hospitalization.
- C. Provide an eye shield to be worn while sleeping.
- D. Encourage deep breathing and coughing exercises.
Explanation
After eye surgery, the immediate priority is protection of the operative site to prevent accidental trauma, infection, or increased intraocular pressure. Applying or providing an eye shield ensures the client does not inadvertently rub or press on the affected eye—especially during sleep—when such movements are unconscious. This intervention helps maintain the integrity of the surgical repair and supports optimal healing.
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?
- A. Restriction of caloric intake.
- B. Higher doses of insulin.
- C. Fewer fingerstick glucose checks.
- D. 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.
A client with Addison’s disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?
- A. Glucose.
- B. Albumin.
- C. Platelets.
- D. Osmolarity.
Explanation
Hydrocortisone is a glucocorticoid that helps replace the cortisol deficiency seen in Addison’s disease. One of its primary effects is to increase blood glucose levels by stimulating gluconeogenesis and decreasing cellular glucose uptake. Therefore, the nurse must closely monitor serum glucose levels to identify potential hyperglycemia, especially in newly initiated therapy or clients with comorbid conditions like diabetes. Monitoring ensures proper dosing and helps prevent complications of excess corticosteroid activity.
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.
Based on the client’s assessment findings, which potential condition, nursing actions, and parameters to monitor are most appropriate for this client?
-
A. Potential Condition: Cataracts
Actions to Take: Apply moisturizing gel to the eyes; Call for an ophthalmological exam
Parameters to Monitor: Pupil size, Blink reflex -
B. Potential Condition: Strabismus
Actions to Take: Provide an eye patch; Orient the client to the environment
Parameters to Monitor: Visual acuity, Pupil size -
C. Potential Condition: Retinopathy
Actions to Take: Call for an ophthalmological exam; Avoid activities that increase intraocular pressure
Parameters to Monitor: Blood glucose, Intraocular pressure -
D. Potential Condition: Glaucoma
Actions to Take: Provide an eye patch; Apply moisturizing gel to the eyes
Parameters to Monitor: Visual acuity, Blink reflex
Explanation
The client’s poorly controlled diabetes (HbA1c 12.9%), combined with progressive vision loss and only being able to “see shadows,” is characteristic of diabetic retinopathy, a microvascular complication of chronic hyperglycemia. The nurse should call for an ophthalmological exam to assess retinal damage and avoid activities that raise intraocular pressure to prevent further retinal hemorrhage or detachment. Ongoing monitoring of blood glucose and intraocular pressure is essential to prevent further vision loss and systemic complications.
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.
A young adult client with osteoarthritis of both knees tells the nurse of the desire to continue daily walks in the park with friends. How should the nurse respond?
- A. Suggest a calcium supplement along with continued walking.
- B. Advise less weight bearing to prevent joint destruction.
- C. Recommend walking indoors for improved stability and safety.
- D. Encourage continued maintenance of the walking routine.
Explanation
Low-impact exercise, such as walking, is highly beneficial for clients with osteoarthritis (OA) because it helps maintain joint mobility, strengthen supporting muscles, and reduce stiffness and pain. The nurse should encourage the client to continue daily walks, emphasizing pacing, wearing supportive shoes, and avoiding uneven terrain when possible. Regular activity prevents further functional decline and promotes social and emotional well-being.
A client is admitted with a deep, productive cough, hemoptysis, and a low-grade fever. The client’s tuberculin skin test (TST) has a 15 mm induration. Which intervention should the nurse implement first?
- A. Collect a sputum specimen for acid-fast bacillus.
- B. Administer the initial dose of rifampin and isoniazid.
- C. Initiate airborne particulate isolation precautions.
- D. Provide a mask for the client to wear in public areas.
Explanation
The client’s symptoms—productive cough, hemoptysis, low-grade fever, and a positive TST (15 mm induration)—are highly suggestive of active tuberculosis (TB). The nurse’s first action is to initiate airborne isolation precautions immediately to prevent transmission of Mycobacterium tuberculosis to others. This includes placing the client in a negative pressure room and ensuring all healthcare personnel wear N95 respirators. Infection control always takes priority before diagnostic or treatment interventions.
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)?
- A. Inspect for distention of peripheral veins.
- B. Assess for inflammation of the calves.
- C. Observe for change in breathing pattern.
- D. 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.
The healthcare provider (HCP) prescribes penicillin G benzathine 1,800,000 units IM for a client with a bacterial infection. The prefilled syringe is labeled, penicillin G benzathine 1,200,000 units/2 mL. How many mL should the nurse administer to this client? (Enter numerical value only, rounded to the nearest whole number.)
- A 2
- B 3
- C 4
- D 6
Explanation
Concentration: 1,200,000 units per 2 mL ⇒ 600,000 units/mL.
Required dose: 1,800,000 units.
mL needed = 1,800,000 ÷ 600,000 = 3 mL (already a whole number).
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