HESI MEDSURG FINAL EXAM ACTUAL EXAM NEWEST 2024-2025
COMPLETE 150 QUESTIONS AND CORRECT DETAILED ANSWERS
|ALREADY GRADED A+
or answers the question While assessing a client with diabetes mellitus , the nurse observes an absence
of hair growth on the client's legs . What additional assessment provides further data to support this
finding a . Palpate for the presence of femoral pulses bilaterally . b . Assess for the presence of a positive
Homan's sign . C.
C. Observe the appearance of the skin on the client's legs .
d Watch the client's posture and balance during ambulation - answer-C. Observe the appearance of the
skin on the client's legs .
posture and balance during ambulation . The healthcare provider prescribes 15 mg / kg of Streptomycin
for an infant weighing 4 pounds . The drug is diluted in 25 ml of D - W to run over 8 hours . How much
Streptomycin will the infant receive ?
a 9 mg .
b . 18 mg .
C. 27 mg .
d . 36 ing mg - answer-C
ing mg . . 3. In assessing a client with preeclampsia who is receiving magnesium sulfate , the nurse
determines that her deep tendon reflexes are 1+ ; respiratory rate is 12 breaths / minute ; urinary output
is 90 ml in 4 hours ; magnesium sulfate level is 9 mg / dl . Based on these findings , what intervention
should the nurse implement ? a
a . . Continue the magnesium sulfate infusion as prescribed .
b . Decrease the magnesium sulfate infusion by one - half .
c . Stop the magnesium sulfate infusion immediately
d . Administer calcium gluconate immediately - answer-C
4. A client is on a mechanical ventilator . Which client response indicates that the neuromuscular blocker
tubocurarine chloride ( Tubarine ) is effective ?
a . The client's expremities are paralyzed .
,b . The peripheral nerve stimulator causes twitching .
c . The client clinches fist upon command .
d . The client's Glagow Coma Scale score is 14 - answer-A
5. An elderly female client comes to the clinic for a regular check - up . The client tells the nurse that she
has increased her daily doses of acetaminophen ( Tylenol ) for the past month to control joint pain .
Based on this client's comment , what previous lab values should the nurse compare with today's lab
report ?
a . Look at last quarter's hemoglobin and hematocrit , expecting an increase today due to dehydration .
b . Look for an increase in today's LDH compared to the previous one to assess for possible liver damage .
- answer-B
6. Aspirin is prescribed for a 9 - year - old child with rheumatic fever to control the inflammatory process
, promote comfort , and reduce fever . What intervention is most important for the nurse to implement ?
a . Instruct the parents to hold the aspirin until the child has first had a tepid sponge bath .
b . Administer the aspirin with at least two ounces of water or juice .
c . Notify the healthcare provider if the child complains of ringing in the ears .
d . Advise the parents to question the child about seeing yellow halos around objects . - answer-C
Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome ?
a . Husky voice and complaints of hoarseness .
b . Warm , soft , moist , salmon - colored skin .
C. Visible swelling of the neck , with no pain . d . Central - type obesity , with thin extremities . - answer-D
8. A charge nurse agrees to cover another nurse's assignment during a lunch break . Based on the status
report provided by the nurse who is leaving for lunch , which client should be checked first by the charge
nurse ? The client
A . admitted yesterday with diabetec ketoacidosis whose blood glucose level is now 195 mg / dl .
B with an ileal conduit created two days ago with a scant amount of blood in the drainage pouch .
C. post - triple coronary bypass four days ago who has serosanguinous drainage in the ch t tube .
,D. with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of 90 % . -
answer-d . with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of
90 % .
An outcome for treatment of peripheral vascular disease is , " The client will have decreased venous
congestion . " What client behavior would indicate to the nurse that this outcome been met ?
a . Avoids prolonged sitting or standing .
b . Avoids trauma and irritation to skin .
c . Wears protective shoes
d . Quits smoking - answer-A
11. The nurse is administering sevelamer ( RenaGel ) during lunch to a client with end stage renal disease
( ESRD ) . The client asks the nurse to bring the medication later . The nurse should describe which action
of RenaGel as an explanation for taking it with meals ?
a de . Prevents indigestion associated with ingestion of spicy foods .
b . Binds with phosphorus in foods and prevents absorption .
c . Promotes stomach emptying and prevents gastric reflux .
d . Buffers hydrochloric acid and prevents gastric erosion . - answer-B
d 12. The nurse formulates a nursing diagnosis of , " High risk for ineffective airway clearance " for a
client with myasthenia gravis . What is the most likely etiology for this nursing diagnosis ? 3
a . Pain when coughing .
b . Diminished cough effort .
C. Thick dry secretions .
d . Excessive inflammation . - answer-B
13. Following a CVA , the nurse assess that a client developed dysphagia , hypoactive bowel sounds and
firm , distended abdomen . Which prescription for the client should the nurse question ?
a . Continous tube feeding at 65 ml / hr via gastrostomy .
b . Total parenteral nutrition to be infused at 125 ml / hour . tube connected to low intermittent suction .
- answer-A
, A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment
finding should the nurse anticipate?
A. Bounding erratic pulse.
B. Regularly irregular pulse.
C. Thready irregular pulse.
D. No palpable pulse. - answer-D
15. In assessing a 70 - year - old female client with Alzheimer's disease , the nurse notes that she has
deep inflamed cracks at the corners of her mouth . What intervention should the nurse include in this
client's plan of care ?
a . Scrub the lesions with warm soapy water . b . Encourage the client to drink orange juice for added
vitamin C.
c . Notify the healthcare provider of the need for oral antibiotics .
d . Ensure that the client gets adequate B vitamins in foods or supplements . - answer-D
C 16. A young adult female client is seen in the emergency department for a minor injury following a
motor vehicle collision . She states she is very angry at the person who hit her car . What is the best
nursing response ? a . " You are lucky to be alive . Be grateful no one was killed . "
b . " I understand your car was not seriously damaged .
"c."
You are upset that this incident has brought you here .
"d."
Have you ever been in the emergency department before ? " - answer-C
17. An 85 - year - old male resident of an extended care facility reaches for the hand of the unlicensed
assistive personnel ( UAP ) and tries to kiss her hand several times morning care . The UAP reports the
incident to the charge nurse . What is the best assessment of the situation ?
a . This is sexual harassment and needs to be reported to the administration immediately .
b . The UAP needs to be reassigned to another group of residents , preferably females only . only .
C. The client may be suffering from touch deprivation and needs to know appropriate ways to express his
need .
COMPLETE 150 QUESTIONS AND CORRECT DETAILED ANSWERS
|ALREADY GRADED A+
or answers the question While assessing a client with diabetes mellitus , the nurse observes an absence
of hair growth on the client's legs . What additional assessment provides further data to support this
finding a . Palpate for the presence of femoral pulses bilaterally . b . Assess for the presence of a positive
Homan's sign . C.
C. Observe the appearance of the skin on the client's legs .
d Watch the client's posture and balance during ambulation - answer-C. Observe the appearance of the
skin on the client's legs .
posture and balance during ambulation . The healthcare provider prescribes 15 mg / kg of Streptomycin
for an infant weighing 4 pounds . The drug is diluted in 25 ml of D - W to run over 8 hours . How much
Streptomycin will the infant receive ?
a 9 mg .
b . 18 mg .
C. 27 mg .
d . 36 ing mg - answer-C
ing mg . . 3. In assessing a client with preeclampsia who is receiving magnesium sulfate , the nurse
determines that her deep tendon reflexes are 1+ ; respiratory rate is 12 breaths / minute ; urinary output
is 90 ml in 4 hours ; magnesium sulfate level is 9 mg / dl . Based on these findings , what intervention
should the nurse implement ? a
a . . Continue the magnesium sulfate infusion as prescribed .
b . Decrease the magnesium sulfate infusion by one - half .
c . Stop the magnesium sulfate infusion immediately
d . Administer calcium gluconate immediately - answer-C
4. A client is on a mechanical ventilator . Which client response indicates that the neuromuscular blocker
tubocurarine chloride ( Tubarine ) is effective ?
a . The client's expremities are paralyzed .
,b . The peripheral nerve stimulator causes twitching .
c . The client clinches fist upon command .
d . The client's Glagow Coma Scale score is 14 - answer-A
5. An elderly female client comes to the clinic for a regular check - up . The client tells the nurse that she
has increased her daily doses of acetaminophen ( Tylenol ) for the past month to control joint pain .
Based on this client's comment , what previous lab values should the nurse compare with today's lab
report ?
a . Look at last quarter's hemoglobin and hematocrit , expecting an increase today due to dehydration .
b . Look for an increase in today's LDH compared to the previous one to assess for possible liver damage .
- answer-B
6. Aspirin is prescribed for a 9 - year - old child with rheumatic fever to control the inflammatory process
, promote comfort , and reduce fever . What intervention is most important for the nurse to implement ?
a . Instruct the parents to hold the aspirin until the child has first had a tepid sponge bath .
b . Administer the aspirin with at least two ounces of water or juice .
c . Notify the healthcare provider if the child complains of ringing in the ears .
d . Advise the parents to question the child about seeing yellow halos around objects . - answer-C
Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome ?
a . Husky voice and complaints of hoarseness .
b . Warm , soft , moist , salmon - colored skin .
C. Visible swelling of the neck , with no pain . d . Central - type obesity , with thin extremities . - answer-D
8. A charge nurse agrees to cover another nurse's assignment during a lunch break . Based on the status
report provided by the nurse who is leaving for lunch , which client should be checked first by the charge
nurse ? The client
A . admitted yesterday with diabetec ketoacidosis whose blood glucose level is now 195 mg / dl .
B with an ileal conduit created two days ago with a scant amount of blood in the drainage pouch .
C. post - triple coronary bypass four days ago who has serosanguinous drainage in the ch t tube .
,D. with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of 90 % . -
answer-d . with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of
90 % .
An outcome for treatment of peripheral vascular disease is , " The client will have decreased venous
congestion . " What client behavior would indicate to the nurse that this outcome been met ?
a . Avoids prolonged sitting or standing .
b . Avoids trauma and irritation to skin .
c . Wears protective shoes
d . Quits smoking - answer-A
11. The nurse is administering sevelamer ( RenaGel ) during lunch to a client with end stage renal disease
( ESRD ) . The client asks the nurse to bring the medication later . The nurse should describe which action
of RenaGel as an explanation for taking it with meals ?
a de . Prevents indigestion associated with ingestion of spicy foods .
b . Binds with phosphorus in foods and prevents absorption .
c . Promotes stomach emptying and prevents gastric reflux .
d . Buffers hydrochloric acid and prevents gastric erosion . - answer-B
d 12. The nurse formulates a nursing diagnosis of , " High risk for ineffective airway clearance " for a
client with myasthenia gravis . What is the most likely etiology for this nursing diagnosis ? 3
a . Pain when coughing .
b . Diminished cough effort .
C. Thick dry secretions .
d . Excessive inflammation . - answer-B
13. Following a CVA , the nurse assess that a client developed dysphagia , hypoactive bowel sounds and
firm , distended abdomen . Which prescription for the client should the nurse question ?
a . Continous tube feeding at 65 ml / hr via gastrostomy .
b . Total parenteral nutrition to be infused at 125 ml / hour . tube connected to low intermittent suction .
- answer-A
, A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment
finding should the nurse anticipate?
A. Bounding erratic pulse.
B. Regularly irregular pulse.
C. Thready irregular pulse.
D. No palpable pulse. - answer-D
15. In assessing a 70 - year - old female client with Alzheimer's disease , the nurse notes that she has
deep inflamed cracks at the corners of her mouth . What intervention should the nurse include in this
client's plan of care ?
a . Scrub the lesions with warm soapy water . b . Encourage the client to drink orange juice for added
vitamin C.
c . Notify the healthcare provider of the need for oral antibiotics .
d . Ensure that the client gets adequate B vitamins in foods or supplements . - answer-D
C 16. A young adult female client is seen in the emergency department for a minor injury following a
motor vehicle collision . She states she is very angry at the person who hit her car . What is the best
nursing response ? a . " You are lucky to be alive . Be grateful no one was killed . "
b . " I understand your car was not seriously damaged .
"c."
You are upset that this incident has brought you here .
"d."
Have you ever been in the emergency department before ? " - answer-C
17. An 85 - year - old male resident of an extended care facility reaches for the hand of the unlicensed
assistive personnel ( UAP ) and tries to kiss her hand several times morning care . The UAP reports the
incident to the charge nurse . What is the best assessment of the situation ?
a . This is sexual harassment and needs to be reported to the administration immediately .
b . The UAP needs to be reassigned to another group of residents , preferably females only . only .
C. The client may be suffering from touch deprivation and needs to know appropriate ways to express his
need .
