HESI Med surg practice questions
A 25-year-old client was admitted yesterday after a motor vehicle collision. Neurodiagnostic
studies showed a basal skull fracture in the middle fossa. Assessment on admission
revealed both halo and Battle signs. Which new symptom indicates that the client is likely to
be experiencing a common life-threatening complication associated with basal skull fracture?
A. Bilateral jugular vein distention.
B. Oral temperature of 102 degrees F.
C. Intermittent focal motor seizures.
D. Intractable pain in the cervical region. - ANS-B. Increased temp indicates meningitis. (C &
D) these symptoms may be exhibited but are not life threatening. (A) JVD is not a typical
complication of basal skull fractures.
\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.
Based on these finding, which IV medication should the nurse administer?
A. Amiodarone (Cordarone)
B. Magnesium sulfate
C. Lidocaine (Xylocaine)
D. Procainamide (Pronestyl) - ANS-B. Because the client has chronic alcoholism, she is
likely to have hypomagnesium. (B) is the recommended drug for torsades de pointes (AHA,
2005), 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 55-year-old male client is admitted to the coronary care unit having suffered an acute
myocardial infarction (MI). Within 24 hours of the occurrence, the nurse can expect to find
which systemic sign?
A. Elevated serum amylase level
B. Elevated CM-MB level
C. Prolonged prothrombin time (PT)
D. Elevated serum BUN and creatinine - ANS-B. Tissue damage in the myocardium causes
the release of cardiac enzymes into the blood system. An elevated CM-MB is a recognized
indicator of an MI. It peaks 12 - 24 hours and returns to normal within 48 - 78 hours. (A)
would indicate pancreatitis or a gastric disorder. (D) Although an elevated BUN might be
related to an acute MI it is usually associated with dehydration, high protein intake or
gastrointestinal bleeding and creatine levels indicate renal damage. (C) Indicates effective
anticoagulation therapy.
\A 58-year-old client, who has no health problems, asks the nurse about taking the
pneumococcal vaccine (Pneumovax). Which statement give by the nurse would offer the
client accurate information about this vaccine?
, A. "The vaccine is given annually before the flue season to those over 50 years of age."
B. "The immunization is administered once to older adults or persons with a history of
chronic illness."
C. "The vaccine is for all ages and is given primarily to those person traveling overseas to
infected areas."
D. "The vaccine will prevent the occurrence of pneumococcal pneumonia for up to 5 years." -
ANS-B. It is usually recommended that persons over 65 years of age and those with a
history of chronic illness should receive the vaccine once in a lifetime. (A) the influenza
vaccine is given annually. (C) travel is not the main rationale for the vaccine. (D) The vaccine
is usually given once in a lifetime.
\A central venous catheter has been inserted via a jugular vein and a radiography has
confirmed placement of the catheter. A prescription has been received for stat medication
but IV fluids have not yet been started. What action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular vein distention.
B. Obtain the needed intravenous solution.
C. Administer a bolus of normal saline solution.
D. Flush the line with heparinized saline. - ANS-C. A medication can be administered central
line without IV fluids, flush with normal saline to remove heparin that may counteract with the
medication. (B) is used following the medication and a second saline bolus. (A) will not
impact the the med administration and is not a priority. (B) Administration of the stat
medication is more of a 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. Assist in safely repositioning and then
administer (C & D). Then the client can be escorted back to the room via wheelchair or
stretcher (B).
\A client diagnosed with chronic kidney disease (CDK) 2 years ago is regularly treated at a
community hemodialysis facility. In assessing the client before his scheduled dialysis
treatment, which electrolyte imbalance should the nurse anticipate?
A. Hypophosphatemia
B. Hypocalcemia
C. Hyponatremia
D. Hypokalemia - ANS-B. Hypocalcemia develops in CKD due to chronic
hyperphosphatemia not (A). (C & D) incorrect you would find hypernatremia and
hyperkalemia
\A client is placed on a mechanical ventilator following a cerebral hemorrhage, and
vecuronium bromide (Norcuron) 0.04 mg/kg every 12 hours IV is prescribed. What is the
priority nursing diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles.
B. Hight risk or infection related to increased ICP.
A 25-year-old client was admitted yesterday after a motor vehicle collision. Neurodiagnostic
studies showed a basal skull fracture in the middle fossa. Assessment on admission
revealed both halo and Battle signs. Which new symptom indicates that the client is likely to
be experiencing a common life-threatening complication associated with basal skull fracture?
A. Bilateral jugular vein distention.
B. Oral temperature of 102 degrees F.
C. Intermittent focal motor seizures.
D. Intractable pain in the cervical region. - ANS-B. Increased temp indicates meningitis. (C &
D) these symptoms may be exhibited but are not life threatening. (A) JVD is not a typical
complication of basal skull fractures.
\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.
Based on these finding, which IV medication should the nurse administer?
A. Amiodarone (Cordarone)
B. Magnesium sulfate
C. Lidocaine (Xylocaine)
D. Procainamide (Pronestyl) - ANS-B. Because the client has chronic alcoholism, she is
likely to have hypomagnesium. (B) is the recommended drug for torsades de pointes (AHA,
2005), 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 55-year-old male client is admitted to the coronary care unit having suffered an acute
myocardial infarction (MI). Within 24 hours of the occurrence, the nurse can expect to find
which systemic sign?
A. Elevated serum amylase level
B. Elevated CM-MB level
C. Prolonged prothrombin time (PT)
D. Elevated serum BUN and creatinine - ANS-B. Tissue damage in the myocardium causes
the release of cardiac enzymes into the blood system. An elevated CM-MB is a recognized
indicator of an MI. It peaks 12 - 24 hours and returns to normal within 48 - 78 hours. (A)
would indicate pancreatitis or a gastric disorder. (D) Although an elevated BUN might be
related to an acute MI it is usually associated with dehydration, high protein intake or
gastrointestinal bleeding and creatine levels indicate renal damage. (C) Indicates effective
anticoagulation therapy.
\A 58-year-old client, who has no health problems, asks the nurse about taking the
pneumococcal vaccine (Pneumovax). Which statement give by the nurse would offer the
client accurate information about this vaccine?
, A. "The vaccine is given annually before the flue season to those over 50 years of age."
B. "The immunization is administered once to older adults or persons with a history of
chronic illness."
C. "The vaccine is for all ages and is given primarily to those person traveling overseas to
infected areas."
D. "The vaccine will prevent the occurrence of pneumococcal pneumonia for up to 5 years." -
ANS-B. It is usually recommended that persons over 65 years of age and those with a
history of chronic illness should receive the vaccine once in a lifetime. (A) the influenza
vaccine is given annually. (C) travel is not the main rationale for the vaccine. (D) The vaccine
is usually given once in a lifetime.
\A central venous catheter has been inserted via a jugular vein and a radiography has
confirmed placement of the catheter. A prescription has been received for stat medication
but IV fluids have not yet been started. What action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular vein distention.
B. Obtain the needed intravenous solution.
C. Administer a bolus of normal saline solution.
D. Flush the line with heparinized saline. - ANS-C. A medication can be administered central
line without IV fluids, flush with normal saline to remove heparin that may counteract with the
medication. (B) is used following the medication and a second saline bolus. (A) will not
impact the the med administration and is not a priority. (B) Administration of the stat
medication is more of a 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. Assist in safely repositioning and then
administer (C & D). Then the client can be escorted back to the room via wheelchair or
stretcher (B).
\A client diagnosed with chronic kidney disease (CDK) 2 years ago is regularly treated at a
community hemodialysis facility. In assessing the client before his scheduled dialysis
treatment, which electrolyte imbalance should the nurse anticipate?
A. Hypophosphatemia
B. Hypocalcemia
C. Hyponatremia
D. Hypokalemia - ANS-B. Hypocalcemia develops in CKD due to chronic
hyperphosphatemia not (A). (C & D) incorrect you would find hypernatremia and
hyperkalemia
\A client is placed on a mechanical ventilator following a cerebral hemorrhage, and
vecuronium bromide (Norcuron) 0.04 mg/kg every 12 hours IV is prescribed. What is the
priority nursing diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles.
B. Hight risk or infection related to increased ICP.
