HESI RN MEDICAL-SURGICAL MED SURG
VERSION A AND VERSION B 2024–2025
COMPREHENSIVE PRACTICE QUESTIONS
AND ANSWERS COMPLETE EXAM
PREPARATION RESOURCE 250 MED SURG
PRACTICE QUESTIONS, CLINICAL
JUDGMENT, NGN-STYLE REVIEW,
DETAILED RATIONALES AND NURSING
STUDY GUIDE
A 77-year-old client is admitted to the hospital with confusion and anorexia
of several days' duration. Additional symptoms reported are nausea and
vomiting, and current complaints of a headache. The client's pulse rate is
43 beats/min. The nurse is most concerned about the client's history
related to which medication?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin - CORRECT ANSWER -D
,Rationale:Older persons are particularly susceptible to the buildup of
cardiac glycosides, such as digoxin or digitoxin (medications derived from
digitalis), to a toxic level in their systems. Toxicity can cause anorexia,
nausea, vomiting, diarrhea, headache, and fatigue. Options A, B, and C are
unlikely to result in the symptoms described.
The nurse is caring for a client with a fractured right elbow. Which
assessment finding has the highest priority and requires immediate
intervention?
A.
Ecchymosis over the right elbow area
B.
Deep unrelenting pain in the right arm
C.
An edematous right elbow
D.
The presence of crepitus in the right elbow - CORRECT ANSWER -B
Rationale:Compartment syndrome is a condition involving increased
pressure and constriction of the nerves and vessels within an anatomic
compartment, causing pain uncontrolled by opioids and neurovascular
compromise. Option A is an expected finding. Option C related to
compartment syndrome cannot be seen, and any visible edema is an
expected finding related to the injury. Option D is an expected finding.
The clinic nurse is providing post-operative teaching for a client scheduled
for a myringoplasty. Which client statements indicate to the nurse that the
teaching has been effective? (Select all that apply.)
A.
,"I can wash my hair in the shower when I get home."
B.
"I will avoid forceful and deep coughing until my post-op checkup."
C.
"I must lay flat on my non-operative side for the first 12 hours after
surgery."
D.
"My hearing may be less or muffled until the packing comes out."
E.
"I need to only take the first two doses of antibiotics and save the rest for
another time." - CORRECT ANSWER -B, C, D
Rationale:The client must keep the ear bandage clean and dry until the
packing is removed. Showering and hair washing is discouraged. As with all
prescriptions for antibiotics, the client must take the full course of
treatment. The remaining client statements do indicate effective teaching.
The nurse is performing a skin assessment on a client who is transferred
from a long-term care facility to an in-patient hospital unit. The client is
unable to move independently while in bed. The nurse observes reddened
areas to the sacrum and on the heals bilaterally. What is the next nursing
action?
A.
Document the size and shape of the reddened areas.
B.
Massage the reddened areas with a hospital-approved lotion.
C.
, Call the nurse from the transferring facility to determine the client's
baseline.
D.
Culture the wounds. - CORRECT ANSWER -A
Rationale:The nurse must document any pressure wounds upon admission
to establish the client's baseline and for insurance purposes. Insurance will
not reimburse from hospital-acquired pressure ulcers. Massaging is not
recommended as it may dislodge the existing tissue. A call is not a good use
of the nurse's time as the pressure ulcers exist upon transfer, and the
baseline is determined upon admission. The health care provider will order
cultures, if needed.
A client with type 2 diabetes takes metformin daily. The client is scheduled
for major surgery requiring general anesthesia the next day. The nurse
anticipates which approach to manage the client's diabetes best while the
client is NPO during the perioperative period?
A.
NPO except for metformin and regular snacks
B.
NPO except for oral antidiabetic agent
C.
Novolin N insulin subcutaneously twice daily
D.
Regular insulin subcutaneously per sliding scale - CORRECT ANSWER -D
Rationale:Regular insulin dosing based on the client's blood glucose levels
(sliding scale) is the best method to achieve control of the client's blood
glucose while the client is NPO and coping with the major stress of surgery.
VERSION A AND VERSION B 2024–2025
COMPREHENSIVE PRACTICE QUESTIONS
AND ANSWERS COMPLETE EXAM
PREPARATION RESOURCE 250 MED SURG
PRACTICE QUESTIONS, CLINICAL
JUDGMENT, NGN-STYLE REVIEW,
DETAILED RATIONALES AND NURSING
STUDY GUIDE
A 77-year-old client is admitted to the hospital with confusion and anorexia
of several days' duration. Additional symptoms reported are nausea and
vomiting, and current complaints of a headache. The client's pulse rate is
43 beats/min. The nurse is most concerned about the client's history
related to which medication?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin - CORRECT ANSWER -D
,Rationale:Older persons are particularly susceptible to the buildup of
cardiac glycosides, such as digoxin or digitoxin (medications derived from
digitalis), to a toxic level in their systems. Toxicity can cause anorexia,
nausea, vomiting, diarrhea, headache, and fatigue. Options A, B, and C are
unlikely to result in the symptoms described.
The nurse is caring for a client with a fractured right elbow. Which
assessment finding has the highest priority and requires immediate
intervention?
A.
Ecchymosis over the right elbow area
B.
Deep unrelenting pain in the right arm
C.
An edematous right elbow
D.
The presence of crepitus in the right elbow - CORRECT ANSWER -B
Rationale:Compartment syndrome is a condition involving increased
pressure and constriction of the nerves and vessels within an anatomic
compartment, causing pain uncontrolled by opioids and neurovascular
compromise. Option A is an expected finding. Option C related to
compartment syndrome cannot be seen, and any visible edema is an
expected finding related to the injury. Option D is an expected finding.
The clinic nurse is providing post-operative teaching for a client scheduled
for a myringoplasty. Which client statements indicate to the nurse that the
teaching has been effective? (Select all that apply.)
A.
,"I can wash my hair in the shower when I get home."
B.
"I will avoid forceful and deep coughing until my post-op checkup."
C.
"I must lay flat on my non-operative side for the first 12 hours after
surgery."
D.
"My hearing may be less or muffled until the packing comes out."
E.
"I need to only take the first two doses of antibiotics and save the rest for
another time." - CORRECT ANSWER -B, C, D
Rationale:The client must keep the ear bandage clean and dry until the
packing is removed. Showering and hair washing is discouraged. As with all
prescriptions for antibiotics, the client must take the full course of
treatment. The remaining client statements do indicate effective teaching.
The nurse is performing a skin assessment on a client who is transferred
from a long-term care facility to an in-patient hospital unit. The client is
unable to move independently while in bed. The nurse observes reddened
areas to the sacrum and on the heals bilaterally. What is the next nursing
action?
A.
Document the size and shape of the reddened areas.
B.
Massage the reddened areas with a hospital-approved lotion.
C.
, Call the nurse from the transferring facility to determine the client's
baseline.
D.
Culture the wounds. - CORRECT ANSWER -A
Rationale:The nurse must document any pressure wounds upon admission
to establish the client's baseline and for insurance purposes. Insurance will
not reimburse from hospital-acquired pressure ulcers. Massaging is not
recommended as it may dislodge the existing tissue. A call is not a good use
of the nurse's time as the pressure ulcers exist upon transfer, and the
baseline is determined upon admission. The health care provider will order
cultures, if needed.
A client with type 2 diabetes takes metformin daily. The client is scheduled
for major surgery requiring general anesthesia the next day. The nurse
anticipates which approach to manage the client's diabetes best while the
client is NPO during the perioperative period?
A.
NPO except for metformin and regular snacks
B.
NPO except for oral antidiabetic agent
C.
Novolin N insulin subcutaneously twice daily
D.
Regular insulin subcutaneously per sliding scale - CORRECT ANSWER -D
Rationale:Regular insulin dosing based on the client's blood glucose levels
(sliding scale) is the best method to achieve control of the client's blood
glucose while the client is NPO and coping with the major stress of surgery.
