HESI RN MEDICAL SURGICAL EXAM QUIZ BANK
2025 QUESTIONS AND ANSWERS WITH
RATIONALE COMPLETE SOLUTION.
An ER nurse is completing an assessment on a patient that is alert but
struggles to answer questions. When she attempts to talk, she slurs her
speech and appears very frightened. What additional clinical
manifestation does the nurse expect to find if nacy's sysmptoms have
been caused by a brain attack (stroke)?
A. A carotid bruit
B. A hypotensive blood pressure
C. hyperreflexic deep tendon relexes.
D. Decreased bowel sounds ~ correct answer~A) A carotid bruit.
Rationale: the carotid artery (artery to the brain) is narrowed in clients
with a brain attack. A bruit is an abnormal sound heard on auscultation
resulting from interference with normal blood flow. Usually the blood
pressure is hypertensive. Initially flaccid paralysis occurs, resulting in
hyporefkexic deep tendon reflexes. Bowel sounds are not indicative of a
brain attack.
Which clinical manifestation further supports an assessment of a left-
sided brain attack?
,A) Visual field deficit on the left side.
B) Spatial-perceptual deficits.
C) Paresthesia of the left side.
D) Global aphasia.
D) Global aphasia. ~ correct answer~D) Global aphasia.
Rationale: Global aphasia refers to difficulty speaking, listening, and
understanding, as well as difficulty reading and writing. Symptoms
vary from person to person. Aphasia may occur secondary to any brain
injury involving the left hemisphere. Visual field deficits, spatial-
perceptual deficits, and paresthsia of the left side usually occur with
right-sided brain attack.
When preparing a patient for a noncontrast computed tomography (CT)
scan STAT, what nursing intervention should the nurse implement?
A) Determine if the client has any allergies to iodine
B) Explain that the client will not be able to move her head throughout
the CT scan.
C) Premedicate the client to decrease pain prior to having the
procedure.
D) Provide an explanation of relaxation exercises prior to the procedure.
~ correct answer~B) Explain that the client will not be able to move her
head throughout the CT scan.
,Rationale: Because head motion will distort the images, Nancy will
have to remain still throughout the procedure. Allergies to iodine is
important if contrast dye is being used for the CT scan. Premedicating
the client to decrease pain prior to the procedure is unnecessary
because CT scanning is a noninvasive and painless procedure.
Providing an explanation of relaxation exercises prior to the procedure
is a worthwhile intervention to decrease anxiety but is not of highest
priority.
A neurologist prescribes a magnetic resonance imaging (MRI) of the
head STAT for a patient. Which data warrants immediate intervention
by the nurse concerning this diagnostic test?
A) Elevated blood pressure.
B) Allergy to shell fish.
C) Right hip replacement.
D) History of atrial fibrillation. ~ correct answer~C) Right hip
replacement.
The magnetic field generated by the MRI is so strong that metal-
containing items are strongly attracted to the magnet. Because the hip
joint is made of metal, a lead shield must be used during the procedure.
Elevated blood pressure, an allergy to shell fish, and a history of atrial
fibrillation would not affect the MRI.
A client's daughter is sitting by her mother's bedside who was recently
transferred to the Intermediate Care Unit. She states "I don't
, understand what a brain attack is. The healthcare provider told me my
mother is in serious condition and they are going to run several tests. I
just don't know what is going on. What happened to my mother?" What
is the best response by the nurse?
A) "I am sorry, but according to the Health Insurance Portability and
Accounting Act (HIPAA), I cannot give you any information."
B) "Your mother has had a stroke, and the blood supply to the brain has
been blocked."
C) "How do you feel about what the healthcare provider said?"
D) "I will call the healthcare provider so he/she can talk to you about
your mother's serious condition." ~ correct answer~B) "Your mother has
had a stroke, and the blood supply to the brain has been blocked."
Rationale: The nurse can discuss what a diagnosis means. Nancy is
unable to make decisions, so the next of kin, her daughter, Gail, needs
sufficient information to make informed decisions. The nurse has the
knowledge, and the responsibility, to explain Nancy's condition to Gail.
The nurse should give facts first, and then address her feelings after the
information is provided.
What is the normal range for cardiac output? ~ correct answer~The
normal range for cardiac output to ensure cerebral blood flow and
oxygen delivery is 4 to 8 L/min.
A client was admitted with the diagnosis of a brain attack. Their
symptoms began 24 hours before being admitted. Why would this client
2025 QUESTIONS AND ANSWERS WITH
RATIONALE COMPLETE SOLUTION.
An ER nurse is completing an assessment on a patient that is alert but
struggles to answer questions. When she attempts to talk, she slurs her
speech and appears very frightened. What additional clinical
manifestation does the nurse expect to find if nacy's sysmptoms have
been caused by a brain attack (stroke)?
A. A carotid bruit
B. A hypotensive blood pressure
C. hyperreflexic deep tendon relexes.
D. Decreased bowel sounds ~ correct answer~A) A carotid bruit.
Rationale: the carotid artery (artery to the brain) is narrowed in clients
with a brain attack. A bruit is an abnormal sound heard on auscultation
resulting from interference with normal blood flow. Usually the blood
pressure is hypertensive. Initially flaccid paralysis occurs, resulting in
hyporefkexic deep tendon reflexes. Bowel sounds are not indicative of a
brain attack.
Which clinical manifestation further supports an assessment of a left-
sided brain attack?
,A) Visual field deficit on the left side.
B) Spatial-perceptual deficits.
C) Paresthesia of the left side.
D) Global aphasia.
D) Global aphasia. ~ correct answer~D) Global aphasia.
Rationale: Global aphasia refers to difficulty speaking, listening, and
understanding, as well as difficulty reading and writing. Symptoms
vary from person to person. Aphasia may occur secondary to any brain
injury involving the left hemisphere. Visual field deficits, spatial-
perceptual deficits, and paresthsia of the left side usually occur with
right-sided brain attack.
When preparing a patient for a noncontrast computed tomography (CT)
scan STAT, what nursing intervention should the nurse implement?
A) Determine if the client has any allergies to iodine
B) Explain that the client will not be able to move her head throughout
the CT scan.
C) Premedicate the client to decrease pain prior to having the
procedure.
D) Provide an explanation of relaxation exercises prior to the procedure.
~ correct answer~B) Explain that the client will not be able to move her
head throughout the CT scan.
,Rationale: Because head motion will distort the images, Nancy will
have to remain still throughout the procedure. Allergies to iodine is
important if contrast dye is being used for the CT scan. Premedicating
the client to decrease pain prior to the procedure is unnecessary
because CT scanning is a noninvasive and painless procedure.
Providing an explanation of relaxation exercises prior to the procedure
is a worthwhile intervention to decrease anxiety but is not of highest
priority.
A neurologist prescribes a magnetic resonance imaging (MRI) of the
head STAT for a patient. Which data warrants immediate intervention
by the nurse concerning this diagnostic test?
A) Elevated blood pressure.
B) Allergy to shell fish.
C) Right hip replacement.
D) History of atrial fibrillation. ~ correct answer~C) Right hip
replacement.
The magnetic field generated by the MRI is so strong that metal-
containing items are strongly attracted to the magnet. Because the hip
joint is made of metal, a lead shield must be used during the procedure.
Elevated blood pressure, an allergy to shell fish, and a history of atrial
fibrillation would not affect the MRI.
A client's daughter is sitting by her mother's bedside who was recently
transferred to the Intermediate Care Unit. She states "I don't
, understand what a brain attack is. The healthcare provider told me my
mother is in serious condition and they are going to run several tests. I
just don't know what is going on. What happened to my mother?" What
is the best response by the nurse?
A) "I am sorry, but according to the Health Insurance Portability and
Accounting Act (HIPAA), I cannot give you any information."
B) "Your mother has had a stroke, and the blood supply to the brain has
been blocked."
C) "How do you feel about what the healthcare provider said?"
D) "I will call the healthcare provider so he/she can talk to you about
your mother's serious condition." ~ correct answer~B) "Your mother has
had a stroke, and the blood supply to the brain has been blocked."
Rationale: The nurse can discuss what a diagnosis means. Nancy is
unable to make decisions, so the next of kin, her daughter, Gail, needs
sufficient information to make informed decisions. The nurse has the
knowledge, and the responsibility, to explain Nancy's condition to Gail.
The nurse should give facts first, and then address her feelings after the
information is provided.
What is the normal range for cardiac output? ~ correct answer~The
normal range for cardiac output to ensure cerebral blood flow and
oxygen delivery is 4 to 8 L/min.
A client was admitted with the diagnosis of a brain attack. Their
symptoms began 24 hours before being admitted. Why would this client
