MedSurg HESI Practice Questions and
Answers.
The nurse is caring for a client who is admitted with a
hemorrhagic stroke. Which nursing action should be included in
the plan of care?
-Perform active range of motion three times daily.
-Monitor for Battle's sign every four hours.
-Teach measures to avoid the Valsalva maneuver.
-Maintain the head of bed in a flat position. - Correct answer -
Teach measures to avoid the Valsalva maneuver.
The nurse is caring for a male client who had an inguinal
herniorrhaphy 3 hours ago. The nurse determines the client's
lower abdomen is distended and assesses dullness to
percussion. Which is the priority nursing action?
-Assessment of the client's vital signs.
-Document the finding as the only action.
-Determine the time the client last voided.
-Insert a rectal tube for the passage of flatus. - Correct answer -
Determine the time the client last voided.
The nurse is providing postoperative instructions for a female
client after a mastectomy. Which information should the nurse
include in the teaching plan? (Select all that apply.)
-Empty surgical drains once a week using procedure gloves.
-Report inflammation of the incision site or the affected arm.
-Wear clothing with snug sleeves over the arm on the operative
side.
,-Avoid lifting more than 4.5 kg (10 pounds) or reaching above her
head. - Correct answer -Report inflammation of the incision site or
the affected arm.
-Avoid lifting more than 4.5 kg (10 pounds) or reaching above her
head.
The nurse is caring for a client after transurethral resection of the
prostate (TURP) and determines the client's urinary catheter is
not draining. What should the nurse implement?
-Reposition the catheter drainage tubing.
-Encourage the client to drink oral fluids.
-Irrigate the catheter.
-Change drainage unit tubing. - Correct answer -Irrigate the
catheter.
A client with a recent history of blood in his stools is scheduled for
a proctoscopy/sigmoidoscopy. The nurse should implement which
protocols to prepare the client for this procedure? (Select all that
apply.)
-Obtain consent for the procedure.
-Initiate preoperative sedation.
-Begin fast the morning of the procedure.
-Administer an enema before the procedure.
-Provide a clear-liquid diet 48 hours before the procedure. -
Correct answer -Obtain consent for the procedure.
-Begin fast the morning of the procedure.
-Administer an enema before the procedure.
-Provide a clear-liquid diet 48 hours before the procedure.
The home health nurse is assessing a client with terminal lung
cancer who is receiving hospice care. Which activity should be
assigned to the (PN)?
-Administer medications for pain relief, shortness of breath, and
nausea.
, -Clarify family members' feelings about the meaning of the client's
behaviors and symptoms.
-Develop a plan of care after assessing the needs of the client
and family.
-Teach the family to recognize restlessness and grimacing as
signs of client discomfort. - Correct answer -Administer
medications for pain relief, shortness of breath, and nausea.
A client's prostate-specific antigen (PSA) exam result showed a
PSA density of 0.13 ng/mL. Which conclusion regarding this lab
data is accurate?
-Probable prostatitis.
-Low risk for prostate cancer.
-The presence of cancer cells.
-A biopsy of the prostate is indicated. - Correct answer -Low risk
for prostate cancer.
Which is the primary nursing problem for a client with
asymptomatic primary syphilis?
-Acute pain.
-Risk for injury.
-Sexual dysfunction.
-Deficient knowledge. - Correct answer -Deficient knowledge.
A client with primary dysmenorrhea has several medications at
home. She calls the clinic to ask the nurse which medication
should she use for her pain. Which option should the nurse
recommend as the first choice in the management of this client's
pain?
-Aspirin.
-Codeine.
-Ibuprofen.
-Acetaminophen. - Correct answer -Ibuprofen.
Answers.
The nurse is caring for a client who is admitted with a
hemorrhagic stroke. Which nursing action should be included in
the plan of care?
-Perform active range of motion three times daily.
-Monitor for Battle's sign every four hours.
-Teach measures to avoid the Valsalva maneuver.
-Maintain the head of bed in a flat position. - Correct answer -
Teach measures to avoid the Valsalva maneuver.
The nurse is caring for a male client who had an inguinal
herniorrhaphy 3 hours ago. The nurse determines the client's
lower abdomen is distended and assesses dullness to
percussion. Which is the priority nursing action?
-Assessment of the client's vital signs.
-Document the finding as the only action.
-Determine the time the client last voided.
-Insert a rectal tube for the passage of flatus. - Correct answer -
Determine the time the client last voided.
The nurse is providing postoperative instructions for a female
client after a mastectomy. Which information should the nurse
include in the teaching plan? (Select all that apply.)
-Empty surgical drains once a week using procedure gloves.
-Report inflammation of the incision site or the affected arm.
-Wear clothing with snug sleeves over the arm on the operative
side.
,-Avoid lifting more than 4.5 kg (10 pounds) or reaching above her
head. - Correct answer -Report inflammation of the incision site or
the affected arm.
-Avoid lifting more than 4.5 kg (10 pounds) or reaching above her
head.
The nurse is caring for a client after transurethral resection of the
prostate (TURP) and determines the client's urinary catheter is
not draining. What should the nurse implement?
-Reposition the catheter drainage tubing.
-Encourage the client to drink oral fluids.
-Irrigate the catheter.
-Change drainage unit tubing. - Correct answer -Irrigate the
catheter.
A client with a recent history of blood in his stools is scheduled for
a proctoscopy/sigmoidoscopy. The nurse should implement which
protocols to prepare the client for this procedure? (Select all that
apply.)
-Obtain consent for the procedure.
-Initiate preoperative sedation.
-Begin fast the morning of the procedure.
-Administer an enema before the procedure.
-Provide a clear-liquid diet 48 hours before the procedure. -
Correct answer -Obtain consent for the procedure.
-Begin fast the morning of the procedure.
-Administer an enema before the procedure.
-Provide a clear-liquid diet 48 hours before the procedure.
The home health nurse is assessing a client with terminal lung
cancer who is receiving hospice care. Which activity should be
assigned to the (PN)?
-Administer medications for pain relief, shortness of breath, and
nausea.
, -Clarify family members' feelings about the meaning of the client's
behaviors and symptoms.
-Develop a plan of care after assessing the needs of the client
and family.
-Teach the family to recognize restlessness and grimacing as
signs of client discomfort. - Correct answer -Administer
medications for pain relief, shortness of breath, and nausea.
A client's prostate-specific antigen (PSA) exam result showed a
PSA density of 0.13 ng/mL. Which conclusion regarding this lab
data is accurate?
-Probable prostatitis.
-Low risk for prostate cancer.
-The presence of cancer cells.
-A biopsy of the prostate is indicated. - Correct answer -Low risk
for prostate cancer.
Which is the primary nursing problem for a client with
asymptomatic primary syphilis?
-Acute pain.
-Risk for injury.
-Sexual dysfunction.
-Deficient knowledge. - Correct answer -Deficient knowledge.
A client with primary dysmenorrhea has several medications at
home. She calls the clinic to ask the nurse which medication
should she use for her pain. Which option should the nurse
recommend as the first choice in the management of this client's
pain?
-Aspirin.
-Codeine.
-Ibuprofen.
-Acetaminophen. - Correct answer -Ibuprofen.
