HESI RN MEDICAL SURGICAL EXAM
PACK 2024 QUESTIONS AND
ANSWERS
An68ER68nurse68is68completing68an68assessment68on68a68patient68that68is68alert68but68st
ruggles68to68answer68questions.68When68she68attempts68to68talk,68she68slurs68her68spee
ch68and68appears68very68frightened.68What68additional68clinical68manifestation68does68th
e68nurse68expect68to68find68if68nacy's68sysmptoms68have68been68caused68by68a68brain68
attack68(stroke)?
A.68A68carotid68bruit
B.68A68hypotensive68blood68pressure
C.68hyperreflexic68deep68tendon68relexes.
D.68Decreased68bowel68sounds68-68answer--A)68A68carotid68bruit.
Rationale:68the68carotid68artery68(artery68to68the68brain)68is68narrowed68in68clients68with6
8a68brain68attack.68A68bruit68is68an68abnormal68sound68heard68on68auscultation68resultin
g68from68interference68with68normal68blood68flow.68Usually68the68blood68pressure68is68hy
pertensive.68Initially68flaccid68paralysis68occurs,68resulting68in68hyporefkexic68deep68tend
on68reflexes.68Bowel68sounds68are68not68indicative68of68a68brain68attack.
Which68clinical68manifestation68further68supports68an68assessment68of68a68left-
sided68brain68attack?
A)68Visual68field68deficit68on68the68left68side.
B)68Spatial-perceptual68deficits.
C)68Paresthesia68of68the68left68side.
D)68Global68aphasia.
D)68Global68aphasia.68-68answer--D)68Global68aphasia.
Rationale:68Global68aphasia68refers68to68difficulty68speaking,68listening,68and68understan
ding,68as68well68as68difficulty68reading68and68writing.68Symptoms68vary68from68person68t
o68person.68Aphasia68may68occur68secondary68to68any68brain68injury68involving68the68lef
t68hemisphere.68Visual68field68deficits,68spatial-
perceptual68deficits,68and68paresthsia68of68the68left68side68usually68occur68with68right-
sided68brain68attack.
,When68preparing68a68patient68for68a68noncontrast68computed68tomography68(CT)68scan6
8STAT,68what68nursing68intervention68should68the68nurse68implement?
A)68Determine68if68the68client68has68any68allergies68to68iodine
B)68Explain68that68the68client68will68not68be68able68to68move68her68head68throughout68the
68CT68scan.
C)68Premedicate68the68client68to68decrease68pain68prior68to68having68the68procedure.
D)68Provide68an68explanation68of68relaxation68exercises68prior68to68the68procedure.68-
68answer--
B)68Explain68that68the68client68will68not68be68able68to68move68her68head68throughout68the
68CT68scan.
Rationale:68Because68head68motion68will68distort68the68images,68Nancy68will68have68to68
remain68still68throughout68the68procedure.68Allergies68to68iodine68is68important68if68contr
ast68dye68is68being68used68for68the68CT68scan.68Premedicating68the68client68to68decreas
e68pain68prior68to68the68procedure68is68unnecessary68because68CT68scanning68is68a68no
ninvasive68and68painless68procedure.68Providing68an68explanation68of68relaxation68exerc
ises68prior68to68the68procedure68is68a68worthwhile68intervention68to68decrease68anxiety68
but68is68not68of68highest68priority.
A68neurologist68prescribes68a68magnetic68resonance68imaging68(MRI)68of68the68head68S
TAT68for68a68patient.68Which68data68warrants68immediate68intervention68by68the68nurse6
8concerning68this68diagnostic68test?
A)68Elevated68blood68pressure.
B)68Allergy68to68shell68fish.
C)68Right68hip68replacement.
D)68History68of68atrial68fibrillation.68-68answer--C)68Right68hip68replacement.
The68magnetic68field68generated68by68the68MRI68is68so68strong68that68metal-
containing68items68are68strongly68attracted68to68the68magnet.68Because68the68hip68joint68
is68made68of68metal,68a68lead68shield68must68be68used68during68the68procedure.68Elevat
ed68blood68pressure,68an68allergy68to68shell68fish,68and68a68history68of68atrial68fibrillation6
8would68not68affect68the68MRI.
A68client's68daughter68is68sitting68by68her68mother's68bedside68who68was68recently68tran
sferred68to68the68Intermediate68Care68Unit.68She68states68"I68don't68understand68what68a
68brain68attack68is.68The68healthcare68provider68told68me68my68mother68is68in68serious68c
ondition68and68they68are68going68to68run68several68tests.68I68just68don't68know68what68is6
8going68on.68What68happened68to68my68mother?"68What68is68the68best68response68by68t
he68nurse?
A)68"I68am68sorry,68but68according68to68the68Health68Insurance68Portability68and68Accou
nting68Act68(HIPAA),68I68cannot68give68you68any68information."
B)68"Your68mother68has68had68a68stroke,68and68the68blood68supply68to68the68brain68has6
8been68blocked."
,C)68"How68do68you68feel68about68what68the68healthcare68provider68said?"
D)68"I68will68call68the68healthcare68provider68so68he/
she68can68talk68to68you68about68your68mother's68serious68condition."68-68answer--
B)68"Your68mother68has68had68a68stroke,68and68the68blood68supply68to68the68brain68has6
8been68blocked."
Rationale:68The68nurse68can68discuss68what68a68diagnosis68means.68Nancy68is68unable6
8to68make68decisions,68so68the68next68of68kin,68her68daughter,68Gail,68needs68sufficient68
information68to68make68informed68decisions.68The68nurse68has68the68knowledge,68and68t
he68responsibility,68to68explain68Nancy's68condition68to68Gail.68The68nurse68should68give
68facts68first,68and68then68address68her68feelings68after68the68information68is68provided.
What68is68the68normal68range68for68cardiac68output?68-68answer--
The68normal68range68for68cardiac68output68to68ensure68cerebral68blood68flow68and68oxyg
en68delivery68is68468to68868L/min.
A68client68was68admitted68with68the68diagnosis68of68a68brain68attack.68Their68symptoms6
8began682468hours68before68being68admitted.68Why68would68this68client68not68be68a68can
didate68for68for68thrombolytic68therapy?68-68answer--
Thrombolytic68therapy68is68contraindicated68in68clients68with68symptom68onset68longer68t
han68368hours68prior68to68admission.68This68client68had68symptoms68for682468hours68bef
ore68being68brought68to68the68medical68center
What68are68plate68guards?68-68answer--
Plate68guards68prevent68food68from68being68pushed68off68the68plate.68Using68plate68guar
ds68and68other68assistive68devices68will68encourage68independence68in68a68client68with68
a68self-care68deficit.
Which68condition68is68considered68a68non-modifiable68risk68factor68for68a68brain68attack?
A)68High68cholesterol68levels.
B)68Obesity.
C)68History68of68atrial68fibrillation.
D)68Advanced68age.68-68answer--D)68Advanced68age.
Rationale:68People68over68age685568are68a68high-
risk68group68for68a68brain68attack68because68the68incidence68of68stroke68more68than68do
ubles68in68each68successive68decade68of68life.68Non-
modifiable68means68the68client68cannot68do68anything68to68change68the68risk68factor.68Al
l68the68other68options68are68modifiable68risk68factors.
A68client68is68experiencing68homonymous68hemianopsia68as68the68result68of68a68brain68
attack.68Which68nursing68intervention68would68the68nurse68implement68to68address68this
68condition?
, A)68Turn68Nancy68every68two68hours68and68perform68active68range68of68motion68exercis
es.
B)68Place68the68objects68Nancy68needs68for68activities68of68daily68living68on68the68left68si
de68of68the68table.
C)68Speak68slowly68and68clearly68to68assist68Nancy68in68forming68sounds68to68words.
D)68Request68that68the68dietary68department68thicken68all68liquids68on68Nancy's68meal68
and68snack68trays.68-68answer--
B)68Place68the68objects68Nancy68needs68for68activities68of68daily68living68on68the68left68si
de68of68the68table.
Rationale:68Homonymous68hemianopsia68is68loss68of68the68visual68field68on68the68same6
8side68as68the68paralyzed68side.68This68results68in68the68client68neglecting68that68side68of
68the68body,68so68it68is68beneficial68to68place68objects68on68that68side.68Nancy68had68a68l
eft-
hemisphere68brain68attack68so68her68right68side68is68the68weak68side.68Speaking68slowly
68and68clearly68would68address68the68client's68verbal68deficits68due68to68aphasia.68Requ
esting68all68liquids68to68be68thickened68would68address68dysphagia.68Turning68the68clien
t68every68268hours68and68performing68active68range68of68motion68exercises68would68addr
ess68the68client's68risk68for68immobility68due68to68paralysis.
A68physical68therapist68(PT)68places68a68gait68belt68on68a68client68and68is68assisting68the
m68with68ambulation68from68the68bed68to68the68chair.68As68they68get68up68out68of68the68b
ed,68they68report68being68dizzy68and68begin68to68fall.68The68PT68carefully68allows68them6
8to68fall68back68to68the68bed68and68notifies68the68primary68nurse.68Which68written68docu
mentation68should68the68nurse68put68in68the68client's68record?68
A)68Client68experienced68orthostatic68hypotension68when68getting68out68of68bed.
B)68PT68reported68client68complained68of68dizziness68when68getting68out68of68bed,68and6
8gait68belt68was68used68to68allow68client68to68fall68back68onto68the68bed.
C)68PT68notified68the68primary68nurse68that68the68client68could68not68ambulate68at68this68
time68because68of68dizziness.
D)68Client68had68difficulty68ambulating68from68the68bed68to68the68chair68when68accompa
nied68by68the68PT,68variance68report68completed.68-68answer--
B)68PT68reported68client68complained68of68dizziness68when68getting68out68of68bed,68and6
8gait68belt68was68used68to68allow68client68to68fall68back68onto68the68bed.
Rationale:68This68documentation68provides68the68factual68data68of68the68events68that68o
ccurred.68A)The68nurse68is68making68an68assumption68that68the68dizziness68was68cause
d68by68orthostatic68hypotension.68C)68Not68all68the68pertinent68facts68are68included68in68t
his68documentation.
D)68A68variance68report68should68never68be68documented68in68the68client's68record.
A68new68nurse68graduate68is68caring68for68a68postoperative68client68with68the68following6
8arterial68blood68gases68(ABGs):68pH,687.30;68PCO2,686068mm68Hg;68PO2,688068mm68H
g;68bicarbonate,682468mEq/
PACK 2024 QUESTIONS AND
ANSWERS
An68ER68nurse68is68completing68an68assessment68on68a68patient68that68is68alert68but68st
ruggles68to68answer68questions.68When68she68attempts68to68talk,68she68slurs68her68spee
ch68and68appears68very68frightened.68What68additional68clinical68manifestation68does68th
e68nurse68expect68to68find68if68nacy's68sysmptoms68have68been68caused68by68a68brain68
attack68(stroke)?
A.68A68carotid68bruit
B.68A68hypotensive68blood68pressure
C.68hyperreflexic68deep68tendon68relexes.
D.68Decreased68bowel68sounds68-68answer--A)68A68carotid68bruit.
Rationale:68the68carotid68artery68(artery68to68the68brain)68is68narrowed68in68clients68with6
8a68brain68attack.68A68bruit68is68an68abnormal68sound68heard68on68auscultation68resultin
g68from68interference68with68normal68blood68flow.68Usually68the68blood68pressure68is68hy
pertensive.68Initially68flaccid68paralysis68occurs,68resulting68in68hyporefkexic68deep68tend
on68reflexes.68Bowel68sounds68are68not68indicative68of68a68brain68attack.
Which68clinical68manifestation68further68supports68an68assessment68of68a68left-
sided68brain68attack?
A)68Visual68field68deficit68on68the68left68side.
B)68Spatial-perceptual68deficits.
C)68Paresthesia68of68the68left68side.
D)68Global68aphasia.
D)68Global68aphasia.68-68answer--D)68Global68aphasia.
Rationale:68Global68aphasia68refers68to68difficulty68speaking,68listening,68and68understan
ding,68as68well68as68difficulty68reading68and68writing.68Symptoms68vary68from68person68t
o68person.68Aphasia68may68occur68secondary68to68any68brain68injury68involving68the68lef
t68hemisphere.68Visual68field68deficits,68spatial-
perceptual68deficits,68and68paresthsia68of68the68left68side68usually68occur68with68right-
sided68brain68attack.
,When68preparing68a68patient68for68a68noncontrast68computed68tomography68(CT)68scan6
8STAT,68what68nursing68intervention68should68the68nurse68implement?
A)68Determine68if68the68client68has68any68allergies68to68iodine
B)68Explain68that68the68client68will68not68be68able68to68move68her68head68throughout68the
68CT68scan.
C)68Premedicate68the68client68to68decrease68pain68prior68to68having68the68procedure.
D)68Provide68an68explanation68of68relaxation68exercises68prior68to68the68procedure.68-
68answer--
B)68Explain68that68the68client68will68not68be68able68to68move68her68head68throughout68the
68CT68scan.
Rationale:68Because68head68motion68will68distort68the68images,68Nancy68will68have68to68
remain68still68throughout68the68procedure.68Allergies68to68iodine68is68important68if68contr
ast68dye68is68being68used68for68the68CT68scan.68Premedicating68the68client68to68decreas
e68pain68prior68to68the68procedure68is68unnecessary68because68CT68scanning68is68a68no
ninvasive68and68painless68procedure.68Providing68an68explanation68of68relaxation68exerc
ises68prior68to68the68procedure68is68a68worthwhile68intervention68to68decrease68anxiety68
but68is68not68of68highest68priority.
A68neurologist68prescribes68a68magnetic68resonance68imaging68(MRI)68of68the68head68S
TAT68for68a68patient.68Which68data68warrants68immediate68intervention68by68the68nurse6
8concerning68this68diagnostic68test?
A)68Elevated68blood68pressure.
B)68Allergy68to68shell68fish.
C)68Right68hip68replacement.
D)68History68of68atrial68fibrillation.68-68answer--C)68Right68hip68replacement.
The68magnetic68field68generated68by68the68MRI68is68so68strong68that68metal-
containing68items68are68strongly68attracted68to68the68magnet.68Because68the68hip68joint68
is68made68of68metal,68a68lead68shield68must68be68used68during68the68procedure.68Elevat
ed68blood68pressure,68an68allergy68to68shell68fish,68and68a68history68of68atrial68fibrillation6
8would68not68affect68the68MRI.
A68client's68daughter68is68sitting68by68her68mother's68bedside68who68was68recently68tran
sferred68to68the68Intermediate68Care68Unit.68She68states68"I68don't68understand68what68a
68brain68attack68is.68The68healthcare68provider68told68me68my68mother68is68in68serious68c
ondition68and68they68are68going68to68run68several68tests.68I68just68don't68know68what68is6
8going68on.68What68happened68to68my68mother?"68What68is68the68best68response68by68t
he68nurse?
A)68"I68am68sorry,68but68according68to68the68Health68Insurance68Portability68and68Accou
nting68Act68(HIPAA),68I68cannot68give68you68any68information."
B)68"Your68mother68has68had68a68stroke,68and68the68blood68supply68to68the68brain68has6
8been68blocked."
,C)68"How68do68you68feel68about68what68the68healthcare68provider68said?"
D)68"I68will68call68the68healthcare68provider68so68he/
she68can68talk68to68you68about68your68mother's68serious68condition."68-68answer--
B)68"Your68mother68has68had68a68stroke,68and68the68blood68supply68to68the68brain68has6
8been68blocked."
Rationale:68The68nurse68can68discuss68what68a68diagnosis68means.68Nancy68is68unable6
8to68make68decisions,68so68the68next68of68kin,68her68daughter,68Gail,68needs68sufficient68
information68to68make68informed68decisions.68The68nurse68has68the68knowledge,68and68t
he68responsibility,68to68explain68Nancy's68condition68to68Gail.68The68nurse68should68give
68facts68first,68and68then68address68her68feelings68after68the68information68is68provided.
What68is68the68normal68range68for68cardiac68output?68-68answer--
The68normal68range68for68cardiac68output68to68ensure68cerebral68blood68flow68and68oxyg
en68delivery68is68468to68868L/min.
A68client68was68admitted68with68the68diagnosis68of68a68brain68attack.68Their68symptoms6
8began682468hours68before68being68admitted.68Why68would68this68client68not68be68a68can
didate68for68for68thrombolytic68therapy?68-68answer--
Thrombolytic68therapy68is68contraindicated68in68clients68with68symptom68onset68longer68t
han68368hours68prior68to68admission.68This68client68had68symptoms68for682468hours68bef
ore68being68brought68to68the68medical68center
What68are68plate68guards?68-68answer--
Plate68guards68prevent68food68from68being68pushed68off68the68plate.68Using68plate68guar
ds68and68other68assistive68devices68will68encourage68independence68in68a68client68with68
a68self-care68deficit.
Which68condition68is68considered68a68non-modifiable68risk68factor68for68a68brain68attack?
A)68High68cholesterol68levels.
B)68Obesity.
C)68History68of68atrial68fibrillation.
D)68Advanced68age.68-68answer--D)68Advanced68age.
Rationale:68People68over68age685568are68a68high-
risk68group68for68a68brain68attack68because68the68incidence68of68stroke68more68than68do
ubles68in68each68successive68decade68of68life.68Non-
modifiable68means68the68client68cannot68do68anything68to68change68the68risk68factor.68Al
l68the68other68options68are68modifiable68risk68factors.
A68client68is68experiencing68homonymous68hemianopsia68as68the68result68of68a68brain68
attack.68Which68nursing68intervention68would68the68nurse68implement68to68address68this
68condition?
, A)68Turn68Nancy68every68two68hours68and68perform68active68range68of68motion68exercis
es.
B)68Place68the68objects68Nancy68needs68for68activities68of68daily68living68on68the68left68si
de68of68the68table.
C)68Speak68slowly68and68clearly68to68assist68Nancy68in68forming68sounds68to68words.
D)68Request68that68the68dietary68department68thicken68all68liquids68on68Nancy's68meal68
and68snack68trays.68-68answer--
B)68Place68the68objects68Nancy68needs68for68activities68of68daily68living68on68the68left68si
de68of68the68table.
Rationale:68Homonymous68hemianopsia68is68loss68of68the68visual68field68on68the68same6
8side68as68the68paralyzed68side.68This68results68in68the68client68neglecting68that68side68of
68the68body,68so68it68is68beneficial68to68place68objects68on68that68side.68Nancy68had68a68l
eft-
hemisphere68brain68attack68so68her68right68side68is68the68weak68side.68Speaking68slowly
68and68clearly68would68address68the68client's68verbal68deficits68due68to68aphasia.68Requ
esting68all68liquids68to68be68thickened68would68address68dysphagia.68Turning68the68clien
t68every68268hours68and68performing68active68range68of68motion68exercises68would68addr
ess68the68client's68risk68for68immobility68due68to68paralysis.
A68physical68therapist68(PT)68places68a68gait68belt68on68a68client68and68is68assisting68the
m68with68ambulation68from68the68bed68to68the68chair.68As68they68get68up68out68of68the68b
ed,68they68report68being68dizzy68and68begin68to68fall.68The68PT68carefully68allows68them6
8to68fall68back68to68the68bed68and68notifies68the68primary68nurse.68Which68written68docu
mentation68should68the68nurse68put68in68the68client's68record?68
A)68Client68experienced68orthostatic68hypotension68when68getting68out68of68bed.
B)68PT68reported68client68complained68of68dizziness68when68getting68out68of68bed,68and6
8gait68belt68was68used68to68allow68client68to68fall68back68onto68the68bed.
C)68PT68notified68the68primary68nurse68that68the68client68could68not68ambulate68at68this68
time68because68of68dizziness.
D)68Client68had68difficulty68ambulating68from68the68bed68to68the68chair68when68accompa
nied68by68the68PT,68variance68report68completed.68-68answer--
B)68PT68reported68client68complained68of68dizziness68when68getting68out68of68bed,68and6
8gait68belt68was68used68to68allow68client68to68fall68back68onto68the68bed.
Rationale:68This68documentation68provides68the68factual68data68of68the68events68that68o
ccurred.68A)The68nurse68is68making68an68assumption68that68the68dizziness68was68cause
d68by68orthostatic68hypotension.68C)68Not68all68the68pertinent68facts68are68included68in68t
his68documentation.
D)68A68variance68report68should68never68be68documented68in68the68client's68record.
A68new68nurse68graduate68is68caring68for68a68postoperative68client68with68the68following6
8arterial68blood68gases68(ABGs):68pH,687.30;68PCO2,686068mm68Hg;68PO2,688068mm68H
g;68bicarbonate,682468mEq/
