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2023 HESI PN MED SURGE /MED SURGE PN HESI EXIT EXAM TEST BANK NEWEST ACTUAL EXAM
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2023 HESI PN MED SURGE /MED SURGE PN HESI EXIT EXAM TEST BANK NEWEST ACTUAL EXAM
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2023 HESI PN MED SURGE /MED SURGE PN HESI EXIT EXAMTEST BANK NEWEST 2023-2024 ACTUAL EXAM
A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the followingactions should the nurse take?
1) Provide a diet high in protein.
2) Provide ibuprofen for retroperitoneal discomfort.
3) Monitor intake and output hourly
4) Encourage the client to consume at least 2 L of fluid daily.
A nurse is reinforcing teaching about an esophagogastroduodenoscopy with a client who has uppergastric pain. Which of the following statements
should the nurse include in the teaching?
1) "A flexible tube is introduced through the nose during the procedure."
2) "During the procedure you are in a sitting position."
3) "You will remain NPO for 8 hours before the procedure."
4) "You will be awake while the procedure is performed."
A nurse is caring for a client who is difficult to arouse and very sleepy for several hours following ageneralized tonic-clonic seizure. Which of the
following descriptions should the nurse use when documenting this finding in the medical record?
1) Aura phase
2) Presence of automatisms
3) Postictal phase
4) Presence of absence seizures
A nurse is reinforcing teaching with a client who reports right shoulder pain following a laparoscopiccholecystectomy. Which of the following statements
should the nurse make?
1) "The pain results from lying in one position too long during surgery."
2) "The pain occurs as a residual pain from cholecystitis."
3) "The pain will dissipate if you ambulate frequently."
4) "The pain is caused from the nitrous dioxide injected into the abdomen."
A nurse is checking the suction control chamber of a client's chest tube and notes that there is nobubbling in the suction control chamber. Which
of the following actions should the nurse take?
1) Notify the provider.
Answer Rationale:
The nurse should check for kinks and take other measures before notifying the provider.
2) Verify that the suction regulator is on.
3) Continue to monitor the client because this is an expected finding.
4) Milk the chest tube to dislodge any clots in the tubing that may be occluding it.
A nurse is assisting with the care of a client immediately following a lumbar puncture. Which of the following actions should the nurse take? (Select all that
apply.)
1) Encourage fluid intake.
2) Monitor the puncture site for hematoma.
3) Insert a urinary catheter.
4) Elevate the client’s head of bed.
5) Apply a cervical collar to the client.
A nurse is assisting with the care of a client who is postoperative following surgical repair of a fracturedmandible. The client’s jaw is
wired shut to repair and stabilize the fracture. The nurse should recognize which of the following is the priority action?
,1) Relieve the client's pain.
2) Check the client’s pressure points for redness.
3) Provide oral hygiene.
4) Prevent aspiration.
A nurse is collecting data from a client who has scleroderma. Which of the following findings should thenurse expect?
1) A dry raised rash
2) Excessive salivation
3) Periorbital edema
4) Hardened skin
A nurse is caring for an older adult client who has dysphagia and left-sided weakness following astroke. Which of the following actions should the
nurse take?
1) Instruct the client to tilt her head back when she swallows.
2) Place food on the left side of the client's mouth.
3) Add thickener to fluids.
4) Serve food at room temperature.
A nurse is caring for a client who has partial-thickness and full-thickness burns of his head, neck, andchest. The nurse should recognize which of
the following is the priority risk to the client?
1) Airway obstruction
2) Infection
3) Fluid imbalance
4) Contractures
A nurse is reinforcing teaching with a client who is newly diagnosed with myasthenia gravis and is to start taking neostigmine. Which of the
following instructions should the nurse include in the teaching?
1) Take the medication 45 minutes before eating.
2) Expect diaphoresis as a side effect of the neostigmine.
3) If a medication dose is missed, wait until the next scheduled dose to take themedication.
4) Treat nasal rhinitis with an over-the-counter antihistamine.
A nurse is caring for a client who is 12 hours postoperative following a transurethral resection of the prostate (TURP) and has a 3-way urinary
catheter with continuous irrigation. The nurse notes there hasnot been any urinary output in the last hour. Which of the following actions should the
nurse perform first?
1) Notify the provider.
2) Administer a prescribed analgesic.
3) Offer oral fluids.
4) Determine the patency of the tubing.
A nurse is caring for a client scheduled for a bone marrow biopsy. The client expresses fear about the procedure and asks the nurse if the biopsy will
hurt. Which of the following responses should the nursemake?
1) "You must be very worried about what the biopsy will show."
2) "You'll be asleep for the whole biopsy procedure and won't be aware of what’shappening."
3) "Your provider scheduled this, so she will want to know you still have questions aboutthe procedure."
4) "The biopsy can be uncomfortable, but we will try to keep you as comfortable aspossible."
,A nurse is assisting with planning care for a client who is recovering from a left-hemispheric stroke.
Which of the following interventions should the nurse include in the plan?
1) Control impulsive behavior.
2) Compensate for left visual field deficits.
3) Re-establish communication.
4) Improve left-side motor function.
A nurse is assisting with the care of a client who has diabetes insipidus. The nurse should monitor the
client for which of the following manifestations?
1) Hypotension
2) Polyphagia
3) Hyperglycemia
4) Bradycardia
A nurse is reviewing the laboratory results of a client who is postoperative and has a respiratory rate of
7/min. The arterial blood gas (ABG) values include:
pH 7.22
PaCO2 68 mm Hg
Base excess -2
PaO2 78 mm Hg
Oxygen saturation 80%
Bicarbonate 28 mEq/L
Which of the following interpretations of the ABG
values should the nurse make
, 1) Metabolic acidosis
2) Respiratory acidosis
3) Metabolic alkalosis
4) Respiratory alkalosis
A nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurseshould recognize that which of the following
statements by the client indicates a need for further teaching?
1) "I will avoid crossing my legs at the knees."
2) "I will use a thermometer to check the temperature of my bath water."
3) "I will not go barefoot."
4) "I will wear stockings with elastic tops."
A nurse is preparing to provide morning hygiene care for a client who has Alzheimer's disease. The client becomes agitated and combative when the
nurse approaches him. Which of the following actionsshould the nurse plan to take?
1) Turn the water on and ask the client to test the temperature.
2) Obtain assistance to place mitten restraints on the client.
3) Firmly tell the client that good hygiene is important.
4) Calmly ask the client if he would like to listen to some music.
A nurse is collecting data on a client’s wound. The nurse observes that the wound surface is covered with soft, red tissue that bleeds easily. The
nurse should recognize this is a manifestation of which of the following?
1) Decreased perfusion
2) Infection
3) Granulation tissue
4) An inflammatory response
A nurse is caring for a client who has multiple myeloma and has a WBC count of 2,200/mm3. Which of the following food items brought by the family
should the nurse prohibit from being given to the client?
1) Baked chicken
2) Bagels
3) A factory-sealed box of chocolates
4) Fresh fruit basket
A nurse is contributing to the plan of care for an older adult client who is postoperative following a right hip arthroplasty. Which of the following
interventions should the nurse include in the plan?
1) Perform the client's personal care activities for her.
2) Limit the client’s fluid intake.
3) Monitor the Homan’s sign.
4) Maintain abduction of the right hip.
A nurse is caring for a client who has heart failure and respiratory arrest. Which of the following actions should the nurse take first?
1) Establish IV access.
2) Feel for a carotid pulse.
3) Establish an open airway.
4) Auscultate for breath sounds.
A nurse is caring for a client scheduled for coronary artery bypass grafting who reports he is no longercertain he wants to have the procedure. Which
of the following responses should the nurse make?
1) "Why have you changed your mind about the surgery?"
2) "Bypass surgery must be very frightening for you."
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