HESI RN MEDICAL SURGICAL EXAM
PACK 2024 QUESTIONS AND
ANSWERS
An17ER17nurse17is17completing17an17assessment17on17a17patient17that17is17alert17but17st
ruggles17to17answer17questions.17When17she17attempts17to17talk,17she17slurs17her17spee
ch17and17appears17very17frightened.17What17additional17clinical17manifestation17does17th
e17nurse17expect17to17find17if17nacy's17sysmptoms17have17been17caused17by17a17brain17
attack17(stroke)?
A.17A17carotid17bruit
B.17A17hypotensive17blood17pressure
C.17hyperreflexic17deep17tendon17relexes.
D.17Decreased17bowel17sounds17-17ans-A)17A17carotid17bruit.
Rationale:17the17carotid17artery17(artery17to17the17brain)17is17narrowed17in17clients17with1
7a17brain17attack.17A17bruit17is17an17abnormal17sound17heard17on17auscultation17resultin
g17from17interference17with17normal17blood17flow.17Usually17the17blood17pressure17is17hy
pertensive.17Initially17flaccid17paralysis17occurs,17resulting17in17hyporefkexic17deep17tend
on17reflexes.17Bowel17sounds17are17not17indicative17of17a17brain17attack.
Which17clinical17manifestation17further17supports17an17assessment17of17a17left-
sided17brain17attack?
A)17Visual17field17deficit17on17the17left17side.
B)17Spatial-perceptual17deficits.
C)17Paresthesia17of17the17left17side.
D)17Global17aphasia.
D)17Global17aphasia.17-17ans-D)17Global17aphasia.
Rationale:17Global17aphasia17refers17to17difficulty17speaking,17listening,17and17understan
ding,17as17well17as17difficulty17reading17and17writing.17Symptoms17vary17from17person17t
o17person.17Aphasia17may17occur17secondary17to17any17brain17injury17involving17the17lef
t17hemisphere.17Visual17field17deficits,17spatial-
perceptual17deficits,17and17paresthsia17of17the17left17side17usually17occur17with17right-
sided17brain17attack.
When17preparing17a17patient17for17a17noncontrast17computed17tomography17(CT)17scan1
7STAT,17what17nursing17intervention17should17the17nurse17implement?
,A)17Determine17if17the17client17has17any17allergies17to17iodine
B)17Explain17that17the17client17will17not17be17able17to17move17her17head17throughout17the
17CT17scan.
C)17Premedicate17the17client17to17decrease17pain17prior17to17having17the17procedure.
D)17Provide17an17explanation17of17relaxation17exercises17prior17to17the17procedure.17-
17ans-
B)17Explain17that17the17client17will17not17be17able17to17move17her17head17throughout17the
17CT17scan.
Rationale:17Because17head17motion17will17distort17the17images,17Nancy17will17have17to17
remain17still17throughout17the17procedure.17Allergies17to17iodine17is17important17if17contr
ast17dye17is17being17used17for17the17CT17scan.17Premedicating17the17client17to17decreas
e17pain17prior17to17the17procedure17is17unnecessary17because17CT17scanning17is17a17no
ninvasive17and17painless17procedure.17Providing17an17explanation17of17relaxation17exerc
ises17prior17to17the17procedure17is17a17worthwhile17intervention17to17decrease17anxiety17
but17is17not17of17highest17priority.
A17neurologist17prescribes17a17magnetic17resonance17imaging17(MRI)17of17the17head17S
TAT17for17a17patient.17Which17data17warrants17immediate17intervention17by17the17nurse1
7concerning17this17diagnostic17test?
A)17Elevated17blood17pressure.
B)17Allergy17to17shell17fish.
C)17Right17hip17replacement.
D)17History17of17atrial17fibrillation.17-17ans-C)17Right17hip17replacement.
The17magnetic17field17generated17by17the17MRI17is17so17strong17that17metal-
containing17items17are17strongly17attracted17to17the17magnet.17Because17the17hip17joint17
is17made17of17metal,17a17lead17shield17must17be17used17during17the17procedure.17Elevat
ed17blood17pressure,17an17allergy17to17shell17fish,17and17a17history17of17atrial17fibrillation1
7would17not17affect17the17MRI.
A17client's17daughter17is17sitting17by17her17mother's17bedside17who17was17recently17tran
sferred17to17the17Intermediate17Care17Unit.17She17states17"I17don't17understand17what17a
17brain17attack17is.17The17healthcare17provider17told17me17my17mother17is17in17serious17c
ondition17and17they17are17going17to17run17several17tests.17I17just17don't17know17what17is1
7going17on.17What17happened17to17my17mother?"17What17is17the17best17response17by17t
he17nurse?
A)17"I17am17sorry,17but17according17to17the17Health17Insurance17Portability17and17Accou
nting17Act17(HIPAA),17I17cannot17give17you17any17information."
B)17"Your17mother17has17had17a17stroke,17and17the17blood17supply17to17the17brain17has1
7been17blocked."
C)17"How17do17you17feel17about17what17the17healthcare17provider17said?"
,D)17"I17will17call17the17healthcare17provider17so17he/
she17can17talk17to17you17about17your17mother's17serious17condition."17-17ans-
B)17"Your17mother17has17had17a17stroke,17and17the17blood17supply17to17the17brain17has1
7been17blocked."
Rationale:17The17nurse17can17discuss17what17a17diagnosis17means.17Nancy17is17unable1
7to17make17decisions,17so17the17next17of17kin,17her17daughter,17Gail,17needs17sufficient17
information17to17make17informed17decisions.17The17nurse17has17the17knowledge,17and17t
he17responsibility,17to17explain17Nancy's17condition17to17Gail.17The17nurse17should17give
17facts17first,17and17then17address17her17feelings17after17the17information17is17provided.
What17is17the17normal17range17for17cardiac17output?17-17ans-
The17normal17range17for17cardiac17output17to17ensure17cerebral17blood17flow17and17oxyg
en17delivery17is17417to17817L/min.
A17client17was17admitted17with17the17diagnosis17of17a17brain17attack.17Their17symptoms1
7began172417hours17before17being17admitted.17Why17would17this17client17not17be17a17can
didate17for17for17thrombolytic17therapy?17-17ans-
Thrombolytic17therapy17is17contraindicated17in17clients17with17symptom17onset17longer17t
han17317hours17prior17to17admission.17This17client17had17symptoms17for172417hours17bef
ore17being17brought17to17the17medical17center
What17are17plate17guards?17-17ans-
Plate17guards17prevent17food17from17being17pushed17off17the17plate.17Using17plate17guar
ds17and17other17assistive17devices17will17encourage17independence17in17a17client17with17
a17self-care17deficit.
Which17condition17is17considered17a17non-modifiable17risk17factor17for17a17brain17attack?
A)17High17cholesterol17levels.
B)17Obesity.
C)17History17of17atrial17fibrillation.
D)17Advanced17age.17-17ans-D)17Advanced17age.
Rationale:17People17over17age175517are17a17high-
risk17group17for17a17brain17attack17because17the17incidence17of17stroke17more17than17do
ubles17in17each17successive17decade17of17life.17Non-
modifiable17means17the17client17cannot17do17anything17to17change17the17risk17factor.17Al
l17the17other17options17are17modifiable17risk17factors.
A17client17is17experiencing17homonymous17hemianopsia17as17the17result17of17a17brain17
attack.17Which17nursing17intervention17would17the17nurse17implement17to17address17this
17condition?
A)17Turn17Nancy17every17two17hours17and17perform17active17range17of17motion17exercis
es.
, B)17Place17the17objects17Nancy17needs17for17activities17of17daily17living17on17the17left17si
de17of17the17table.
C)17Speak17slowly17and17clearly17to17assist17Nancy17in17forming17sounds17to17words.
D)17Request17that17the17dietary17department17thicken17all17liquids17on17Nancy's17meal17
and17snack17trays.17-17ans-
B)17Place17the17objects17Nancy17needs17for17activities17of17daily17living17on17the17left17si
de17of17the17table.
Rationale:17Homonymous17hemianopsia17is17loss17of17the17visual17field17on17the17same1
7side17as17the17paralyzed17side.17This17results17in17the17client17neglecting17that17side17of
17the17body,17so17it17is17beneficial17to17place17objects17on17that17side.17Nancy17had17a17l
eft-
hemisphere17brain17attack17so17her17right17side17is17the17weak17side.17Speaking17slowly
17and17clearly17would17address17the17client's17verbal17deficits17due17to17aphasia.17Requ
esting17all17liquids17to17be17thickened17would17address17dysphagia.17Turning17the17clien
t17every17217hours17and17performing17active17range17of17motion17exercises17would17addr
ess17the17client's17risk17for17immobility17due17to17paralysis.
A17physical17therapist17(PT)17places17a17gait17belt17on17a17client17and17is17assisting17the
m17with17ambulation17from17the17bed17to17the17chair.17As17they17get17up17out17of17the17b
ed,17they17report17being17dizzy17and17begin17to17fall.17The17PT17carefully17allows17them1
7to17fall17back17to17the17bed17and17notifies17the17primary17nurse.17Which17written17docu
mentation17should17the17nurse17put17in17the17client's17record?17
A)17Client17experienced17orthostatic17hypotension17when17getting17out17of17bed.
B)17PT17reported17client17complained17of17dizziness17when17getting17out17of17bed,17and1
7gait17belt17was17used17to17allow17client17to17fall17back17onto17the17bed.
C)17PT17notified17the17primary17nurse17that17the17client17could17not17ambulate17at17this17
time17because17of17dizziness.
D)17Client17had17difficulty17ambulating17from17the17bed17to17the17chair17when17accompa
nied17by17the17PT,17variance17report17completed.17-17ans-
B)17PT17reported17client17complained17of17dizziness17when17getting17out17of17bed,17and1
7gait17belt17was17used17to17allow17client17to17fall17back17onto17the17bed.
Rationale:17This17documentation17provides17the17factual17data17of17the17events17that17o
ccurred.17A)The17nurse17is17making17an17assumption17that17the17dizziness17was17cause
d17by17orthostatic17hypotension.17C)17Not17all17the17pertinent17facts17are17included17in17t
his17documentation.
D)17A17variance17report17should17never17be17documented17in17the17client's17record.
A17new17nurse17graduate17is17caring17for17a17postoperative17client17with17the17following1
7arterial17blood17gases17(ABGs):17pH,177.30;17PCO2,176017mm17Hg;17PO2,178017mm17H
g;17bicarbonate,172417mEq/
L;17and17O217saturation,1796%.17Which17of17these17actions17by17the17new17graduate17is1
7indicated?
PACK 2024 QUESTIONS AND
ANSWERS
An17ER17nurse17is17completing17an17assessment17on17a17patient17that17is17alert17but17st
ruggles17to17answer17questions.17When17she17attempts17to17talk,17she17slurs17her17spee
ch17and17appears17very17frightened.17What17additional17clinical17manifestation17does17th
e17nurse17expect17to17find17if17nacy's17sysmptoms17have17been17caused17by17a17brain17
attack17(stroke)?
A.17A17carotid17bruit
B.17A17hypotensive17blood17pressure
C.17hyperreflexic17deep17tendon17relexes.
D.17Decreased17bowel17sounds17-17ans-A)17A17carotid17bruit.
Rationale:17the17carotid17artery17(artery17to17the17brain)17is17narrowed17in17clients17with1
7a17brain17attack.17A17bruit17is17an17abnormal17sound17heard17on17auscultation17resultin
g17from17interference17with17normal17blood17flow.17Usually17the17blood17pressure17is17hy
pertensive.17Initially17flaccid17paralysis17occurs,17resulting17in17hyporefkexic17deep17tend
on17reflexes.17Bowel17sounds17are17not17indicative17of17a17brain17attack.
Which17clinical17manifestation17further17supports17an17assessment17of17a17left-
sided17brain17attack?
A)17Visual17field17deficit17on17the17left17side.
B)17Spatial-perceptual17deficits.
C)17Paresthesia17of17the17left17side.
D)17Global17aphasia.
D)17Global17aphasia.17-17ans-D)17Global17aphasia.
Rationale:17Global17aphasia17refers17to17difficulty17speaking,17listening,17and17understan
ding,17as17well17as17difficulty17reading17and17writing.17Symptoms17vary17from17person17t
o17person.17Aphasia17may17occur17secondary17to17any17brain17injury17involving17the17lef
t17hemisphere.17Visual17field17deficits,17spatial-
perceptual17deficits,17and17paresthsia17of17the17left17side17usually17occur17with17right-
sided17brain17attack.
When17preparing17a17patient17for17a17noncontrast17computed17tomography17(CT)17scan1
7STAT,17what17nursing17intervention17should17the17nurse17implement?
,A)17Determine17if17the17client17has17any17allergies17to17iodine
B)17Explain17that17the17client17will17not17be17able17to17move17her17head17throughout17the
17CT17scan.
C)17Premedicate17the17client17to17decrease17pain17prior17to17having17the17procedure.
D)17Provide17an17explanation17of17relaxation17exercises17prior17to17the17procedure.17-
17ans-
B)17Explain17that17the17client17will17not17be17able17to17move17her17head17throughout17the
17CT17scan.
Rationale:17Because17head17motion17will17distort17the17images,17Nancy17will17have17to17
remain17still17throughout17the17procedure.17Allergies17to17iodine17is17important17if17contr
ast17dye17is17being17used17for17the17CT17scan.17Premedicating17the17client17to17decreas
e17pain17prior17to17the17procedure17is17unnecessary17because17CT17scanning17is17a17no
ninvasive17and17painless17procedure.17Providing17an17explanation17of17relaxation17exerc
ises17prior17to17the17procedure17is17a17worthwhile17intervention17to17decrease17anxiety17
but17is17not17of17highest17priority.
A17neurologist17prescribes17a17magnetic17resonance17imaging17(MRI)17of17the17head17S
TAT17for17a17patient.17Which17data17warrants17immediate17intervention17by17the17nurse1
7concerning17this17diagnostic17test?
A)17Elevated17blood17pressure.
B)17Allergy17to17shell17fish.
C)17Right17hip17replacement.
D)17History17of17atrial17fibrillation.17-17ans-C)17Right17hip17replacement.
The17magnetic17field17generated17by17the17MRI17is17so17strong17that17metal-
containing17items17are17strongly17attracted17to17the17magnet.17Because17the17hip17joint17
is17made17of17metal,17a17lead17shield17must17be17used17during17the17procedure.17Elevat
ed17blood17pressure,17an17allergy17to17shell17fish,17and17a17history17of17atrial17fibrillation1
7would17not17affect17the17MRI.
A17client's17daughter17is17sitting17by17her17mother's17bedside17who17was17recently17tran
sferred17to17the17Intermediate17Care17Unit.17She17states17"I17don't17understand17what17a
17brain17attack17is.17The17healthcare17provider17told17me17my17mother17is17in17serious17c
ondition17and17they17are17going17to17run17several17tests.17I17just17don't17know17what17is1
7going17on.17What17happened17to17my17mother?"17What17is17the17best17response17by17t
he17nurse?
A)17"I17am17sorry,17but17according17to17the17Health17Insurance17Portability17and17Accou
nting17Act17(HIPAA),17I17cannot17give17you17any17information."
B)17"Your17mother17has17had17a17stroke,17and17the17blood17supply17to17the17brain17has1
7been17blocked."
C)17"How17do17you17feel17about17what17the17healthcare17provider17said?"
,D)17"I17will17call17the17healthcare17provider17so17he/
she17can17talk17to17you17about17your17mother's17serious17condition."17-17ans-
B)17"Your17mother17has17had17a17stroke,17and17the17blood17supply17to17the17brain17has1
7been17blocked."
Rationale:17The17nurse17can17discuss17what17a17diagnosis17means.17Nancy17is17unable1
7to17make17decisions,17so17the17next17of17kin,17her17daughter,17Gail,17needs17sufficient17
information17to17make17informed17decisions.17The17nurse17has17the17knowledge,17and17t
he17responsibility,17to17explain17Nancy's17condition17to17Gail.17The17nurse17should17give
17facts17first,17and17then17address17her17feelings17after17the17information17is17provided.
What17is17the17normal17range17for17cardiac17output?17-17ans-
The17normal17range17for17cardiac17output17to17ensure17cerebral17blood17flow17and17oxyg
en17delivery17is17417to17817L/min.
A17client17was17admitted17with17the17diagnosis17of17a17brain17attack.17Their17symptoms1
7began172417hours17before17being17admitted.17Why17would17this17client17not17be17a17can
didate17for17for17thrombolytic17therapy?17-17ans-
Thrombolytic17therapy17is17contraindicated17in17clients17with17symptom17onset17longer17t
han17317hours17prior17to17admission.17This17client17had17symptoms17for172417hours17bef
ore17being17brought17to17the17medical17center
What17are17plate17guards?17-17ans-
Plate17guards17prevent17food17from17being17pushed17off17the17plate.17Using17plate17guar
ds17and17other17assistive17devices17will17encourage17independence17in17a17client17with17
a17self-care17deficit.
Which17condition17is17considered17a17non-modifiable17risk17factor17for17a17brain17attack?
A)17High17cholesterol17levels.
B)17Obesity.
C)17History17of17atrial17fibrillation.
D)17Advanced17age.17-17ans-D)17Advanced17age.
Rationale:17People17over17age175517are17a17high-
risk17group17for17a17brain17attack17because17the17incidence17of17stroke17more17than17do
ubles17in17each17successive17decade17of17life.17Non-
modifiable17means17the17client17cannot17do17anything17to17change17the17risk17factor.17Al
l17the17other17options17are17modifiable17risk17factors.
A17client17is17experiencing17homonymous17hemianopsia17as17the17result17of17a17brain17
attack.17Which17nursing17intervention17would17the17nurse17implement17to17address17this
17condition?
A)17Turn17Nancy17every17two17hours17and17perform17active17range17of17motion17exercis
es.
, B)17Place17the17objects17Nancy17needs17for17activities17of17daily17living17on17the17left17si
de17of17the17table.
C)17Speak17slowly17and17clearly17to17assist17Nancy17in17forming17sounds17to17words.
D)17Request17that17the17dietary17department17thicken17all17liquids17on17Nancy's17meal17
and17snack17trays.17-17ans-
B)17Place17the17objects17Nancy17needs17for17activities17of17daily17living17on17the17left17si
de17of17the17table.
Rationale:17Homonymous17hemianopsia17is17loss17of17the17visual17field17on17the17same1
7side17as17the17paralyzed17side.17This17results17in17the17client17neglecting17that17side17of
17the17body,17so17it17is17beneficial17to17place17objects17on17that17side.17Nancy17had17a17l
eft-
hemisphere17brain17attack17so17her17right17side17is17the17weak17side.17Speaking17slowly
17and17clearly17would17address17the17client's17verbal17deficits17due17to17aphasia.17Requ
esting17all17liquids17to17be17thickened17would17address17dysphagia.17Turning17the17clien
t17every17217hours17and17performing17active17range17of17motion17exercises17would17addr
ess17the17client's17risk17for17immobility17due17to17paralysis.
A17physical17therapist17(PT)17places17a17gait17belt17on17a17client17and17is17assisting17the
m17with17ambulation17from17the17bed17to17the17chair.17As17they17get17up17out17of17the17b
ed,17they17report17being17dizzy17and17begin17to17fall.17The17PT17carefully17allows17them1
7to17fall17back17to17the17bed17and17notifies17the17primary17nurse.17Which17written17docu
mentation17should17the17nurse17put17in17the17client's17record?17
A)17Client17experienced17orthostatic17hypotension17when17getting17out17of17bed.
B)17PT17reported17client17complained17of17dizziness17when17getting17out17of17bed,17and1
7gait17belt17was17used17to17allow17client17to17fall17back17onto17the17bed.
C)17PT17notified17the17primary17nurse17that17the17client17could17not17ambulate17at17this17
time17because17of17dizziness.
D)17Client17had17difficulty17ambulating17from17the17bed17to17the17chair17when17accompa
nied17by17the17PT,17variance17report17completed.17-17ans-
B)17PT17reported17client17complained17of17dizziness17when17getting17out17of17bed,17and1
7gait17belt17was17used17to17allow17client17to17fall17back17onto17the17bed.
Rationale:17This17documentation17provides17the17factual17data17of17the17events17that17o
ccurred.17A)The17nurse17is17making17an17assumption17that17the17dizziness17was17cause
d17by17orthostatic17hypotension.17C)17Not17all17the17pertinent17facts17are17included17in17t
his17documentation.
D)17A17variance17report17should17never17be17documented17in17the17client's17record.
A17new17nurse17graduate17is17caring17for17a17postoperative17client17with17the17following1
7arterial17blood17gases17(ABGs):17pH,177.30;17PCO2,176017mm17Hg;17PO2,178017mm17H
g;17bicarbonate,172417mEq/
L;17and17O217saturation,1796%.17Which17of17these17actions17by17the17new17graduate17is1
7indicated?
