HESI MED SURG PROCTORED EXAM 2021-STUDY GUIDE
1. The nurse obtains a fingerstick blood glucose level utilizing bedside lancet/glucose meter
equipment from a client with a prescribed sliding scale insulin protocol. The meter indicated
56 mg/dl (3.12 mmol/l). At this time, which intervention should the nurse implement first?
A. Collect a blood specimen by venipuncture to send to the laboratory for serum glucose analysis
B. Prepare the prescribed dose of rapid acting insulin from the sliding scale instructions
C. Give the client six ounces of non-diet carbonated soda and instruct client to drink it entirely
D. Document the glucose reading in the electronic medical record as the only action needed
2. To achieve maximum mobility and independence for a client multiple sclerosis (MS),
which intervention is most important for the nurse to implement?
A. Provide a walker for ambulation
B. Frequently assist client to bathroom
C. Apply alternating patches over
eyes D. Teaching strengthening
exercises
3. A client is admitted to the hospital with symptoms consistent with a right hemisphere
stroke. Which neurovascular assessment requires immediate intervention by the nurse?
A. Pupillary changes to ipsilateral dilation
B. Orientation to person and place only
C. Left-sided facial drooping and dysphagia
D. Unequal bilateral hand grip strengths
4. The nurse is teaching a client with glomerulonephritis about self care. Which
dietary recommendations should the nurse encourage the client to follow?
A. Limit oral fluid intake to 500 mL per day
B. Restrict protein intake by limiting meats and other high-protein foods
C. Increase intake of potassium-rich foods such as bananas or cantaloupe
D. Increase intake of high-fiber foods, such as bran cereal
, 5. The nurse id caring for a client with Herpes zoster who reports painful, red blisters that
align from the back along the chest’s curvature to the anterior chest. Which intervention is
the highest priority for the nurse?
A. Place the client on contact precautions
B. Administer antiviral medications
C. Place wet compresses to ruptured vesicles
D. Administer narcotic analgesics
6. A young adult who suffered a severe brain injury in an automobile collision has been
mechanically ventilated for the past three days and has no spontaneous respiratory effort.
After serial electroencephalograms (EEG) reveal no brain activity, the healthcare provider
discusses end-of-life options with the family who agree to discontinue life support. Which
intervention should the nurse implement?
A. Ask the family if they wish to remain at the bedside during withdrawal
B. Request a living will be placed in the client’s medical record
C. Discuss the withdrawal procedure with the family and offer support
D. Turn off the mechanical ventilator and note the time of death
7. Following a transurethral resection of the prostate (TURP), a client is discharged from the
hospital with an indwelling urinary catheter. Which instruction is most important for the nurse
to include in the discharge teaching plan?
A. Eliminate all spicy foods from your diet
B. Drink 3 liters of water each day
C. Clamp the catheter when taking a shower
D. Avoid driving a care for 2 weeks
8. On the first postoperative day, the nurse finds an older male client disoriented and trying to
climb over the bed railing. Previously, he was oriented to person, place, and time on
admission. Which intervention should the nurse implement first?
A. Apply wrist restraints
B. Determine the client’s blood pressure
C. Administer a mild
sedative D. Assess the client
for pain
1. The nurse obtains a fingerstick blood glucose level utilizing bedside lancet/glucose meter
equipment from a client with a prescribed sliding scale insulin protocol. The meter indicated
56 mg/dl (3.12 mmol/l). At this time, which intervention should the nurse implement first?
A. Collect a blood specimen by venipuncture to send to the laboratory for serum glucose analysis
B. Prepare the prescribed dose of rapid acting insulin from the sliding scale instructions
C. Give the client six ounces of non-diet carbonated soda and instruct client to drink it entirely
D. Document the glucose reading in the electronic medical record as the only action needed
2. To achieve maximum mobility and independence for a client multiple sclerosis (MS),
which intervention is most important for the nurse to implement?
A. Provide a walker for ambulation
B. Frequently assist client to bathroom
C. Apply alternating patches over
eyes D. Teaching strengthening
exercises
3. A client is admitted to the hospital with symptoms consistent with a right hemisphere
stroke. Which neurovascular assessment requires immediate intervention by the nurse?
A. Pupillary changes to ipsilateral dilation
B. Orientation to person and place only
C. Left-sided facial drooping and dysphagia
D. Unequal bilateral hand grip strengths
4. The nurse is teaching a client with glomerulonephritis about self care. Which
dietary recommendations should the nurse encourage the client to follow?
A. Limit oral fluid intake to 500 mL per day
B. Restrict protein intake by limiting meats and other high-protein foods
C. Increase intake of potassium-rich foods such as bananas or cantaloupe
D. Increase intake of high-fiber foods, such as bran cereal
, 5. The nurse id caring for a client with Herpes zoster who reports painful, red blisters that
align from the back along the chest’s curvature to the anterior chest. Which intervention is
the highest priority for the nurse?
A. Place the client on contact precautions
B. Administer antiviral medications
C. Place wet compresses to ruptured vesicles
D. Administer narcotic analgesics
6. A young adult who suffered a severe brain injury in an automobile collision has been
mechanically ventilated for the past three days and has no spontaneous respiratory effort.
After serial electroencephalograms (EEG) reveal no brain activity, the healthcare provider
discusses end-of-life options with the family who agree to discontinue life support. Which
intervention should the nurse implement?
A. Ask the family if they wish to remain at the bedside during withdrawal
B. Request a living will be placed in the client’s medical record
C. Discuss the withdrawal procedure with the family and offer support
D. Turn off the mechanical ventilator and note the time of death
7. Following a transurethral resection of the prostate (TURP), a client is discharged from the
hospital with an indwelling urinary catheter. Which instruction is most important for the nurse
to include in the discharge teaching plan?
A. Eliminate all spicy foods from your diet
B. Drink 3 liters of water each day
C. Clamp the catheter when taking a shower
D. Avoid driving a care for 2 weeks
8. On the first postoperative day, the nurse finds an older male client disoriented and trying to
climb over the bed railing. Previously, he was oriented to person, place, and time on
admission. Which intervention should the nurse implement first?
A. Apply wrist restraints
B. Determine the client’s blood pressure
C. Administer a mild
sedative D. Assess the client
for pain
