HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
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.
The nurse is caring for a client with acute kidney injury (AKI). Which assessment finding warrants immediate intervention?
- Productive cough and fever.
- Dyspnea and sinus tachycardia.
- Reports of a bad taste in the mouth.
- Low, concentrated urine output.
Explanation
Dyspnea and sinus tachycardia indicate fluid overload and potential pulmonary edema, both of which are life-threatening complications of acute kidney injury (AKI). When the kidneys fail to excrete excess fluid, it accumulates in the vascular and pulmonary systems, leading to respiratory distress, hypoxia, and cardiac strain. Immediate intervention is required—such as oxygen administration, diuretics (if indicated), or dialysis—to prevent respiratory or cardiac failure.
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?
- Collect a sputum specimen for acid-fast bacillus.
- Administer the initial dose of rifampin and isoniazid.
- Initiate airborne particulate isolation precautions.
- 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.
Select the 3 areas of teaching that should be included when providing education to the client with symptomatic benign prostate hyperplasia.
- A Avoid cough or cold remedies that contain pseudoephedrine or phenylephrine.
- B Urinate every 4 to 6 hours or when you first feel the urge.
- C Refrain from exercise because it can lead to incontinence.
- D Limit your intake of alcohol and caffeine.
- E Schedule yearly prostate-specific antigen blood test.
- 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 reports that a client is at risk for a stroke based on which assessment finding?
- Jugular vein distention
- Carotid bruit
- Nuchal rigidity
- 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 with sickle cell anemia develops a fever during the last hour of administration of a unit of packed red blood cells (PRBCs). When notifying the healthcare provider (HCP), which information should the nurse provide first using the situation, background, assessment, and recommendation (SBAR) communication process?
- Explain specific reason for urgent notification.
- Communicate the pretransfusion temperatures.
- Obtain a PRN prescription for acetaminophen for fever over 101°F (38.3°C).
- Begin the report by stating the client's name and admitting diagnosis.
Explanation
When using the SBAR communication framework, the Situation portion begins with identifying the client by name, age, and admitting diagnosis to ensure clarity and accuracy before describing the urgent issue. This introduction sets the context for the HCP to understand who the client is and why they are hospitalized. After identification, the nurse should describe the specific reason for the call—in this case, a fever during a PRBC transfusion, which may indicate a transfusion reaction.
The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?
- Bounding peripheral pulse.
- Uneven hair distribution.
- Bronze pigmentation.
- Lower leg edema.
Explanation
Uneven hair distribution on the lower extremities is a key indicator of peripheral arterial disease (PAD). Compromised arterial circulation leads to reduced oxygen and nutrient delivery to tissues, resulting in hair loss, thin, shiny skin, cool temperature, and weak or absent peripheral pulses. This occurs because chronic ischemia impairs hair follicle and skin integrity, often appearing first on the shins and feet.
The nurse assesses an adult client 24 hours following abdominal surgery and finds the client's blood pressure is 98/40 mm Hg. The client is tachycardic, restless, and irritable. Which action should the nurse perform first?
- Check under the back for evidence of bleeding.
- Ensure the IV solution is infusing at the prescribed rate.
- Listen to lung sounds.
- Notify the healthcare provider of the findings.
Explanation
The client’s low blood pressure, tachycardia, and restlessness indicate early hypovolemic shock, most likely due to postoperative internal bleeding. The nurse’s first action is to assess for active bleeding, especially under the client’s back, as blood may pool beneath them and go unnoticed. Identifying and stopping the source of bleeding is the priority before notifying the provider or taking secondary actions.
A client who works at a computer most of the working day comes to the clinic reporting pain in both hands that causes the client to awake during the night. Which action should the nurse implement to assess for carpal tunnel syndrome?
- Apply firm pressure over the ulnar artery.
- Tap the client's wrists to locate the pain.
- Compare the capillary refill in the hands.
- Determine the client's sleeping position.
Explanation
Tapping the client’s wrists directly over the median nerve is known as Tinel’s sign, a common assessment technique for carpal tunnel syndrome. A positive Tinel’s sign occurs when the client reports tingling, numbness, or pain radiating into the fingers, confirming compression or irritation of the median nerve. This condition often results from repetitive hand movements, such as long hours of computer use, leading to inflammation and nerve entrapment.
The nurse is caring for a client with herpes zoster virus who reports painful, red, blisters that align from the back along the chest's curvature to the anterior chest. Which intervention is the highest priority for the nurse?
- Place wet compresses to ruptured vesicles.
- Administer antiviral medications.
- Administer narcotic analgesics.
- Place the client on contact precautions.
Explanation
Early initiation of antivirals (e.g., acyclovir, valacyclovir, famciclovir) within 72 hours of rash onset is the top priority because it reduces viral replication, shortens disease duration, decreases acute pain, and lowers the risk of postherpetic neuralgia and complications. While pain control and precautions matter, promptly starting antivirals most directly alters the disease course and long-term outcomes.
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