MS HESI / HESI Med-Surg RN V1
55-Question & Answer with
Rationale
1) A patient had abdominal surgery and states that after coughing it feels like his guts
have spilled out. What should the nurse do first?
Answer: Visualize the abdominal area
Rationale: First priority is assessment to confirm evisceration before covering and notifying
provider.
2) A patient has been taking Kenalog (corticosteroid) and has increased redness.
What should the nurse do?
Answer: Schedule an appointment
Rationale: May indicate infection or adverse steroid reaction requiring evaluation.
3) A patient had a BDP. What finding warrants further intervention?
Answer: Positive gastro-ocult emesis
Rationale: Indicates GI bleeding requiring urgent follow-up.
4) A patient taking Vitamin B12 reports fatigue. What lab should be monitored?
Answer: CBC
Rationale: Evaluates improvement in anemia (Hgb, Hct, RBC).
5) A patient with Parkinson’s disease is walking. What indicates treatment is
effective?
Answer: Improved mobility
Rationale: Increased motor function indicates therapeutic response.
6) What is priority for a patient allergic to bananas?
Answer: Replace latex products
Rationale: Banana allergy is associated with latex cross-reactivity.
7) How can renal calculi be prevented?
Answer: Limit tea and chocolate
Rationale: Reduces oxalate intake and stone formation risk.
, 8) A patient is in F-vib. What medication should be given?
Answer: Defibrillation (NOT adenosine)
Rationale: Ventricular fibrillation requires immediate defibrillation.
9) A nurse cannot palpate a pedal pulse. What should the nurse do next?
Answer: Use Doppler ultrasound
Rationale: Detects weak or absent pulses.
10) A COPD patient has started a walking program. How do we know it is effective?
Answer: Cardiovascular improvement
Rationale: Increased endurance indicates improvement.
11) A post-op patient says they know how to breathe. What should the nurse do?
Answer: Request return demonstration
Rationale: Confirms understanding of teaching.
12) Order: 100 units in 250 mL at 12 units/hr. What is the infusion rate?
Answer: 30 mL/hr
Rationale: (12 ÷ 100) × 250 = 30 mL/hr.
13) A patient complains of right calf pain. What is the nurse’s priority?
Answer: Remain in bed
Rationale: Suspected DVT—prevents embolus movement.
14) A patient returns after TURP with clots. What should the nurse do?
Answer: Slowly irrigate catheter
Rationale: Maintains catheter patency.
15) Priority for multiple sclerosis patient with urinary retention?
Answer: Self-catheterization
Rationale: Promotes bladder emptying and independence.
16) What lab should be monitored for abscess drainage?
Answer: WBC count
Rationale: Indicates infection severity.
17) CHF intervention?
Answer: Use bedside commode
Rationale: Reduces cardiac workload.
55-Question & Answer with
Rationale
1) A patient had abdominal surgery and states that after coughing it feels like his guts
have spilled out. What should the nurse do first?
Answer: Visualize the abdominal area
Rationale: First priority is assessment to confirm evisceration before covering and notifying
provider.
2) A patient has been taking Kenalog (corticosteroid) and has increased redness.
What should the nurse do?
Answer: Schedule an appointment
Rationale: May indicate infection or adverse steroid reaction requiring evaluation.
3) A patient had a BDP. What finding warrants further intervention?
Answer: Positive gastro-ocult emesis
Rationale: Indicates GI bleeding requiring urgent follow-up.
4) A patient taking Vitamin B12 reports fatigue. What lab should be monitored?
Answer: CBC
Rationale: Evaluates improvement in anemia (Hgb, Hct, RBC).
5) A patient with Parkinson’s disease is walking. What indicates treatment is
effective?
Answer: Improved mobility
Rationale: Increased motor function indicates therapeutic response.
6) What is priority for a patient allergic to bananas?
Answer: Replace latex products
Rationale: Banana allergy is associated with latex cross-reactivity.
7) How can renal calculi be prevented?
Answer: Limit tea and chocolate
Rationale: Reduces oxalate intake and stone formation risk.
, 8) A patient is in F-vib. What medication should be given?
Answer: Defibrillation (NOT adenosine)
Rationale: Ventricular fibrillation requires immediate defibrillation.
9) A nurse cannot palpate a pedal pulse. What should the nurse do next?
Answer: Use Doppler ultrasound
Rationale: Detects weak or absent pulses.
10) A COPD patient has started a walking program. How do we know it is effective?
Answer: Cardiovascular improvement
Rationale: Increased endurance indicates improvement.
11) A post-op patient says they know how to breathe. What should the nurse do?
Answer: Request return demonstration
Rationale: Confirms understanding of teaching.
12) Order: 100 units in 250 mL at 12 units/hr. What is the infusion rate?
Answer: 30 mL/hr
Rationale: (12 ÷ 100) × 250 = 30 mL/hr.
13) A patient complains of right calf pain. What is the nurse’s priority?
Answer: Remain in bed
Rationale: Suspected DVT—prevents embolus movement.
14) A patient returns after TURP with clots. What should the nurse do?
Answer: Slowly irrigate catheter
Rationale: Maintains catheter patency.
15) Priority for multiple sclerosis patient with urinary retention?
Answer: Self-catheterization
Rationale: Promotes bladder emptying and independence.
16) What lab should be monitored for abscess drainage?
Answer: WBC count
Rationale: Indicates infection severity.
17) CHF intervention?
Answer: Use bedside commode
Rationale: Reduces cardiac workload.
