HESI MEDSURG 2020 EXAM- LATEST STUDY GUIDE
1. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection
the previous day and note that 1000 ml of gastric secretions were collected in the last 4 hours.
a. Metabolic alkalosis
b. Hyperkalemia
c. Metabolic acidosis
d. Hypoglycemia
2. A young client who is being taught to use an inhaler for symptoms of asthma tells the nurse the intention
to use the inhaler but, plans to continue smoking cigarettes in evaluating the client’s response, what is
the best initial action by the nurse?
a. Inform the health care provider of this statement made by the client.
b. Explain that denial of illness can interfere with the treatment regimen.
c. Revise the plan of care based on the client’s plans to continue
smoking. d. Review factors surrounding client’s beliefs about smoking
cessation.
3. A client with sudden onset of big toe joint pain and swelling is diagnosed with gout. Which
pathophysiologic process is producing the symptoms of gout?
a. An immune complex and autoantibody deposition in connective tissue results in inflammation.
b. Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation.
c. An autoimmune inflammation involving IgG response to an antigen causes joint destruction.
d. Deposition of crystals in the synovial space of the joint produce inflammation and irritation.
4. An older female client has normal saline infusing at 45ml/hour. She complains of pain the insertion site
of the IV catheter. There is no redness or edema around the IV site. Which action should the nurse
take?
a. Determine what IV medications have recently been administered.
b. Explain that without redness or edema, there is no need to re-start the IV.
c. Consult with the healthcare provider about the best localization to start a new IV.
d. Convert the IV to a saline lock and continue to monitor the site.
5. While assessing a female client who is chronically fatigued and was recently diagnosed with adrenal
insufficiency, the client tells the nurse that she is very nervous that her hospitalization will cause her
to lose her job. Which intervention should the nurse implement first?
a. Teach client about risk for infection.
b. Offer support and care measure to reduce anxiety and stress.
c. Encourage the client to rest quietly to reduce fatigue.
d. Place a referral to social service to discuss financial options.
6. The nurse is collecting information from a client with chronic pancreatitis who report persistent gnawing
abdominal pain. To help the client manage the pain. Which assessment data is most important for the
nurse to obtain?
a. Color and consistency of feces.
b. Eating patterns and dietary intake.
c. Presence and activity of bowel sounds.
d. Level and amount of physical activity.
,7. A young adult client, admitted to the Emergency Department following a motor vehicle collision, is
transfused with 4 unit of PRBCs (packed red blood cells). The client’s pretransfusion hematocrit is
17%. Which hematocrit value should the nurse expect the client to have after all the PRBCs have been
transfused?
a. 19%
b. 9%
c. 39%
d. 29%
8. A client admitted with left-sided heart failure has a heart rate of 110 beats per minute and is becoming
increasing dyspneic. Which additional assessment finding by the nurse support the client’s admitting
diagnosis?
a. An enlarged, distended abdomen.
b. Crackles in the bases of both lungs.
c. Jugular vein distension.
d. Peripheral edema.
9. When planning care for a client newly diagnosed with open angle glaucoma, the nurse identifies a
priority nursing problem of “visual sensory/perceptual alterations”. This problem is based on which
etiology?
a. Blurred distance vision.
b. Limited eye movement.
c. Decreased peripheral vision
d. Photosensitivity.
10. A postoperative client report incisional pain. The client has two prescriptions for PRN analgesia that
accompanied the client from the post anesthesia unit. Before selecting which medication to
administer, which action should the nurse implement?
a. Determine which prescription will have the quickest onset of action.
b. Compare the client’s pain scale rating with the prescribed dosing.
c. Ask the client to choose which medication is needed for the pain.
d. Document the client’s report of pain in the electronic medical record.
11. The nurse is caring for a client that had a thyroidectomy 24 hours ago. The client reports
experiencing numbness and tingling and tingling and tingling of the face. Which intervention should
the nurse implement?
a. Open and prepare the tracheostomy kit.
b. Inspect the neck for increase in swelling.
c. Monitor for presence of Chvostek’s
sign.
d. Assess lung sound for laryngeal stridor.
12. When conducting discharge teaching for a client diagnosed with diverticulosis, which diet
instruction should the nurse include?
a. Eat a high-fiber and increase fluid intake.
b. Have small frequent meals and sit up for at least two hours after meal.
, c. Eat s bland diet and avoid spicy foods.
d. Eat a soft diet with increased intake of milk and milk products.
13. An older female client with long term type 2 diabetes mellitus (DM) is seen in the client for a routine
health assessment. To determine if the client is experiencing any long – term complications of DM,
which assessments should the nurse obtain? (Select all that apply)
a. Serum creatinine and blood urea nitrogen (BUN).
b. Sensation in feet and legs.
c. Skin condition of lower extremities.
d. Signs of respiratory tract infection
e. Visual acuity.
14. A client with chronic kidney disease missed dialysis yesterday to attend a funeral. The client’s wife the
home health nurse and reports that her husband is lethargic and hard to arouse. Which instruction is
most important for the nurse to provide?
a. Apply the client’s home oxygen.
b. Check for a thrill and bruit at the client’s dialysis access site.
c. Ensure the client avoids salt intake for the rest of the day.
d. Take client to emergency department (ED).
15. The healthcare provider writes several prescriptions for a client diagnosed with hospital-acquired
pneumonia (HAP) that include a combination of broad- spectrum antibiotics. Which intervention
should the nurse implement first?
a. Monitor client’s metabolic panel results during course of antibiotic therapy.
b. Review medical record for results of a chest x-ray obtained on admission.
c. Schedule prescribed nebulizer treatments with respiratory therapy.
d. Collect blood specimens for culture prior to starting antibiotic therapy.
16. The nurse provides dietary instructions about iron rich food to a client with iron deficiency anemia.
Which food selection made by the client indicates a need for additional instructions?
a. Liver.
b. Kidney beans.
c. Oranges.
d. Leafy green vegetable.
17. A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which
pathophysiological process supports the client’s respiratory acidosis.
a. Carbon dioxide is converted in the kidneys for elimination.
b. Blood oxygen levels are stimulating the respiratory rate.
c. Hyperventilation is eliminating carbon dioxide rapidly.
d. High levels of carbon dioxide have accumulated in the blood
18. Methotrexate is prescribed for a client with rheumatoid arthritis (RA) who is also taking aspirin. What
is the best explanation for the nurse to provide as to why a second medication has been added?
a. Methotrexate slows the disease progression while aspirin controls the symptoms.
b. Methotrexate has less harmful side effects than aspirin.
1. The nurse empties the nasogastric suction collection canister of a client who had a bowel resection
the previous day and note that 1000 ml of gastric secretions were collected in the last 4 hours.
a. Metabolic alkalosis
b. Hyperkalemia
c. Metabolic acidosis
d. Hypoglycemia
2. A young client who is being taught to use an inhaler for symptoms of asthma tells the nurse the intention
to use the inhaler but, plans to continue smoking cigarettes in evaluating the client’s response, what is
the best initial action by the nurse?
a. Inform the health care provider of this statement made by the client.
b. Explain that denial of illness can interfere with the treatment regimen.
c. Revise the plan of care based on the client’s plans to continue
smoking. d. Review factors surrounding client’s beliefs about smoking
cessation.
3. A client with sudden onset of big toe joint pain and swelling is diagnosed with gout. Which
pathophysiologic process is producing the symptoms of gout?
a. An immune complex and autoantibody deposition in connective tissue results in inflammation.
b. Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation.
c. An autoimmune inflammation involving IgG response to an antigen causes joint destruction.
d. Deposition of crystals in the synovial space of the joint produce inflammation and irritation.
4. An older female client has normal saline infusing at 45ml/hour. She complains of pain the insertion site
of the IV catheter. There is no redness or edema around the IV site. Which action should the nurse
take?
a. Determine what IV medications have recently been administered.
b. Explain that without redness or edema, there is no need to re-start the IV.
c. Consult with the healthcare provider about the best localization to start a new IV.
d. Convert the IV to a saline lock and continue to monitor the site.
5. While assessing a female client who is chronically fatigued and was recently diagnosed with adrenal
insufficiency, the client tells the nurse that she is very nervous that her hospitalization will cause her
to lose her job. Which intervention should the nurse implement first?
a. Teach client about risk for infection.
b. Offer support and care measure to reduce anxiety and stress.
c. Encourage the client to rest quietly to reduce fatigue.
d. Place a referral to social service to discuss financial options.
6. The nurse is collecting information from a client with chronic pancreatitis who report persistent gnawing
abdominal pain. To help the client manage the pain. Which assessment data is most important for the
nurse to obtain?
a. Color and consistency of feces.
b. Eating patterns and dietary intake.
c. Presence and activity of bowel sounds.
d. Level and amount of physical activity.
,7. A young adult client, admitted to the Emergency Department following a motor vehicle collision, is
transfused with 4 unit of PRBCs (packed red blood cells). The client’s pretransfusion hematocrit is
17%. Which hematocrit value should the nurse expect the client to have after all the PRBCs have been
transfused?
a. 19%
b. 9%
c. 39%
d. 29%
8. A client admitted with left-sided heart failure has a heart rate of 110 beats per minute and is becoming
increasing dyspneic. Which additional assessment finding by the nurse support the client’s admitting
diagnosis?
a. An enlarged, distended abdomen.
b. Crackles in the bases of both lungs.
c. Jugular vein distension.
d. Peripheral edema.
9. When planning care for a client newly diagnosed with open angle glaucoma, the nurse identifies a
priority nursing problem of “visual sensory/perceptual alterations”. This problem is based on which
etiology?
a. Blurred distance vision.
b. Limited eye movement.
c. Decreased peripheral vision
d. Photosensitivity.
10. A postoperative client report incisional pain. The client has two prescriptions for PRN analgesia that
accompanied the client from the post anesthesia unit. Before selecting which medication to
administer, which action should the nurse implement?
a. Determine which prescription will have the quickest onset of action.
b. Compare the client’s pain scale rating with the prescribed dosing.
c. Ask the client to choose which medication is needed for the pain.
d. Document the client’s report of pain in the electronic medical record.
11. The nurse is caring for a client that had a thyroidectomy 24 hours ago. The client reports
experiencing numbness and tingling and tingling and tingling of the face. Which intervention should
the nurse implement?
a. Open and prepare the tracheostomy kit.
b. Inspect the neck for increase in swelling.
c. Monitor for presence of Chvostek’s
sign.
d. Assess lung sound for laryngeal stridor.
12. When conducting discharge teaching for a client diagnosed with diverticulosis, which diet
instruction should the nurse include?
a. Eat a high-fiber and increase fluid intake.
b. Have small frequent meals and sit up for at least two hours after meal.
, c. Eat s bland diet and avoid spicy foods.
d. Eat a soft diet with increased intake of milk and milk products.
13. An older female client with long term type 2 diabetes mellitus (DM) is seen in the client for a routine
health assessment. To determine if the client is experiencing any long – term complications of DM,
which assessments should the nurse obtain? (Select all that apply)
a. Serum creatinine and blood urea nitrogen (BUN).
b. Sensation in feet and legs.
c. Skin condition of lower extremities.
d. Signs of respiratory tract infection
e. Visual acuity.
14. A client with chronic kidney disease missed dialysis yesterday to attend a funeral. The client’s wife the
home health nurse and reports that her husband is lethargic and hard to arouse. Which instruction is
most important for the nurse to provide?
a. Apply the client’s home oxygen.
b. Check for a thrill and bruit at the client’s dialysis access site.
c. Ensure the client avoids salt intake for the rest of the day.
d. Take client to emergency department (ED).
15. The healthcare provider writes several prescriptions for a client diagnosed with hospital-acquired
pneumonia (HAP) that include a combination of broad- spectrum antibiotics. Which intervention
should the nurse implement first?
a. Monitor client’s metabolic panel results during course of antibiotic therapy.
b. Review medical record for results of a chest x-ray obtained on admission.
c. Schedule prescribed nebulizer treatments with respiratory therapy.
d. Collect blood specimens for culture prior to starting antibiotic therapy.
16. The nurse provides dietary instructions about iron rich food to a client with iron deficiency anemia.
Which food selection made by the client indicates a need for additional instructions?
a. Liver.
b. Kidney beans.
c. Oranges.
d. Leafy green vegetable.
17. A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which
pathophysiological process supports the client’s respiratory acidosis.
a. Carbon dioxide is converted in the kidneys for elimination.
b. Blood oxygen levels are stimulating the respiratory rate.
c. Hyperventilation is eliminating carbon dioxide rapidly.
d. High levels of carbon dioxide have accumulated in the blood
18. Methotrexate is prescribed for a client with rheumatoid arthritis (RA) who is also taking aspirin. What
is the best explanation for the nurse to provide as to why a second medication has been added?
a. Methotrexate slows the disease progression while aspirin controls the symptoms.
b. Methotrexate has less harmful side effects than aspirin.
