HESI MED-SURG Practice Questions &
Key Terms
A 43-year-old homeless, malnourished female client with a history of alcoholism is
transferred to the ICU. She is placed on telemetry, and the rhythm strip shown is obtained.
The nurse palpates a heart rate of 160 beats/min, and the client's blood pressure is 90/54
mm Hg. Based on these findings, which IV medication should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl) - ANS-B.
Magnesium sulfate
Rationale:
Because the client has chronic alcoholism, she is likely to have hypomagnesemia. (B) is the
recommended drug for torsades de pointes, which is a form of polymorphic ventricular
tachycardia (VT) usually associated with a prolonged QT interval that occurs with
hypomagnesemia. (A and D) increase the QT interval, which can cause the torsades to
worsen. (C) is the antiarrhythmic of choice in most cases of drug-induced monomorphic VT,
not torsades.
\A 62-year-old woman who lives alone tripped on a rug in her home and fractured her hip.
Which predisposing factor most likely contributed to the fracture in the proximal end of her
femur?
A.
Failing eyesight resulting in an unsafe environment
B.
Renal osteodystrophy resulting from chronic kidney disease (CKD)
C.
Osteoporosis resulting from declining hormone levels
D.
Cerebral vessel changes causing transient ischemic attacks - ANS-C.
Osteoporosis resulting from declining hormone levels
,The most common cause of a fractured hip in older women is osteoporosis, resulting from
reduced calcium in the bones as a result of hormonal changes in the perimenopausal years
(C). (A) may or may not have contributed to the accident, but eye changes were not involved
in promoting the hip fracture. (B) is not a common condition of older people but is associated
with CKD. Although (D) may result in transient ischemic attacks (TIAs) or stroke, it will not
result in fragility of the bones, as does osteoporosis.
\A 74-year-old male client is admitted to the intensive care unit (ICU) with a diagnosis of
respiratory failure secondary to pneumonia. Currently, he is ventilator-dependent, with
settings of tidal volume (VT) of 750 mL and an intermittent mandatory ventilation (IMV) rate
of 10 breaths/min. Arterial blood gas (ABG) results are as follows: pH, 7.48; Paco2, 30 mm
Hg; Pao2, 64 mm Hg; HCO3, 25 mEq/L; and Fio2, 0.80. Which intervention should the nurse
implement first?
A.
Increase the ventilator VT to 850 mL.
B.
Decrease the ventilator IMV to a rate of 8 breaths/min.
C.
Reduce the Fio2 to 0.70 and redraw ABGs.
D.
Add 5 cm positive end-expiratory pressure (PEEP). - ANS-D.
Add 5 cm positive end-expiratory pressure (PEEP).
Rationale:
Adding PEEP (D) helps improve oxygenation while reducing Fio2 to a less toxic level. (A, B,
and C) will not result in improved oxygenation and could cause further complications for this
client, who is experiencing respiratory failure.
\A 77-year-old female client is admitted to the hospital with confusion and anorexia of
several days' duration. She has symptoms of nausea and vomiting and is currently
complaining of a headache. The client's pulse rate is 43 beats/min. The nurse is most
concerned about the client's history related to which medication?
A.
Warfarin (Coumadin)
B.
Ibuprofen (Motrin)
C.
Nitroglycerin (Nitrostat)
, D.
Digoxin (Lanoxin) - ANS-D.
Digoxin (Lanolin)
Ratioanle:
Older persons are particularly susceptible to the buildup of cardiac glycosides, such as
digoxin (Lanoxin) or digitoxin (medications derived from digitalis) (D), to a toxic level in their
systems. Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and fatigue.
(A, B, and C) are unlikely to result in the symptoms described.
\A central venous catheter has been inserted via a jugular vein, and a radiograph has
confirmed placement of the catheter. A prescription has been received for a medication
STAT, but IV fluids have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A.
Assess for signs of jugular venous distention.
B.
Obtain the needed intravenous solution.
C.
Flush the line with heparinized solution.
D.
Flush the line with normal saline. - ANS-D.
Flush the line with normal saline.
Rationale:
Medication can be administered via a central line without additional IV fluids. The line should
first be flushed with a normal saline solution (D) to ensure patency. Insufficient evidence
exists on the effectiveness of flushing catheters with heparin (C). (A) will not affect the
decision to administer the medication and is not a priority. Administration of the medication
STAT is of greater priority than (B).
\A client diagnosed with angina pectoris complains of chest pain while ambulating in the
hallway. Which action should the nurse implement first?
A.
Support the client to a sitting position.
B.
Ask the client to walk slowly back to the room.
C.
Administer a sublingual nitroglycerin tablet.
D.
Provide oxygen via nasal cannula. - ANS-A.
Support the client to a sitting position.
Rationale:
Key Terms
A 43-year-old homeless, malnourished female client with a history of alcoholism is
transferred to the ICU. She is placed on telemetry, and the rhythm strip shown is obtained.
The nurse palpates a heart rate of 160 beats/min, and the client's blood pressure is 90/54
mm Hg. Based on these findings, which IV medication should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl) - ANS-B.
Magnesium sulfate
Rationale:
Because the client has chronic alcoholism, she is likely to have hypomagnesemia. (B) is the
recommended drug for torsades de pointes, which is a form of polymorphic ventricular
tachycardia (VT) usually associated with a prolonged QT interval that occurs with
hypomagnesemia. (A and D) increase the QT interval, which can cause the torsades to
worsen. (C) is the antiarrhythmic of choice in most cases of drug-induced monomorphic VT,
not torsades.
\A 62-year-old woman who lives alone tripped on a rug in her home and fractured her hip.
Which predisposing factor most likely contributed to the fracture in the proximal end of her
femur?
A.
Failing eyesight resulting in an unsafe environment
B.
Renal osteodystrophy resulting from chronic kidney disease (CKD)
C.
Osteoporosis resulting from declining hormone levels
D.
Cerebral vessel changes causing transient ischemic attacks - ANS-C.
Osteoporosis resulting from declining hormone levels
,The most common cause of a fractured hip in older women is osteoporosis, resulting from
reduced calcium in the bones as a result of hormonal changes in the perimenopausal years
(C). (A) may or may not have contributed to the accident, but eye changes were not involved
in promoting the hip fracture. (B) is not a common condition of older people but is associated
with CKD. Although (D) may result in transient ischemic attacks (TIAs) or stroke, it will not
result in fragility of the bones, as does osteoporosis.
\A 74-year-old male client is admitted to the intensive care unit (ICU) with a diagnosis of
respiratory failure secondary to pneumonia. Currently, he is ventilator-dependent, with
settings of tidal volume (VT) of 750 mL and an intermittent mandatory ventilation (IMV) rate
of 10 breaths/min. Arterial blood gas (ABG) results are as follows: pH, 7.48; Paco2, 30 mm
Hg; Pao2, 64 mm Hg; HCO3, 25 mEq/L; and Fio2, 0.80. Which intervention should the nurse
implement first?
A.
Increase the ventilator VT to 850 mL.
B.
Decrease the ventilator IMV to a rate of 8 breaths/min.
C.
Reduce the Fio2 to 0.70 and redraw ABGs.
D.
Add 5 cm positive end-expiratory pressure (PEEP). - ANS-D.
Add 5 cm positive end-expiratory pressure (PEEP).
Rationale:
Adding PEEP (D) helps improve oxygenation while reducing Fio2 to a less toxic level. (A, B,
and C) will not result in improved oxygenation and could cause further complications for this
client, who is experiencing respiratory failure.
\A 77-year-old female client is admitted to the hospital with confusion and anorexia of
several days' duration. She has symptoms of nausea and vomiting and is currently
complaining of a headache. The client's pulse rate is 43 beats/min. The nurse is most
concerned about the client's history related to which medication?
A.
Warfarin (Coumadin)
B.
Ibuprofen (Motrin)
C.
Nitroglycerin (Nitrostat)
, D.
Digoxin (Lanoxin) - ANS-D.
Digoxin (Lanolin)
Ratioanle:
Older persons are particularly susceptible to the buildup of cardiac glycosides, such as
digoxin (Lanoxin) or digitoxin (medications derived from digitalis) (D), to a toxic level in their
systems. Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and fatigue.
(A, B, and C) are unlikely to result in the symptoms described.
\A central venous catheter has been inserted via a jugular vein, and a radiograph has
confirmed placement of the catheter. A prescription has been received for a medication
STAT, but IV fluids have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A.
Assess for signs of jugular venous distention.
B.
Obtain the needed intravenous solution.
C.
Flush the line with heparinized solution.
D.
Flush the line with normal saline. - ANS-D.
Flush the line with normal saline.
Rationale:
Medication can be administered via a central line without additional IV fluids. The line should
first be flushed with a normal saline solution (D) to ensure patency. Insufficient evidence
exists on the effectiveness of flushing catheters with heparin (C). (A) will not affect the
decision to administer the medication and is not a priority. Administration of the medication
STAT is of greater priority than (B).
\A client diagnosed with angina pectoris complains of chest pain while ambulating in the
hallway. Which action should the nurse implement first?
A.
Support the client to a sitting position.
B.
Ask the client to walk slowly back to the room.
C.
Administer a sublingual nitroglycerin tablet.
D.
Provide oxygen via nasal cannula. - ANS-A.
Support the client to a sitting position.
Rationale:
