HESI Medical Surgical Practice Exam With Answers (131 Solved Questions)

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1.Which assessment is most important for the nurse to perform on a client who ishospitalized for Guillain-Barre syndrome that is rapidly progressing?Respiratory effort.Unsteady gait.Intensity of pain.Ability to eat.Guillain-Barre syndrome causes paralysis or weakness that typically starts at the feetand progresses upwards. As the condition progresses, the nurse must ensure that theclient is able to breathe effectively.Heuther, Understanding Pathophysiology, 6th ed. p. 4122.A male client comes into the clinic with a history of penile discharge with painful,burning urination. Which action should the nurse implement?Collect a culture of the penile discharge.Palpate the inguinal lymph nodes gently.Observe for scrotal swelling and redness.Express the discharge to determine color.Penile discharge with painful urination is commonly associated with gonorrhea. Thenurse should collect a culture of the penile discharge to determine the cause of thesesymptoms. The cause must be determined or confirmed through culture to identify theorganism and ensure effective treatment.Jarvis Physical Examination and Health Assessment, 6th edition3.A client with history of atrial fibrillation is admitted to the telemetry unit with suddenonset of shortness of breath. The nurse observes a new irregular heart rhythm andshould perform which assessment at this time?Check for a pulse deficit.Palpate the apical impulse.Inspect jugular vein pulse.Examine for a carotid bruit.A client with a past history of atrial fibrillation may return to that rhythm. Any signsof atrial fibrillation, such as sudden onset shortness of breath, requires furtherinvestigation. The nurse should assess this client for a pulse deficit because thiscondition occurs with atrial fibrillation.

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Jarvis. (2016); Physical Examination and Health Assessment, (Chap 19) 7th ed., p.4814.Which client should be further assessed for an ectopic pregnancy?A 24-year-old with shoulder and lower abdominal quadrant pain.A 33-year-old with intermittent lower abdominal cramping.A 20-year-old with fever and right lower abdominal colic.A 40-year-old with jaundice and right lower abdominal pain.A 24-year-old with sudden onset of lower abdominal quadrant pain should beassessed for an ectopic pregnancy. The pain can also be referred to the shoulder andmay be associated with vaginal bleeding.Health Assessment for Nursing Practice, Wilson and Giddens. p.2695.Which dietary assessment finding is most important for the nurse to address whencaring for a client with diabetic nephropathy?Drinks a six pack of beer every day.Enjoys a hamburger once a month.Eats fortified breakfast cereal daily.Consumes beans and rice every day.Drinking six beers every day is the dietary assessment finding most important for thenurse to address when caring for a client with diabetic nephropathy. The usual can ofbeer is 12 ounces (355 mL). Clients with diabetes are recommended to drink no morethan 12 ounces of beer per day because beer contains carbohydrates that can createunhealthy fluctuations in blood glucose and promote poor glucose control.Nephropathy is exacerbated by poor blood glucose control.6.Which assessment finding is of greatest concern to the nurse who is caring for a clientwith stomatitis?Cough brought on by swallowing.Sore throat caused by speaking.Painful and dry oral cavity.Unintended weight loss.A cough brought on by swallowing is a sign of dysphagia, which is a finding ofparticular concern in a client with stomatitis. Dysphagia can cause numerousproblems, including airway obstruction, and should be reported to the healthcareprovider immediately.

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Ignatavicius, (2016). Medical-surgical nursing: Patient-centered collaborative care,eight edition., Ch. 53, p. 1100.7.The nurse is teaching a client diagnosed with peripheral arterial disease. Whichgenitourinary system complication should the nurse include in the teaching?Altered sexual response.Sterility.Urinary incontinence.Decreased pelvic muscle tone.Peripheral arterial disease (PAD) is a cardiovascular condition characterized bynarrowing of the arteries and reduced blood flow to the extremities. PAD is known toalter the blood flow to the male's penis and is associated with erectile dysfunction inmen.Ignatavicius,. (2016). Medical-surgical nursing: Patient-centered collaborative care,eight edition., Ch. 69, p. 1452.8.A 40-year-old female client has a history of smoking. Which finding should the nurseidentify as a risk factor for myocardia infarction?Oral contraceptives.Senile osteopenia.Levothyroxine therapy.Pernicious anemia.Women older than 35 years old who smoke and take oral contraceptives have anincreased risk of myocardial infarction or stroke.Ignatavicius, (2013). Medical-surgical nursing: Patient-centered collaborative care,7th ed.., Ch. 35, p. 694.9.A client has been told that there is cataract formation over both eyes. Which findingshould the nurse expect when assessing the client?Decreased color perception.Presence of floaters.Loss of central vision.Reduced peripheral vision.Decreased color perception occurs with cataract formation. Cataract formation is alsoassociated with blurred vision and a global loss of vision so gradual that the clientmay not be aware of it.

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Ignatavicius, (2016). Medical-surgical nursing: Patient-centered collaborative care,eight edition., Ch. 47,10.Which assessment finding should most concern the nurse who is monitoring a clienttwo hours after a thoracentesis?New onset of coughing.Low resting heart rate.Distended neck veins.Decreased shallow respirations.A pneumothorax (partial or complete lung collapse) is the potential complication of athoracentesis. Manifestations of a pneumothorax include new onset of a naggingcough, tachycardia, and an increased shallow respiration rate.Ignatavicius,(2016). Medical-surgical nursing: Patient-centered collaborative care,eight edition., Ch. 27, pp. 511-13.11.While caring for a client who has esophageal varices, which nursing intervention ismost important for the registered nurse (RN) to implement?Monitor infusing IV fluids and any replacement blood products.Prepare for esophagogastroduodenoscopy (EGD).Maintain the client on strict bedrest.Insert a nasogastric tube (NGT) for intermittent suction.Maintaining hemodynamic stability in a client with esophageal varices can precipitatea life-threatening crisis if esophageal varies leak or rupture and can result inhemorrhage. The priority is assessing and monitoring infusions of IV fluids and anyreplacement blood products.12.The registered nurse (RN) is caring for a client who developed oliguria and wasdiagnosed with sepsis and dehydration 48 hours ago. Which assessment findingindicates to the RN that the client is stabilizing?Urine output of 40 mL/hour.Apical pulse 100 and blood pressure 76/42.Urine specific gravity 1.001.Tented skin on dorsal surface of hands.

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A decrease in urinary output is a sign of dehydration. When the urine output returns toa normal range, 40 mL/hour, the client's kidneys are perfusing adequately andindicates the client's status is stabilizing.13.After a liver biopsy is performed at the bedside, the registered nurse (RN) is assignedthe care of the client. Which nursing intervention is most important for the RN toimplement?Position client on left side with pillow placed under the costal margin.Assist the client with voiding immediately after the procedure.Evaluate vital signs q10 to 20 minutes for 2 hours after procedure.Ambulate client 3 times in first hour with pillow held at abdomen.Vital signs should be checked every 10 to 20 minutes to assess for bleeding afterbiopsy of the liver, which is highly vascular. The client should be positioned on theright side with a pillow or sandbag under the costal margin and supporting the biopsysite. The client should be maintained on bedrest for several hours to decrease the riskof bleeding from the biopsy site.14.The registered nurse (RN) is caring for a client with aplastic anemia who ishospitalized for weight loss and generalized weakness. Laboratory values show awhite blood count (WBC) of 2,500/mm 3 and a platelet count of 160,000/mm 3.Which intervention is the primary focus in the client's plan of care for the RN toimplement?Assist with frequent ambulation.Encourage visitors to visit.Maintain strict protective precautions.Avoid peripheral injections.The client should be under strict protective transmission precautions because theWBC values are low and normal WBC levels are 4,000-10,000/mm3, so the client isan increased high risk for infection.15.The registered nurse (RN) is caring for a young adult who is having an oral glucosetolerance tests (OGTT). Which laboratory result should the RN assess as a normalvalue for the two hour postprandial result?140 mg/dl.160 mg/dl.180 mg/dl.200 mg/dl.

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The two hour postprandial level should be less 140 mg/dl for a young adult client.16.The registered nurse (RN) is caring for an older client who recently experienced afractured pelvis from a fall. Which assessment finding is most important for the RN toreport the healthcare provider?Lower back pain.Headache of 7 on scale 1 to 10.Blood pressure of 140/98.Dyspnea.A client with a large bone fracture is at risk for intramedullary fat leaking into theblood stream and becoming embolic. Dyspnea is an indication of fat embolism to thelungs and should be reported to the healthcare provider immediately.17.The registered nurse (RN) is caring for a client with tuberculosis (TB) who is taking acombination drug regimen. The client complains about taking "so many pills." Whatinformation should the RN provide to the client about the prescribed treatment?The development of resistant strains of TB are decreased with a combinationof drugs.Compliance to the medication regimen is challenging but should bemaintained.Side effects are minimized with the use of a single medication but is lesseffective.The treatment time is decreased from 6 months to 3 months with this standardregimen.Combination therapy is necessary to decrease the development of resistant strains ofTB and ensure treatment efficacy.18.The registered nurse (RN) is teaching a client who is newly diagnosed withemphysema how to perform pursed lip breathing. What is the primary reason forteaching the client this method of breathing?Decreases respiratory rate.Increases O 2 saturation throughout the body.Conserves energy while ambulating.Promotes CO 2 elimination.Pursed lip breathing helps eliminate CO2 by increasing positive pressure within thealveoli increasing the surface area of the alveoli making it easier for the O2 and CO2gas exchange to occur .

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19.The registered nurse (RN) is caring for a client with acute pancreatitis and reviews theadmission laboratory results. What laboratory value should the RN anticipate beingelevated with this diagnosis?Triglycerides.Amylase.Creatinine.Uric acid.An elevated amylase level is associated with acute pancreatitis.20.A client in an ambulatory clinic describes awaking in the middle of the night withdifficulty breathing and shortness of breath related to paroxysmal nocturnal dyspnea.Which underlying condition should the registered nurse (RN) identify in the client'shistory?Chronic bronchitis.Gastroesophageal reflux disease (GERD).Heart failure (HF).Chronic pancreatitis.Paroxysmal nocturnal dyspnea is classic sign of heart failure and is secondary to fluidoverload associated with heart failure which causes pulmonary edema.21.A client is recently diagnosed with systemic lupus erythematosus (SLE) and theregistered nurse (RN) is assessing for common complications. Which symptomshould the RN instruct the client to report immediately?Fever related to infection.Weight loss and anorexia.Depressed mood.Break in tissue integrity.Secondary infections are a major concern with SLE clients due to the use ofcorticosteroids and chemotherapeutic agents, which suppresses the immune system,so reporting fever and infections should be reported immediately.22.A male client is admitted after falling from his bed. The healthcare provider (HCP)tells the family that he has an incomplete fracture of the humerus. The family ask the

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RN what this means. Which explanation by the nurse accurately describes the client'sfracture?Straight fracture line that is also a simple, closed fracture.Nondisplaced fracture line that wraps around the bone.A complete fracture that also punctures the skin.A fracture that bends or splinters part of the bone.An incomplete fracture occurs when part of the bone is splintered (broken) and it hasnot gone completely through the thickness of the bone.23.The registered nurse (RN) is caring for a client who has a closed head injury from amotor vehicle collision. Which finding would indicate to the nurse that the client is atrisk for diabetes insipidus (DI)?High fever.Low blood pressure.Muscle rigidity.Polydipsia.A characteristic finding of DI is excretion of large quantities of urine (5 to 20L/day),and most clients compensate for fluid loss by drinking large amounts of water(polydipsia). DI can occur when there has been damage or injury to the pituitarygland or hypothalamus as a result of head trauma, tumor or an illness such asmeningitis. This damage interrupts the ADH production, storage and release causingthe excessive urination and thirst.24.The registered nurse (RN) is assisting the healthcare provider (HCP) with the removalof a chest tube. Which intervention has the highest priority and should be anticipatedby the RN after the removal of the chest tube?Prepare the client for chest x-ray at the bedside.Review arterial blood gases after removal.Elevate the head of bed to 45 degrees.Assist with disassembling the drainage system.A chest x-ray should be performed immediately after the removal of a chest tube toensure lung expansion has been maintained after its removal.25.A client with chest pain, dizziness, and vomiting for the last 2 hours is admitted forevaluation for Acute Coronary Syndrome (ACS). Which cardiac biomarker should theregistered nurse (RN) anticipate to be elevated if the client experienced myocardialdamage?

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Creatine Kinase (CK-MB).Serum troponin.Myoglobin.Ischemia modified albumin.Troponin is the most sensitive and specific test for myocardial damage. Troponinelevation is more specific than CK-MB.26.A female client is recently diagnosed with Sarcoidosis. The client tells the registerednurse (RN) that she does not understand why she has this. When teaching the client,the RN should include that sarcoidosis most commonly occurs with which ethnicgroup of women?African American women.Caucasian women.Asian women.Hispanic women.Sarcoidosis, an autoimmune inflammatory disease affecting multiple organs and hasshown familial tendency due to multiple genes that together increase the susceptibilityof developing the disease. In research studies it occurs more commonly in AfricanAmerican women (10-80 out of 100,000); compare to Caucasian women of theUnited States (8 out of 100,000).27.The registered nurse (RN) is evaluating a client who presents with symptoms of viralgastroenteritis. Which assessment finding should the RN report to the healthcareprovider?Dry mucous membranes and lips.Rebound abdominal tenderness over right lower quadrant.Dizziness when client ambulates from a sitting position.Poor skin turgor over client's wrist.Right lower quadrant (RLQ) rebound abdominal tenderness may be related to acuteappendicitis and should be reported to the healthcare provider.28.The registered nurse (RN) is caring for a client with peptic ulcer disease (PUD). Whatassessment should the RN identify and document that is consistent with PUD? (Selectall that apply).Hematemesis.Gastric pain on an empty stomach.Colic-like pain with fatty food ingestion.

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Intolerance of spicy foods.Diarrhea and steatorrhea.Manifestations of PUD include hematemesis, gastric pain, and spicy food intolerance.29.The registered nurse (RN) recognizes which client group is at the greatest risk fordeveloping a urinary tract infection (UTI)? (Rank from highest risk to lowest risk.)1Older males.2School-age female.3Older females.4Adolescent males.CorrectOlder females.School-age female.Older males.Adolescent males.Hypoestrogenism and alkalotic urine are other age-related factors put older women atthe highest risk for UTIs. School age girls (6 to 12 years) are at risk for UTIs due to ahigher prevalence to taking baths instead of showers, but these risks can be controlledin this population as well as hypoestrogenism and alkalotic urine. Older men are atrisk due to possible obstruction of the bladder due to benign prostatic hypertrophy(BPH). Adolescent males (12 to 19 years) are the lowest at risk for a UTI.All individuals regardless of gender and/or age are at risk if the following conditionsexist: vesicoureteral reflux, neuromuscular conditions, like Parkinson's disease,previous brain attacks, or the use of anticholinergic medications can all causeincomplete bladder emptying which can create bacterial overgrowth. Fecal andurinary incontinence contributes to poor perineal hygiene and bacterial growth.30.A female client admitted with abdominal pain is diagnosed with cholelithiasis. Theclient asks the registered nurse (RN) what she should expect as a common treatment.What recommended plan of care should the nurse provide the client?Rest with liquid diet only.Drugs such as ursodiol.Cholecystectomy via laparoscopy.LaVeen vena caval shunt.

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The nurse should explain to the client that gall bladder surgical removal is most oftenrecommended via laparoscopic excision.31.Which action should the nurse implement on the scheduled day of surgery for a clientwith type 1 diabetes mellitus (DM)?Obtain a prescription for an adjusted dose of insulin.Administer an oral anti-diabetic agent.Give an insulin dose using parameters of a sliding scale.Withhold insulin while the client is NPO.Stressors, such as surgery, increase serum glucose levels. A client with type 1 DMwho is NPO for scheduled surgery should receive a prescribed adjusted dose ofinsulin.32.A young adult female reports that she is experiencing a lack of appetite, hypersomnia,stress incontinence, and heart palpitations. Which symptom is characteristic ofpremenstrual syndrome?Heart palpitations.Anorexia.Hypersomnia.Stress incontinence.Characteristic features of premenstrual syndrome include heart palpitations,sleeplessness, increased appetite and food cravings, and oliguria or enuresis.33.Which preexisting diagnosis places a client at greatest risk of developing superiorvena cava syndrome?Carotid stenosis.Steatosis hepatitis.Metastatic cancer.Clavicular fracture.Superior vena cava syndrome occurs when the superior vena cava (SVC) iscompressed by outside structures, such as a growing tumor that impedes the returnblood flow to the heart. Superior vena cava syndrome is likely to occur withmetastatic cancer from a primary tumor in the upper lobe of the right lung thatcompresses the superior vena cava.

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34.When planning care for a client with right renal calculi, which nursing diagnosis hasthe highest priority?Acute pain related to movement of the stone.Impaired urinary elimination related to obstructed flow of urine.Risk for infection related to urinary stasis.Deficient knowledge related to need for prevention of recurrence of calculi.The nursing diagnosis of the highest priority is "Acute pain related the the renalcalculi's movement".35.The nurse should explain to a client with lung cancer that pleurodesis is performed toachieve which expected outcome?Prevent the formation of effusion fluid.Remove fluid from the intrapleural space.Debulk tumor to maintain patency of air passages.Relieve empyema after pneumonectomy.Instillation of a sclerosing agent to create pleurodesis is aimed at preventing theformation of a pleural effusion by causing the pleural spaces sealed together, therebypreventing the accumulation of pleural fluid.36.The PET (positron emission tomography) scan is commonly used with oncologyclients to provide for which diagnostic information?A description of inflammation, infection, and tumors.Continuous visualization of intracranial neoplasms.Imaging of tumors without exposure to radiation.An image that describes metastatic sites of cancer.PET scans provide information regarding certain diseases of the heart (determinationof tissue viability), brain (dementia, Parkinson's disease), and early detection oftumors and their metastasis.37.A female client with type 2 diabetes mellitus reports dysuria. Which assessmentfinding is most important for the nurse to report to the healthcare provider?Suprapubic pain and distention.Bounding pulse at 100 beats/minute.Fingerstick glucose of 300 mg/dl.Small vesicular perineal lesions.

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