MED SURG HESI VERSION 1 Exam Questions And Answers Verified 100% Correct

MED SURG HESI VERSION 1 Exam Questions And Answers Verified 100% Correct A nurse is assessing a client's hydration status. Which of the following findings indicates fluid volume overload? Distended neck veins A nurse is assessing a group of clients for indications of role changes. the nurse should identify that which of the following clients is at risk for experiencing a role change? a client who has multiple sclerosis and is experiencing progressive difficulty ambulating. A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings should the nurse identify as a manifestation of this condition? Pain that increases with passive movement A nurse is assessing heart sounds of a client who reports substernal precordial pain. Identify which of the following sounds the nurse should document in the client's medical record by listening to the audio clip. (Click on the audio button to listen to the clip.) Pericardial friction rub A nurse is caring for a client 1 hr following a cardiac catheterization. the nurse notes the formation of a hematoma at the insertion side and a decreased pulse rate in the affected extremity. which of the following interventions is the nurse's priority? apply firm pressure to the insertion site. A nurse is caring for a client following extubation of an endotracheal tube 10 min ago. Which of the following findings should the nurse report to the provider immediately? Stridor A nurse is caring for a client who had a nephrostomy tube inserted 12 hr ago. Which of the following findings should the nurse report to the provider? Client reports back pain A nurse is caring for a client who has a cervical spinal cord injury sustained 1 month ago. Which of the following manifestations indicates that the client is experiencing autonomic dysreflexia (AD)? Heart rate 52/min A nurse is caring for a client who has a closed head injury and has an intravascular catheter placed. which of the following findings indicate that the client is experiencing increased intracranial pressure (ICP)? sleepiness exhibited by the client widening pulse pressure decerebrate posturing A nurse is caring for a client who has a leg cast and is returning demonstration on the proper use of crutches while climbing stairs. identify the sequence the client should follow when demonstrating crutch use. places body weight on the crutches. advances the unaffected leg onto the stair. shifts weight from the crutches to the unaffected leg. brings the crutches and effected leg up to the stair. A nurse is caring for a client who has a new diagnosis of hyperthyroidism. which of the following is the priority assessment finding that the nurse should report to the provider? blood pressure 170/80 mm Hg A nurse is caring for a client who has a new prescription for total parenteral nutrition (TPN). the client is to receive 2,000 kcal per day. the TPN solution has 500 kcal/L. the IV pump should be set at how many mL/hr? 167 mL/hr A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system. Which of the following findings is an indication of lung re-expansion? Bubbling in the water seal chamber has ceased. A nurse is caring for a client who has a positive culture for methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take? Bathe the client using chlorhexidine solution. A nurse is caring for a client who has a potassium level of 3 mEq/L. which of the following assessment findings should the nurse expect? hypoactive bowel sounds A nurse is caring for a client who has a prescription for enalapril. the nurse should identify which of the following findings as an adverse effect of the medication? orthostatic hypotension A nurse is caring for a client who has a stage 3 pressure injury. which of the following findings contributes to delayed wound healing? urine output 25 mL/hr A nurse is caring for a client who has amyotrophic lateral sclerosis (ALS) and is being admitted to the hospital with pneumonia. which of the following assessment findings in the nurse's priority? increased respiratory secretions A nurse is caring for a client who has an arterial line. Which of the following actions should the nurse take? place a pressure bag around the flush solution A nurse is caring for a client who has anorexia, low-grade fever, night sweats, and a productive cough. which of the following actions should the nurse take first? initiate airborne precautions. A nurse is caring for a client who has bilateral pneumonia and an SaO2 of 85%. the client has dyspnea with a productive cough and is using accessory muscles to breathe. which of the following actions should the nurse take first? place the client in high-fowler's position. A nurse is caring for a client who has breast cancer and tells the nurse that they would like to have acupuncture because it provides greater relief than pain medication. Which of the following statements should the nurse make? "I can speak to the provider about incorporating acupuncture into your treatment plan." A nurse is caring for a client who has chronic glomerulonephritis with oliguria. which of the following findings should the nurse identify as a manifestation of chronic glomerulonephritis? hyperkalemia A nurse is caring for a client who has portal hypertension. the client is vomiting blood mixed with food after a meal. which of the following actions should the nurse take first? obtain vital signs. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following should the nurse plan to administer? Regular insulin 20 units IV A nurse is caring for a client who has DKA. which of the following laboratory findings should the nurse expect? BUN 32 mg/dl A nurse is caring for a client who has DKA. Which of the following findings should indicate to the nurse that the client's condition is improving? Glucose 272 A nurse is caring for a client who has emphysema and is receiving mechanical ventilation. the client appears anxious and restless, and the high-pressure alarm is sounding. which of the following actions should the nurse take first? instruct the client to allow the machine to breathe for them. A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. the client is experiencing excessive stools. which of the following findings is an adverse effect of the medication? hypokalemia A nurse is caring for a client who has HIV. which of the following findings indicates a positive response to the prescribed HIV treatment? decreased viral load A nurse is caring for a client who has homonymous hemianopsia as a result of a stroke. To reduce the risk of falls when ambulating, the nurse should provide which of the following instructions to the client? Scan the environment by turning your head from side to side." A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect? Constipation A nurse is caring for a client who has increased intracranial pressure (ICP) and is receiving mannitol via continuous IV infusion. Which of the following findings should the nurse report to the provider as an adverse effect of this medication? Crackles heard on auscultation A nurse is caring for a client who has pancreatitis. the nurse should expect which of the following laboratory results to be below the expected reference range? calcium