HESI MEDICAL SURGICAL NURSING EXAM 2021|ACTUAL HESI EXAM QUESTIONS AND 100% CORRECT ANSWERS| LATEST UPDATE 2024 1. What instruction should the nurse include in the discharge teaching plan of a client who had a cataract extraction today? b. Light housekeeping is permitted but avoid heavy lifting . 2. A male adult comes to the urgent care clinic 5 days after being diagnose with influenza. He is short of breath, febrile, and coughing green colored sputum. Which intervention should the nurse implement first? a. Obtain a sputum sample for culture 3. An elder male client tells the nurse that he is loosing sleep because he has to get up several times at night to go to the bathroom that he has trouble starting his urinary stream and that he does not feel like his bladder is ever c ompletely empty. Which intervention should the nurse implement? c. palpate the bladder above the symphysis pubis 4. An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI) Prescriptions for intravenous antibiotics and insulin infusion are initiated. Which serum laboratory value warrants the most immediate intervention by the nurse? d. potassium of 2.5 meq/l 5. A client with sickle cell anemia develops a fever during the last hour of administration of a unit of packed red bloo d cell. When notifying the healthcare provider what information should the nurse provide first using the SBAR communication process? a. explain specific reason for urgent notification 6. An adult male client is admitted for pneumocystis carinil pneumonia (PCP) s econdary to aids. While hospitalize he receives IV pentamidine isethionate therapy. In preparing this client for discharge what important aspect regarding his medication therapy should the nurse explain? c. It will be necessary to continue prophylactic dos es of IV or aerosol pentamine every month 7. A client subjective data includes dysuria, urgency, and urinary frequency. What action should the nurse implement next? a. collect a clean catch specimen 8. A client tells the nurse that her biopsy results indicate that the cancer cells are well differentiated How should the nurse respond? c. ask the client in the healthcare provider has giving her any information about the classification of her cancer 9. A client with a chronic kidney disease is treated on hemod ialysis. During the 1 treatment clients blood pressure drops from 150/90 to 80/30 Which action should the nurse take first? c. stop dialysis treatment 10. A client with deep vain thrombosis (DVT) is receiving a continues infusion of heparin sodium 25,000 unit in 5% dextrose injection 250ml. The prescription indicates the dosage should be increase 900 units/hr. The nurse should program the infusion pump to deliver how many ml/hr? =9 11. The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD). Which subjective data reported by the client supports this diagnosis? a. upper mid abdominal gnawing and burning pain 12. The nurse is providing preoperative education for a jewish client schedule to receive a xenograft graft to promote burn healing. Which information should the nurse provide this client? a. the xenograft is taken from nonhuman sources 13. A client who took a camping vacation two weeks ago in a country with a tropical climate comes to the clinic describing vague symptoms and diarrhea for the past week. Which finding is most important for the nurse to report? a. jaundice sclera 14. During a home visit the nurse assesses the skin of a client with eczema who reports than an exacerbat ion of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms? d. a grandson and his new dog recently visited 15. When explaining dietary guidelines to a client with acute glomerulonephrit is (AGN) which instruction should the nurse include in the dietary teaching? b. restrict sodium intake 16. A male client who is 24hr post operative for an exploratory laparoctomy complains that he is starving because he has had no real food since before surgery. Prior to advancing his diet which intervention should the nurse implememt? d. Auscultate bowel sound in all four quadrants 17. A client diagnose with stable angina s econdary to ischemic heart disease has a prescription for sublingual (SL) nitroglycerin (NTG). The nurse should tell the client to follow which instructions if chest pain is not relieved after taking 3 NTG tables 5 min apart? d. call 911 pain is unrelieved and chew a tablet of aspirin 325mg 18. After taking orlistat (Xenical) for one week a femela client tells the home health nurse that she is experiencing increasingly frequent oily stools and flatus. What action should the nurse take? c. ask the client to describe her dietary intake history for the last several days 19. Two days after an abscess of the chin was drained the client returns to the clinic with fever chills and a maculopapular rash with pruritis. The client has taken an oral antibiotic and cleansed the wound today with provide iodine (Betadine) solution. Which intervention should the nurse implement first? b. assess airway patency and oxygen saturation 20. A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the health care provider? a. low back pain and hypotension 21 .A young adult male who has had type 2 diabetes mellitu s (DM) is admitted to the intensive care unit with hyperglycemic nonketotic syndrome (HHNS). A sliding scale protocol for an isotonic IV solution with regular insulin is prescribed based on the results of a continuous blood glucose monitoring device that i s attached to the client’s central venous catheter. When the client’s respirations become labored and his lungs sound indicate crackles what action should the nurse take? d. decrease infusion rate to address fluid overload 22. When preparing to apply a fentanyl ( Duragesic) transdermal patch the nurse notes that the previously applied patch is intact on the client’s upper back and the client denies pain. What action should the nurse take? d. Apply a new patch in a different location after removing the original patch 23. A client who had a myocardial infarction is admitted to the coronary critical care unit (CCU) with a nitroglycerin drip infusing. The clients last blood pressure measurements was 78/36.What action should the nurse implement? c. reduce the rate of the nitroglycerin infusion 24. An adolescent is admitted to the hospital because of a suicide attempt with an overdose of acetaminophen (Tylenol). Which blood values are most important for the nurse to monitor during the first 72 hours following ingestion of this o verdose?
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