HESI RN MED SURG ACTUAL EXAM
CONTAINS 125 QUESTIONS AND
CORRECT DETAILED ANSWERS
Q1. A 25-year-old client was admitted after a motor vehicle collision with a
basal skull fracture in the middle fossa. Assessment revealed both halo and
Battle signs. Which new symptom indicates the client is likely experiencing a
common life-threatening complication associated with a basal skull fracture?
A. Bilateral jugular venous distention
B. Oral temperature of 102°F
C. Intermittent focal motor seizures
D. Intractable pain in the cervical region
ANS: B. Oral temperature of 102°F
Rationale: Clients with basilar skull fractures are at high risk for infection of the
brain, as indicated by an increased oral temperature, because the fracture
leaves the meninges open to bacterial invasion. Clients may experience
options C and D, but these findings do not pose as great a life-threatening risk
as infection. Jugular distention is not a typical complication of basal skull
fractures.
Q2. A 43-year-old homeless, malnourished client with a history of alcoholism
is transferred to the ICU. The nurse palpates a heart rate of 160 beats/min
and the client's blood pressure is 90/54 mm Hg. Which IV medication should
the nurse administer?
A. Amiodarone (Cordarone)
B. Magnesium sulfate
C. Lidocaine (Xylocaine)
D. Procainamide (Pronestyl)
ANS: B. Magnesium sulfate
Rationale: The client with chronic alcoholism is likely to have
hypomagnesemia. Magnesium sulfate is the recommended drug for torsades
de pointes, which is a form of polymorphic ventricular tachycardia usually
associated with a prolonged QT interval that occurs with hypomagnesemia.
Options A and D increase the QT interval, which can cause the torsades to
worsen. Option C is the antiarrhythmic of choice in most cases of
drug-induced monomorphic VT, not torsades.
,Q3. A 55-year-old male client has been admitted with a medical diagnosis of
COPD. Which risk factor is the most significant in the development of this
client's COPD?
A. The client's father was diagnosed with COPD in his 50s
B. A close family member contracted tuberculosis last year
C. The client smokes one to two packs of cigarettes per day
D. The client has been 40 pounds overweight for 15 years
ANS: C. The client smokes one to two packs of cigarettes per day
Rationale: Smoking, considered to be a modifiable risk factor, is the most
significant risk factor for the development of COPD. The exact mechanism of
genetic and hereditary implications for the development of COPD is still under
investigation. Options B and D do not exceed the risks associated with
cigarette smoking in the development of COPD.
Q4. A 58-year-old client with no health problems asks the nurse about the
pneumococcal vaccine. Which statement by the nurse offers accurate
information?
A. The vaccine is given annually before the flu season to those older than 50
years
B. The immunization is administered once to older adults or those at risk for
illness
C. The vaccine is for all ages and is given primarily to those traveling
overseas to areas of infection
D. The vaccine will prevent the occurrence of pneumococcal pneumonia for
up to 5 years
ANS: B. The immunization is administered once to older adults or those at risk
for illness
Rationale: It is usually recommended that persons older than 65 years and
those with a history of chronic illness should receive the vaccine once in their
lifetime. Some recommend receiving the vaccine at 50 years of age. The
influenza vaccine is given once a year. Although the vaccine might be given to
a person traveling overseas, that is not the main rationale. The vaccine is
usually given once in a lifetime, but with immunosuppressed clients or clients
with a history of pneumonia, revaccination is sometimes required.
Q5. A 62-year-old woman who lives alone tripped on a scatter rug resulting in
a fractured hip. Which predisposing factor most likely contributed to the
fracture in the proximal end of her femur?
A. Failing eyesight resulting in an unsafe environment
B. Renal osteodystrophy resulting from chronic kidney disease (CKD)
,C. Osteoporosis resulting from declining hormone levels
D. Cerebral vessel changes causing transient ischemic attacks
ANS: C. Osteoporosis resulting from declining hormone levels
Rationale: The most common cause of a fractured hip in older women is
osteoporosis, resulting from reduced calcium in the bones as a result of
hormonal changes in the perimenopausal years. Option A may or may not
have contributed to the accident, but eye changes were not involved in
promoting the hip fracture. Option B is not a common condition of older people
but is associated with CKD. Although option D may result in TIAs or stroke, it
will not result in fragility of the bones, as does osteoporosis.
Q6. A 63-year-old client with type 2 diabetes is admitted for treatment of an
unhealed ulcer on the heel of the left foot. The nurse observes that the entire
left foot is darker in color than the right foot. Which additional symptom should
the nurse expect to find?
A. Pedal pulses will be weak or absent in the left foot
B. The client will state that the left foot is usually warm
C. Flexion and extension of the left foot will be limited
D. Capillary refill of the client's left toes will be brisk
ANS: A. Pedal pulses will be weak or absent in the left foot
Rationale: Symptoms associated with decreased blood supply are weak or
absent pedal and tibial pulses. The client with diabetes experiences vascular
scarring as a result of atherosclerotic changes in the peripheral vessels,
resulting in compromised perfusion to the dependent extremities, which further
delays wound healing. Options B and D are signs of adequate perfusion,
which would not be expected in this client.
Q7. A 74-year-old male client in the ICU with respiratory failure secondary to
pneumonia has ventilator settings of VT 750 mL and IMV rate of 10
breaths/min. ABG results: pH 7.48, PaCO2 30 mm Hg, PaO2 64 mm Hg,
HCO3 25 mEq/L, FiO2 0.80. Which action should the nurse take first?
A. Increase the ventilator VT to 850 mL
B. Decrease the ventilator IMV to a rate of 8 breaths/min
C. Reduce the FiO2 to 0.70 and redraw ABGs
D. Add 5 cm positive end-expiratory pressure (PEEP)
ANS: D. Add 5 cm positive end-expiratory pressure (PEEP)
Rationale: Adding PEEP helps improve oxygenation while reducing FiO2 to a
less toxic level. Options A, B, and C will not result in improved oxygenation
and could cause further complications for this client who is experiencing
respiratory failure.
, Q8. A 77-year-old client is admitted with confusion and anorexia of several
days' duration. Additional symptoms include nausea, vomiting, headache, and
a pulse rate of 43 beats/min. The nurse is most concerned about the client's
history related to which medication?
A. Warfarin
B. Ibuprofen
C. Nitroglycerin
D. Digoxin
ANS: D. Digoxin
Rationale: Older persons are particularly susceptible to the buildup of cardiac
glycosides, such as digoxin or digitoxin, to a toxic level in their systems.
Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and
fatigue. Options A, B, and C are unlikely to result in the symptoms described.
Q9. A central venous catheter has been inserted via a jugular vein and
confirmed by radiograph. A STAT medication has been ordered but IV fluids
have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular venous distention
B. Obtain the needed intravenous solution
C. Flush the line with heparinized solution
D. Flush the line with normal saline
ANS: D. Flush the line with normal saline
Rationale: Medication can be administered via a central line without additional
IV fluids. The line should first be flushed with a normal saline solution to
ensure patency. Insufficient evidence exists on the effectiveness of flushing
catheters with heparin. Option A will not affect the decision to administer the
medication and is not a priority. Administration of the STAT medication is of
greater priority than option B.
Q10. A client diagnosed with angina pectoris complains of chest pain while
ambulating in the hallway. Which action should the nurse take first?
A. Support the client to a sitting position
B. Ask the client to walk slowly back to the room
C. Administer a sublingual nitroglycerin tablet
D. Provide oxygen via nasal cannula
ANS: A. Support the client to a sitting position
Rationale: The nurse should safely assist the client to a resting position and
then perform options C and D. The client must cease all activity immediately,
CONTAINS 125 QUESTIONS AND
CORRECT DETAILED ANSWERS
Q1. A 25-year-old client was admitted after a motor vehicle collision with a
basal skull fracture in the middle fossa. Assessment revealed both halo and
Battle signs. Which new symptom indicates the client is likely experiencing a
common life-threatening complication associated with a basal skull fracture?
A. Bilateral jugular venous distention
B. Oral temperature of 102°F
C. Intermittent focal motor seizures
D. Intractable pain in the cervical region
ANS: B. Oral temperature of 102°F
Rationale: Clients with basilar skull fractures are at high risk for infection of the
brain, as indicated by an increased oral temperature, because the fracture
leaves the meninges open to bacterial invasion. Clients may experience
options C and D, but these findings do not pose as great a life-threatening risk
as infection. Jugular distention is not a typical complication of basal skull
fractures.
Q2. A 43-year-old homeless, malnourished client with a history of alcoholism
is transferred to the ICU. The nurse palpates a heart rate of 160 beats/min
and the client's blood pressure is 90/54 mm Hg. Which IV medication should
the nurse administer?
A. Amiodarone (Cordarone)
B. Magnesium sulfate
C. Lidocaine (Xylocaine)
D. Procainamide (Pronestyl)
ANS: B. Magnesium sulfate
Rationale: The client with chronic alcoholism is likely to have
hypomagnesemia. Magnesium sulfate is the recommended drug for torsades
de pointes, which is a form of polymorphic ventricular tachycardia usually
associated with a prolonged QT interval that occurs with hypomagnesemia.
Options A and D increase the QT interval, which can cause the torsades to
worsen. Option C is the antiarrhythmic of choice in most cases of
drug-induced monomorphic VT, not torsades.
,Q3. A 55-year-old male client has been admitted with a medical diagnosis of
COPD. Which risk factor is the most significant in the development of this
client's COPD?
A. The client's father was diagnosed with COPD in his 50s
B. A close family member contracted tuberculosis last year
C. The client smokes one to two packs of cigarettes per day
D. The client has been 40 pounds overweight for 15 years
ANS: C. The client smokes one to two packs of cigarettes per day
Rationale: Smoking, considered to be a modifiable risk factor, is the most
significant risk factor for the development of COPD. The exact mechanism of
genetic and hereditary implications for the development of COPD is still under
investigation. Options B and D do not exceed the risks associated with
cigarette smoking in the development of COPD.
Q4. A 58-year-old client with no health problems asks the nurse about the
pneumococcal vaccine. Which statement by the nurse offers accurate
information?
A. The vaccine is given annually before the flu season to those older than 50
years
B. The immunization is administered once to older adults or those at risk for
illness
C. The vaccine is for all ages and is given primarily to those traveling
overseas to areas of infection
D. The vaccine will prevent the occurrence of pneumococcal pneumonia for
up to 5 years
ANS: B. The immunization is administered once to older adults or those at risk
for illness
Rationale: It is usually recommended that persons older than 65 years and
those with a history of chronic illness should receive the vaccine once in their
lifetime. Some recommend receiving the vaccine at 50 years of age. The
influenza vaccine is given once a year. Although the vaccine might be given to
a person traveling overseas, that is not the main rationale. The vaccine is
usually given once in a lifetime, but with immunosuppressed clients or clients
with a history of pneumonia, revaccination is sometimes required.
Q5. A 62-year-old woman who lives alone tripped on a scatter rug resulting in
a fractured hip. Which predisposing factor most likely contributed to the
fracture in the proximal end of her femur?
A. Failing eyesight resulting in an unsafe environment
B. Renal osteodystrophy resulting from chronic kidney disease (CKD)
,C. Osteoporosis resulting from declining hormone levels
D. Cerebral vessel changes causing transient ischemic attacks
ANS: C. Osteoporosis resulting from declining hormone levels
Rationale: The most common cause of a fractured hip in older women is
osteoporosis, resulting from reduced calcium in the bones as a result of
hormonal changes in the perimenopausal years. Option A may or may not
have contributed to the accident, but eye changes were not involved in
promoting the hip fracture. Option B is not a common condition of older people
but is associated with CKD. Although option D may result in TIAs or stroke, it
will not result in fragility of the bones, as does osteoporosis.
Q6. A 63-year-old client with type 2 diabetes is admitted for treatment of an
unhealed ulcer on the heel of the left foot. The nurse observes that the entire
left foot is darker in color than the right foot. Which additional symptom should
the nurse expect to find?
A. Pedal pulses will be weak or absent in the left foot
B. The client will state that the left foot is usually warm
C. Flexion and extension of the left foot will be limited
D. Capillary refill of the client's left toes will be brisk
ANS: A. Pedal pulses will be weak or absent in the left foot
Rationale: Symptoms associated with decreased blood supply are weak or
absent pedal and tibial pulses. The client with diabetes experiences vascular
scarring as a result of atherosclerotic changes in the peripheral vessels,
resulting in compromised perfusion to the dependent extremities, which further
delays wound healing. Options B and D are signs of adequate perfusion,
which would not be expected in this client.
Q7. A 74-year-old male client in the ICU with respiratory failure secondary to
pneumonia has ventilator settings of VT 750 mL and IMV rate of 10
breaths/min. ABG results: pH 7.48, PaCO2 30 mm Hg, PaO2 64 mm Hg,
HCO3 25 mEq/L, FiO2 0.80. Which action should the nurse take first?
A. Increase the ventilator VT to 850 mL
B. Decrease the ventilator IMV to a rate of 8 breaths/min
C. Reduce the FiO2 to 0.70 and redraw ABGs
D. Add 5 cm positive end-expiratory pressure (PEEP)
ANS: D. Add 5 cm positive end-expiratory pressure (PEEP)
Rationale: Adding PEEP helps improve oxygenation while reducing FiO2 to a
less toxic level. Options A, B, and C will not result in improved oxygenation
and could cause further complications for this client who is experiencing
respiratory failure.
, Q8. A 77-year-old client is admitted with confusion and anorexia of several
days' duration. Additional symptoms include nausea, vomiting, headache, and
a pulse rate of 43 beats/min. The nurse is most concerned about the client's
history related to which medication?
A. Warfarin
B. Ibuprofen
C. Nitroglycerin
D. Digoxin
ANS: D. Digoxin
Rationale: Older persons are particularly susceptible to the buildup of cardiac
glycosides, such as digoxin or digitoxin, to a toxic level in their systems.
Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and
fatigue. Options A, B, and C are unlikely to result in the symptoms described.
Q9. A central venous catheter has been inserted via a jugular vein and
confirmed by radiograph. A STAT medication has been ordered but IV fluids
have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular venous distention
B. Obtain the needed intravenous solution
C. Flush the line with heparinized solution
D. Flush the line with normal saline
ANS: D. Flush the line with normal saline
Rationale: Medication can be administered via a central line without additional
IV fluids. The line should first be flushed with a normal saline solution to
ensure patency. Insufficient evidence exists on the effectiveness of flushing
catheters with heparin. Option A will not affect the decision to administer the
medication and is not a priority. Administration of the STAT medication is of
greater priority than option B.
Q10. A client diagnosed with angina pectoris complains of chest pain while
ambulating in the hallway. Which action should the nurse take first?
A. Support the client to a sitting position
B. Ask the client to walk slowly back to the room
C. Administer a sublingual nitroglycerin tablet
D. Provide oxygen via nasal cannula
ANS: A. Support the client to a sitting position
Rationale: The nurse should safely assist the client to a resting position and
then perform options C and D. The client must cease all activity immediately,
