MED-SURG EXAM: MED-SURG HESI
PN, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
A client is diagnosed with acute myocardial infarction (MI). Which
diagnostic laboratory value should the practical nurse (PN)
anticipate to be the first to elevate to establish a diagnosis of an
acute myocardial infarction (MI)?
a. Elevated troponin
b. Elevated creatine kinase-MB (CK-MB) level
c. Prolonged prothrombin time (PT)
d. Elevated serum blood urea nitrogen (BUN) and creatinine -
CORRECT ANSWERS- a. Elevated troponin
Rationale:
Tissue damage in the myocardium causes the release of cardiac
enzymes into the blood system. According to the American
College of Cardiology (ACS) and the European Society of
cardiology (ESC), an elevation of the troponin will occur within 2
to 3 hours of an MI and is used to establish the diagnosis. It takes
the CK-MB level 6 to 9 hours or longer to elevate.
A plan of care for a 56-year-old client who has been diagnosed
with osteopenia has been developed. The plan is focused on
,preventing further bone resorption and increasing bone mass.
Which outcome statement should be included in the plan of care?
a. The nurse practitioner will instruct the client on the use of
alendronate.
b. The client will decrease the number of cigarettes smoked by
50% within 2 weeks.
c. The client will swim for 30 minutes three to four times per week
for the next 2 months.
d. The practical nurse will provide the client with a list of foods
that are high in calcium - CORRECT ANSWERS- b. The client will
decrease the number of cigarettes smoked by 50% within 2
weeks.
Rationale:
A desired outcome statement should be client-centered with a
measurable outcome, and the client decreasing the number of
cigarettes smoked by 50% within 2 weeks is both client-centered
and measurable. Cigarette smoking has a negative effect on bone
resorption, so the client should be advised to stop smoking.
In order to provide culturally competent care to a group of clients,
what action must the practical nurse do first?
a. Treat each client the same, regardless of race or religion.
b. Ensure that all Native American clients have access to a
shaman.
c. Understand one's own world views in addition to the client's.
d. Include the family in the plan of care for older adult clients. -
CORRECT ANSWERS- c. Understand one's own world views in
addition to the client's.
,Rationale:
The nurse should understand their own values and views to
prevent those beliefs being imparted to others, in addition to
understanding the client's cultural views when providing cultural
competent care. Treating every client the same or assuming that
all clients share the same values does not exhibit cultural
competence or sensitivity.
The nurse is reinforcing hygiene instructions to unlicensed
assistive personnel (UAP) who will be bathing a client who has
been diagnosed with pneumonia. The nurse should instruct the
UAP to plan to bathe the client at which time?
a. The client with pneumonia should not be bathed.
b. The client should be bathed according to facility schedule.
c. The client should be bathed after noninfectious clients are
bathed.
d. The client should have activities such as bathing, alternated
with rest periods. - CORRECT ANSWERS- d. The client should
have activities such as bathing, alternated with rest periods.
Rationale:
The client should be allowed to rest before activities such as
bathing take place. There is no contraindication for bathing a
client with pneumonia. Facility schedules are not the primary
reason to determine the timing of a client's bath. By using
standard and other precautions, it would not matter whether the
client with pneumonia is bathed before or after other
noninfectious clients.
, A client is admitted from the emergency department with a
diagnosis of left tibia fracture and the left leg has a splint in place.
The client was medicated approximately 2 hours ago with a
prescribed analgesic. The client is now complaining of
excruciating leg pain and demanding "stronger pain medications."
What initial action is most important for the practical nurse (PN)
to take?
a. Ask about any past history of drug abuse or addiction.
b. Measure the pulse strength and capillary refill distal to the
fracture.
c. Apply an ice pack over the fracture area of the splint.
d. Evaluate the fractured leg on two pillows. - CORRECT
ANSWERS- b. Measure the pulse strength and capillary refill distal
to the fracture.
Rationale:
The PN needs to measure the pulse strength and capillary refill
distal to the fracture. Pain and diminished pulse volume are signs
of compartment syndrome, which can progress to complete loss
of the peripheral pulse in the extremity. Compartment syndrome
occurs when external pressure (usually from a cast) or internal
pressure after an injury resulting in inflammation and edema
building up in the fascia space of the muscle which results in the
pressure in this space building up and stopping the flow of blood
to the tissues in the compartment. This is a medical emergency
requiring a fasciotomy to relieve the pressure.
A client diagnosed with a skull hematoma and fractured left (L)
clavicle following a six foot fall from a ladder is admitted to the
unit. Which sign should the practical nurse (PN) report
immediately?
PN, 2025/2026 WITH
CORRECT/ACCURATE ANSWERS
A client is diagnosed with acute myocardial infarction (MI). Which
diagnostic laboratory value should the practical nurse (PN)
anticipate to be the first to elevate to establish a diagnosis of an
acute myocardial infarction (MI)?
a. Elevated troponin
b. Elevated creatine kinase-MB (CK-MB) level
c. Prolonged prothrombin time (PT)
d. Elevated serum blood urea nitrogen (BUN) and creatinine -
CORRECT ANSWERS- a. Elevated troponin
Rationale:
Tissue damage in the myocardium causes the release of cardiac
enzymes into the blood system. According to the American
College of Cardiology (ACS) and the European Society of
cardiology (ESC), an elevation of the troponin will occur within 2
to 3 hours of an MI and is used to establish the diagnosis. It takes
the CK-MB level 6 to 9 hours or longer to elevate.
A plan of care for a 56-year-old client who has been diagnosed
with osteopenia has been developed. The plan is focused on
,preventing further bone resorption and increasing bone mass.
Which outcome statement should be included in the plan of care?
a. The nurse practitioner will instruct the client on the use of
alendronate.
b. The client will decrease the number of cigarettes smoked by
50% within 2 weeks.
c. The client will swim for 30 minutes three to four times per week
for the next 2 months.
d. The practical nurse will provide the client with a list of foods
that are high in calcium - CORRECT ANSWERS- b. The client will
decrease the number of cigarettes smoked by 50% within 2
weeks.
Rationale:
A desired outcome statement should be client-centered with a
measurable outcome, and the client decreasing the number of
cigarettes smoked by 50% within 2 weeks is both client-centered
and measurable. Cigarette smoking has a negative effect on bone
resorption, so the client should be advised to stop smoking.
In order to provide culturally competent care to a group of clients,
what action must the practical nurse do first?
a. Treat each client the same, regardless of race or religion.
b. Ensure that all Native American clients have access to a
shaman.
c. Understand one's own world views in addition to the client's.
d. Include the family in the plan of care for older adult clients. -
CORRECT ANSWERS- c. Understand one's own world views in
addition to the client's.
,Rationale:
The nurse should understand their own values and views to
prevent those beliefs being imparted to others, in addition to
understanding the client's cultural views when providing cultural
competent care. Treating every client the same or assuming that
all clients share the same values does not exhibit cultural
competence or sensitivity.
The nurse is reinforcing hygiene instructions to unlicensed
assistive personnel (UAP) who will be bathing a client who has
been diagnosed with pneumonia. The nurse should instruct the
UAP to plan to bathe the client at which time?
a. The client with pneumonia should not be bathed.
b. The client should be bathed according to facility schedule.
c. The client should be bathed after noninfectious clients are
bathed.
d. The client should have activities such as bathing, alternated
with rest periods. - CORRECT ANSWERS- d. The client should
have activities such as bathing, alternated with rest periods.
Rationale:
The client should be allowed to rest before activities such as
bathing take place. There is no contraindication for bathing a
client with pneumonia. Facility schedules are not the primary
reason to determine the timing of a client's bath. By using
standard and other precautions, it would not matter whether the
client with pneumonia is bathed before or after other
noninfectious clients.
, A client is admitted from the emergency department with a
diagnosis of left tibia fracture and the left leg has a splint in place.
The client was medicated approximately 2 hours ago with a
prescribed analgesic. The client is now complaining of
excruciating leg pain and demanding "stronger pain medications."
What initial action is most important for the practical nurse (PN)
to take?
a. Ask about any past history of drug abuse or addiction.
b. Measure the pulse strength and capillary refill distal to the
fracture.
c. Apply an ice pack over the fracture area of the splint.
d. Evaluate the fractured leg on two pillows. - CORRECT
ANSWERS- b. Measure the pulse strength and capillary refill distal
to the fracture.
Rationale:
The PN needs to measure the pulse strength and capillary refill
distal to the fracture. Pain and diminished pulse volume are signs
of compartment syndrome, which can progress to complete loss
of the peripheral pulse in the extremity. Compartment syndrome
occurs when external pressure (usually from a cast) or internal
pressure after an injury resulting in inflammation and edema
building up in the fascia space of the muscle which results in the
pressure in this space building up and stopping the flow of blood
to the tissues in the compartment. This is a medical emergency
requiring a fasciotomy to relieve the pressure.
A client diagnosed with a skull hematoma and fractured left (L)
clavicle following a six foot fall from a ladder is admitted to the
unit. Which sign should the practical nurse (PN) report
immediately?
