HESI MED SURG PRACTICE MODE NAXLEX QUESTIONS
AND CORRECT ANSWERS|GRADED A+ |VERIFIED
ANSWERS
Lactulose was prescribed two days ago for a client who was recently
diagnosed with hepatic encephalopathy. The client is confused and
experiencing frequent loose stools. Laboratory findings show an
elevated serum ammonia (NH) level of 220 μg/dL (157.1 μmol/dL).
Which action should the nurse take? Reference Range: Ammonia [10 to
80 μg/dL (6 to 47 μmol/L)]
A Hold the next dose of lactulose.
B Continue the prescribed dose of lactulose.
C Replace total volume voided with oral or IV fluids.
D Report the number of diarrhea stools to the healthcare provider
(HCP). Correct Answers B Continue the prescribed dose of lactulose.
Lactulose works by acidifying the colonic contents, which promotes the
conversion of ammonia (NH3) to ammonium (NH4+). Ammonium is
less readily absorbed from the colon into the bloodstream, reducing
systemic ammonia levels. This action helps alleviate the neurotoxic
effects of ammonia on the brain, thereby improving neurological
symptoms associated with hepatic encephalopathy
The nurse is obtaining the admission history for a client with suspected
peptic ulcer disease (PUD). Which subjective data reported by the client
supports this disease process?
A Severe abdominal cramps and diarrhea after eating spicy foods.
B Frequent use of chewable and liquid antacids for indigestion.
,C Upper mid abdominal pain described as gnawing and burning.
D Marked loss of weight and appetite over the last 3 or 4 months
Correct Answers C Upper mid abdominal pain described as gnawing
and burning.
Peptic ulcer disease involves the formation of open sores in the lining of
the stomach or the duodenum. The characteristic symptom of PUD is
abdominal pain, typically located in the upper mid abdomen. This pain
is often described as gnawing, burning, or aching in nature. The pain
may occur shortly after eating, especially when the stomach is empty
(gastric ulcer), or it may occur 2-3 hours after eating, typically at night
(duodenal ulcer).
A client with benign prostatic hyperplasia (BPH) is preparing for
discharge following a transurethral needle ablation (TUNA). Which
information should the nurse include in the discharge instructions?
A Restrict physical activities.
B Use incentive spirometer.
C Report when hematuria becomes pink tinged.
D Monitor urinary stream for decrease in output. Correct Answers D
Monitor urinary stream for decrease in output.
After TUNA, clients need to be vigilant about their urinary output
because a decrease can indicate complications such as re-obstruction,
which is a significant concern following the procedure. Monitoring
urinary stream is essential for detecting potential issues early, making
this the best choice for discharge instructions.
,The nurse is caring for a client receiving thrombolytic therapy following
an acute myocardial infarction (MI). Which nursing problem should the
nurse identify as priority for this client?
A Risk for injury related to effects of thrombolysis.
B Activity intolerance related to ischemia.
C Ineffective breathing pattern related to adverse drug effects.
D Deficient knowledge related to a new medication regimen. Correct
Answers A Risk for injury related to effects of thrombolysis.
Clients receiving thrombolytic therapy are at an increased risk of
bleeding, which can manifest as internal bleeding, hemorrhage at
vascular access sites, gastrointestinal bleeding, or intracranial bleeding.
The nurse's priority is to closely monitor the client for signs and
symptoms of bleeding, such as sudden onset or worsening of headache,
changes in level of consciousness, hematuria, melena, ecchymosis, or
hematoma formation.
The nurse is caring for a client who had an appendectomy 4 hours ago.
Which finding requires immediate action by the nurse?
A High-pitched sound heard upon inspiration.
B Apical heart rate of 100 to 110 beats/minute.
C Redness and edema noted at the incision site.
D Pain rating of 8 on a scale of 0 to 10. Correct Answers A High-
pitched sound heard upon inspiration.
, A high-pitched sound heard upon inspiration, known as a "stridor," can
indicate airway obstruction or respiratory distress. In the postoperative
period following an appendectomy, airway patency and adequate
ventilation are essential for the client's oxygenation and recovery
An adult client newly diagnosed with left ventricular dysfunction is
admitted to the hospital with fine rales and wheezing. When assessing
this client, which additional finding is the nurse likely to obtain?
A Fatigue.
B Lower extremity edema.
C Hepatomegaly.
D Jugular vein distension. Correct Answers A Fatigue.
Left ventricular dysfunction leads to inadequate stroke volume and
cardiac output to the systemic circulation. This leads to fatigue and
exertional dyspnea.
A client with a right ulnar fracture and cast placement reports an
increase in arm pain. Which action should the nurse take next?
A Implement distraction techniques.
B Assess right radial pulse volume.
C Administer a PRN analgesic.
D Measure the blood pressure. Correct Answers B Assess right radial
pulse volume.
AND CORRECT ANSWERS|GRADED A+ |VERIFIED
ANSWERS
Lactulose was prescribed two days ago for a client who was recently
diagnosed with hepatic encephalopathy. The client is confused and
experiencing frequent loose stools. Laboratory findings show an
elevated serum ammonia (NH) level of 220 μg/dL (157.1 μmol/dL).
Which action should the nurse take? Reference Range: Ammonia [10 to
80 μg/dL (6 to 47 μmol/L)]
A Hold the next dose of lactulose.
B Continue the prescribed dose of lactulose.
C Replace total volume voided with oral or IV fluids.
D Report the number of diarrhea stools to the healthcare provider
(HCP). Correct Answers B Continue the prescribed dose of lactulose.
Lactulose works by acidifying the colonic contents, which promotes the
conversion of ammonia (NH3) to ammonium (NH4+). Ammonium is
less readily absorbed from the colon into the bloodstream, reducing
systemic ammonia levels. This action helps alleviate the neurotoxic
effects of ammonia on the brain, thereby improving neurological
symptoms associated with hepatic encephalopathy
The nurse is obtaining the admission history for a client with suspected
peptic ulcer disease (PUD). Which subjective data reported by the client
supports this disease process?
A Severe abdominal cramps and diarrhea after eating spicy foods.
B Frequent use of chewable and liquid antacids for indigestion.
,C Upper mid abdominal pain described as gnawing and burning.
D Marked loss of weight and appetite over the last 3 or 4 months
Correct Answers C Upper mid abdominal pain described as gnawing
and burning.
Peptic ulcer disease involves the formation of open sores in the lining of
the stomach or the duodenum. The characteristic symptom of PUD is
abdominal pain, typically located in the upper mid abdomen. This pain
is often described as gnawing, burning, or aching in nature. The pain
may occur shortly after eating, especially when the stomach is empty
(gastric ulcer), or it may occur 2-3 hours after eating, typically at night
(duodenal ulcer).
A client with benign prostatic hyperplasia (BPH) is preparing for
discharge following a transurethral needle ablation (TUNA). Which
information should the nurse include in the discharge instructions?
A Restrict physical activities.
B Use incentive spirometer.
C Report when hematuria becomes pink tinged.
D Monitor urinary stream for decrease in output. Correct Answers D
Monitor urinary stream for decrease in output.
After TUNA, clients need to be vigilant about their urinary output
because a decrease can indicate complications such as re-obstruction,
which is a significant concern following the procedure. Monitoring
urinary stream is essential for detecting potential issues early, making
this the best choice for discharge instructions.
,The nurse is caring for a client receiving thrombolytic therapy following
an acute myocardial infarction (MI). Which nursing problem should the
nurse identify as priority for this client?
A Risk for injury related to effects of thrombolysis.
B Activity intolerance related to ischemia.
C Ineffective breathing pattern related to adverse drug effects.
D Deficient knowledge related to a new medication regimen. Correct
Answers A Risk for injury related to effects of thrombolysis.
Clients receiving thrombolytic therapy are at an increased risk of
bleeding, which can manifest as internal bleeding, hemorrhage at
vascular access sites, gastrointestinal bleeding, or intracranial bleeding.
The nurse's priority is to closely monitor the client for signs and
symptoms of bleeding, such as sudden onset or worsening of headache,
changes in level of consciousness, hematuria, melena, ecchymosis, or
hematoma formation.
The nurse is caring for a client who had an appendectomy 4 hours ago.
Which finding requires immediate action by the nurse?
A High-pitched sound heard upon inspiration.
B Apical heart rate of 100 to 110 beats/minute.
C Redness and edema noted at the incision site.
D Pain rating of 8 on a scale of 0 to 10. Correct Answers A High-
pitched sound heard upon inspiration.
, A high-pitched sound heard upon inspiration, known as a "stridor," can
indicate airway obstruction or respiratory distress. In the postoperative
period following an appendectomy, airway patency and adequate
ventilation are essential for the client's oxygenation and recovery
An adult client newly diagnosed with left ventricular dysfunction is
admitted to the hospital with fine rales and wheezing. When assessing
this client, which additional finding is the nurse likely to obtain?
A Fatigue.
B Lower extremity edema.
C Hepatomegaly.
D Jugular vein distension. Correct Answers A Fatigue.
Left ventricular dysfunction leads to inadequate stroke volume and
cardiac output to the systemic circulation. This leads to fatigue and
exertional dyspnea.
A client with a right ulnar fracture and cast placement reports an
increase in arm pain. Which action should the nurse take next?
A Implement distraction techniques.
B Assess right radial pulse volume.
C Administer a PRN analgesic.
D Measure the blood pressure. Correct Answers B Assess right radial
pulse volume.
