NGN RNSG HESI EXTRA CREDIT MODULE 9 EXAM
ACTUAL QUESTIONS AND ANSWERS GRADE A+.
1. Questions
1. 1.ID: 9477047208
A nurse is caring for a client who has lost a significant amount of
blood as a result of complications during a surgical procedure.
Which parameter does the nurse recognize as the earliest indication
of new decreases in fluid volume?
A. Pulse rate Correct
B. Blood pressure
C. Pulmonary artery systolic pressure
D. Pulmonary artery end-diastolic pressure
Rationale: Cardiac output is determined by the volume of the circulating blood,
the pumping action of the heart, and the tone of the vascular bed. Early
decreases in fluid volume are compensated for by an increase in the pulse
rate. Remember that pulse rate multiplied by stroke volume equals cardiac
output. An increase in pulse is often sufficient with small amounts of volume
1|Page
, depletion to maintain the blood pressure. Pulmonary artery systolic pressure
and pulmonary artery end-diastolic pressure, measurements obtained with the
use of a pulmonary artery catheter, provide information about the pressures in
the pulmonary artery and in the left ventricle at the end of diastole.
Test-Taking Strategy: Note the strategic word “earliest.” Pulmonary artery
systolic pressure and pulmonary artery end-diastolic pressure can be
eliminated first, because these measurements are obtained with the use of a
pulmonary artery catheter. To select from the remaining options, focus on the
strategic word, which will direct you to the correct option. Review the
physiology of the cardiovascular system and the means of compensation
inherent in that system.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Assessment
Content Area: Adult Health/Cardiovascular
Giddens Concepts: Clinical Judgment, Fluid and Electrolyte Balance
HESI Concepts: Clinical Decision Making/Clinical Judgment, Fluid and
Electroytes
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinical
problems (9th ed., p. 292). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
2. 2.ID: 9477054249
A nurse is reviewing the results of serum laboratory studies of a
client with suspected hepatitis. Which increased parameter is
interpreted by the nurse as the most specific indicator of this
disease?
A. Hemoglobin
B. Serum bilirubin Correct
2|Page
, C. Blood urea nitrogen (BUN)
D. Erythrocyte sedimentation rate (ESR)
Rationale: Laboratory indicators of hepatitis include increased liver enzymes, serum
bilirubin level, and ESR. However, ESR is a nonspecific test that indicates the
presence of inflammation somewhere in the body. An increased BUN may indicate
renal dysfunction. The hemoglobin level is unrelated to thisdiagnosis.
Test-Taking Strategy: Note the strategic word, most. Focusing on the client’sdiagnosis
and recalling that the liver is the organ involved in this disease process will direct you
to the correct option. Review the expected findings inhepatitis.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/AssessmentContent
Area: Adult Health/Gastrointestinal Giddens Concepts:
Cellular Regulation, Evidence
HESI Concepts:Cellular Regulation, Evidence Based Practice/Evidence
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinicalproblems (9th
ed., pp. 1010-1011). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
3. 3.ID: 9477051455
A client who has just undergone surgery suddenly experiences
chest pain, dyspnea, and tachypnea. The nurse suspects that the
client has a pulmonary embolism and immediately sets about to
take which action?
A. Preparing the client for a perfusion scan
B. Attaching the client to a cardiac monitor
C. Administering oxygen by way of nasal cannula Correct
D. Ensuring that the intravenous (IV) line is patent
, Rationale: Pulmonary embolism is a life-threatening emergency. Oxygen is
immediately administered nasally to relieve hypoxemia, respiratory distress,
and central cyanosis, and the
health care provideris notified. IV infusion lines are needed to administer
medications or fluids. A perfusion scan, among other tests, may be performed.
The electrocardiogram is monitored for the presence of dysrhythmias.
Additionally, a urinary catheter may be inserted and blood for arterial blood gas
determinations drawn. The immediate priority, however, is the administration of
oxygen.
Test-Taking Strategy: Focus on the client’s diagnosis and use the skills of
prioritizing. Use the ABCs (airway, breathing, and circulation) to find the correct
option. Review the nursing actions to be taken immediately in the event of
pulmonary embolism
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Critical Care: Emergency Situation/Management
Giddens Concepts: Perfusion, Clotting
HESI Concepts: Oxygenation/Gas Exchange, Perfusion-Clotting
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinical
problems (9th ed., p. 552). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
4. 4.ID: 9477051498
A client who has undergone abdominal surgery calls the nurse and
reports that she just felt “something give way” in the abdominal
incision. The nurse checks the incision and notes the presence of
wound dehiscence. The nurse should take which immediate action?
A. Document the findings
B. Contact the health care provider
C. Place the client in a supine position with the legs flat
D. Cover the abdominal wound with a sterile dressing
moistened with sterile saline solution Correct
Rationale: Wound dehiscence is the disruption of a surgical incision or wound.
When dehiscence occurs, the nurse immediately places the client in a low
Fowler’s position or supine with the knees bent and instructs the client to lie
quietly. These actions will minimize protrusion of the underlying tissues. The
nurse then covers the wound with a sterile dressing moistened with sterile
saline. The health care provider is notified, and the nurse documents the
occurrence and the nursing actions that were implemented in response.
ACTUAL QUESTIONS AND ANSWERS GRADE A+.
1. Questions
1. 1.ID: 9477047208
A nurse is caring for a client who has lost a significant amount of
blood as a result of complications during a surgical procedure.
Which parameter does the nurse recognize as the earliest indication
of new decreases in fluid volume?
A. Pulse rate Correct
B. Blood pressure
C. Pulmonary artery systolic pressure
D. Pulmonary artery end-diastolic pressure
Rationale: Cardiac output is determined by the volume of the circulating blood,
the pumping action of the heart, and the tone of the vascular bed. Early
decreases in fluid volume are compensated for by an increase in the pulse
rate. Remember that pulse rate multiplied by stroke volume equals cardiac
output. An increase in pulse is often sufficient with small amounts of volume
1|Page
, depletion to maintain the blood pressure. Pulmonary artery systolic pressure
and pulmonary artery end-diastolic pressure, measurements obtained with the
use of a pulmonary artery catheter, provide information about the pressures in
the pulmonary artery and in the left ventricle at the end of diastole.
Test-Taking Strategy: Note the strategic word “earliest.” Pulmonary artery
systolic pressure and pulmonary artery end-diastolic pressure can be
eliminated first, because these measurements are obtained with the use of a
pulmonary artery catheter. To select from the remaining options, focus on the
strategic word, which will direct you to the correct option. Review the
physiology of the cardiovascular system and the means of compensation
inherent in that system.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Assessment
Content Area: Adult Health/Cardiovascular
Giddens Concepts: Clinical Judgment, Fluid and Electrolyte Balance
HESI Concepts: Clinical Decision Making/Clinical Judgment, Fluid and
Electroytes
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinical
problems (9th ed., p. 292). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
2. 2.ID: 9477054249
A nurse is reviewing the results of serum laboratory studies of a
client with suspected hepatitis. Which increased parameter is
interpreted by the nurse as the most specific indicator of this
disease?
A. Hemoglobin
B. Serum bilirubin Correct
2|Page
, C. Blood urea nitrogen (BUN)
D. Erythrocyte sedimentation rate (ESR)
Rationale: Laboratory indicators of hepatitis include increased liver enzymes, serum
bilirubin level, and ESR. However, ESR is a nonspecific test that indicates the
presence of inflammation somewhere in the body. An increased BUN may indicate
renal dysfunction. The hemoglobin level is unrelated to thisdiagnosis.
Test-Taking Strategy: Note the strategic word, most. Focusing on the client’sdiagnosis
and recalling that the liver is the organ involved in this disease process will direct you
to the correct option. Review the expected findings inhepatitis.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/AssessmentContent
Area: Adult Health/Gastrointestinal Giddens Concepts:
Cellular Regulation, Evidence
HESI Concepts:Cellular Regulation, Evidence Based Practice/Evidence
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinicalproblems (9th
ed., pp. 1010-1011). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
3. 3.ID: 9477051455
A client who has just undergone surgery suddenly experiences
chest pain, dyspnea, and tachypnea. The nurse suspects that the
client has a pulmonary embolism and immediately sets about to
take which action?
A. Preparing the client for a perfusion scan
B. Attaching the client to a cardiac monitor
C. Administering oxygen by way of nasal cannula Correct
D. Ensuring that the intravenous (IV) line is patent
, Rationale: Pulmonary embolism is a life-threatening emergency. Oxygen is
immediately administered nasally to relieve hypoxemia, respiratory distress,
and central cyanosis, and the
health care provideris notified. IV infusion lines are needed to administer
medications or fluids. A perfusion scan, among other tests, may be performed.
The electrocardiogram is monitored for the presence of dysrhythmias.
Additionally, a urinary catheter may be inserted and blood for arterial blood gas
determinations drawn. The immediate priority, however, is the administration of
oxygen.
Test-Taking Strategy: Focus on the client’s diagnosis and use the skills of
prioritizing. Use the ABCs (airway, breathing, and circulation) to find the correct
option. Review the nursing actions to be taken immediately in the event of
pulmonary embolism
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Critical Care: Emergency Situation/Management
Giddens Concepts: Perfusion, Clotting
HESI Concepts: Oxygenation/Gas Exchange, Perfusion-Clotting
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L.
(2014). Medical-surgical nursing: Assessment and management of clinical
problems (9th ed., p. 552). St. Louis: Mosby.
Awarded 1.0 points out of 1.0 possible points.
4. 4.ID: 9477051498
A client who has undergone abdominal surgery calls the nurse and
reports that she just felt “something give way” in the abdominal
incision. The nurse checks the incision and notes the presence of
wound dehiscence. The nurse should take which immediate action?
A. Document the findings
B. Contact the health care provider
C. Place the client in a supine position with the legs flat
D. Cover the abdominal wound with a sterile dressing
moistened with sterile saline solution Correct
Rationale: Wound dehiscence is the disruption of a surgical incision or wound.
When dehiscence occurs, the nurse immediately places the client in a low
Fowler’s position or supine with the knees bent and instructs the client to lie
quietly. These actions will minimize protrusion of the underlying tissues. The
nurse then covers the wound with a sterile dressing moistened with sterile
saline. The health care provider is notified, and the nurse documents the
occurrence and the nursing actions that were implemented in response.
