HESI medsurg Questions with Detailed Verified
Answers
The nurse is assessing a client who was admitted 24 hours ago to the critical care unit
following a motorcycle collision. which client finding requires intervention by the nurse
to reduce the risk of complications related to ICP
A. Presence of core body temperature of approx 97 F
B. Infusion of mannitol (Osmitrol) despite serum osmolarity of 258 mOsm/L
C. Change of PaCO2 to 55mmHg following ventilator setting adjustments
D. Prescription for propofol IV through the left subclavian IV Ans: C
A male client with skin grafts covering full-thickness burns on both arms and legs is
scheduled for a dressing change. The client is nervous and requests that the dressing
change be skipped at this time. What action is most important for the nurse to take?
A. Administer an anti-anxiety medication
B. Encourage the client to express his anxieties.
C. Explain the importance of regular dressing changes.
D. Proceed with the scheduled dressing change. Ans: B
Which instruction should the nurse include in the teaching plan of a client with portal
hypertension and esoph
,A. Use stool softeners to avoid straining at stool.
B. Eat several small meals throughout the day.
C. Eat high potassium foods like bananas to help prevent bleeding.
D. Take prescribed anticoagulants at the same time every day. Ans: A
The nurse reports that a client is at risk for a brain attack (stroke) based on which
assessment finding?
A. Nuchal rigidity
B. Palpable cervical lymph nodes.
C. Jugular vein distention
D. Carotid bruit Ans: D
A client has an absolute neutrophil count (ANC) OF 500/MM2 after completing
chemotherapy. Which intervention is most to the nurse to implement?
A. Place the client in protective isolation
B. Implement bleeding precautions
C. Assess vital signs every 4 hours
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,D. Review need for pneumococcal vaccine Ans: A
Normal ANC is 1000/mm2
The nurse applies an automatic external defibrillator (AED) to a client who collapsed
in an exam room at a community event. What should the nurse do next?
A. Bring a crash cart to the exam room
B. Measure the client's BP
C. Assess the client's O2 sat
D. Determine the defibrillator reading Ans: D
A client with pheocromocytoma reports the onset of a severe headache. The nurse
observes that the client is very diaphoretic.... What assessment data should the nurse
obtain next?
A. Capillary glucose
B. BP
C. Body temp
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, D. O2 sat Ans: B
A female client with cancer tells the home care nurse that she has a good appetite but
experiences nausea whenever she smells food cooking. What action should the nurse
implement?
A. Encourage family members to cook meals outdoors and bring the cooked food
inside
B. Instruct the client to take an antiemetic before every meal to prevent excessive
vomiting
C. Assess the client's mucous membranes and report the findings to the HCP
D. Advice the client to replace cooked foods with a variety of different nutritional
supplements Ans: A
... what pathophysiologic condition should the nurse identify as primary responsible for
the declining PaO2 (refractory hypoxemia) which is PaO2 below 50 at FiO2 of 60%
Ans: ARDS
The nurse is providing preoperative education for a Jewish client scheduled to receive
a xenograft graft to pro... what information should the nurse provide this client?
A. The xenograft is taken from nonhuman sources
B. Grafting increases the risk of bacterial infections
© Get it right 2025 Getaway - Stuvia US All rights reserved
Answers
The nurse is assessing a client who was admitted 24 hours ago to the critical care unit
following a motorcycle collision. which client finding requires intervention by the nurse
to reduce the risk of complications related to ICP
A. Presence of core body temperature of approx 97 F
B. Infusion of mannitol (Osmitrol) despite serum osmolarity of 258 mOsm/L
C. Change of PaCO2 to 55mmHg following ventilator setting adjustments
D. Prescription for propofol IV through the left subclavian IV Ans: C
A male client with skin grafts covering full-thickness burns on both arms and legs is
scheduled for a dressing change. The client is nervous and requests that the dressing
change be skipped at this time. What action is most important for the nurse to take?
A. Administer an anti-anxiety medication
B. Encourage the client to express his anxieties.
C. Explain the importance of regular dressing changes.
D. Proceed with the scheduled dressing change. Ans: B
Which instruction should the nurse include in the teaching plan of a client with portal
hypertension and esoph
,A. Use stool softeners to avoid straining at stool.
B. Eat several small meals throughout the day.
C. Eat high potassium foods like bananas to help prevent bleeding.
D. Take prescribed anticoagulants at the same time every day. Ans: A
The nurse reports that a client is at risk for a brain attack (stroke) based on which
assessment finding?
A. Nuchal rigidity
B. Palpable cervical lymph nodes.
C. Jugular vein distention
D. Carotid bruit Ans: D
A client has an absolute neutrophil count (ANC) OF 500/MM2 after completing
chemotherapy. Which intervention is most to the nurse to implement?
A. Place the client in protective isolation
B. Implement bleeding precautions
C. Assess vital signs every 4 hours
© Get it right 2025 Getaway - Stuvia US All rights reserved
,D. Review need for pneumococcal vaccine Ans: A
Normal ANC is 1000/mm2
The nurse applies an automatic external defibrillator (AED) to a client who collapsed
in an exam room at a community event. What should the nurse do next?
A. Bring a crash cart to the exam room
B. Measure the client's BP
C. Assess the client's O2 sat
D. Determine the defibrillator reading Ans: D
A client with pheocromocytoma reports the onset of a severe headache. The nurse
observes that the client is very diaphoretic.... What assessment data should the nurse
obtain next?
A. Capillary glucose
B. BP
C. Body temp
© Get it right 2025 Getaway - Stuvia US All rights reserved
, D. O2 sat Ans: B
A female client with cancer tells the home care nurse that she has a good appetite but
experiences nausea whenever she smells food cooking. What action should the nurse
implement?
A. Encourage family members to cook meals outdoors and bring the cooked food
inside
B. Instruct the client to take an antiemetic before every meal to prevent excessive
vomiting
C. Assess the client's mucous membranes and report the findings to the HCP
D. Advice the client to replace cooked foods with a variety of different nutritional
supplements Ans: A
... what pathophysiologic condition should the nurse identify as primary responsible for
the declining PaO2 (refractory hypoxemia) which is PaO2 below 50 at FiO2 of 60%
Ans: ARDS
The nurse is providing preoperative education for a Jewish client scheduled to receive
a xenograft graft to pro... what information should the nurse provide this client?
A. The xenograft is taken from nonhuman sources
B. Grafting increases the risk of bacterial infections
© Get it right 2025 Getaway - Stuvia US All rights reserved
