HESI MED SURG / MED SURG
55 QUESTIONS RN V1
A 55-year-old patient is preparing to start an exercise program. The health care
provider wants 60% of maximum target heart rate. Calculate the heart rate that the
nurse will add to the care plan as the target heart rate. Record answer as a whole
number.
maximum
heart rate ANS:
99
Teach patients to calculate their maximum heart rate by subtracting their current
age in years from 220 and then obtaining their target heart rate by taking 60% to
90% of the maximum, depending on their health care provider’s
recommendation. 220 − 55 = 165 × 0.6 = 99.
1. A nurse is teaching a patient about medications. Which statement from
the patient indicates teaching is effective?
a. “My parenteral medication must be taken with food.”
b. “I will rotate the sites in my left leg when I give my insulin.”
c. “Once I start feeling better, I will stop taking my antibiotic.”
“If I am 30 minutes late taking my medication, I should skip that
d. dose.”
ANS: B
For daily insulin, rotate site within anatomical area. Rotating injections within
the same body part (instrasite rotation) provides greater consistency in
absorption of medication. Parenteral medication absorption is not affected by
the timing of meals. Taking a medication 30 minutes late is within the 60-
minute window of the time medications should be taken. Medications are
usually
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, stopped based on the provider’s orders except in extenuating circumstances.
With some medications, such as antibiotics, it is crucial that the full course of
medication is taken to avoid relapse of infection.
2. A nurse is preparing to administer an injection to a patient. Which
statement made by the patient is an indication for the nurse to use the Z-track
method?
a. “I am allergic to many medications.”
b. “I’m really afraid that a big needle will hurt.”
c. “The last shot like that turned my skin colors.”
d. “My legs are too obese for the needle to go through.”
ANS: C
The Z-track is indicated when the medication being administered has the potential
to irritate sensitive tissues. It is recommended that, when administering IM
injections, the Z-track method be used to minimize local skin irritation by sealing
the medication in muscle tissue. The Z-track method is not meant to reduce
discomfort from the procedure. If a patient is allergic to a medication, it should not
be administered. If a patient has additional subcutaneous tissue to go through, a
needle of a different size may be selected.
3. A 2-year-old child is ordered to have eardrops daily. Which action will
the nurse take?
a. Pull the auricle down and back to straighten the ear canal.
b. Pull the auricle upward and outward to straighten the ear canal.
c. Sit the child up for 2 to 3 minutes after instilling drops in ear canal.
d. Sit the child up to insert the cotton ball into the innermost ear canal.
ANS: A
Children up to 3 years of age should have the auricle pulled down and back,
children 3 years of age to adults should have the auricle pulled upward and
outward. Solution should be instilled 1 cm (1/2 in) above the opening of the ear
canal. The patient should remain in the side-lying position 2 to 3 minutes. If a
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55 QUESTIONS RN V1
A 55-year-old patient is preparing to start an exercise program. The health care
provider wants 60% of maximum target heart rate. Calculate the heart rate that the
nurse will add to the care plan as the target heart rate. Record answer as a whole
number.
maximum
heart rate ANS:
99
Teach patients to calculate their maximum heart rate by subtracting their current
age in years from 220 and then obtaining their target heart rate by taking 60% to
90% of the maximum, depending on their health care provider’s
recommendation. 220 − 55 = 165 × 0.6 = 99.
1. A nurse is teaching a patient about medications. Which statement from
the patient indicates teaching is effective?
a. “My parenteral medication must be taken with food.”
b. “I will rotate the sites in my left leg when I give my insulin.”
c. “Once I start feeling better, I will stop taking my antibiotic.”
“If I am 30 minutes late taking my medication, I should skip that
d. dose.”
ANS: B
For daily insulin, rotate site within anatomical area. Rotating injections within
the same body part (instrasite rotation) provides greater consistency in
absorption of medication. Parenteral medication absorption is not affected by
the timing of meals. Taking a medication 30 minutes late is within the 60-
minute window of the time medications should be taken. Medications are
usually
154
, stopped based on the provider’s orders except in extenuating circumstances.
With some medications, such as antibiotics, it is crucial that the full course of
medication is taken to avoid relapse of infection.
2. A nurse is preparing to administer an injection to a patient. Which
statement made by the patient is an indication for the nurse to use the Z-track
method?
a. “I am allergic to many medications.”
b. “I’m really afraid that a big needle will hurt.”
c. “The last shot like that turned my skin colors.”
d. “My legs are too obese for the needle to go through.”
ANS: C
The Z-track is indicated when the medication being administered has the potential
to irritate sensitive tissues. It is recommended that, when administering IM
injections, the Z-track method be used to minimize local skin irritation by sealing
the medication in muscle tissue. The Z-track method is not meant to reduce
discomfort from the procedure. If a patient is allergic to a medication, it should not
be administered. If a patient has additional subcutaneous tissue to go through, a
needle of a different size may be selected.
3. A 2-year-old child is ordered to have eardrops daily. Which action will
the nurse take?
a. Pull the auricle down and back to straighten the ear canal.
b. Pull the auricle upward and outward to straighten the ear canal.
c. Sit the child up for 2 to 3 minutes after instilling drops in ear canal.
d. Sit the child up to insert the cotton ball into the innermost ear canal.
ANS: A
Children up to 3 years of age should have the auricle pulled down and back,
children 3 years of age to adults should have the auricle pulled upward and
outward. Solution should be instilled 1 cm (1/2 in) above the opening of the ear
canal. The patient should remain in the side-lying position 2 to 3 minutes. If a
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