HESI MED SURG LATEST VERSION
2025 BEST GRADED WITH CORRECT
QUESTIONS AND ANSWERS
Which preexisting diagnosis places a client at greatest risk of developing superior
vena cava syndrome?
o Carotid stenosis.
o Steatosis hepatitis.
o Metastatic cancer. Correct
o Clavicular fracture. - -answer--Metastatic cancer.
Superior vena cava syndrome occurs when the superior vena cava (SVC) is
compressed by outside structures, such as a growing tumor that impedes the return
blood flow to the heart. Superior vena cava syndrome is likely to occur with
metastatic cancer (C) from a primary tumor in the upper lobe of the right lung that
compresses the superior vena cava. (A, B, and D) do not result in SVC syndrome.
A male client with chronic atrial fibrillation and a slow ventricular response is
scheduled for surgical placement of a permanent pacemaker. The client asks the
nurse how this devise will help him. How should the nurse explain the action of a
synchronous pacemaker?
o Ventricular irritability is prevented by the constant rate setting of pacemaker.
o Ectopic stimulus in the atria is suppressed by the device usurping depolarization.
o An impulse is fired every second to maintain a heart rate of 60 beats per minute.
o An electrical stimulus is discharged when no ventricular response is sensed. - -
answer--An electrical stimulus is discharged when no ventricular response is sensed.
Correct
The artificial cardiac pacemaker is an electronic device used to pace the heart when
the normal conduction pathway is damaged or diseased, such as a symptomatic
dysrhythmias like atrial fibrillation with a slow ventricular response. Pacing modes
that are synchronous (impulse generated on demand or as needed according to the
patient's intrinsic rhythm) send an electrical signal from the pacemaker to the wall of
the myocardium stimulating it to contract when no ventricular depolarization is
sensed (D). (A, B, and C) do not provide accurate information.
The nurse is caring for a client with end stage liver disease who is being assessed
for the presence of asterixis. To assess the client for asterixis, what position should
the nurse ask the client to demonstrate?
o Extend the left arm laterally with the left palm upward.
o Extend the arm, dorsiflex the wrist, and extend the fingers.
,8. Which of the following clinical manifestations would the nurse expect to find during
assessment of a patient admitted with pneumococcal pneumonia? A.
Hyperresonance on percussion
B. Fine crackles in all lobes on auscultation
C. Increased vocal fremitus on palpation D. Vesicular breath sounds in all lobes - -
answer--C. Increased vocal fremitus on palpation. A typical physical examination
finding for a patient with pneumonia is increased vocal fremitus on palpation. Other
signs of pulmonary consolidation include dullness to percussion, bronchial breath
sounds, and crackles in the affected area.
9. Which of the following nursing interventions is of the highest priority in helping a
patient expectorate thick secretions related to pneumonia?
A. Humidify the oxygen as able
B. Increase fluid intake to 3L/day if tolerated.
C. Administer cough suppressant q4hr.
D. Teach patient to splint the affected area. - -answer--B. Increase fluid intake to
3L/day if tolerated. Although several interventions may help the patient expectorate
mucus, the highest priority should be on increasing fluid intake, which will liquefy the
secretions so that the patient can expectorate them more easily. Humidifying the
oxygen is also helpful, but is not the primary intervention. Teaching the patient to
splint the affected area may also be helpful, but does not liquefy the secretions so
that they can be removed.
10. During discharge teaching for a 65-year-old patient with emphysema and
pneumonia, which of the following vaccines should the nurse recommend the patient
receive?
A. S. aureus
B. H. influenzae
C. Pneumococcal
D. Bacille Calmette-Guérin (BCG) - -answer--C. Pneumococcal The pneumococcal
vaccine is important for patients with a history of heart or lung disease, recovering
from a severe illness, age 65 or over, or living in a long-term care facility.
11. The nurse evaluates that discharge teaching for a patient hospitalized with
pneumonia has been most effective when the patient states which of the following
measures to prevent a relapse?
A. "I will increase my food intake to 2400 calories a day to keep my immune system
well."
B. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to
reevaluate."
C. "I will seek immediate medical treatment for any upper respiratory infections."
D. "I should continue to do deep-breathing and coughing exercises for at least 6
weeks." - -answer--D. "I should continue to do deep-breathing and coughing
exercises for at least 6 weeks." It is important for the patient to continue with
coughing and deep breathing exercises for 6 to 8 weeks until all of the infection has
cleared from the lungs. A patient should seek medical treatment for upper respiratory
infections that persist for more than 7 days. Increased fluid intake, not caloric intake,
is required to liquefy secretions. Home O2 is not a requirement unless the patient's
oxygenation saturation is below normal.
,12. After admitting a patient to the medical unit with a diagnosis of pneumonia, the
nurse will verify that which of the following physician orders have been completed
before administering a dose of cefotetan (Cefotan) to the patient?
A. Serum laboratory studies ordered for AM
B. Pulmonary function evaluation
C. Orthostatic blood pressures
D. Sputum culture and sensitivity - -answer--D. Sputum culture and sensitivityThe
nurse should ensure that the sputum for culture and sensitivity was sent to the
laboratory before administering the cefotetan. It is important that the organisms are
correctly identified (by the culture) before their numbers are affected by the antibiotic;
the test will also determine whether the proper antibiotic has been ordered
(sensitivity testing). Although antibiotic administration should not be unduly delayed
while waiting for the patient to expectorate sputum, all of the other options will not be
affected by the administration of antibiotics.
13. Which of the following nursing interventions is most appropriate to enhance
oxygenation in a patient with unilateral malignant lung disease?
A. Positioning patient on right side.
B. Maintaining adequate fluid intake
C. Performing postural drainage every 4 hours
D. Positioning patient with "good lung down" - -answer--D. Positioning patient with
"good lung down" Therapeutic positioning identifies the best position for the patient
assuring stable oxygenation status. Research indicates that positioning the patient
with the unaffected lung (good lung) dependent best promotes oxygenation in
patients with unilateral lung disease. For bilateral lung disease, the right lung down
has best ventilation and perfusion. Increasing fluid intake and performing postural
drainage will facilitate airway clearance, but positioning is most appropriate to
enhance oxygenation.
14. A 71-year-old patient is admitted with acute respiratory distress related to cor
pulmonale. Which of the following nursing interventions is most appropriate during
admission of this patient?
A. Delay any physical assessment of the patient and review with the family the
patient's history of respiratory problems. B. Perform a comprehensive health history
with the patient to review prior respiratory problems.
C. Perform a physical assessment of the respiratory system and ask specific
questions related to this episode of respiratory distress.
D. Complete a full physical examination to determine the effect of the respiratory
distress on other body functions. - -answer--C. Perform a physical assessment of the
respiratory system and ask specific questions related to this episode of respiratory
distress.Because the patient is having respiratory difficulty, the nurse should ask
specific questions about this episode and perform a physical assessment of this
system. Further history taking and physical examination of other body systems can
proceed once the patient's acute respiratory distress is being managed.
15. When planning appropriate nursing interventions for a patient with metastatic
lung cancer and a 60-pack-year history of cigarette smoking, the nurse recognizes
that the smoking has most likely decreased the patient's underlying respiratory
defenses because of impairment of which of the following?
A. Reflex bronchoconstriction
, B. Ability to filter particles from the air
C. Cough reflex
D. Mucociliary clearance - -answer--D. Mucociliary clearance Smoking decreases
the ciliary action in the tracheobronchial tree, resulting in impaired clearance of
respiratory secretions, chronic cough, and frequent respiratory infections.
16. While ambulating a patient with metastatic lung cancer, the nurse observes a
drop in oxygen saturation from 93% to 86%. Which of the following nursing
interventions is most appropriate based upon these findings?
A. Continue with ambulation as this is a normal response to activity.
B. Move the oximetry probe from the finger to the earlobe for more accurate
monitoring during activity.
C. Obtain a physician's order for supplemental oxygen to be used during ambulation
and other activity.
D. Obtain a physician's order for arterial blood gas determinations to verify the
oxygen saturation. - -answer--C. Obtain a physician's order for supplemental oxygen
to be used during ambulation and other activity. An oxygen saturation level that
drops below 90% with activity indicates that the patient is not tolerating the exercise
and needs to have supplemental oxygen applied.
17. The nurse is caring for a 73-year-old patient who underwent a left total knee
arthroplasty. On the third postoperative day, the patient complains of shortness of
breath, slight chest pain, and that "something is wrong." Temperature is 98.4o F,
blood pressure 130/88, respirations 36, and oxygen saturation 91% on room air.
Which of the following should the nurse first suspect as the etiology of this episode?
A. Septic embolus from the knee joint
B. Pulmonary embolus from deep vein thrombosis
C. New onset of angina pectoris
D. Pleural effusion related to positioning in the operating room - -answer--B.
Pulmonary embolus from deep vein thrombosis The patient presents the classic
symptoms of pulmonary embolus: acute onset of symptoms, tachypnea, shortness of
breath, and chest pain.
18. In the case of pulmonary embolus from deep vein thrombosis, which of the
following actions should the nurse take first?
A. Notify the physician.
B. Administer a nitroglycerin tablet sublingually.
C. Conduct a thorough assessment of the chest pain.
D. Sit the patient up in bed as tolerated and apply oxygen. - -answer--D. Sit the
patient up in bed as tolerated and apply oxygen.The patient's clinical picture is
consistent with pulmonary embolus, and the first action the nurse takes should be to
assist the patient. For this reason, the nurse should sit the patient up as tolerated
and apply oxygen before notifying the physician.
19. The nurse is caring for a postoperative patient with sudden onset of respiratory
distress. The physician orders a STAT ventilation-perfusion scan. Which of the
following explanations should the nurse provide to the patient about the procedure?
A. This test involves injection of a radioisotope to outline the blood vessels in the
lungs, followed by inhalation of a radioisotope gas.
2025 BEST GRADED WITH CORRECT
QUESTIONS AND ANSWERS
Which preexisting diagnosis places a client at greatest risk of developing superior
vena cava syndrome?
o Carotid stenosis.
o Steatosis hepatitis.
o Metastatic cancer. Correct
o Clavicular fracture. - -answer--Metastatic cancer.
Superior vena cava syndrome occurs when the superior vena cava (SVC) is
compressed by outside structures, such as a growing tumor that impedes the return
blood flow to the heart. Superior vena cava syndrome is likely to occur with
metastatic cancer (C) from a primary tumor in the upper lobe of the right lung that
compresses the superior vena cava. (A, B, and D) do not result in SVC syndrome.
A male client with chronic atrial fibrillation and a slow ventricular response is
scheduled for surgical placement of a permanent pacemaker. The client asks the
nurse how this devise will help him. How should the nurse explain the action of a
synchronous pacemaker?
o Ventricular irritability is prevented by the constant rate setting of pacemaker.
o Ectopic stimulus in the atria is suppressed by the device usurping depolarization.
o An impulse is fired every second to maintain a heart rate of 60 beats per minute.
o An electrical stimulus is discharged when no ventricular response is sensed. - -
answer--An electrical stimulus is discharged when no ventricular response is sensed.
Correct
The artificial cardiac pacemaker is an electronic device used to pace the heart when
the normal conduction pathway is damaged or diseased, such as a symptomatic
dysrhythmias like atrial fibrillation with a slow ventricular response. Pacing modes
that are synchronous (impulse generated on demand or as needed according to the
patient's intrinsic rhythm) send an electrical signal from the pacemaker to the wall of
the myocardium stimulating it to contract when no ventricular depolarization is
sensed (D). (A, B, and C) do not provide accurate information.
The nurse is caring for a client with end stage liver disease who is being assessed
for the presence of asterixis. To assess the client for asterixis, what position should
the nurse ask the client to demonstrate?
o Extend the left arm laterally with the left palm upward.
o Extend the arm, dorsiflex the wrist, and extend the fingers.
,8. Which of the following clinical manifestations would the nurse expect to find during
assessment of a patient admitted with pneumococcal pneumonia? A.
Hyperresonance on percussion
B. Fine crackles in all lobes on auscultation
C. Increased vocal fremitus on palpation D. Vesicular breath sounds in all lobes - -
answer--C. Increased vocal fremitus on palpation. A typical physical examination
finding for a patient with pneumonia is increased vocal fremitus on palpation. Other
signs of pulmonary consolidation include dullness to percussion, bronchial breath
sounds, and crackles in the affected area.
9. Which of the following nursing interventions is of the highest priority in helping a
patient expectorate thick secretions related to pneumonia?
A. Humidify the oxygen as able
B. Increase fluid intake to 3L/day if tolerated.
C. Administer cough suppressant q4hr.
D. Teach patient to splint the affected area. - -answer--B. Increase fluid intake to
3L/day if tolerated. Although several interventions may help the patient expectorate
mucus, the highest priority should be on increasing fluid intake, which will liquefy the
secretions so that the patient can expectorate them more easily. Humidifying the
oxygen is also helpful, but is not the primary intervention. Teaching the patient to
splint the affected area may also be helpful, but does not liquefy the secretions so
that they can be removed.
10. During discharge teaching for a 65-year-old patient with emphysema and
pneumonia, which of the following vaccines should the nurse recommend the patient
receive?
A. S. aureus
B. H. influenzae
C. Pneumococcal
D. Bacille Calmette-Guérin (BCG) - -answer--C. Pneumococcal The pneumococcal
vaccine is important for patients with a history of heart or lung disease, recovering
from a severe illness, age 65 or over, or living in a long-term care facility.
11. The nurse evaluates that discharge teaching for a patient hospitalized with
pneumonia has been most effective when the patient states which of the following
measures to prevent a relapse?
A. "I will increase my food intake to 2400 calories a day to keep my immune system
well."
B. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to
reevaluate."
C. "I will seek immediate medical treatment for any upper respiratory infections."
D. "I should continue to do deep-breathing and coughing exercises for at least 6
weeks." - -answer--D. "I should continue to do deep-breathing and coughing
exercises for at least 6 weeks." It is important for the patient to continue with
coughing and deep breathing exercises for 6 to 8 weeks until all of the infection has
cleared from the lungs. A patient should seek medical treatment for upper respiratory
infections that persist for more than 7 days. Increased fluid intake, not caloric intake,
is required to liquefy secretions. Home O2 is not a requirement unless the patient's
oxygenation saturation is below normal.
,12. After admitting a patient to the medical unit with a diagnosis of pneumonia, the
nurse will verify that which of the following physician orders have been completed
before administering a dose of cefotetan (Cefotan) to the patient?
A. Serum laboratory studies ordered for AM
B. Pulmonary function evaluation
C. Orthostatic blood pressures
D. Sputum culture and sensitivity - -answer--D. Sputum culture and sensitivityThe
nurse should ensure that the sputum for culture and sensitivity was sent to the
laboratory before administering the cefotetan. It is important that the organisms are
correctly identified (by the culture) before their numbers are affected by the antibiotic;
the test will also determine whether the proper antibiotic has been ordered
(sensitivity testing). Although antibiotic administration should not be unduly delayed
while waiting for the patient to expectorate sputum, all of the other options will not be
affected by the administration of antibiotics.
13. Which of the following nursing interventions is most appropriate to enhance
oxygenation in a patient with unilateral malignant lung disease?
A. Positioning patient on right side.
B. Maintaining adequate fluid intake
C. Performing postural drainage every 4 hours
D. Positioning patient with "good lung down" - -answer--D. Positioning patient with
"good lung down" Therapeutic positioning identifies the best position for the patient
assuring stable oxygenation status. Research indicates that positioning the patient
with the unaffected lung (good lung) dependent best promotes oxygenation in
patients with unilateral lung disease. For bilateral lung disease, the right lung down
has best ventilation and perfusion. Increasing fluid intake and performing postural
drainage will facilitate airway clearance, but positioning is most appropriate to
enhance oxygenation.
14. A 71-year-old patient is admitted with acute respiratory distress related to cor
pulmonale. Which of the following nursing interventions is most appropriate during
admission of this patient?
A. Delay any physical assessment of the patient and review with the family the
patient's history of respiratory problems. B. Perform a comprehensive health history
with the patient to review prior respiratory problems.
C. Perform a physical assessment of the respiratory system and ask specific
questions related to this episode of respiratory distress.
D. Complete a full physical examination to determine the effect of the respiratory
distress on other body functions. - -answer--C. Perform a physical assessment of the
respiratory system and ask specific questions related to this episode of respiratory
distress.Because the patient is having respiratory difficulty, the nurse should ask
specific questions about this episode and perform a physical assessment of this
system. Further history taking and physical examination of other body systems can
proceed once the patient's acute respiratory distress is being managed.
15. When planning appropriate nursing interventions for a patient with metastatic
lung cancer and a 60-pack-year history of cigarette smoking, the nurse recognizes
that the smoking has most likely decreased the patient's underlying respiratory
defenses because of impairment of which of the following?
A. Reflex bronchoconstriction
, B. Ability to filter particles from the air
C. Cough reflex
D. Mucociliary clearance - -answer--D. Mucociliary clearance Smoking decreases
the ciliary action in the tracheobronchial tree, resulting in impaired clearance of
respiratory secretions, chronic cough, and frequent respiratory infections.
16. While ambulating a patient with metastatic lung cancer, the nurse observes a
drop in oxygen saturation from 93% to 86%. Which of the following nursing
interventions is most appropriate based upon these findings?
A. Continue with ambulation as this is a normal response to activity.
B. Move the oximetry probe from the finger to the earlobe for more accurate
monitoring during activity.
C. Obtain a physician's order for supplemental oxygen to be used during ambulation
and other activity.
D. Obtain a physician's order for arterial blood gas determinations to verify the
oxygen saturation. - -answer--C. Obtain a physician's order for supplemental oxygen
to be used during ambulation and other activity. An oxygen saturation level that
drops below 90% with activity indicates that the patient is not tolerating the exercise
and needs to have supplemental oxygen applied.
17. The nurse is caring for a 73-year-old patient who underwent a left total knee
arthroplasty. On the third postoperative day, the patient complains of shortness of
breath, slight chest pain, and that "something is wrong." Temperature is 98.4o F,
blood pressure 130/88, respirations 36, and oxygen saturation 91% on room air.
Which of the following should the nurse first suspect as the etiology of this episode?
A. Septic embolus from the knee joint
B. Pulmonary embolus from deep vein thrombosis
C. New onset of angina pectoris
D. Pleural effusion related to positioning in the operating room - -answer--B.
Pulmonary embolus from deep vein thrombosis The patient presents the classic
symptoms of pulmonary embolus: acute onset of symptoms, tachypnea, shortness of
breath, and chest pain.
18. In the case of pulmonary embolus from deep vein thrombosis, which of the
following actions should the nurse take first?
A. Notify the physician.
B. Administer a nitroglycerin tablet sublingually.
C. Conduct a thorough assessment of the chest pain.
D. Sit the patient up in bed as tolerated and apply oxygen. - -answer--D. Sit the
patient up in bed as tolerated and apply oxygen.The patient's clinical picture is
consistent with pulmonary embolus, and the first action the nurse takes should be to
assist the patient. For this reason, the nurse should sit the patient up as tolerated
and apply oxygen before notifying the physician.
19. The nurse is caring for a postoperative patient with sudden onset of respiratory
distress. The physician orders a STAT ventilation-perfusion scan. Which of the
following explanations should the nurse provide to the patient about the procedure?
A. This test involves injection of a radioisotope to outline the blood vessels in the
lungs, followed by inhalation of a radioisotope gas.
