MED-SURG HESI EXAM QUESTIONS AND ANSWERS | 100% CORRECT/VERIFIED | GRADED A+ | LATEST UPDATED 2024/2025

A 74-year-old male client is admitted to the intensive care unit (ICU) with a diagnosis of respiratory failure secondary to pneumonia. Currently, the client is ventilatordependent, with settings of tidal volume (VT) of 750 mL and an intermittent mandatory ventilation (IMV) rate of 10 breaths/min. Arterial blood gas (ABG) results are as follows: pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg; HCO3 , 25 mEq/L; and FiO2, 0.80. Which action should the nurse take first? a. Increase the ventilator VT to 850 mL b. Decrease the ventilator IMV to a rate of 8 breaths/min c. Reduce the FiO 2 to 0.70 and redraw ABGs d. Add 5 cm positive end-expiratory pressure (PEEP) ANS: D Adding PEEP helps improve oxygenation while reducing FiO2 to a less toxic level. Options A, B, and C will not result in improved oxygenation and could cause further complications for this client, who is experiencing respiratory failure.  Which nursing action would be appropriate for a client who is newly diagnosed with Cushing syndrome? a. Monitor blood glucose levels daily b. Increase intake of fluids high in potassium c. Encourage adequate rest between activities d. Offer the client a sodium-enriched menu ANS: A Cushing syndrome results from a hypersecretion of glucocorticoids in the adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus. Monitoring of serum glucose levels assesses for increased blood glucose levels so that treatment can begin early. A common finding in Cushing syndrome is generalized edema. Although potassium is needed, it is generally obtained from food intake, not by offering potassium-enhanced fluids. Fatigue is usually not an overwhelming factor in Cushing syndrome, so an emphasis on the need for rest is not indicated. A low-calorie, low-carbohydrate, low-sodium diet is not recommended.  One day after a Billroth II surgery, the client suddenly grabs his right chest and becomes pale and diaphoretic. Vital signs are assessed as blood pressure 100/80 mm Hg, pulse 110 beats/min, and respirations 36 breaths/min. Which action is most important for the nurse to take? a. Provide a paper bag for his hyperventilation b. Administer a prescribed PRN analgesic c. Have the client drink a glass of sweetened fruit juice d. Apply oxygen at 2 L via nasal cannula ANS: D Pulmonary embolism and pneumothorax are risks associated with major abdominal surgery. The nurse should immediately provide oxygen while performing further assessment. A rapid respiratory rate should not be treated as hyperventilation. Option B should not be administered until more ominous causes are ruled out or treated. There is no evidence that the client is hypoglycemic.  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 ANS: A, B, C, D, F 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.  A 25-year-old client was admitted yesterday after a motor vehicle collision. Neurodiagnostic studies have shown a basal skull fracture in the middle fossa. Assessment on admission revealed both halo and Battle signs. Which new symptom indicates that the client is likely to be experiencing a common life-threatening complication associated with a basal skull fracture? a. Bilateral jugular venous distention b. Oral temperature of 102°F c. Intermittent focal motor seizures d. Intractable pain in the cervical region ANS: B Clients with basilar skull fractures are at high risk for infection of the brain, as indicated by an increased oral temperature, because the fracture leaves the meninges open to bacterial invasion. Clients may experience options C and D, but these findings do not pose as great a life-threatening risk as infection. Jugular distention is not a typical complication of basal skull fractures.  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 ANS: B 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.  The nurse is caring for a critically ill client with cirrhosis of the liver who has a nasogastric tube draining bright red blood. The nurse notes that the client’s serum hemoglobin and hematocrit levels are decreased. Which additional change in laboratory data should the nurse expect? a. Increased serum albumin level b. Decreased serum creatinine c. Decreased serum ammonia level d. Increased liver function test results ANS: C The breakdown of glutamine in the intestine and the increased activity of colonic bacteria from the digestion of proteins increase ammonia levels in clients with advanced liver disease, so removal of blood, a protein source, from the intestine results in a reduced level of ammonia. Options A, B, and D will not be significantly affected by the removal of blood.  A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment? a. Administer Lidocaine, 75 mg IV push b. Perform synchronized cardioversion c. Defibrillate the client as soon as possible d. Administer Atropine, 0.4 mg IV push ANS: B With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A is a medication used for ventricular dysrhythmias. Option C is not for a client with atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug of choice in symptomatic sinus bradycardia, not atrial fibrillation.  The nurse is interviewing a client who is taking interferon-alfa-2a and ribavirin combination therapy for hepatitis C. The client reports experiencing overwhelming feelings of depression. Which action should the nurse take first? a. Recommend mental health counseling b. Review the medication actions and interactions c. Assess for the client’s daily activity level d. Provide information regarding a support group ANS: B Interferon-alfa-2a and ribavirin combination therapy can cause severe depression; therefore, it is most important for the nurse to review the medication effects and report these to the health care provider. Options A, C, and D might be implemented after the physiologic aspects of the situation have been assessed.  The nurse is counseling a healthy 30-year-old female client regarding osteoporosis prevention. Which activity would be most beneficial in achieving the client’s goal of osteoporosis prevention? a. Cross-country skiing b. Scuba diving c. Horseback riding d. Kayaking ANS: A Weight-bearing exercise is an important measure to reduce the risk of osteoporosis. Of the activities listed, cross-country skiing includes the most weight-bearing, whereas options B, C, and D involve less.  Which content about self-care should the nurse include in the teaching plan of a female client who has genital herpes? (Select all that apply.) a. Encourage annual physical and Pap smear b. Take antiviral medication as prescribed c. Use condoms to avoid transmission to others EMAIL ME: For help with report, Assignment, Essay and thesis writing d. Warms sitz baths may relieve itching e. Use Nystatin suppositories to control itching f. Use a douche with weak vinegar solution to decrease itching ANS: A, B, C, D The nurse should include (A, B, C, and D) in the teaching plan of a female client with genital herpes. (E) is specific for Candida infections, and option (F) is used to treat Trichomonas.  A 55-year-old male client has been admitted to the hospital with a medical diagnosis of chronic obstructive pulmonary disease (COPD). Which risk factor is the most significant in the development of this client’s COPD? a. The client’s father was diagnosed with COPD in his 50s b. A close family member contracted tuberculosis last year c. The client smokes one to two packs of cigarettes per day d. The client has been 40 pounds overweight for 15 years ANS: C Smoking, considered to be a modifiable risk factor, is the most significant risk factor for the development of COPD. The exact mechanism of genetic and hereditary implications for the development of COPD is still under investigation, although exposure to similar predisposing factors (e.g., smoking or inhaling secondhand smoke) may increase the likelihood of COPD incidence among family members. Options B and D do not exceed the risks associated with cigarette smoking in the development of COPD.  A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of 102°F/38.9°C. What other assessments should the nurse include in the client’s focused assessment? (Select all that apply.) a. Nausea and vomiting b. Loss of appetite c. Abdominal cramping d. Guarding with abdominal palpation e. Low urine output f. Cool, clammy skin ANS: A, B, C, D The client is showing signs of peritonitis with the sudden spike in temperature. Low urine output and cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the health care provider must be notified immediately.  The nurse assesses a postoperative client whose skin is cool, pale, and moist. The client is very restless and has scant urine output. Oxygen is being administered at 2 L/min, and a saline lock is in place. Which action should the nurse take first? a. Measure the urine specific gravity b. Obtain IV fluids for infusion per protocol c. Prepare for insertion of a central venous catheter d. Auscultate the client’s breath sounds ANS: B The client is at risk for hypovolemic shock because of the postoperative status and is exhibiting early signs of shock. A priority intervention is the initiation of IV fluids to restore tissue perfusion. Options A, C, and D are all important interventions but are of lower priority than option B.  A home health nurse is assessing a 70-year-old male client who is convalescing at home following a hip replacement. The nurse is concerned that the client may develop pressure ulcers. Which physical characteristic of aging puts the client at risk? a. 16% increase in overall body fat b. Reduced melanin production c. Thinning of the skin, with loss of elasticity d. Calcium loss in the bones ANS: C Thin nonelastic skin is an important factor in pressure formation. The proportion of body fat to lean mass increases with age and might help decrease ulcer tendency. Option B causes gray hair. Option D can contribute to broken bones, but it is probably not a factor in pressure ulcer formation.  A client diagnosed with angina pectoris complains of chest pain while ambulating in the hallway. Which action should the nurse take first? a. Support the client to a sitting position b. Ask he client to walk slowly back to the room c. Administer a sublingual nitroglycerin tablet