2021 HESI PN Medical surigical Proctored Exam Versions 3 With Answers (102 Solved Questions)

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VERSION 3ATI MED-SURG PROCTORED EXAM PRACTICE QUESTIONS WITH ANSWERS (100Q/A)1. A nurse is caring for a client who has a closed head injury and has an intraventricularcatheter placed. Which of the following findings indicates that the client is experiencingincreased ICP?a. Flat jugular veinsb. GCS score of 15c. Sleepiness exhibited by the clientd. Widening pulse pressuree. Decerebrate posturingf.Flat jugular veinsis incorrect.With increased ICP, the jugular veins are typicallydistended.A Glasgow Coma Scale score of 15is incorrect.A Glasgow Coma Scale score of15 indicates neurological functioning within the expected reference range for eye

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opening, motor, and verbal response.Sleepiness exhibited by the clientis correct.Sleepiness or difficulty arousing theclient from sleep is an indication of increased ICP.Widening pulse pressureis correct.A widening pulse pressure (increase insystolic with concurrent decrease in diastolic blood pressure) is an indication ofincreased ICP.Decerebrate posturingis correct.Both decerebrate and decorticate posturingindicate increased ICP.2. A nurse is preparing a client who has supraventricular tachycardia for electivecardioversion. Which of the following prescribed medications should the nurse instruct theclients to withhold for 48hr prior to cardioversion?a. Enoxaparinb. Metforminc. Diazepamd. Digoxine. Anticoagulants can be beneficial during cardioversion due to their ability to preventblood clots that can be released into the client's circulatory system aftercardioversion. This medication should not be withheld.f.Metforming. Metformin might be withheld for a client scheduled for cardiac catheterization orother procedures involving contrast dye in order to prevent damage to the kidneys.However, metformin should not be withheld prior to cardioversion.h.Diazepami.Sedatives are generally administered to clients prior to cardioversion to reduceanxiety and minimize the discomfort associated with the procedure. This medicationshould not be withheld.j.Digoxin: ANSWERk. Cardiac glycosides, such as digoxin, are withheld prior to cardioversion. Thesemedications can increase ventricular irritability and put the client at risk forventricular fibrillation after the synchronized countershock of cardioversion.3. A nurse is assessing a client who has acute cholecystitis. which of the following findings isthe nurse’s priority?a. Anorexiab. Abdominal pain radiating to the right shoulderc. Tachycardiad. Rebound abdominal tenderness

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i.Anorexiaii.Anorexia is nonurgent because it is an expected finding for a client who hasacute cholecystitis. Therefore, there is another finding that is the nurse'spriority.iii.Abdominal pain radiating to the right shoulderiv.MY ANSWERv.Abdominal pain radiating to the right shoulder is nonurgent because it is anexpected finding for a client who has acute cholecystitis. Therefore, there isanother finding that is the nurse's priority.vi.Tachycardiavii.When using the urgent vs. nonurgent approach to client care, the nurse shoulddetermine that the priority finding is tachycardia. Tachycardia is amanifestation of biliary colic, which can lead to shock. The nurse shouldposition the head of the client's bed flat and report this finding immediately tothe provider.viii.Rebound abdominal tendernessix.Rebound abdominal tenderness is nonurgent because it is an expected findingfor a client who has acute cholecystitis. Therefore, there is another finding thatis the nurse's priority.4. A nurse is preparing to admit a client who has dysphagia. The nurse should plant to placewhich of the following items at the client’s bedside?a. Suction machineb. Wire cuttersc. Padded clampd. Communication boarde. Suction machine: ANSWERThe nurse should ensure that a suction machine is at thebedside of a client who has dysphagia to clear the client's airway as needed andreduce the risk for aspiration.f.Wire cutters: The nurse should ensure wire cutters are at the bedside of a clientwho has an inner maxillary fixation to cut the wires in case the client vomits. Thisenables the client to clear their airway and reduce the risk for aspiration.g.Padded clamp: The nurse should ensure a padded clamp is at the bedside of aclient who has a chest tube to clamp the tube and prevent air from entering theclient's chest if there is an interruption in the sealed drainage system.h.Communication board: The nurse should ensure a communication board is at thebedside of a client who has aphasia to assist the client with communicating.

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5. A nurse is caring for a client who is having a seizure. Which of the following interventionis the nurse’s priority?a. Loosen the clothing around the client’s neckb. Check the client’s pupillary responsec. Turn the client to the side.d. Move furniture away from the clienti.Loosen the clothing around the client's neck: The nurse should loosen anyrestrictive clothing the client is wearing to prevent injury to the client.However, another action is the priority.ii.Check the client's pupillary response: The nurse should performneurologic checks after the seizure to monitor the client's recovery. However,another action is the priority.iii.Turn the client to the side.: The greatest risk to this client is hypoxia froman impaired airway. Therefore, the priority intervention the nurse should takeis to place the client in a side-lying position to prevent aspiration.iv.Move furniture away from the client.: AThe nurse should move furnitureaway from the client to prevent self-injury. However, another action is thepriority.6. A nurse is providing teaching to aclient who has hypothyroidism and is receivinglevothyroxine. The nurse should instruct the client that which of the following supplementscan interfere with the effectiveness of the medication?a. Ginkgo bilobab. Glucosaminec. Calciumd. Vitamin Ci.Ginkgo bilobaii.Ginkgo biloba reduces the pain associated with peripheral vascular disease bypromoting vasodilation. It can interact with medications that haveanticoagulant properties, but it is not known to interfere with the absorption oflevothyroxine.iii.Glucosamine: Glucosamine treats osteoarthritis by decreasinginflammation and stimulating the body's production of synovial fluid andcartilage. It can interact with medications that have antiplatelet oranticoagulant properties, but it is not known to interfere with the absorption oflevothyroxine.iv.Calcium:NSWER

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v.Calcium limits the development of osteoporosis in clients who arepostmenopausal and works as an antacid. Calcium supplements can interferewith the metabolism of a number of medications, including levothyroxine.The nurse should instruct the client to avoid taking calcium within 4 hr oflevothyroxine administration.vi.Vitamin C: Vitamin C promotes wound healing. It can cause a falsenegative in fecal occult blood tests, but it is not known to interfere with theabsorption of levothyroxine.7. A nurse is planning to irrigate and dress a clean, granulation wound for a client who has apressure injury. Which of the following actions should the nurse take?a. Apply a wet-to-dry gauze dressingb. Irrigate with hydrogen peroxide solutionc. Use a 30-ml syringed. Attach a 24-gauge angiocatheter to the syringe.8.a.Apply a wet-to-dry gauze dressing.: The nurse should not apply wet-to-drydressings to clean, granulating wounds as they interrupt viable, healing tissues whenthey are removed. Appropriate dressings for a wound that is developing granulationtissue include a hydrocolloid dressing and a transparent film dressing.b.Irrigate with hydrogen peroxide solution: the nurse should use hydrogenperoxide to clean contaminated surfaces. Hydrogen peroxide should not be used on apressure injury wound because it destroys newly granulated tissue. Instead, the nurseshould use solutions specifically designed as wound cleansers or 0.9% sodiumchloride irrigation to irrigate the wound.c.Use a 30-mL syringe: NSWERThe nurse should use a 30-mL to 60-mL syringewith an 18- or 19-gauge catheter to deliver the ideal pressure of 8 pounds per squareinch (psi) when irrigating a wound. To maintain healthy granulation tissue, thewound irrigation should be delivered at between 4 and 15 psi.d.Attach a 24-gauge angiocatheter to the syringe:the nurse should use an 18- or 19-gauge catheter that will apply the appropriate irrigation pressure. A 24-gaugeangiocatheter delivers solutions at a higher pressure than necessary for irrigation anda can potentially damage the developing granulation tissues.1. a nurse Is assessing a client who has Graves’ disease. Thich of the collowing imagesshould undicate to the nurse that the client has exophthalmos:

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ooThis image depicts entropion, which occurs when the skin of the eyelids turnsinward, causing the eyelids to rub the eye. Entropion is caused by spasms of theeyelid muscle or trauma and occurs most often in older adult clients due to theloss of supportive tissue.ooThis image depicts ectropion, which occurs when the skin of the eyelids turnsoutward, causing sagging of the lower lids due to muscle weakness. Ectropionoccurs with aging and can cause drying of the cornea and ulceration.ooThis image depicts ptosis, which occurs when excess skin of the upper eyeliddrops down over the eye. Ptosis can occur due to aging or at any age due todiabetes, myasthenia gravis, or stroke.

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ooMY ANSWERoThe nurse should identify an outward protrusion of the eyes as exophthalmos, acommon finding of Graves' disease. An overproduction of the thyroid hormonecauses edema of the extraocular muscle and increases fatty tissue behind the eye,which results in the eyes protruding outward. Exophthalmos can cause the clientto experience problems with vision, including focusing on objects, as well aspressure on the optic nerve.11.the nurse is providing teaching to a female client who has a history of UTI’s. which of thefollowing information should the nurse include in the teaching?a. Avoid foods that are high in ascorbic acidb. Add oatmeal to the water when taking a tub bathc. Urinate every 6 hoursd. Take daily cranberry supplements?12. A nurse is providing teaching to a client who has esophageal cancer and is to undergoradiation therapy. Which off the following statements should the nurse identify as anindication that the client understands the teaching?a. “ I will wash the ink markings off the radiation area after each treatment.”b. “I will use my hands rather than a washcloth to clean the radiation area.”c. “I will be able to be out in the sun 1 month after my radiation treatments are over.”d. “I will use a heating pad on my neck it if becomes sore during the radiationtherapy.”i."I will wash the ink markings off the radiation area after each treatment."ii.The ink markings designate the exact radiation area. The client should notremove these markings until they complete the entire radiation treatment.iii."I will use my hands rather than a washcloth to clean the radiation area."iv.MY ANSWERv.The client should gently wash the radiation area with their hands using warmwater and mild soap to protect the skin from further irritation.

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vi."I will be able to be out in the sun 1 month after my radiation treatmentsare over."vii.Radiation therapy causes skin to become sensitive to the effects of sunexposure and increases the risk for developing skin cancer. The client shouldavoid direct sunlight during the radiation treatments and for at least 1 yearfollowing the conclusion of the therapy.viii."I will use a heating pad on my neck if it becomes sore during theradiation therapy."ix.The client should avoid exposing the treatment area to heat as this can causefurther irritation to the skin.13.A nurse is caring for a client 1 hr following a cardiac catheterization. The nurse notes theformation of a hematoma at the insertion site and a decreased pulse rate in the affectedextremity. Which of the following interventions is the nurse’s priority?a. Initiate oxygen at 2 L via nasal cannulab. Apply firm pressure to the insertion sitec. Take the client’s vital signsd. Obtain a stat order for an aPTTi.Initiate oxygen at 2 L/min via nasal cannula.: The nurse can apply oxygen topromote adequate tissue oxygenation. However, another intervention is thepriority.ii.Apply firm pressure to the insertion site.: MY ANSWERThe greatest riskto the client is bleeding. Therefore, the priority intervention is for the nurse toapply firm pressure to the hematoma to stop the bleeding.iii.Take the client's vital signs.: The nurse should take the client's vital signsto further determine the client's status. However, another intervention is thepriority.iv.Obtain a stat order for an aPTT.: The nurse can request laboratory data toprovide information about the client's coagulation status. However, anotherintervention is the priority.14.A nurse is caring for a client who has emphysema and is receiving mechanical ventilation.The client appears anxious and restless, and the high-pressure alarm is sounding. Which ofthe following actions should the nurse take first?a. Obtain ABGsb. Administer propofol to the clientc. Instruct the client to allow the machine to breathe for themd. Disconnect the machine and manually ventilate the client.i.Obtain ABGs. The nurse should monitor ABG results to determine theeffectiveness of mechanical ventilation, but this is not the first action the nurseshould take.

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ii.Administer propofol to the client.: The nurse might need to administerpropofol to provide sedation and increase the client's tolerance of mechanicalventilation, but this is not the first action the nurse should take.iii.Instruct the client to allow the machine to breathe for them.: Whenproviding client care, the nurse should first use the least restrictiveintervention. Therefore, the first action the nurse should take is to provideverbal instructions and emotional support to help the client relax and allow theventilator to work. Clients can exhibit anxiety and restlessness when trying to"fight the ventilator."iv.Disconnect the machine and manually ventilate the client.: Many factorscan cause a high-pressure alarm to sound. The nurse might have to disconnectthe machine and manually ventilate the client if the ventilator fails or theclient experiences respiratory distress, but this is not the first action the nurseshould take.15.A nurse is reviewing the lab results of a client who has cirrhosis. Which of the followinglaboratory values should the nurse expect?a. Decreased prothrombin timeb. Elevated bilirubin levelc. Decreased ammonia leveld. Elevated albumin leveli.Decreased prothrombin time: liver disease and severe liver cell damage causesthe liver cells to produce less prothrombin, which prolongs prothrombin time.ii.Elevated bilirubin level: Bilirubin levels reflect the liver's ability toconjugate and excrete bilirubin, a byproduct of the hemolysis of red bloodcells. Bilirubin levels rise with liver disease and clinically reflect the client'sdegree of jaundice.iii.Decreased ammonia level: The liver converts ammonia to urea. When thisprocess is interrupted, as it is with liver disease or liver failure, ammonialevels rise.iv.Elevated albumin level: Albumin forms in the liver. When liver function isimpaired, as it is with cirrhosis, albumin levels decrease.16.A nurse is teaching a client who has venous insufficiency about self-care. Which of thefollowing statements should the nurse identify as an indication that the client understandsthe teaching?a. “ I should avoid walking as much as possible.”b. “I should sit down and read for several hours a day”c. “I will wear clean graduatied compression stockings every day.”d. “I will keep my legs level with my body when I sleep at night.”

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i."I should avoid walking as much as possible.": A client who has venousinsufficiency should maintain an exercise regimen, such as routine walking, todecrease venous stasis.ii."I should sit down and read for several hours a day.": A client who hasvenous insufficiency should avoid sitting or standing for prolonged periods oftime due to the risk of developing deep-vein thrombosis or skin breakdown.iii."I will wear clean graduated compression stockings every day.": YANSWERThe client should apply a clean pair of graduated compressionstockings each day and clean soiled stockings with mild detergent and warmwater by hand.iv."I will keep my legs level with my body when I sleep at night.": A clientwho has venous insufficiency should elevate the legs above heart level whilein bed to facilitate venous return and avoid venous stasis.17.A nurse is caring for a client who is postoperative following a total hip arthroplasty. Whichof the following laboratory values should the nurse report to the provider?a. Potassium 4 mEq/Lb. WBC count 10,000/mm3c. Hct 45%d. Hgb 8 g/dLi.Potassium 4 mEq/L: A potassium level of 4 mEq/L is within the expectedreference range.ii.WBC count 10,000/mm3:A WBC count of 10,000/mm3is within theexpected reference range.iii.Hct 45%: An Hct level of 45% is within the expected reference range.iv.Hgb 8 g/dL: Y ANSWERThe nurse should report an Hgb level of 8 g/dL,which is below the expected reference range and is an indicator ofpostoperative hemorrhage or anemia.18.A nurse is caring for a client who has a stage III pressure injury. Which of the followingfindings contributes to delayed would healing?a. WBC count 6Kb. BMI 24c. Urine output 25ml/hrd. Albumin 4WBC count 6,000/mm3:ANSWERWBCs fight infection and respond to foreign bodies.Increased amounts are seen in clients who have an infectious process, and decreasedamounts are seen in clients who are immunocompromised. A WBC count of 6,000/mm3is within the expected reference range.

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BMI 24: BMI readings provide a means of determining a client's nutritional status.Clients who have a BMI less than 18.5 are considered at risk for complications, such aspoor wound healing.Urine output 25 mL/hr: Urinary output reflects fluid status. Inadequate urine outputcan indicate dehydration, which can delay wound healing.Albumin 4 g/dL: Albumin reflects nutritional status. A low level can indicatemalnutrition, which would impair wound healing. An albumin level of 4 g/dL is withinthe expected reference range and indicates adequate nutritional status.i.19.A nurse is caring for a client who is undergoing hemodialysis to treat ESKD. The clientreports muscle cramps and a tingling sensation in their hands. Which of the followingmedications should the nurse plan to administer?i.Epoetin alfa: A client who has ESKD is at risk for anemia manifested bymalaise, fatigue, and activity intolerance. The nurse should plan to administeran erythrocyte-stimulating agent, such as epoetin alfa, to a client who hasanemia.ii.Furosemide: A client who has ESKD can develop pulmonary edemamanifested by restlessness, shortness of breath, crackles, and blood-tingedsputum. The nurse should plan to administer a loop diuretic, such asfurosemide, to a client who has pulmonary edema.iii.Captopril: A client who has ESKD often is hypertensive, which canfurther damage renal function. The nurse should plan to administer anantihypertensive medication, such as captopril, to a client who is hypertensive.iv.Calcium carbonate: ANSHypocalcemia is a manifestation of ESKD andan adverse effect of dialysis. Often occurring late in the dialysis session,hypocalcemia can cause the client to experience muscle cramping and tinglingto extremities. The nurse should plan to administer a calcium supplement,such as calcium carbonate, as a calcium replacement.22.a nurse is planning care for a client who is undergoing brachytherapy via a sealed vaginalimplant to treat endometrial cancer. Which of the following actions should the nurseinclude in the client’s plan of care?a. Collect and place the client’s urine or feces in a biohazard bagb. Limit the client’s ambulation to their own roomc. Wear a lead apron while providing care to the clientd. Limit each visitor to 1 hr per day.i.Collect and place the client's urine or feces in a biohazard bag.

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ii.With sealed implants, the client's excretions are not radioactive. Standardprecautions require gloves when handling body fluids or waste, but there areno special precautions required for this client's excreta.iii.Limit the client's ambulation to their own room.iv.Not only does the client require bedrest in a private room while the radiationimplant is in place, but the nurse must also discourage the client from anyexcessive movements while in bed to prevent dislodging the implant.v.Wear a lead apron while providing care to the client.vi.MY ANSWERvii.The nurse should wear a lead apron when providing direct care to provideprotection from the radiation source and not turn their back toward the client,because the apron only shields the front of the body. The nurse should alsowear a dosimeter film badge to measure radiation exposure.viii.Limit each visitor to 1 hr per day.: The nurse should limit each of theclient's visitors to 30 min per day and instruct them to remain at least 1.8 m (6ft) from the client at all times.23.A nurse is preparing to administer a unit of PRBCs to a client. Which of the followingactions should the nurse take?i.Remain with the client for the first 15 min of the infusion.: Y ANSWERii.The nurse should remain with the client for the first 15 to 30 min of theinfusion because hemolytic reactions usually occur during the infusion of thefirst 50 mL of blood.iii.Prime the blood administration IV tubing with lactated Ringer's solution.iv.The nurse should use 0.9% sodium chloride when transfusing blood to preventclotting or hemolysis of the RBCs.v.Verify the client's identity by using the client's room number prior tostarting the transfusion.vi.The client's room number is not an acceptable client identifier. The nurseshould ensure that the name and number on the client's identification bandmatches the name and identification number on the blood label. The client'sidentification, the blood compatibility, and the expiration date of the bloodshould be verified by two nurses.vii.Infuse the unit of packed RBCs within 8 hr.: The nurse should transfusethe packed RBCs within 2 to 4 hr based upon the client's age and

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cardiovascular status. Longer infusion times increase the risk for bacterialcontamination of the blood product.26.a nurse is caring for a client who presents to a clinic for a 1-week follow-up visit afterhospitalization for heart failure. Based on the information in the client’s chart, which of thefollowing findings should the nurse report to the provider?a.Potassium 4.1 mEq/L : The client's potassium level of 4.1 mEq/L is within theexpected reference range.b.Heart rate 55/min: The client's heart rate of 55/min is a decrease from the client'sbaseline of 74/min, and it can indicate the development of digoxin toxicity. Thenurse should report this finding to the provider.c.SaO292%: Y ANSWERThe nurse should ensure that the client's SaO2levelremains at or above 90%. This finding is within the expected reference range.d.Weight 67.1 kg (148 lb): The nurse should report a client's weight gain of 1.4 kg(3 lb) in a day or 2.3 kg (5 lb) or more in a week.27.A nurse is caring for a client who has a potassium level of 3 mEq/L/ Whichh of thefollowing assessment findings should the nurse expect?a. Positive trousseaus signb. 4+ deep tendon reflexesc. Deep respirationsd. Hypoactive bowel soundsi.Positive Trousseau's sign: positive Trousseau's sign indicates altered calciumlevels.ii.4+ deep tendon reflexes: Deep tendon reflexes are used to monitormagnesium levels.iii.Deep respirations: Shallow respirations occur with hypokalemia due torespiratory muscle weakness.iv.hypoactive bowel sounds: Y ANSWERHypokalemia decreases smoothmuscle contraction in the gastrointestinal tract leading to decreased peristalsis.28.A nurse is providing dietary teaching to a client who is postoperative following athyroidectomy with removal of the parathyroid glands. The nurse shouldinstruct the clientto include which of the following foods that has the greatest amount of calcium in her diet.i.12 almonds: Y ANSWERThe nurse should determine that almonds are thebest source of calcium to recommend because 12 almonds contain 36 mg ofcalcium. Removal of the parathyroid glands, which regulate calcium in thebody, can result in hypocalcemia.

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ii.One small banana: The nurse should recommend a different food becausethere is another choice that contains more calcium. One small banana contains5 mg of calcium.iii.1 tbsp peanut butter: The nurse should recommend a different foodbecause there is another choice that contains more calcium. One tbsp ofpeanut butter contains 8 mg of calcium.iv.1/2 cup tomato juice: The nurse should recommend a different foodbecause there is another choice that contains more calcium. A half cup oftomato juice contains 12 mg of calcium.v.29.A nurse in a community clinic is caring for a client who reports an increase in thefrequency of migraine headaches. To reduce the risk for migraine headaches, which of thefollowing foods should the nurse recommend the client avoid?a. Shellfishb. Aged cheese:Aged cheese30.MY ANSWERi.Foods that contain tyramine, such as aged cheese and sausage, can triggermigraine headaches.b. Peppermint candyc. Enriched pasta31.A nurse in an emergency department is caring for a client who reports vomiting anddiarrhea for the past 3 days. Which of the following findings should indicate to the nursethat the client is experiencing FVD?a. HR 110/minb. BP 138/90c. Urine Specific Gravity 1.020d. BUN 15 mg/dLi.Heart rate 110/min client who has a 3-day history of vomiting anddiarrhea is likely to have fluid volume deficit and an elevated heart rate.ii.Blood pressure 138/90 mm Hg: A blood pressure of 138/90 mm Hg iswithin the expected reference range. A client who has a 3-day history ofvomiting and diarrhea is likely to have fluid volume deficit and hypotension.iii.Urine specific gravity 1.020: A urine specific gravity of 1.020 is within theexpected reference range. A client who has a 3-day history of vomiting anddiarrhea is likely to have fluid volume deficit, which is indicated by a urinespecific gravity greater than 1.030.

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