2023 HESI MED SURG REVIEW GRADED A 125 QUESTIONS AND ANSWERS
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2023 HESI MED SURG
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2023 HESI MED SURG
2023 HESI MED SURG REVIEW GRADED A 125
QUESTIONS AND ANSWERS
.
1. When a nurse assesses a client receiving total parenteral nutrition (TPN), which laboratory value is most
important for the nurse to monitor regularly?
A. Albumin
B. Calcium
C. Glucose
D. Alkaline phosphatase
Rationale:
TPN...
2023 hesi med surg review graded a 125 questions a
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2023 HESI MED SURG REVIEW GRADED A 125
QUESTIONS AND ANSWERS
.
1. When a nurse assesses a client receiving total parenteral nutrition (TPN), which laboratory value is most
important for the nurse to monitor regularly?
A. Albumin
B. Calcium
C. Glucose
D. Alkaline phosphatase
Rationale:
TPN solutions contain high concentrations of glucose, so the blood glucose level is often monitored as often as q6h
because of the risk for hyperglycemia. Option A is monitored periodically because an increase in the albumin level,
a serum protein, is generally a desired effect of TPN. Option B may be added to TPN solutions, but calcium
imbalances are not generally a risk during TPN administration. Option D may be decreased in the client with
malnutrition who receives TPN, but abnormal values, reflecting liver or bone disorders, are not a common
complication of TPN administration.
2. When educating a client after a total laryngectomy, which instruction would be most important for the
nurse to include in the discharge teaching?
A. Recommend that the client carry suction equipment at all times.
B. Instruct the client to carry writing materials at all times.
C. Tell the client to carry a medical alert card that explains the condition.
D. Caution the client not to travel outside the United States alone.
Rationale:
Neck breathers carry a medical alert card that notifies health care personnel of the need to use mouth to stoma
breathing in the event of a cardiac arrest in this client. Mouth-to-mouth resuscitation will not establish a patent
airway. Options A and D are not necessary. There are many alternative means of communication for clients who
have had a laryngectomy; dependence on writing messages is probably the least effective.
3. When developing a discharge teaching plan for a client after the insertion of a permanent pacemaker, the
nurse writes a goal of “The client will verbalize symptoms of pacemaker failure.” Which behavior indicates that the
goal has been met?
A. The client demonstrates the procedures to change the rate of the pacemaker using a magnet.
B. The client carries a card in his wallet stating the type and serial number of the pacemaker.
C. The client tells the nurse that it is important to report redness and tenderness at the insertion site.
D. The client states that changes in the pulse and feelings of dizziness are significant changes. Rationale:
Changes in pulse rate and/or rhythm may indicate pacer failure. Feelings of dizziness may be caused by a
decreased heart rate, leading to decreased cardiac output. The rate of a pacemaker is not changed by a client,
although the client may be familiar with this procedure as explained by his health care provider. Option B is an
important step in preparing the client for discharge but does not demonstrate knowledge of the symptoms of
pacer failure. Option C indicates symptoms of possible incisional infection or irritation but does not indicate pacer
failure.
4. The nurse assesses a client who has been prescribed furosemide for cardiac disease. Which
electrocardiographicchange would be a concern for a client taking a diuretic?
, A. Tall, spiked T waves
B. A prolonged QT interval
C. A widening QRS complex
D. Presence of a U wave
Rationale:
A U wave is a positive deflection following the T wave and is often present with hypokalemia (low potassium level).
Options A, B, and C are all signs of hyperkalemia.
,5. What is the correct location for placement of the hands for manual chest compressions during
cardiopulmonary resuscitation (CPR) on the adult client?
A. Just above the xiphoid process, on the upper third of the sternum
B. Below the xiphoid process, midway between the sternum and the umbilicus
C. Just above the xiphoid process, on the lower third of the sternum
D. Below the xiphoid process, midway between the sternum and the
first rib
Rationale:
The correct placement of the hands for chest compressions in CPR is just above the notch where the ribs meet the
sternum on the lower part of the sternum. Option A is too high. Option B would not compress the heart. Option D
would likely cause damage to both structures, possibly causing a puncture of the heart, and would not render
effective compressions.
6. Zolpidem tartrate, 1.75 mg PRN at bedtime, is prescribed for rest. The scored tablets are labeled 3.5 mg
per tablet. What dose should the nurse plan to administer? Rationale:
1.75 is ordered. 3.5 is available. 1.75/3.5 time one tab equals. 0.5 or one half tablet.
7. A central venous catheter has been inserted via a jugular vein, and a radiograph has confirmed placement
of the catheter. A prescription has been received for a medication STAT, but IV fluids have not yet been started.
Which action should the nurse take prior to administering the prescribed medication? A. Assess for signs of
jugular venous distention.
B. Obtain the needed intravenous solution.
C. Flush the line with heparinized solution.
D. Flush the line with normal saline.
Rationale:
Medication can be administered via a central line without additional IV fluids. The line should first be flushed with
a normal saline solution to ensure patency. Insufficient evidence exists on the effectiveness of flushing catheters
with heparin. Option A will not affect the decision to administer the medication and is not a priority.
Administration of the medication STAT is of greater priority than option B.
8. A client diagnosed with chronic kidney disease (CKD) 2 years ago is regularly treated at a community
hemodialysis facility. Before the scheduled dialysis treatment, which electrolyte imbalance should the nurse
anticipate?
A. Hypophosphatemia
B. Hypocalcemia
C. Hyponatremia
D. Hypokalemia
Rationale:
Hypocalcemia develops in CKD because of chronic hyperphosphatemia, not option A. Increased phosphate levels
cause the peripheral deposition of calcium and resistance to vitamin D absorption needed for calcium absorption.
Prior to dialysis, the nurse would expect to find the client hypernatremic and hyperkalemic, not with option C or D.
9. A client is placed on a mechanical ventilator following a cerebral hemorrhage. What are the priority
nursing actions for this client? (Select all that apply.)
A. Assess lung sounds.
B. Look for equal and bilateral expansion of the chest.
C. Monitor skin color.
D. Evaluate the need for suctioning.
, E. Tell the family the client is expected to fully recover.
F. Make sure the ventilator alarms are set.
Rationale:
The outcome of the client is too early to relay to the family. The nurse must not offer false reassurance. The
remaining actions are correct for a client on a ventilator.
10. In assessing a client diagnosed with primary aldosteronism, the nurse expects the laboratory test results
to indicate a decreased serum level of which substance?
A. Sodium
B. Phosphate
C. Potassium
D. Glucose
Rationale:
Clients with primary aldosteronism exhibit a profound decline in serum levels of potassium; hypokalemia;
hypertension is the most prominent and universal sign. The serum sodium level is normal or elevated, depending
on the amount of water resorbed with the sodium. Option B is influenced by parathyroid hormone (PTH). Option D
is not affected by primary aldosteronism.
11. A client with a nasogastric tube attached to low suction states that she is nauseated. The nurse
assesses that there has been no drainage through the nasogastric tube in the last 2 hours. Which action should
the nurse take first? A. Irrigate the nasogastric tube with sterile normal saline.
B. Reposition the client on her side.
C. Advance the nasogastric tube 5 cm.
D. Administer an intravenous antiemetic as prescribed.
Rationale:
The immediate priority is to determine if the tube is functioning correctly, which would then relieve the client’s
nausea. The least invasive intervention, repositioning the client, should be attempted first, followed by options A
and C, unless either of these interventions is contraindicated. If these measures are unsuccessful, the client may
require option D.
12. A client with cirrhosis develops increasing pedal edema and ascites. Which dietary modification is most
important for the nurse to teach this client? A. Avoid high-carbohydrate foods.
B. Decrease intake of fat-soluble vitamins.
C. Decrease caloric intake. D. Restrict salt and fluid intake.
Rationale:
Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as manifested by
edema and ascites. Options A, B, and C will not affect fluid retention.
13. W The nurse is providing care for a client diagnosed with trigeminal neuralgia (tic douloureux). Which
symptoms will the nurse be looking for in the focused assessment related to this condition? (Select all that apply.)
A. Facial muscle spasms
B. Sudden facial pain
C. Unilateral facial weakness
D. Difficulty in chewing
E. Tinnitus
F. Hearing difficulties
Rationale:
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