MED SURG HESI V2 - 2024/2025 ACTUAL EXAMINATION TEST WITH
ALL ANSWERS RATED+
What information should the nurse include in the teaching plan of a client diagnosed
with GERD?
A. Sleep without pillows
B. Adjust food intake to three full meals per day with no snacks
C. Minimize symptoms by wearing loose comfortable clothing
D. Avoid participation in any aerobic exercise program - correct answer-Minimize
symptoms by wearing loose comfortable clothing
After hospitalization for SIADH, a client develops pontine myelinolysis. Which
intervention should the nurse implement first?
A. Reorient client to room
B. Place a patch on one eye
C. Evaluate clients ability to swallow
D. Perform range of motion exercises - correct answer-Reorient client to room
A male client with heart failure calls the clinic and reports that he cannot put his
shoes on because they are too tight. Which additional information should the nurse
obtain?
A. What time did he take his medication?
B. Has his weight changed in the last several days?
C. Is he still able to tighten his belt buckle?
D. How many hours did he sleep last night? - correct answer-Has his weight
changed in the last several days?
An older adult woman with a long history of COPD is admitted with progressive
shortness of breath and a persistent cough, is anxious, and is complaining of dry
mouth. which intervention should the nurse implement?
,A. Administer a prescribed sedative
B. Encourage client to drink water
C. Apply a high flow Venturi mask
D. Assist her to an upright position - correct answer-Assist her to an upright position
A client with a history of asthma and bronchitis arrives at the clinic with shortness of
breath, productive cough with thickening mucous and the inability to walk up a flight
of stairs without experiencing breathlessness. Which action is most important for the
nurse to instruct the client about self care?
A. Increase the daily intake of oral fluids to liquify secretions
B. Avoid crowded enclosed areas to reduce pathogens exposure
C. Call the clinic if undesirable side effects or medications - correct answer-Increase
the daily intake of oral fluids to liquify secretions
A cardiac catherization of a client with heart disease indicates the following
blockages: 95% proximal left anterior descending (LAD), 99% proximal circumflex,
and 95% proximal right coronary artery (RCA) the client later asks the nurse "What
does all of that mean for me?" What information should the nurse provide.
B. Three main arteries have major blockages, with only 1-5% of the blood flow
getting through to the heart muscles - correct answer-Three main arteries have
major blockages, with only 1-5% of the blood flow getting through to the heart
muscles
The nurse is caring for a client with a lower left lobe pulmonary abscess. what
position should the nurse instruct the client to maintain?
A. Left lateral
B. Supine, knees flexed.
C. Dorsal recumbent
D. Knee-chest - correct answer-Left lateral
A client with Cholelithiasis has a gallstone lodged in the common bile duct and is
unable to eat or drink without becoming nauseous and vomiting. Which finding
should the nurse report to the healthcare provider?
A. Belching
B. Amber urine
C. Yellow sclera
D. Flatulence - correct answer-Yellow sclera
While caring for a client with Amyotrophic lateral sclerosis (ALS) a nurse performs a
neurological assessment every 4 hours. Which assessment finding warrants
immediate intervention by the nurse?
A. Inappropriate laughter
B. Increasing anxiety
C. Weakened cough effort
D. Asymmetrical weakness - correct answer-Asymmetrical weakness
, The nurse is providing preoperative education for a Jewish client scheduled to
receive a xenograft to promote burn healing. Which information should the provider
this client?
A. Grafting increase the risk for bacterial infections
B. The xenograft is taken from a non-human source.
C. Grafts are later removed by a debriding procedure
D. As the burns heals, the graft permanently - correct answer-The xenograft is taken
from a non-human source
A male client who had colon surgery 3 days ago is anxious and requesting
assistance to reposition. While the nurse is turning him, the wound dehiscences and
ulcerates. The nurse moistens an available sterile dressing and places it over the
wound. Which intervention should the nurse implement next.
A. Bring additional sterile dressing supplies to the room.
B. Prepare the client to return to the OR
C. Obtain a sample of the drainage to send to the lab
D. ausculate the abdomen for bowel sounds - correct answer-Bring additional sterile
dressing supplies to the room
A client with carcinoma of the lung is complaining of weakness and has a serum
sodium level of 117/meq. Which nursing problem should the nurse include in the
clients plan of care.
A. Altered urinary elimination
B. Impaired gas exchange
C. Fluid volume excess
D. Decreased cardiac output - correct answer-Fluid volume excess
A female client enters the clinic and insists on being seen. She is weak, nervous and
reports a racing heart beat and recent weight loss of 15 pounds. After ruling out
substance withdrawal, the MD suspects hyperthyroidisms and admits her for testing.
which action should the nurse do?
A. Begin preparing the client for thyroidectomy procedure
B. Space the clients care to provide periods of rest
C. Assess the client for hyperactive bowel sounds
D. Provide warm blanket to prevent heat loss - correct answer-Assess the client for
hyperactive bowel sounds
The nurse is teaching a client with glomerulonephritis about self care. Which dietary
recommendations should the nurse encourage the client to follow.
A. increase intake of high-fiber foods, such as bran cereal.
B. Restrict protein intake by limiting meals and other high-protein foods
C. limit oral fluid intake of 500/ml/day
D. Increase intake of potassium rich foods such as bananas and cantaloupe - correct
answer-Restrict protein intake by limiting meals and other high-protein foods
An overweight young adult male who was recently diagnosed with type 2 DM is
admitted for a hernia repair. he tells the nurse that he is feeling very weak and jittery.
Which actions should the nurse implement? Select all that apply.
A.Check his fingerstick glucose
B. Assess his skin temperature and moisture
ALL ANSWERS RATED+
What information should the nurse include in the teaching plan of a client diagnosed
with GERD?
A. Sleep without pillows
B. Adjust food intake to three full meals per day with no snacks
C. Minimize symptoms by wearing loose comfortable clothing
D. Avoid participation in any aerobic exercise program - correct answer-Minimize
symptoms by wearing loose comfortable clothing
After hospitalization for SIADH, a client develops pontine myelinolysis. Which
intervention should the nurse implement first?
A. Reorient client to room
B. Place a patch on one eye
C. Evaluate clients ability to swallow
D. Perform range of motion exercises - correct answer-Reorient client to room
A male client with heart failure calls the clinic and reports that he cannot put his
shoes on because they are too tight. Which additional information should the nurse
obtain?
A. What time did he take his medication?
B. Has his weight changed in the last several days?
C. Is he still able to tighten his belt buckle?
D. How many hours did he sleep last night? - correct answer-Has his weight
changed in the last several days?
An older adult woman with a long history of COPD is admitted with progressive
shortness of breath and a persistent cough, is anxious, and is complaining of dry
mouth. which intervention should the nurse implement?
,A. Administer a prescribed sedative
B. Encourage client to drink water
C. Apply a high flow Venturi mask
D. Assist her to an upright position - correct answer-Assist her to an upright position
A client with a history of asthma and bronchitis arrives at the clinic with shortness of
breath, productive cough with thickening mucous and the inability to walk up a flight
of stairs without experiencing breathlessness. Which action is most important for the
nurse to instruct the client about self care?
A. Increase the daily intake of oral fluids to liquify secretions
B. Avoid crowded enclosed areas to reduce pathogens exposure
C. Call the clinic if undesirable side effects or medications - correct answer-Increase
the daily intake of oral fluids to liquify secretions
A cardiac catherization of a client with heart disease indicates the following
blockages: 95% proximal left anterior descending (LAD), 99% proximal circumflex,
and 95% proximal right coronary artery (RCA) the client later asks the nurse "What
does all of that mean for me?" What information should the nurse provide.
B. Three main arteries have major blockages, with only 1-5% of the blood flow
getting through to the heart muscles - correct answer-Three main arteries have
major blockages, with only 1-5% of the blood flow getting through to the heart
muscles
The nurse is caring for a client with a lower left lobe pulmonary abscess. what
position should the nurse instruct the client to maintain?
A. Left lateral
B. Supine, knees flexed.
C. Dorsal recumbent
D. Knee-chest - correct answer-Left lateral
A client with Cholelithiasis has a gallstone lodged in the common bile duct and is
unable to eat or drink without becoming nauseous and vomiting. Which finding
should the nurse report to the healthcare provider?
A. Belching
B. Amber urine
C. Yellow sclera
D. Flatulence - correct answer-Yellow sclera
While caring for a client with Amyotrophic lateral sclerosis (ALS) a nurse performs a
neurological assessment every 4 hours. Which assessment finding warrants
immediate intervention by the nurse?
A. Inappropriate laughter
B. Increasing anxiety
C. Weakened cough effort
D. Asymmetrical weakness - correct answer-Asymmetrical weakness
, The nurse is providing preoperative education for a Jewish client scheduled to
receive a xenograft to promote burn healing. Which information should the provider
this client?
A. Grafting increase the risk for bacterial infections
B. The xenograft is taken from a non-human source.
C. Grafts are later removed by a debriding procedure
D. As the burns heals, the graft permanently - correct answer-The xenograft is taken
from a non-human source
A male client who had colon surgery 3 days ago is anxious and requesting
assistance to reposition. While the nurse is turning him, the wound dehiscences and
ulcerates. The nurse moistens an available sterile dressing and places it over the
wound. Which intervention should the nurse implement next.
A. Bring additional sterile dressing supplies to the room.
B. Prepare the client to return to the OR
C. Obtain a sample of the drainage to send to the lab
D. ausculate the abdomen for bowel sounds - correct answer-Bring additional sterile
dressing supplies to the room
A client with carcinoma of the lung is complaining of weakness and has a serum
sodium level of 117/meq. Which nursing problem should the nurse include in the
clients plan of care.
A. Altered urinary elimination
B. Impaired gas exchange
C. Fluid volume excess
D. Decreased cardiac output - correct answer-Fluid volume excess
A female client enters the clinic and insists on being seen. She is weak, nervous and
reports a racing heart beat and recent weight loss of 15 pounds. After ruling out
substance withdrawal, the MD suspects hyperthyroidisms and admits her for testing.
which action should the nurse do?
A. Begin preparing the client for thyroidectomy procedure
B. Space the clients care to provide periods of rest
C. Assess the client for hyperactive bowel sounds
D. Provide warm blanket to prevent heat loss - correct answer-Assess the client for
hyperactive bowel sounds
The nurse is teaching a client with glomerulonephritis about self care. Which dietary
recommendations should the nurse encourage the client to follow.
A. increase intake of high-fiber foods, such as bran cereal.
B. Restrict protein intake by limiting meals and other high-protein foods
C. limit oral fluid intake of 500/ml/day
D. Increase intake of potassium rich foods such as bananas and cantaloupe - correct
answer-Restrict protein intake by limiting meals and other high-protein foods
An overweight young adult male who was recently diagnosed with type 2 DM is
admitted for a hernia repair. he tells the nurse that he is feeling very weak and jittery.
Which actions should the nurse implement? Select all that apply.
A.Check his fingerstick glucose
B. Assess his skin temperature and moisture
