MED SURG 2 | ACTUAL
QUESTIONS &
ANSWERS | BRAND
NEW!!!
,LATEST 2025 HESI MED SURG 2 | ACTUAL QUESTIONS & ANSWERS | BRAND
NEW!!!
The nurse should be correct in withholding a dose of digoxin in a client with congestive
heart failure without specific instruction from the healthcare provider if the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min. - CORRECT ANSWER C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which will
increase the chance of dangerous dysrhythmias (normal potassium level is 3.5 to 5.5
mEq/L). The therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels= >2 ng/ml); (A) is
within this range. (B) would not warrant the nurse withholding the digoxin. The nurse should
withhold the digoxin if the apical pulse is less than 60/min (D).
During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is
not moving. What action should the nurse take first?
A) Use a laryngoscope to check for a foreign body lodged in the esophagus.
B) Reposition the head to validate that the head is in the proper position to open the airway.
C) Turn the client to the side and administer three back blows.
D) Perform a finger sweep of the mouth to remove any vomitus. - CORRECT ANSWER B)
Reposition the head to validate that the head is in the proper position to open the airway.
The most frequent cause of inadequate aeration of the client's lungs during CPR is
improper positioning of the head resulting in occlusion of the airway (B). A foreign body can
occlude the airway, but this is not common unless choking preceded the cardiac
emergency, and (A, C and D) should not be the nurse's first action.
Despite several eye surgeries, a 78-year-old client who lives alone has persistent vision
problems. The visiting nurse is discussing painting the house with the client. The nurse
suggests that the edge of the steps should be painted which color?
A) Black.
,B) White.
C) Light green.
D) Medium yellow. - CORRECT ANSWER D) Medium yellow.
Yellow is the easiest for a person with failing vision to see (D). (A) will be almost impossible
to see at night because the shadows of the steps will be too difficult to determine, and
would pose a safety hazard. (B) is very hard to see with a glare from the sun and it could
hurt the eyes in the daytime to look at them. (C) is a pastel color and is difficult for elderly
clients to see.
, The bnurse bis bassessing ba bclient bwith bbacterial bmeningitis. bWhich bassessment bfinding
indicates bthe bclient bmay bhave bdeveloped bseptic bemboli?
b
A) Cyanosis bof bthe bfingertips.
B) Bradycardia band bbradypnea.
C) Presence bof bS3 band bS4 bheart bsounds.
D) 3+ bpitting bedema bof bthe blower bextremities. b- bCORRECT bANSWER bA) bCyanosis bof
the bfingertips.
b
Septic bemboli bsecondary bto bmeningitis bcommonly blodge bin bthe bsmall barterioles bof bthe
extremities, bcausing ba bdecrease bin bcirculation bto bthe bhands b(A) bwhich bmay blead bto
b
gangrene. b(B, bC, band bD) bare babnormal bfindings, bbut bdo bnot bindicate bthe bdevelopment bof
b
septic bemboli.
b
In bassessing ba bclient bdiagnosed bwith bprimary bhyperaldosteronism, bthe bnurse bexpects bthe
laboratory btest bresults bto bindicate ba bdecreased bserum blevel bof bwhich bsubstance?
b
A) Sodium.
B) Antidiuretic bhormone.
C) Potassium.
D) Glucose. b- bCORRECT bANSWER bC) bPotassium.
Clients bwith bprimary baldosteronism bexhibit ba bprofound bdecline bin bthe bserum blevels bof
potassium b(C) b(hypokalemia)--hypertension bis bthe bmost bprominent band buniversal bsign. b(A)
b
is bnormal bor belevated, bdepending bon bthe bamount bof bwater breabsorbed bwith bthe bsodium.
b
(B) bis bdecreased bwith bdiabetes binsipidus. b(D) bis bnot baffected bby bprimary baldosteronism.
b
A bclient bwith bdiabetes bmellitus bis bexperiencing bpolyphagia. bWhich boutcome bstatement bis bthe
priority bfor bthis bclient?
b
A) Fluid band belectrolyte bbalance.
B) Prevention bof bwater btoxicity.
C) Reduced bglucose bin bthe burine.
D) Adequate bcellular bnourishment. b- bCORRECT bANSWER bD) bAdequate
cellular bnourishment.
b