HESI RN Medical-Surgical NGN
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Free HESI RN Medical-Surgical NGN Questions
The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?
- A. Platelet count.
- B. White blood cell count.
- C. Red blood cell count.
- D. 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.
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.
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).
A client with draining skin lesions of the lower extremity is admitted with possible methicillin-resistant Staphylococcus aureus (MRSA). Which nursing intervention(s) should the nurse include in the plan of care (POC)? Select all that apply.
- A. Explain the purpose of a low bacteria diet.
- B. Use standard precautions and wear a mask.
- C. Monitor the client’s white blood cell (WBC) count.
- D. Institute contact precautions for staff and visitors.
- E. Send wound drainage for culture and sensitivity.
Explanation
C. Monitor the client’s white blood cell (WBC) count
An elevated WBC count may indicate a systemic infection or worsening of a localized MRSA infection. Ongoing monitoring helps evaluate the client’s response to therapy and detect sepsis early, guiding adjustments in antibiotic treatment.
D. Institute contact precautions for staff and visitors
MRSA is spread primarily through direct contact with infected wounds or contaminated surfaces. The nurse must initiate contact precautions—use of gloves, gown, and proper hand hygiene—to prevent transmission to other clients and healthcare workers.
E. Send wound drainage for culture and sensitivity
Obtaining a culture and sensitivity test confirms the presence of MRSA and determines the most effective antibiotic therapy. This diagnostic step is essential for targeted treatment and infection control.
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 diagnostic tests for a client whose chest x-ray indicates pneumonia. Which diagnostic test should the nurse review for implementation in the most therapeutic treatment of the pneumonia?
- A. Sputum culture and sensitivity
- B. Arterial blood gas (ABG)
- C. Blood cultures
- D. Computerized tomography (CT) of the chest
Explanation
A sputum culture and sensitivity identifies the specific organism causing the pneumonia and determines which antibiotics are most effective against it. This information guides targeted antimicrobial therapy, ensuring the client receives the most therapeutic and appropriate treatment rather than broad-spectrum antibiotics alone. Accurate identification of the pathogen improves outcomes, prevents antibiotic resistance, and promotes recovery.
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?
- A. Place wet compresses to ruptured vesicles.
- B. Administer antiviral medications.
- C. Administer narcotic analgesics.
- D. 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.
A client is recovering from an episode of urinary tract calculi. During discharge teaching, the client asks about dietary restrictions. In discussing fluid intake, the nurse should include which type of fluid limitation?
- A. Citrus fruit juices.
- B. Overall fluid intake.
- C. Low sodium soups.
- D. Tea and hot chocolate.
Explanation
Tea and hot chocolate should be limited because they are high in oxalates, which can contribute to the formation of calcium oxalate kidney stones, the most common type of urinary tract calculi. Clients with a history of stones should avoid or minimize foods and beverages rich in oxalates while maintaining adequate hydration to prevent stone recurrence. Encouraging fluids low in oxalate content, such as water, is preferred.
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?
- A. Has intestinal polyps.
- B. Is excessively exposed to sunlight.
- C. Smokes cigars.
- D. 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.
Select the 4 assessment findings that require immediate follow up.
- A Temperature 100.8° F (38.2° C) orally
- B Feels anxious
- C Radial and pedal pulses 2+
- D Heart rate 121 beats/minute
- E Severe abdominal pain in right lower quadrant
- F Blood pressure 115/76 mm Hg
- G Respirations 28 breaths/minute with shallow breathing
- H Vomiting small amounts of green bile
- I Capillary refill 2 seconds
Explanation
D. Heart rate 121 beats/minute
Tachycardia can signal systemic infection, sepsis, or early hypovolemia related to an intra-abdominal process such as appendicitis or perforation. This finding requires immediate evaluation to prevent deterioration.
E. Severe abdominal pain in right lower quadrant
Acute right lower quadrant pain is characteristic of appendicitis or another surgical emergency (e.g., ovarian torsion, ectopic pregnancy). The intensity and sudden onset demand prompt diagnostic testing and surgical consultation.
G. Respirations 28 breaths/minute with shallow breathing
Tachypnea indicates pain, anxiety, fever, or metabolic acidosis. In this context, shallow respirations may also reflect guarding due to peritoneal irritation—an urgent sign of a potentially life-threatening intra-abdominal process.
H. Vomiting small amounts of green bile
Bilious vomiting suggests intestinal obstruction or severe gastrointestinal inflammation. This can quickly lead to dehydration and electrolyte imbalance and requires immediate evaluation and supportive care.
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