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HESI RN MED SURG
1. A client with a productive cough has obtained a sputum specimen for culture as instructed. What is the best initial nursing act...
hesi rn med surg exam pack exam mereged from 201920202021 actual exams best for 2022 next gen actual exam review med surg exam pack hesi rn med surg 1 a client with a productive cough has ob
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HESI RN MED SURG EXAM
PACK-EXAM MEREGED FROM
2019/2020/2021 ACTUAL
EXAMS
BEST FOR 2022 NEXT GEN
ACTUAL EXAM REVIEW
MED SURG EXAM PACK
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, HESI RN MED SURG
1. A client with a productive cough has obtained a sputum specimen for culture as instructed. What is the
best initial nursing action?
Answer: Administer the first dose of prescribed antibiotic therapy
2. A client is brought to the Emergency Department by ambulation in cardiac arrest with cardiopulmonary
resuscitation (CPR) in progress. The client is intubated and receiving 100% oxygen per self‐inflating (ambu)
bag. The nurse determines that the client is cyanotic, cold, and diaphoretic. Which assessment is most
important for the nurse to obtain?
Answer: deep tendon reflexes.
3. After hospitalization for Syndrome of Inappropriate Antidiuretic hormone (SIADH), a client develops
myelinolysis. Which intervention should the nurse implement first?
Answer: Reorient client to his room.
4. A male client with heart failure (HF) calls the clinic and reports that he cannot put his shoes on because
they are too tight. Which additional information should the nurse obtain?
Answer: Has his weight changed in the last several days?
5. An older adult woman with a long history of COPD is admitted with progressive shortness of breath and a
persistent cough. She is anxious and is complaining of a dry mouth. Which intervention should the nurse
implement?
Answer: Apply a high‐flow venturi mask.
6. A client with a history of asthma and bronchitis arrives at the clinic with SOB, productive cough with
thickened, tenacious mucous, and the inability to walk up flight of stairs without experiencing
breathlessness. Which action is most important for the nurse to instruct the client about self‐care?
Answer: Increase the daily intake of oral fluids to liquefy secretions.
7. A cardiac catheterization of a client with heart disease indicates the following blockages: 95% LAD, 99%
proximal circumflex, and 95% proximal RCA. The client later asks the nurse “what does all that mean for
me?”
Answer: Three main arteries have major blockage with only 1 to 5% of the blood flow getting through to
the heart muscle.
8. A client who weighs 175 pounds is receiving an IV bolus dose of heparin 80 units/kg. The heparin is
available in a 2 mL vial, labeled 10,000 units/mL. How many mL should the nurse administer? (enter
numeric value only. If rounding, round to nearest tenth.)
Answer: 1.3 mL
after calculations: the calculator will show 1.272727272727273, but you must round to the nearest tenth.
So, the answer is 1.3 mL.
9. What information should the nurse include in the teaching plan of a client diagnosed with
gastroesophageal reflux disease (GERD)?
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, Answer: minimize symptoms by wearing loose, comfortable clothing.
10. The nurse is caring for a client with a lower left lobe pulmonary abscess. Which position should the nurse
instruct the client to maintain?
Answer: Left Lateral.
11. A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable to eat or drink
without becoming nauseated and vomiting. Which finding should the nurse report to the healthcare
provider?
Answer: Yellow Sclera
12. While caring for a client with Amyotrophic Lateral Sclerosis (ALS), the nurse performs a neurological
assessment every four hours. Which assessment finding warrants immediate intervention by the nurse?
Answer: Increasing anxiety.
13. The nurse is providing preoperative education for a Jewish client scheduled to receive a xenograft to
promote burn healing. Which information should the nurse provide this client?
Answer: The xenograft is taken from nonhuman sources.
14. A male client who had colon surgery 3 days ago is anxious and request assistance to reposition. The
wound dehiscences and eviscerates. The nurse moistens an available sterile dressing and palaces it over
the wound. Which intervention should the nurse implement next?
answer: prepare the client to return to the operating room.
15. A client with carcinoma of the lung is complaining of weakness and has a serum sodium level of 117
mEq/L. Which nursing problem should the nurse include in this client’s plan of care?
answer: fluid volume excess
16. A female client enters the clinic and insists on being seen. She is weak, nervous, and reports a racing heart
beat and recent weight loss of 15 pounds. After ruling out substance withdrawal, the healthcare provider
suspects hyperthyroidism. Which action should the nurse implement?
answer: space the client’s care to provide periods of rest
17. The nurse is teaching a client with glomerulonephritis about self‐care. Which dietary recommendations
should the nurse encourage the client to follow?
answer: restrict intake by limiting meats and other high‐protein foods.
18. An overweight, young adult male who has recently diagnosed with type diabetes mellitus is admitted for a
hernia repair. He tells the nurse he is feeling very weak and jittery. Which actions should the nurse
implement? (select all that apply).
☒Assess his skin temperature and moisture.
☒Document anxiety on the surgical checklist.
☒Administer a PRN dose of regular insulin
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, 19. A client with Cushing’s syndrome is recovering from an elective laparoscopic procedure. Which
assessment finding warrants immediate intervention by the nurse?
answer: irregular apical pulse
20. An adult woman with primary Raynaud phenomenon develops pallor and then cyanosis of her fingers.
After warming her hands, the fingers turn red and the client reports a burning sensation. What action
should the nurse take?
answer: secure a pulse oximeter to monitor the client’soxygen saturation.
21. A male client with muscular dystrophy fell in his home and is admitted with a right hip fracture. His right
foot is cool, with palpable pedal pulses. Lungs are coarse with diminished bibasilar breath sounds. Vital
signs are temperature 101° F, heart rate 128 beats/minute, respirations 28 breaths/minute, and blood
pressure 122/82, which intervention is most important for the nurse to implement first?
Answer: assess lower extremity circulation.
22. The nurse is completing the preoperative assessment of a client who is scheduled for a laparoscopic
cholecystectomy under general anesthesia. Which finding warrants notification of the healthcare provider
prior to proceeding with the scheduled procedure?
answer: the client’s blood pressure is 184/88 mm Hg.
23. A client who has a history of hypothyroidism was initially admitted with lethargy and confusion. Which
additional finding warrants the most immediate action by the nurse?
answer: hematocrit of 30%
24. Following surgical repair of the bladder, a female client is being discharged from the hospital to home
with an indwelling urinary catheter. Which instruction is most important for the nurse to provide to this
client?
answer: keep the drainage bag lower than the level of the bladder
25. Which client has the highest risk for developing skin cancer?
answer: a 65‐year‐old fair skinned male who is a construction worker.
26. When caring for a client with nephrotic syndrome, which assessment is most important for the nurse to
obtain?
answer: level of consciousness
27. A female client who was involved in a motor vehicle collision is admitted with a fractured left femur which
is immobilized using a fracture traction splint in preparation for an open reduction internal fixation (ORIF).
(select all that apply).
☒Verify pedal pulses using a doppler pulse device.
☒Monitor left leg for pain, pallor, paresthesia, paralysis, pressure.
☒Evaluate the application of the splint to the left leg.
28. A male client with herpes zoster (shingles) on his thorax tells the nurse that he is having difficulty sleeping.
What is the probably etiology of this problem?
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