lOMoARcPSD|7293922
Med Surg HESI
Questions and Answers
Latest 2023
1. A client is admitted to the hospital with symptoms consistent with right
hemisphere stroke. With Neurovascular assessment requires immediate
intervention by the nurse?
A. Pupillary changes to ipsilateral dilation
B. Orientation to person and place only.
C. Left Sided Facial dropping and dysphagia
D. Unequal bilateral hand grip strengths
2. Achieve maximum mobility and independence for a client multiple
sclerosis (MS). Which intervention is most important for the nurse to
implement?
A. Provide a walker for ambulation
B. Frequently assist client to the bathroom
C. Apply alternating patches over the eyes
D. Teach strengthing exercises
3. The Nurse is teaching a client with glomerulonephritis about self-care.
Which dietary recommendations should the nurse recommend the client to
follow?
A. Limit oral Fluid intake to 500 mL per day
B. Restrict protein intake by including meats and other high protein foods
C. Increase intake of potassium-rich foods such as bananas or cantaloupe
D. Increase intake of high fiber foods, such as bran cereal.
4. The nurse Is caring for a client with herpes zoster who reports painful
blisters that align from the back along the chest curvature to the anterior
chest. Which intervention is the highest priority for the nurse?
A. Place the client on contact precaution
B. Administer antiviral medication
C. Place wet compresses to ruptured vesicles
D. Administer narcotic analgesics
5. A young adult who suffered a severe brain injury in an automobile
collision has been mechanically ventilated for the past three days and has
no spontaneous respiratory effort. After serial electroencephalograms (EEG)
reveal no brain activity, the healthcare provider discusses end-of-life
options with family who agree to discontinue life support. Which
intervention should the nurse implement?
A. Ask the family if they wish would remain at bedside during withdrawal
B. Request a living will be placed in the client's medical record
C. Discuss the withdrawal procedure with the family and offer support
D. Turn off the mechanical ventilator and note the time of death
6. Following a transurethral resection of the prostate (TURP), a client is
discharged from the hospital with an indwelling urinary catheter. Which
instruction is most important for the nurse to include in the discharge
teaching plan?
A. Eliminate all the spicy food from your diet
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, lOMoARcPSD|7293922
B. Drinl 3 liters of water each day
C. Clamp the catheter when taking a shower
D. Avoid driving a car for 2 weeks
7. On the first postoperative day, the nurse finds an older male client
disoriented and trying to climb over the bed railing. Previously he was
oriented to person, place, and
Downloaded by jane murage
()
, lOMoARcPSD|7293922
time on admission. Which intervention should the nurse implement first?
A. Apply wrist restraints
B. Determine the clients blood pressure
C. Administer a mild sedative
D. Asses the client for pain
8. Acute soft-tissue injuries (I.e. sprains, strains) provide the nurse with a
variety of teaching opportunities. Which instruction should the nurse provide
to a client with a soft- tissue injury?
A. Watch for shortness of breath which may indicate a fat embolus
B. Begin range of motion exercises within the first 24 hours
C. Apply Ice intermittently for the first 24 hours
D. After edema subsides, apply heat continuously
9. A male client is admitted to the rehabilitation unit following a
cerebrovascular (CVA), which resulted in paralysis of his right arm. When
the nurse enters the room, he is struggling to put on a shirt, and he curses
at the nurse. What is the best response from the nurse?
A. “We will give you a class on dressing tomorrow”
B. This unit has a policy against staff harassment
C. Dressing must be a frustrating experience for you”
D. “It is important to dress the right arm first”
10.A client returns to unit following a craniotomy for removal of brain
tumor and is obtunded but arouses to painful stimuli. Which assessment
is most important for the nurse to obtain?
A. Drainage on dressing
B. Last administration of analgesia
C. Body temperature
D. Serial blood pressure and pulse
11. An older client who is agitated, dyspneic, orthopneic, and using
accessory muscle to breathe is admitted for further treatment. Initial
assessment indicates beats/minute and irregular, respirations 36
breaths/minute, blood pressure 168/100 mmHg. Wheezes and crackles in all
lung fields. An hour after the administered mg IV, which assessment should
the nurse obtain to determine the client's response to treatment? (Select all
that apply)
A. Skin
B. Pain scale
C. Lung Sounds
D. Urinary output
E. Oxygen saturation
12.The nurse is caring for an older male client with impaired skin integrity
to sheering forces and pressure that is manifested as a draining stage 3
sacral ulcer. Which intervention is most important for the nurse to
implement?
A. Teach the family how to perform wound care
B. Encourage a diet high in protein
C. Ensure that IV fluids are administered as prescribed
D. Daily Range of motion exercise
Downloaded by jane murage
()
, lOMoARcPSD|7293922
13.While planning care for a client with carpal tunnel syndrome. The nurse
identifies a collaborative problem of pain. What is the etiology of this
problem?
A. Compression of a nerve
B. Diminished blood flow
C. Ischemic tissue changes
D. Irritation of nerve endings
14.A young adult female visits the clinic for primary dysmenorrhea and tells
the nurse that she started taking a calcium supplement to reduce her
menstrual cramps. But I quit taking calcium because it caused constipation.
The client to know what she does to relive her menstrual cramps. Which
action should the nurse implement first to address the client's concern?
A. Encourage client to increase her dietary intake fiber
B. Question the client about her use of birth control pills
C. Ask her how much calcium she had been taking daily
D. Determine if she takes any over-the-counter analgesics
15.A client with a medical diagnosis of a ruptured cerebral aneurysm
exhibits these symptoms no eye opening, no sound vocalized, and flexion
to pain (decorticate posturing). When calculating the Glasgow Coma Scale
score, Which value should the nurse document for this client?
A. 13
B. 9
C. 3
D.
5
16.A client with acute myelogenic leukemia (AML) is admitted to
chemotherapy (CT) using cytarabine and the antitumor daunorubion .
Which measures are most important for the nurse to implement during the
induction stage of chemotherapy?
A. Assessment for graft versus host disease
B. Precautions to prevent infection and bleeding
C. Administration of whole blood product
D. Scheduling of outpatient maintenance therapy
17.To reduce pulmonary complications for a client with Amyotrophic
Lateral sclerosis (ALS). Which intervention should the nurse implement?
(Select all that apply)
A. Perform chest physiotherapy
B. Establish a regular bladder routine
C. Initiate passives engage of motion
exercises D. Encourage use of incentive
spirometer
E. Teach the client breathing exercises
18.A client with polycystic Kidney is admitted because of an abrupt onset
of massive polyuria. The client is pale, tachycardia and female. Which
serum laboratory finding requires immediate intervention by the nurse?
A. Sodium 184 mEq/L
B. Glucose 110 mg/dL
C. Calcium 9 mg/dL
D. HCO3 25 mEq/L
19.A client tells the nurse, “I just received good news about my
Downloaded by jane murage
()
Med Surg HESI
Questions and Answers
Latest 2023
1. A client is admitted to the hospital with symptoms consistent with right
hemisphere stroke. With Neurovascular assessment requires immediate
intervention by the nurse?
A. Pupillary changes to ipsilateral dilation
B. Orientation to person and place only.
C. Left Sided Facial dropping and dysphagia
D. Unequal bilateral hand grip strengths
2. Achieve maximum mobility and independence for a client multiple
sclerosis (MS). Which intervention is most important for the nurse to
implement?
A. Provide a walker for ambulation
B. Frequently assist client to the bathroom
C. Apply alternating patches over the eyes
D. Teach strengthing exercises
3. The Nurse is teaching a client with glomerulonephritis about self-care.
Which dietary recommendations should the nurse recommend the client to
follow?
A. Limit oral Fluid intake to 500 mL per day
B. Restrict protein intake by including meats and other high protein foods
C. Increase intake of potassium-rich foods such as bananas or cantaloupe
D. Increase intake of high fiber foods, such as bran cereal.
4. The nurse Is caring for a client with herpes zoster who reports painful
blisters that align from the back along the chest curvature to the anterior
chest. Which intervention is the highest priority for the nurse?
A. Place the client on contact precaution
B. Administer antiviral medication
C. Place wet compresses to ruptured vesicles
D. Administer narcotic analgesics
5. A young adult who suffered a severe brain injury in an automobile
collision has been mechanically ventilated for the past three days and has
no spontaneous respiratory effort. After serial electroencephalograms (EEG)
reveal no brain activity, the healthcare provider discusses end-of-life
options with family who agree to discontinue life support. Which
intervention should the nurse implement?
A. Ask the family if they wish would remain at bedside during withdrawal
B. Request a living will be placed in the client's medical record
C. Discuss the withdrawal procedure with the family and offer support
D. Turn off the mechanical ventilator and note the time of death
6. Following a transurethral resection of the prostate (TURP), a client is
discharged from the hospital with an indwelling urinary catheter. Which
instruction is most important for the nurse to include in the discharge
teaching plan?
A. Eliminate all the spicy food from your diet
Downloaded by jane murage
()
, lOMoARcPSD|7293922
B. Drinl 3 liters of water each day
C. Clamp the catheter when taking a shower
D. Avoid driving a car for 2 weeks
7. On the first postoperative day, the nurse finds an older male client
disoriented and trying to climb over the bed railing. Previously he was
oriented to person, place, and
Downloaded by jane murage
()
, lOMoARcPSD|7293922
time on admission. Which intervention should the nurse implement first?
A. Apply wrist restraints
B. Determine the clients blood pressure
C. Administer a mild sedative
D. Asses the client for pain
8. Acute soft-tissue injuries (I.e. sprains, strains) provide the nurse with a
variety of teaching opportunities. Which instruction should the nurse provide
to a client with a soft- tissue injury?
A. Watch for shortness of breath which may indicate a fat embolus
B. Begin range of motion exercises within the first 24 hours
C. Apply Ice intermittently for the first 24 hours
D. After edema subsides, apply heat continuously
9. A male client is admitted to the rehabilitation unit following a
cerebrovascular (CVA), which resulted in paralysis of his right arm. When
the nurse enters the room, he is struggling to put on a shirt, and he curses
at the nurse. What is the best response from the nurse?
A. “We will give you a class on dressing tomorrow”
B. This unit has a policy against staff harassment
C. Dressing must be a frustrating experience for you”
D. “It is important to dress the right arm first”
10.A client returns to unit following a craniotomy for removal of brain
tumor and is obtunded but arouses to painful stimuli. Which assessment
is most important for the nurse to obtain?
A. Drainage on dressing
B. Last administration of analgesia
C. Body temperature
D. Serial blood pressure and pulse
11. An older client who is agitated, dyspneic, orthopneic, and using
accessory muscle to breathe is admitted for further treatment. Initial
assessment indicates beats/minute and irregular, respirations 36
breaths/minute, blood pressure 168/100 mmHg. Wheezes and crackles in all
lung fields. An hour after the administered mg IV, which assessment should
the nurse obtain to determine the client's response to treatment? (Select all
that apply)
A. Skin
B. Pain scale
C. Lung Sounds
D. Urinary output
E. Oxygen saturation
12.The nurse is caring for an older male client with impaired skin integrity
to sheering forces and pressure that is manifested as a draining stage 3
sacral ulcer. Which intervention is most important for the nurse to
implement?
A. Teach the family how to perform wound care
B. Encourage a diet high in protein
C. Ensure that IV fluids are administered as prescribed
D. Daily Range of motion exercise
Downloaded by jane murage
()
, lOMoARcPSD|7293922
13.While planning care for a client with carpal tunnel syndrome. The nurse
identifies a collaborative problem of pain. What is the etiology of this
problem?
A. Compression of a nerve
B. Diminished blood flow
C. Ischemic tissue changes
D. Irritation of nerve endings
14.A young adult female visits the clinic for primary dysmenorrhea and tells
the nurse that she started taking a calcium supplement to reduce her
menstrual cramps. But I quit taking calcium because it caused constipation.
The client to know what she does to relive her menstrual cramps. Which
action should the nurse implement first to address the client's concern?
A. Encourage client to increase her dietary intake fiber
B. Question the client about her use of birth control pills
C. Ask her how much calcium she had been taking daily
D. Determine if she takes any over-the-counter analgesics
15.A client with a medical diagnosis of a ruptured cerebral aneurysm
exhibits these symptoms no eye opening, no sound vocalized, and flexion
to pain (decorticate posturing). When calculating the Glasgow Coma Scale
score, Which value should the nurse document for this client?
A. 13
B. 9
C. 3
D.
5
16.A client with acute myelogenic leukemia (AML) is admitted to
chemotherapy (CT) using cytarabine and the antitumor daunorubion .
Which measures are most important for the nurse to implement during the
induction stage of chemotherapy?
A. Assessment for graft versus host disease
B. Precautions to prevent infection and bleeding
C. Administration of whole blood product
D. Scheduling of outpatient maintenance therapy
17.To reduce pulmonary complications for a client with Amyotrophic
Lateral sclerosis (ALS). Which intervention should the nurse implement?
(Select all that apply)
A. Perform chest physiotherapy
B. Establish a regular bladder routine
C. Initiate passives engage of motion
exercises D. Encourage use of incentive
spirometer
E. Teach the client breathing exercises
18.A client with polycystic Kidney is admitted because of an abrupt onset
of massive polyuria. The client is pale, tachycardia and female. Which
serum laboratory finding requires immediate intervention by the nurse?
A. Sodium 184 mEq/L
B. Glucose 110 mg/dL
C. Calcium 9 mg/dL
D. HCO3 25 mEq/L
19.A client tells the nurse, “I just received good news about my
Downloaded by jane murage
()
