HESI MED SURG EXIT EXAM
1. While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth
on the client's legs. What additional assessment provides further data to support this
finding?
a. Palpate for the presence of femoral pulses bilaterally.
b. Assess for the presence of a positive Homan's sign.
c. Observe the appearance of the skin on the client's legs.
d. Watch the client's posture and balance during ambulation ( CORRECT ANSWER: ) ANS: C
Signs of chronic arterial insufficiency include decreased hair growth in the legs and feet,
absent or decreased pedal pulses, infection in the foot, poor wound healing, thickened nails,
and a shiny appearance of the skin (C). Femoral pulses (A) should still be palpable in the
diabetic with chronic arterial insufficiency. A positive Homan's sign is an indicator of deep
vein thrombosis (B). (D) would probably not be affected significantly by chronic arterial
insufficiency.
2. The healthcare provider prescribes 15 mg/kg of Streptomycin for an infant weighing 4 pounds.
,The drug is diluted in 25 ml of D5W to run over 8 hours. How much Streptomycin will the
infant receive?
a. 9 mg.
b. 18 mg.
c. 27 mg.
d. 36 mg ( CORRECT ANSWER: ) ANS: C
4 lbs / 2.2 = 1.8 kg. 1.8 x 15 = 27 mg (C).
NOTE, the fact that the drug is diluted in 25 ml of D5W, is not relevant to the calculation
requested
In assessing a client with preeclampsia who is receiving magnesium sulfate, the nurse
determines that her deep tendon reflexes are 1+; respiratory rate is 12 breaths/minute;
urinary output is 90 ml in 4 hours; magnesium sulfate level is 9 mg/dl. Based on these
findings, what intervention should the nurse implement?
a. Continue the magnesium sulfate infusion as prescribed.
b. Decrease the magnesium sulfate infusion by one-half.
c. Stop the magnesium sulfate infusion immediately.
d. Administer calcium gluconate immediately. ( CORRECT ANSWER: ) ANS: C
The client is exhibiting symptoms of magnesium sulfate toxicity--decreased reflexes (normal is
+2), a low normal respiratory rate (normal is 12 to 20 breaths/min), a less than average
urinary output (30 ml/hour is average), and a low magnesium sulfate level (normal is 4 to
8mg/dl). Based on these findings, the nurse should stop the infusion (C). (A) is
contraindicated. (B) would not fully alleviate the magnesium sulfate toxicity symptoms. (D)
(the antagonist for magnesium sulfate) would be indicated if the respiratory rate were less
than 12 breaths/minute.
A client is on a mechanical ventilator. Which client response indicates that the neuromuscular
,blocker tubocurarine chloride (Tubarine) is effective?
a. The client's expremities are paralyzed.
b. The peripheral nerve stimulator causes twitching.
c. The client clinches fist upon command.
d. The client's Glagow Coma Scale score is 14 ( CORRECT ANSWER: ) ANS: A
This medication causes paralysis (A) following intravenous injection. Peak effects persist for
35 to 60 minutes. (B and C) would not be possible if the medication is effective. The Glasgow
coma scale is used to evaluate the neurological status of the client and does not evaluate the
effectiveness (D) of this medication.
5. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse
that she has increased her daily doses of acetaminophen (Tylenol) for the past month to
control joint pain. Based on this client's comment, what previous lab values should the nurse
compare with today's lab report?
a. Look at last quarter's hemoglobin and hematocrit, expecting an increase today due
to dehydration.
b. Look for an increase in today's LDH compared to the previous one to assess
for possible liver damage. c. Expect to find an increase in today's APTT as compared to last
quarter's due
to bleeding.
d. Determine if there is a decrease in serum potassium due to renal compromise. ( CORRECT
ANSWER: ) ANS: B
Frequent and/or large doses of acetaminophen can cause an increase in liver enzymes,
indicating possible liver damage (B). If the client reported unusual bleeding, or an increase in
aspirin usage, it would be important for the nurse to assess for increased bleeding and monitor
(A and/or C). (D) is not affected by increases in acetaminophen doses.
6. Aspirin is prescribed for a 9-year-old child with rheumatic fever to control the inflammatory
, process, promote comfort, and reduce fever. What intervention is most important for the
nurse to implement?
a. Instruct the parents to hold the aspirin until the child has first had a tepid sponge
bath.
b. Administer the aspirin with at least two ounces of water or juice.
c. Notify the healthcare provider if the child complains of ringing in the ears.
d. Advise the parents to question the child about seeing yellow halos around objects (
CORRECT ANSWER: ) ANS: C
Ringing in the ears (tinnitus) (C) is an important sign of aspirin overdosage and should be
reported immediately. Though a tepid sponge bath may lower the child's temperature, the
prescription for aspirin should not be held (A). Aspirin should be taken with at least eight
ounces of water to completely wash the tablet into the stomach and to help prevent GI
discomfort (B). Yellow halos are associated with Digoxin toxicity, not aspirin (D)
7. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's
syndrome?
a. Husky voice and complaints of hoarseness.
b. Warm, soft, moist, salmon-colored skin.
c. Visible swelling of the neck, with no pain.
d. Central-type obesity, with thin extremities. ( CORRECT ANSWER: ) ANS: D
The classic picture of Cushing's syndrome in the adult is central-type obesity with thin
extremities (D), along with a "buffalo hump" in the supraclavicular area, heavy trunk, and
thin fragile skin. The symptoms described in (A) are clinical manifestations of
hypothyroidism, and in (B) of hyperthyroidism. (C) may indicate a goiter or a tumor of the
thyroid gland
8. A charge nurse agrees to cover another nurse's assignment during a lunch break. Based on the
1. While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth
on the client's legs. What additional assessment provides further data to support this
finding?
a. Palpate for the presence of femoral pulses bilaterally.
b. Assess for the presence of a positive Homan's sign.
c. Observe the appearance of the skin on the client's legs.
d. Watch the client's posture and balance during ambulation ( CORRECT ANSWER: ) ANS: C
Signs of chronic arterial insufficiency include decreased hair growth in the legs and feet,
absent or decreased pedal pulses, infection in the foot, poor wound healing, thickened nails,
and a shiny appearance of the skin (C). Femoral pulses (A) should still be palpable in the
diabetic with chronic arterial insufficiency. A positive Homan's sign is an indicator of deep
vein thrombosis (B). (D) would probably not be affected significantly by chronic arterial
insufficiency.
2. The healthcare provider prescribes 15 mg/kg of Streptomycin for an infant weighing 4 pounds.
,The drug is diluted in 25 ml of D5W to run over 8 hours. How much Streptomycin will the
infant receive?
a. 9 mg.
b. 18 mg.
c. 27 mg.
d. 36 mg ( CORRECT ANSWER: ) ANS: C
4 lbs / 2.2 = 1.8 kg. 1.8 x 15 = 27 mg (C).
NOTE, the fact that the drug is diluted in 25 ml of D5W, is not relevant to the calculation
requested
In assessing a client with preeclampsia who is receiving magnesium sulfate, the nurse
determines that her deep tendon reflexes are 1+; respiratory rate is 12 breaths/minute;
urinary output is 90 ml in 4 hours; magnesium sulfate level is 9 mg/dl. Based on these
findings, what intervention should the nurse implement?
a. Continue the magnesium sulfate infusion as prescribed.
b. Decrease the magnesium sulfate infusion by one-half.
c. Stop the magnesium sulfate infusion immediately.
d. Administer calcium gluconate immediately. ( CORRECT ANSWER: ) ANS: C
The client is exhibiting symptoms of magnesium sulfate toxicity--decreased reflexes (normal is
+2), a low normal respiratory rate (normal is 12 to 20 breaths/min), a less than average
urinary output (30 ml/hour is average), and a low magnesium sulfate level (normal is 4 to
8mg/dl). Based on these findings, the nurse should stop the infusion (C). (A) is
contraindicated. (B) would not fully alleviate the magnesium sulfate toxicity symptoms. (D)
(the antagonist for magnesium sulfate) would be indicated if the respiratory rate were less
than 12 breaths/minute.
A client is on a mechanical ventilator. Which client response indicates that the neuromuscular
,blocker tubocurarine chloride (Tubarine) is effective?
a. The client's expremities are paralyzed.
b. The peripheral nerve stimulator causes twitching.
c. The client clinches fist upon command.
d. The client's Glagow Coma Scale score is 14 ( CORRECT ANSWER: ) ANS: A
This medication causes paralysis (A) following intravenous injection. Peak effects persist for
35 to 60 minutes. (B and C) would not be possible if the medication is effective. The Glasgow
coma scale is used to evaluate the neurological status of the client and does not evaluate the
effectiveness (D) of this medication.
5. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse
that she has increased her daily doses of acetaminophen (Tylenol) for the past month to
control joint pain. Based on this client's comment, what previous lab values should the nurse
compare with today's lab report?
a. Look at last quarter's hemoglobin and hematocrit, expecting an increase today due
to dehydration.
b. Look for an increase in today's LDH compared to the previous one to assess
for possible liver damage. c. Expect to find an increase in today's APTT as compared to last
quarter's due
to bleeding.
d. Determine if there is a decrease in serum potassium due to renal compromise. ( CORRECT
ANSWER: ) ANS: B
Frequent and/or large doses of acetaminophen can cause an increase in liver enzymes,
indicating possible liver damage (B). If the client reported unusual bleeding, or an increase in
aspirin usage, it would be important for the nurse to assess for increased bleeding and monitor
(A and/or C). (D) is not affected by increases in acetaminophen doses.
6. Aspirin is prescribed for a 9-year-old child with rheumatic fever to control the inflammatory
, process, promote comfort, and reduce fever. What intervention is most important for the
nurse to implement?
a. Instruct the parents to hold the aspirin until the child has first had a tepid sponge
bath.
b. Administer the aspirin with at least two ounces of water or juice.
c. Notify the healthcare provider if the child complains of ringing in the ears.
d. Advise the parents to question the child about seeing yellow halos around objects (
CORRECT ANSWER: ) ANS: C
Ringing in the ears (tinnitus) (C) is an important sign of aspirin overdosage and should be
reported immediately. Though a tepid sponge bath may lower the child's temperature, the
prescription for aspirin should not be held (A). Aspirin should be taken with at least eight
ounces of water to completely wash the tablet into the stomach and to help prevent GI
discomfort (B). Yellow halos are associated with Digoxin toxicity, not aspirin (D)
7. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's
syndrome?
a. Husky voice and complaints of hoarseness.
b. Warm, soft, moist, salmon-colored skin.
c. Visible swelling of the neck, with no pain.
d. Central-type obesity, with thin extremities. ( CORRECT ANSWER: ) ANS: D
The classic picture of Cushing's syndrome in the adult is central-type obesity with thin
extremities (D), along with a "buffalo hump" in the supraclavicular area, heavy trunk, and
thin fragile skin. The symptoms described in (A) are clinical manifestations of
hypothyroidism, and in (B) of hyperthyroidism. (C) may indicate a goiter or a tumor of the
thyroid gland
8. A charge nurse agrees to cover another nurse's assignment during a lunch break. Based on the
