MASTERING THE HESI MED-SURG
EXAM: A COMPREHENSIVE -
QUESTION BANK WITH DETAILED
RATIONALES The Ultimate Study
Resource for Nursing Students
Question 1
The nurse assesses a client with advanced cirrhosis of the liver for signs
of hepatic encephalopathy. Which finding would the nurse consider an
indication of progressive hepatic encephalopathy?
A) An increase in abdominal girth
B) Hypertension and a bounding pulse
C) Decreased bowel sounds
D) Difficulty in handwriting
Rationale: A daily record of handwriting may provide evidence of
progression or reversal of hepatic encephalopathy leading to coma. Hepatic
encephalopathy is primarily caused by increased serum ammonia levels,
which affects neurological function. Early signs include subtle changes in
handwriting, sleep disturbances, and personality changes. Abdominal girth
increase (A) indicates ascites, not encephalopathy. Hypertension and
bounding pulse (B) are not characteristic of hepatic encephalopathy.
Decreased bowel sounds (C) does not correlate with elevated ammonia
levels .
,Question 2
A female client receiving IV vasopressin (Pitressin) for esophageal
variceal rupture reports substernal tightness and pressure across her
chest. Which PRN protocol should the nurse initiate?
A) Start an IV nitroglycerin infusion
B) Nasogastric lavage with cool saline
C) Increase the vasopressin infusion
D) Prepare for endotracheal intubation
Rationale: Vasopressin promotes vasoconstriction to reduce esophageal
variceal bleeding but can cause coronary artery vasoconstriction leading to
angina or myocardial infarction. IV nitroglycerin should be initiated per
protocol to counteract coronary vasospasm. Nasogastric lavage (B) is not
indicated for chest pain. Increasing vasopressin (C) would worsen coronary
vasoconstriction. Endotracheal intubation (D) is premature without evidence
of respiratory compromise .
Question 3
What instruction should the nurse give a client diagnosed with
fibrocystic changes of the breast?
A) Observe cyst size fluctuations as a sign of malignancy
B) Use estrogen supplements to reduce breast discomfort
C) Notify the healthcare provider if whitish nipple discharge occurs
D) Perform a breast self-exam (BSE) procedure monthly
Rationale: Fibrocystic changes increase breast density and obscure
mammography results. Women should perform monthly BSE to detect
changes in their typical "lumpiness." Cyst size fluctuates with the menstrual
,cycle and typically lessens after menopause. Fibrocystic changes do not
increase breast cancer risk. Estrogen supplements (B) would worsen
symptoms. Whitish nipple discharge (C) is common and not necessarily
concerning .
Question 4
A postmenopausal client asks why she is experiencing discomfort
during intercourse. What response is best for the nurse to provide?
A) Estrogen deficiency causes the vaginal tissues to become dry
and thinner
B) Infrequent intercourse results in vaginal tissues losing elasticity
C) Dehydration from inadequate fluid intake causes vulvar tissue
dryness
D) Lack of adequate stimulation is the most common reason for
dyspareunia
Rationale: Estrogen deprivation decreases the moisture-secreting capacity
of vaginal cells, causing tissues to become thinner, drier, and less elastic.
This is the primary physiological cause of dyspareunia in postmenopausal
women. Infrequent intercourse (B) may contribute but is not the primary
cause. Dehydration (C) does not specifically cause vulvar tissue changes.
Inadequate stimulation (D) may be a factor but is not the most common
reason in this population .
Question 5
A client is to receive progesterone 10 mg IM daily. The medication is
labeled progesterone 50 mg/mL. How many mL should the nurse
administer?
, A) 0.2 mL
B) 0.5 mL
C) 2 mL
D) 5 mL
Rationale: Use the formula: Desired dose ÷ Available dose = mL to
administer. 10 mg ÷ 50 mg/mL = 0.2 mL .
Question 6
A client with a gram-positive bacterial skin infection is receiving
daptomycin 500 mg IV every 24 hours. The pharmacy delivers a
secondary infusion of 0.9% sodium chloride with daptomycin 500
mg/100 mL to be infused in 30 minutes. How many mL/hour should
the nurse program the infusion pump?
A) 200 mL/hour
B) 100 mL/hour
C) 150 mL/hour
D) 50 mL/hour
Rationale: Convert 30 minutes to hours: 30 ÷ 60 = 0.5 hours. Infusion rate
= Total volume ÷ Time in hours = 100 mL ÷ 0.5 hours = 200 mL/hour .
Question 7
The nurse plans to provide diet instructions to a client recently
diagnosed with diverticulosis. Which dietary recommendation should
the nurse include in the teaching plan?
A) Increase intake of insoluble fiber
B) Augment intake of dairy products
EXAM: A COMPREHENSIVE -
QUESTION BANK WITH DETAILED
RATIONALES The Ultimate Study
Resource for Nursing Students
Question 1
The nurse assesses a client with advanced cirrhosis of the liver for signs
of hepatic encephalopathy. Which finding would the nurse consider an
indication of progressive hepatic encephalopathy?
A) An increase in abdominal girth
B) Hypertension and a bounding pulse
C) Decreased bowel sounds
D) Difficulty in handwriting
Rationale: A daily record of handwriting may provide evidence of
progression or reversal of hepatic encephalopathy leading to coma. Hepatic
encephalopathy is primarily caused by increased serum ammonia levels,
which affects neurological function. Early signs include subtle changes in
handwriting, sleep disturbances, and personality changes. Abdominal girth
increase (A) indicates ascites, not encephalopathy. Hypertension and
bounding pulse (B) are not characteristic of hepatic encephalopathy.
Decreased bowel sounds (C) does not correlate with elevated ammonia
levels .
,Question 2
A female client receiving IV vasopressin (Pitressin) for esophageal
variceal rupture reports substernal tightness and pressure across her
chest. Which PRN protocol should the nurse initiate?
A) Start an IV nitroglycerin infusion
B) Nasogastric lavage with cool saline
C) Increase the vasopressin infusion
D) Prepare for endotracheal intubation
Rationale: Vasopressin promotes vasoconstriction to reduce esophageal
variceal bleeding but can cause coronary artery vasoconstriction leading to
angina or myocardial infarction. IV nitroglycerin should be initiated per
protocol to counteract coronary vasospasm. Nasogastric lavage (B) is not
indicated for chest pain. Increasing vasopressin (C) would worsen coronary
vasoconstriction. Endotracheal intubation (D) is premature without evidence
of respiratory compromise .
Question 3
What instruction should the nurse give a client diagnosed with
fibrocystic changes of the breast?
A) Observe cyst size fluctuations as a sign of malignancy
B) Use estrogen supplements to reduce breast discomfort
C) Notify the healthcare provider if whitish nipple discharge occurs
D) Perform a breast self-exam (BSE) procedure monthly
Rationale: Fibrocystic changes increase breast density and obscure
mammography results. Women should perform monthly BSE to detect
changes in their typical "lumpiness." Cyst size fluctuates with the menstrual
,cycle and typically lessens after menopause. Fibrocystic changes do not
increase breast cancer risk. Estrogen supplements (B) would worsen
symptoms. Whitish nipple discharge (C) is common and not necessarily
concerning .
Question 4
A postmenopausal client asks why she is experiencing discomfort
during intercourse. What response is best for the nurse to provide?
A) Estrogen deficiency causes the vaginal tissues to become dry
and thinner
B) Infrequent intercourse results in vaginal tissues losing elasticity
C) Dehydration from inadequate fluid intake causes vulvar tissue
dryness
D) Lack of adequate stimulation is the most common reason for
dyspareunia
Rationale: Estrogen deprivation decreases the moisture-secreting capacity
of vaginal cells, causing tissues to become thinner, drier, and less elastic.
This is the primary physiological cause of dyspareunia in postmenopausal
women. Infrequent intercourse (B) may contribute but is not the primary
cause. Dehydration (C) does not specifically cause vulvar tissue changes.
Inadequate stimulation (D) may be a factor but is not the most common
reason in this population .
Question 5
A client is to receive progesterone 10 mg IM daily. The medication is
labeled progesterone 50 mg/mL. How many mL should the nurse
administer?
, A) 0.2 mL
B) 0.5 mL
C) 2 mL
D) 5 mL
Rationale: Use the formula: Desired dose ÷ Available dose = mL to
administer. 10 mg ÷ 50 mg/mL = 0.2 mL .
Question 6
A client with a gram-positive bacterial skin infection is receiving
daptomycin 500 mg IV every 24 hours. The pharmacy delivers a
secondary infusion of 0.9% sodium chloride with daptomycin 500
mg/100 mL to be infused in 30 minutes. How many mL/hour should
the nurse program the infusion pump?
A) 200 mL/hour
B) 100 mL/hour
C) 150 mL/hour
D) 50 mL/hour
Rationale: Convert 30 minutes to hours: 30 ÷ 60 = 0.5 hours. Infusion rate
= Total volume ÷ Time in hours = 100 mL ÷ 0.5 hours = 200 mL/hour .
Question 7
The nurse plans to provide diet instructions to a client recently
diagnosed with diverticulosis. Which dietary recommendation should
the nurse include in the teaching plan?
A) Increase intake of insoluble fiber
B) Augment intake of dairy products
