HESI RN MEDSURG PRACTICE QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. A client with diabetes insipidus is preparing for discharge. Which instruction should the nurse include?
The scenario occurs in a different care setting with additional comorbidity (variant 107).
A. maintain access to water and monitor weight
B. use incentive spirometer regularly while awake as instructed
C. avoid unapproved antithrombotics after hemorrhage
D. monitor weight and edema
Correct Answer: A. maintain access to water and monitor weight
Rationale: The instruction to maintain access to water and monitor weight addresses safe self-management of
diabetes insipidus.
2. A nurse evaluates a client for rheumatoid arthritis. Which finding best supports this condition?
A. symmetric inflammatory joint pain with prolonged morning stiffness
B. heavy proteinuria, hypoalbuminemia, and edema
C. low-grade fever, diminished bases, and hypoxemia after surgery
D. rising creatinine and reduced urine output
Correct Answer: A. symmetric inflammatory joint pain with prolonged morning stiffness
Rationale: symmetric inflammatory joint pain with prolonged morning stiffness is a characteristic clinical pattern
of rheumatoid arthritis.
3. Which complication should the nurse monitor for most closely in a client with tension pneumothorax?
The scenario occurs in a different care setting with additional comorbidity (variant 63).
A. venous thrombosis
B. sepsis or hemorrhage
C. obstructive shock
D. hemorrhagic shock
Correct Answer: C. obstructive shock
Rationale: obstructive shock is a serious recognized complication of tension pneumothorax.
4. A client is suspected of having DKA. Which nursing action is the priority? The scenario occurs in a
different care setting with additional comorbidity (variant 110).
A. rapid analgesia, hydration as appropriate, and oxygen if hypoxemic
B. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
C. establish IV access, assess hemodynamics, and prepare for endoscopy
D. start isotonic fluids then insulin with close potassium monitoring
Correct Answer: D. start isotonic fluids then insulin with close potassium monitoring
Rationale: The priority response for DKA is to start isotonic fluids then insulin with close potassium monitoring.
5. NGN-style case: a client with pyelonephritis develops fever, flank pain, and urinary symptoms. Which
response best links the cue to the required action?
A. fever, headache, neck stiffness, and altered mental status; then initiate isolation as indicated and give prompt
empiric antimicrobials after cultures when feasible
B. portal hypertension with edema/ascites and synthetic dysfunction; then manage sodium, diuretics, and evaluate
for complications
C. fever, flank pain, and urinary symptoms; then obtain urine testing and start appropriate antibiotics
D. tachycardia, hypotension, cool skin, low urine output; then control source and restore intravascular
volume/blood as indicated
Correct Answer: C. fever, flank pain, and urinary symptoms; then obtain urine testing and start appropriate
antibiotics
Rationale: Recognizing fever, flank pain, and urinary symptoms and then acting to obtain urine testing and start
appropriate antibiotics demonstrates cue recognition followed by an appropriate clinical action.
6. Which assessment or diagnostic monitoring is most useful when caring for a client with sepsis?
A. serial sodium and fluid balance
B. noncontrast head CT and vascular imaging
C. lactate, urine output, hemodynamics
D. ECG and anticoagulation risk assessment
Correct Answer: C. lactate, urine output, hemodynamics
,Rationale: lactate, urine output, hemodynamics directly supports evaluation of sepsis.
7. A client with ARDS is preparing for discharge. Which instruction should the nurse include?
A. avoid unapproved potassium supplements
B. report fever or bleeding immediately
C. take levodopa on schedule and use fall precautions
D. family education focuses on critical illness course and complications
Correct Answer: D. family education focuses on critical illness course and complications
Rationale: The instruction to family education focuses on critical illness course and complications addresses safe
self-management of ARDS.
8. A nurse evaluates a client for postoperative atelectasis. Which finding best supports this condition?
A. low-grade fever, diminished bases, and hypoxemia after surgery
B. ascending weakness and areflexia after infection
C. facial burns, soot, hoarseness, or stridor
D. refractory hypoxemia with bilateral opacities not fully explained by heart failure
Correct Answer: A. low-grade fever, diminished bases, and hypoxemia after surgery
Rationale: low-grade fever, diminished bases, and hypoxemia after surgery is a characteristic clinical pattern of
postoperative atelectasis.
9. A client with Crohn disease flare is preparing for discharge. Which instruction should the nurse include?
A. avoid activities that markedly increase pressure if instructed
B. avoid unapproved antithrombotics after hemorrhage
C. stop smoking and maintain follow-up
D. seek care for severe pain, vomiting, or inability to pass stool/gas
Correct Answer: C. stop smoking and maintain follow-up
Rationale: The instruction to stop smoking and maintain follow-up addresses safe self-management of Crohn
disease flare.
10. Which complication should the nurse monitor for most closely in a client with postoperative atelectasis?
A. pneumonia
B. thrombosis and neurologic injury
C. hypercapnic respiratory failure
D. venous thrombosis
Correct Answer: A. pneumonia
Rationale: pneumonia is a serious recognized complication of postoperative atelectasis.
11. A client is suspected of having SIADH. Which nursing action is the priority? The scenario occurs in a
different care setting with additional comorbidity (variant 98).
A. protect from bleeding/infection and treat cause
B. urgent CT/vascular evaluation and neurosurgical management
C. aggressive fluid replacement then insulin and electrolyte management
D. fluid restrict when appropriate and treat severe symptomatic hyponatremia urgently
Correct Answer: D. fluid restrict when appropriate and treat severe symptomatic hyponatremia urgently
Rationale: The priority response for SIADH is to fluid restrict when appropriate and treat severe symptomatic
hyponatremia urgently.
12. NGN-style case: a client with ARDS develops refractory hypoxemia with bilateral opacities not fully
explained by heart failure. Which response best links the cue to the required action? The scenario occurs in
a different care setting with additional comorbidity (variant 72).
A. portal hypertension with edema/ascites and synthetic dysfunction; then manage sodium, diuretics, and evaluate
for complications
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. refractory hypoxemia with bilateral opacities not fully explained by heart failure; then lung-protective
ventilation and treat underlying cause
D. potassium elevation with weakness or peaked T waves; then cardiac monitoring and urgent membrane
stabilization/shifting/removal when severe
Correct Answer: C. refractory hypoxemia with bilateral opacities not fully explained by heart failure; then
lung-protective ventilation and treat underlying cause
,Rationale: Recognizing refractory hypoxemia with bilateral opacities not fully explained by heart failure and
then acting to lung-protective ventilation and treat underlying cause demonstrates cue recognition followed by an
appropriate clinical action.
13. Which assessment or diagnostic monitoring is most useful when caring for a client with postoperative
atelectasis?
A. serum sodium/osmolality and urine osmolality
B. oxygen saturation and respiratory exam
C. creatinine, potassium, urine output
D. serial neurovascular assessment
Correct Answer: B. oxygen saturation and respiratory exam
Rationale: oxygen saturation and respiratory exam directly supports evaluation of postoperative atelectasis.
14. A nurse evaluates a client for tension pneumothorax. Which finding best supports this condition?
A. fever, headache, neck stiffness, and altered mental status
B. exertional syncope, angina, and dyspnea with systolic murmur
C. severe respiratory distress with absent unilateral breath sounds and hemodynamic compromise
D. periumbilical pain migrating to right lower quadrant with anorexia
Correct Answer: C. severe respiratory distress with absent unilateral breath sounds and hemodynamic
compromise
Rationale: severe respiratory distress with absent unilateral breath sounds and hemodynamic compromise is a
characteristic clinical pattern of tension pneumothorax.
15. A client is suspected of having ischemic stroke. Which nursing action is the priority?
A. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
B. establish IV access, assess hemodynamics, and prepare for endoscopy
C. optimize mobility and medication timing
D. manage sodium, diuretics, and evaluate for complications
Correct Answer: A. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
Rationale: The priority response for ischemic stroke is to activate stroke pathway and determine
thrombolysis/thrombectomy eligibility.
16. A client with appendicitis is preparing for discharge. Which instruction should the nurse include?
A. avoid laxatives or heating pad before evaluation
B. never take extra potassium without instructions
C. follow fluid/salt plan
D. stop smoking and maintain follow-up
Correct Answer: A. avoid laxatives or heating pad before evaluation
Rationale: The instruction to avoid laxatives or heating pad before evaluation addresses safe self-management of
appendicitis.
17. Which complication should the nurse monitor for most closely in a client with sepsis?
A. septic shock
B. acute chest syndrome
C. myasthenic crisis
D. multiorgan failure
Correct Answer: A. septic shock
Rationale: septic shock is a serious recognized complication of sepsis.
18. NGN-style case: a client with atrial fibrillation develops irregularly irregular rhythm. Which response
best links the cue to the required action?
A. low platelet count with petechiae or mucosal bleeding; then avoid IM injections/trauma and treat cause
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. crampy pain, vomiting, distention, and high-pitched sounds early; then NPO, IV fluids, gastric decompression
when ordered, surgical evaluation
D. irregularly irregular rhythm; then assess stability and control rate/rhythm or cardiovert if unstable
Correct Answer: D. irregularly irregular rhythm; then assess stability and control rate/rhythm or cardiovert if
unstable
, Rationale: Recognizing irregularly irregular rhythm and then acting to assess stability and control rate/rhythm or
cardiovert if unstable demonstrates cue recognition followed by an appropriate clinical action.
19. A client is suspected of having COPD exacerbation. Which nursing action is the priority? The
scenario occurs in a different care setting with additional comorbidity (variant 44).
A. replace fluids and give desmopressin for central DI when ordered
B. obtain cultures when indicated and begin timely antimicrobial/supportive care
C. rapid cultures/lactate and early antibiotics and fluids according to condition
D. titrate oxygen to prescribed target and give bronchodilators
Correct Answer: D. titrate oxygen to prescribed target and give bronchodilators
Rationale: The priority response for COPD exacerbation is to titrate oxygen to prescribed target and give
bronchodilators.
20. Which assessment or diagnostic monitoring is most useful when caring for a client with Guillain-Barre
syndrome?
A. urine protein, albumin, lipids
B. glucose, potassium, anion gap, venous pH
C. vital capacity and neurologic exam
D. clinical response and recurrence
Correct Answer: C. vital capacity and neurologic exam
Rationale: vital capacity and neurologic exam directly supports evaluation of Guillain-Barre syndrome.
21. A nurse evaluates a client for Guillain-Barre syndrome. Which finding best supports this condition?
A. confusion or asterixis in advanced liver disease
B. low platelet count with petechiae or mucosal bleeding
C. heavy proteinuria, hypoalbuminemia, and edema
D. ascending weakness and areflexia after infection
Correct Answer: D. ascending weakness and areflexia after infection
Rationale: ascending weakness and areflexia after infection is a characteristic clinical pattern of Guillain-Barre
syndrome.
22. A client with hypernatremia is preparing for discharge. Which instruction should the nurse include?
A. maintain hydration unless restricted
B. avoid nephrotoxins unless specifically directed
C. avoid unapproved antithrombotics after hemorrhage
D. splint incision when coughing and avoid strain
Correct Answer: A. maintain hydration unless restricted
Rationale: The instruction to maintain hydration unless restricted addresses safe self-management of
hypernatremia.
23. NGN-style case: a client with neutropenic fever develops fever in a patient with severe neutropenia.
Which response best links the cue to the required action?
A. claudication and diminished distal pulses; then protect feet and promote walking program when stable
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. fever in a patient with severe neutropenia; then obtain cultures and give prompt broad-spectrum
antipseudomonal antibiotics
D. confusion or asterixis in advanced liver disease; then identify precipitant and reduce ammonia with prescribed
therapy
Correct Answer: C. fever in a patient with severe neutropenia; then obtain cultures and give prompt
broad-spectrum antipseudomonal antibiotics
Rationale: Recognizing fever in a patient with severe neutropenia and then acting to obtain cultures and give
prompt broad-spectrum antipseudomonal antibiotics demonstrates cue recognition followed by an appropriate
clinical action.
24. Which complication should the nurse monitor for most closely in a client with myxedema coma? The
scenario occurs in a different care setting with additional comorbidity (variant 129).
A. ARDS
B. septic shock or neurologic injury
WITH ANSWERS AND EXPLANATIONS
1. A client with diabetes insipidus is preparing for discharge. Which instruction should the nurse include?
The scenario occurs in a different care setting with additional comorbidity (variant 107).
A. maintain access to water and monitor weight
B. use incentive spirometer regularly while awake as instructed
C. avoid unapproved antithrombotics after hemorrhage
D. monitor weight and edema
Correct Answer: A. maintain access to water and monitor weight
Rationale: The instruction to maintain access to water and monitor weight addresses safe self-management of
diabetes insipidus.
2. A nurse evaluates a client for rheumatoid arthritis. Which finding best supports this condition?
A. symmetric inflammatory joint pain with prolonged morning stiffness
B. heavy proteinuria, hypoalbuminemia, and edema
C. low-grade fever, diminished bases, and hypoxemia after surgery
D. rising creatinine and reduced urine output
Correct Answer: A. symmetric inflammatory joint pain with prolonged morning stiffness
Rationale: symmetric inflammatory joint pain with prolonged morning stiffness is a characteristic clinical pattern
of rheumatoid arthritis.
3. Which complication should the nurse monitor for most closely in a client with tension pneumothorax?
The scenario occurs in a different care setting with additional comorbidity (variant 63).
A. venous thrombosis
B. sepsis or hemorrhage
C. obstructive shock
D. hemorrhagic shock
Correct Answer: C. obstructive shock
Rationale: obstructive shock is a serious recognized complication of tension pneumothorax.
4. A client is suspected of having DKA. Which nursing action is the priority? The scenario occurs in a
different care setting with additional comorbidity (variant 110).
A. rapid analgesia, hydration as appropriate, and oxygen if hypoxemic
B. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
C. establish IV access, assess hemodynamics, and prepare for endoscopy
D. start isotonic fluids then insulin with close potassium monitoring
Correct Answer: D. start isotonic fluids then insulin with close potassium monitoring
Rationale: The priority response for DKA is to start isotonic fluids then insulin with close potassium monitoring.
5. NGN-style case: a client with pyelonephritis develops fever, flank pain, and urinary symptoms. Which
response best links the cue to the required action?
A. fever, headache, neck stiffness, and altered mental status; then initiate isolation as indicated and give prompt
empiric antimicrobials after cultures when feasible
B. portal hypertension with edema/ascites and synthetic dysfunction; then manage sodium, diuretics, and evaluate
for complications
C. fever, flank pain, and urinary symptoms; then obtain urine testing and start appropriate antibiotics
D. tachycardia, hypotension, cool skin, low urine output; then control source and restore intravascular
volume/blood as indicated
Correct Answer: C. fever, flank pain, and urinary symptoms; then obtain urine testing and start appropriate
antibiotics
Rationale: Recognizing fever, flank pain, and urinary symptoms and then acting to obtain urine testing and start
appropriate antibiotics demonstrates cue recognition followed by an appropriate clinical action.
6. Which assessment or diagnostic monitoring is most useful when caring for a client with sepsis?
A. serial sodium and fluid balance
B. noncontrast head CT and vascular imaging
C. lactate, urine output, hemodynamics
D. ECG and anticoagulation risk assessment
Correct Answer: C. lactate, urine output, hemodynamics
,Rationale: lactate, urine output, hemodynamics directly supports evaluation of sepsis.
7. A client with ARDS is preparing for discharge. Which instruction should the nurse include?
A. avoid unapproved potassium supplements
B. report fever or bleeding immediately
C. take levodopa on schedule and use fall precautions
D. family education focuses on critical illness course and complications
Correct Answer: D. family education focuses on critical illness course and complications
Rationale: The instruction to family education focuses on critical illness course and complications addresses safe
self-management of ARDS.
8. A nurse evaluates a client for postoperative atelectasis. Which finding best supports this condition?
A. low-grade fever, diminished bases, and hypoxemia after surgery
B. ascending weakness and areflexia after infection
C. facial burns, soot, hoarseness, or stridor
D. refractory hypoxemia with bilateral opacities not fully explained by heart failure
Correct Answer: A. low-grade fever, diminished bases, and hypoxemia after surgery
Rationale: low-grade fever, diminished bases, and hypoxemia after surgery is a characteristic clinical pattern of
postoperative atelectasis.
9. A client with Crohn disease flare is preparing for discharge. Which instruction should the nurse include?
A. avoid activities that markedly increase pressure if instructed
B. avoid unapproved antithrombotics after hemorrhage
C. stop smoking and maintain follow-up
D. seek care for severe pain, vomiting, or inability to pass stool/gas
Correct Answer: C. stop smoking and maintain follow-up
Rationale: The instruction to stop smoking and maintain follow-up addresses safe self-management of Crohn
disease flare.
10. Which complication should the nurse monitor for most closely in a client with postoperative atelectasis?
A. pneumonia
B. thrombosis and neurologic injury
C. hypercapnic respiratory failure
D. venous thrombosis
Correct Answer: A. pneumonia
Rationale: pneumonia is a serious recognized complication of postoperative atelectasis.
11. A client is suspected of having SIADH. Which nursing action is the priority? The scenario occurs in a
different care setting with additional comorbidity (variant 98).
A. protect from bleeding/infection and treat cause
B. urgent CT/vascular evaluation and neurosurgical management
C. aggressive fluid replacement then insulin and electrolyte management
D. fluid restrict when appropriate and treat severe symptomatic hyponatremia urgently
Correct Answer: D. fluid restrict when appropriate and treat severe symptomatic hyponatremia urgently
Rationale: The priority response for SIADH is to fluid restrict when appropriate and treat severe symptomatic
hyponatremia urgently.
12. NGN-style case: a client with ARDS develops refractory hypoxemia with bilateral opacities not fully
explained by heart failure. Which response best links the cue to the required action? The scenario occurs in
a different care setting with additional comorbidity (variant 72).
A. portal hypertension with edema/ascites and synthetic dysfunction; then manage sodium, diuretics, and evaluate
for complications
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. refractory hypoxemia with bilateral opacities not fully explained by heart failure; then lung-protective
ventilation and treat underlying cause
D. potassium elevation with weakness or peaked T waves; then cardiac monitoring and urgent membrane
stabilization/shifting/removal when severe
Correct Answer: C. refractory hypoxemia with bilateral opacities not fully explained by heart failure; then
lung-protective ventilation and treat underlying cause
,Rationale: Recognizing refractory hypoxemia with bilateral opacities not fully explained by heart failure and
then acting to lung-protective ventilation and treat underlying cause demonstrates cue recognition followed by an
appropriate clinical action.
13. Which assessment or diagnostic monitoring is most useful when caring for a client with postoperative
atelectasis?
A. serum sodium/osmolality and urine osmolality
B. oxygen saturation and respiratory exam
C. creatinine, potassium, urine output
D. serial neurovascular assessment
Correct Answer: B. oxygen saturation and respiratory exam
Rationale: oxygen saturation and respiratory exam directly supports evaluation of postoperative atelectasis.
14. A nurse evaluates a client for tension pneumothorax. Which finding best supports this condition?
A. fever, headache, neck stiffness, and altered mental status
B. exertional syncope, angina, and dyspnea with systolic murmur
C. severe respiratory distress with absent unilateral breath sounds and hemodynamic compromise
D. periumbilical pain migrating to right lower quadrant with anorexia
Correct Answer: C. severe respiratory distress with absent unilateral breath sounds and hemodynamic
compromise
Rationale: severe respiratory distress with absent unilateral breath sounds and hemodynamic compromise is a
characteristic clinical pattern of tension pneumothorax.
15. A client is suspected of having ischemic stroke. Which nursing action is the priority?
A. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
B. establish IV access, assess hemodynamics, and prepare for endoscopy
C. optimize mobility and medication timing
D. manage sodium, diuretics, and evaluate for complications
Correct Answer: A. activate stroke pathway and determine thrombolysis/thrombectomy eligibility
Rationale: The priority response for ischemic stroke is to activate stroke pathway and determine
thrombolysis/thrombectomy eligibility.
16. A client with appendicitis is preparing for discharge. Which instruction should the nurse include?
A. avoid laxatives or heating pad before evaluation
B. never take extra potassium without instructions
C. follow fluid/salt plan
D. stop smoking and maintain follow-up
Correct Answer: A. avoid laxatives or heating pad before evaluation
Rationale: The instruction to avoid laxatives or heating pad before evaluation addresses safe self-management of
appendicitis.
17. Which complication should the nurse monitor for most closely in a client with sepsis?
A. septic shock
B. acute chest syndrome
C. myasthenic crisis
D. multiorgan failure
Correct Answer: A. septic shock
Rationale: septic shock is a serious recognized complication of sepsis.
18. NGN-style case: a client with atrial fibrillation develops irregularly irregular rhythm. Which response
best links the cue to the required action?
A. low platelet count with petechiae or mucosal bleeding; then avoid IM injections/trauma and treat cause
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. crampy pain, vomiting, distention, and high-pitched sounds early; then NPO, IV fluids, gastric decompression
when ordered, surgical evaluation
D. irregularly irregular rhythm; then assess stability and control rate/rhythm or cardiovert if unstable
Correct Answer: D. irregularly irregular rhythm; then assess stability and control rate/rhythm or cardiovert if
unstable
, Rationale: Recognizing irregularly irregular rhythm and then acting to assess stability and control rate/rhythm or
cardiovert if unstable demonstrates cue recognition followed by an appropriate clinical action.
19. A client is suspected of having COPD exacerbation. Which nursing action is the priority? The
scenario occurs in a different care setting with additional comorbidity (variant 44).
A. replace fluids and give desmopressin for central DI when ordered
B. obtain cultures when indicated and begin timely antimicrobial/supportive care
C. rapid cultures/lactate and early antibiotics and fluids according to condition
D. titrate oxygen to prescribed target and give bronchodilators
Correct Answer: D. titrate oxygen to prescribed target and give bronchodilators
Rationale: The priority response for COPD exacerbation is to titrate oxygen to prescribed target and give
bronchodilators.
20. Which assessment or diagnostic monitoring is most useful when caring for a client with Guillain-Barre
syndrome?
A. urine protein, albumin, lipids
B. glucose, potassium, anion gap, venous pH
C. vital capacity and neurologic exam
D. clinical response and recurrence
Correct Answer: C. vital capacity and neurologic exam
Rationale: vital capacity and neurologic exam directly supports evaluation of Guillain-Barre syndrome.
21. A nurse evaluates a client for Guillain-Barre syndrome. Which finding best supports this condition?
A. confusion or asterixis in advanced liver disease
B. low platelet count with petechiae or mucosal bleeding
C. heavy proteinuria, hypoalbuminemia, and edema
D. ascending weakness and areflexia after infection
Correct Answer: D. ascending weakness and areflexia after infection
Rationale: ascending weakness and areflexia after infection is a characteristic clinical pattern of Guillain-Barre
syndrome.
22. A client with hypernatremia is preparing for discharge. Which instruction should the nurse include?
A. maintain hydration unless restricted
B. avoid nephrotoxins unless specifically directed
C. avoid unapproved antithrombotics after hemorrhage
D. splint incision when coughing and avoid strain
Correct Answer: A. maintain hydration unless restricted
Rationale: The instruction to maintain hydration unless restricted addresses safe self-management of
hypernatremia.
23. NGN-style case: a client with neutropenic fever develops fever in a patient with severe neutropenia.
Which response best links the cue to the required action?
A. claudication and diminished distal pulses; then protect feet and promote walking program when stable
B. surgical wound opens with visible tissue or organs; then cover with sterile saline-moistened dressings and
notify surgeon; do not reinsert organs
C. fever in a patient with severe neutropenia; then obtain cultures and give prompt broad-spectrum
antipseudomonal antibiotics
D. confusion or asterixis in advanced liver disease; then identify precipitant and reduce ammonia with prescribed
therapy
Correct Answer: C. fever in a patient with severe neutropenia; then obtain cultures and give prompt
broad-spectrum antipseudomonal antibiotics
Rationale: Recognizing fever in a patient with severe neutropenia and then acting to obtain cultures and give
prompt broad-spectrum antipseudomonal antibiotics demonstrates cue recognition followed by an appropriate
clinical action.
24. Which complication should the nurse monitor for most closely in a client with myxedema coma? The
scenario occurs in a different care setting with additional comorbidity (variant 129).
A. ARDS
B. septic shock or neurologic injury
