Summary HESI Med Surg V1 Correct answers
and Rationales, Latest A+ guide, 55 questions
and answers.
1. Guaiac Occult Test. What lab is most important?
Platelet Count
2. Patient had BDP 3 months ago with dehydration. What would warrant
the nurse immediate intervention?
Positive Gastro Occult
3. A patient with Parkinson’s. “Freezes.” Pretends there is a crack on the
floor and Carefully lifts leg and steps over.
Confirm that this is the correct and effective technique.
4. Patient had Atrial Fibrillation and then AED was used. One minute later,
Patient sudden goes in to ventricular Tachycardia. What should the nurse
do?
Administer Adenosine over 1-2 seconds IV
5. Heart failure acute exacerbation. How to Reduce Cardiac Workload?
Bedside Commode
6. External Fixation Device- What should the nurse do first?
Assess for peripheral pulse at the foot
7. COPD patient is experience shortness of breath.
Pursed Lip Breathing
8. Client with CVA (stroke). Has only eaten half of their food. Family is
concern about nutrition. What should the nurse tell the family?
Demonstrate the use of Visual Scanning.
9. A male client with asthma has bronchoconstriction and mucous
production due to exercising. What should the nurse do?
Determine if the client is using an inhaler before exercising.
10.A client with liver abscess and drainage of abscess. Which lab value?
White blood Cell Count
11.Suprapubic prostatectomy. Three-way catheter. Which assessment?
Urine Leaking meatus
12.A client with ulcerative colitis. UAP report what finding?
Stool with fatty streaks
13.Flank pain and acute pyelonephritis. Priority nursing action.
Administer IV antibiotics.
14.Long-standing pulmonary infection. Assess for hypoxia. Select All That Apply.
Breathing patterns, Check mentation, color of skin and nailbeds
15.Traction applied, but client is frustrated because client keeps calling nurse
for help with repositioning.
Use a trapeze bar.
16.Multiple Sclerosis and urinary retention.
Self-Catheterization
17.Client works as a data desk job with Raynaud’s syndrome. What to do to
prevent wrist injury?
Space Heater
18.C.K.D. Lab to
report. Potassium
6.5
, 19.Client withy Gullian Barre is not
blinking. Administer Lubricant
20.Taking prednisone PO 5mg. What
symptom? Rapid Weight Gain.
21.Succinylcholine. High
Temperature. Ice Pack axillary
22.The nurse drops a sterile package of supplies on the floor in the operating
room (OR) suite. The … impervious wrapper. Which action should the
nurse implement?
Open contents to sterile field package intact.
23.Client with Acute
Glomerulonephritis. Restrict
Sodium.
24.Client ask about biopsy results from cancer cells well differentiated. What
response? Ask Healthcare provider to gather more information.
25.Right cataract and lens implant. Which intervention should the
nurse first? Provide an eye shield to be worn while sleeping.
26.The unlicensed assistive personnel (UAP) reports to the nurse that a client
who was admitted with abdominal pain has just had a large black tarry
stool. What intervention should the nurse implement first?
- Test the stool for occult blood.
27.Which action is most important for the nurse to implement to reduce the
risk for deep vein thrombosis in a postoperative client?
-Advise the client to perform leg exercises regularly.
28.The nurse is preparing a client for a bronchoscopy. While obtaining consent,
the client complains of thirst and admits to drinking a small amount of
orange juice two hours ago. What action should the nurse take?
-Delay procedure for 6 hours.
29.A client uses triamcinolone (kenalog), a corticosteroid ointment, to
manage pruritis caused by a chronic skin rash. The client calls the clinic
nurse to report increased erythema with purulent exudate at the site.
What action should the nurse implement?
-Schedule an appointment for the client to the healthcare provider.
30.The nurse learns in change of shift report that the x-ray report for a newly
admitted client indicates consolidation in the left lower lung. What action
should the nurse take?
-Administer a PRN dose of a bronchodilator.
31.The nurse is monitoring the glucose q4h of an adult woman admitted with
DKA. Two hours after receiving 10 units of regular insulin for glucose of 255,
the client is perspiring and complaining of shakiness. What intervention
should the nurse implement?
-Check Capillary glucose level.
32.The chest x-ray for a client who is admitted for pneumonia shows pleural
effusion with decreased air flow in the entire left upper lobe. What breath
sounds that verify the x-ray findings should the nurse document after
auscultation of the left upper lobe?
-Diminished breath sounds
33.Which food is most important for the nurse to encourage a male
patient with osteomalacia to include in his daily diet?
- Fortified milk and cereals.
34.An older adult woman is seen in the clinic 3 months following her diagnosis
and Rationales, Latest A+ guide, 55 questions
and answers.
1. Guaiac Occult Test. What lab is most important?
Platelet Count
2. Patient had BDP 3 months ago with dehydration. What would warrant
the nurse immediate intervention?
Positive Gastro Occult
3. A patient with Parkinson’s. “Freezes.” Pretends there is a crack on the
floor and Carefully lifts leg and steps over.
Confirm that this is the correct and effective technique.
4. Patient had Atrial Fibrillation and then AED was used. One minute later,
Patient sudden goes in to ventricular Tachycardia. What should the nurse
do?
Administer Adenosine over 1-2 seconds IV
5. Heart failure acute exacerbation. How to Reduce Cardiac Workload?
Bedside Commode
6. External Fixation Device- What should the nurse do first?
Assess for peripheral pulse at the foot
7. COPD patient is experience shortness of breath.
Pursed Lip Breathing
8. Client with CVA (stroke). Has only eaten half of their food. Family is
concern about nutrition. What should the nurse tell the family?
Demonstrate the use of Visual Scanning.
9. A male client with asthma has bronchoconstriction and mucous
production due to exercising. What should the nurse do?
Determine if the client is using an inhaler before exercising.
10.A client with liver abscess and drainage of abscess. Which lab value?
White blood Cell Count
11.Suprapubic prostatectomy. Three-way catheter. Which assessment?
Urine Leaking meatus
12.A client with ulcerative colitis. UAP report what finding?
Stool with fatty streaks
13.Flank pain and acute pyelonephritis. Priority nursing action.
Administer IV antibiotics.
14.Long-standing pulmonary infection. Assess for hypoxia. Select All That Apply.
Breathing patterns, Check mentation, color of skin and nailbeds
15.Traction applied, but client is frustrated because client keeps calling nurse
for help with repositioning.
Use a trapeze bar.
16.Multiple Sclerosis and urinary retention.
Self-Catheterization
17.Client works as a data desk job with Raynaud’s syndrome. What to do to
prevent wrist injury?
Space Heater
18.C.K.D. Lab to
report. Potassium
6.5
, 19.Client withy Gullian Barre is not
blinking. Administer Lubricant
20.Taking prednisone PO 5mg. What
symptom? Rapid Weight Gain.
21.Succinylcholine. High
Temperature. Ice Pack axillary
22.The nurse drops a sterile package of supplies on the floor in the operating
room (OR) suite. The … impervious wrapper. Which action should the
nurse implement?
Open contents to sterile field package intact.
23.Client with Acute
Glomerulonephritis. Restrict
Sodium.
24.Client ask about biopsy results from cancer cells well differentiated. What
response? Ask Healthcare provider to gather more information.
25.Right cataract and lens implant. Which intervention should the
nurse first? Provide an eye shield to be worn while sleeping.
26.The unlicensed assistive personnel (UAP) reports to the nurse that a client
who was admitted with abdominal pain has just had a large black tarry
stool. What intervention should the nurse implement first?
- Test the stool for occult blood.
27.Which action is most important for the nurse to implement to reduce the
risk for deep vein thrombosis in a postoperative client?
-Advise the client to perform leg exercises regularly.
28.The nurse is preparing a client for a bronchoscopy. While obtaining consent,
the client complains of thirst and admits to drinking a small amount of
orange juice two hours ago. What action should the nurse take?
-Delay procedure for 6 hours.
29.A client uses triamcinolone (kenalog), a corticosteroid ointment, to
manage pruritis caused by a chronic skin rash. The client calls the clinic
nurse to report increased erythema with purulent exudate at the site.
What action should the nurse implement?
-Schedule an appointment for the client to the healthcare provider.
30.The nurse learns in change of shift report that the x-ray report for a newly
admitted client indicates consolidation in the left lower lung. What action
should the nurse take?
-Administer a PRN dose of a bronchodilator.
31.The nurse is monitoring the glucose q4h of an adult woman admitted with
DKA. Two hours after receiving 10 units of regular insulin for glucose of 255,
the client is perspiring and complaining of shakiness. What intervention
should the nurse implement?
-Check Capillary glucose level.
32.The chest x-ray for a client who is admitted for pneumonia shows pleural
effusion with decreased air flow in the entire left upper lobe. What breath
sounds that verify the x-ray findings should the nurse document after
auscultation of the left upper lobe?
-Diminished breath sounds
33.Which food is most important for the nurse to encourage a male
patient with osteomalacia to include in his daily diet?
- Fortified milk and cereals.
34.An older adult woman is seen in the clinic 3 months following her diagnosis
