HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
The nurse observes an increased number of blood clots in the drainage tubing of a client with continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which is the best initial nursing action?
- Increase the flow of the bladder irrigation.
- Provide additional oral fluid intake.
- Measure the client’s intake and output.
- Administer a PRN dose of an antispasmodic agent.
Explanation
After a TURP, continuous bladder irrigation (CBI) is used to prevent clot formation and maintain catheter patency. When the nurse observes an increased number of blood clots, it suggests that the irrigation is not flowing fast enough to keep the bladder free of clots. The best initial action is to increase the irrigation flow rate to help clear existing clots and prevent obstruction, which could cause bladder distention, pain, or bleeding.
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.
After two days of the cardiovascular intensive care unit (CV-ICU), the client is transferred k the telemetry floor. The floor nurse is preparing a plan of care (POC) for the client.
Which modifiable risk factor(s) should the nurse include in the teaching for this client? Select all that apply.
- Male gender
- Obesity
- Tobacco use
- Family history
- Hypertension
- Coronary artery disease
- Age
- High cholesterol
Explanation
B. Obesity
The client’s body mass index (BMI) of 32.2 kg/m² classifies him as obese, which is a significant modifiable risk factor for atherosclerosis and aneurysm progression. Weight reduction through diet modification and exercise can improve cardiovascular health and reduce strain on the aortic wall.
C. Tobacco use
The client’s 20-year smoking history increases the risk of aneurysm formation, rupture, and poor vascular healing. Smoking causes endothelial damage and promotes atherosclerosis, making smoking cessation one of the most effective interventions to improve vascular outcomes.
E. Hypertension
Chronic high blood pressure contributes to weakening of the arterial wall, leading to aneurysm expansion and risk of rupture. Maintaining blood pressure within normal limits through lifestyle changes and antihypertensive therapy is crucial in preventing further vascular damage.
H. High cholesterol
The client’s hyperlipidemia promotes plaque buildup in arteries, reducing elasticity and increasing the risk of aneurysm and cardiovascular events. Teaching should emphasize dietary management, adherence to statin therapy, and routine lipid monitoring to reduce this risk.
When caring for a client with nephrotic syndrome, which assessment is most important for the nurse to obtain?
- Vital signs.
- Bowel sounds.
- Daily weight.
- 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 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?
- Record the observations and check the limb every 15 minutes.
- Notify the healthcare provider of the assessment findings.
- Release the traction and notify the healthcare provider.
- 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 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.
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?
- Suggest a calcium supplement along with continued walking.
- Advise less weight bearing to prevent joint destruction.
- Recommend walking indoors for improved stability and safety.
- 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.
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.
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?
- 48 gtt/min
- 56 gtt/min
- 62 gtt/min
- 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.
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.
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