HESI-RN Med-Surg Test QUESTIONS AND
ANSWERS
1. A 25-yr-vintage customer changed into admitted the day before today after a motor
automobile collision. Neurodiagnostic research have shown a basal skull fracture in the
center fossa. Assessment on admission found out both halo and Battle signs. Which new
symptom shows that the customer is probably to be experiencing a not unusual
existence-threatening hassle associated with a basal skull fracture?
A.
Bilateral jugular venous distention
B.
Oral temperature of 102°F
C.
Intermittent focal motor seizures
D.
Intractable pain in the cervical place - ANS -B
Rationale:Clients with basilar skull fractures are at excessive danger for
contamination of the brain, as indicated through an extended oral temperature,
because the fracture leaves the meninges open to bacterial invasion. Clients may
also experience options C and D, however those findings do now not pose as
brilliant a existence-threatening danger as contamination. Jugular distention isn't
always an average worry of basal skull fractures.
2. A 43-year-old homeless, malnourished client with a history of alcoholism is transferred to
the ICU. The nurse palpates a heart charge of one hundred sixty beats/min, and the
customer's blood strain is 90/54 mm Hg. Based on those findings, which IV medication
should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl) - ANS -B
Rationale:The client with continual alcoholism is likely to have hypomagnesemia.
Option B is the endorsed drug for torsades de pointes, that is a form of
polymorphic ventricular tachycardia (VT) generally related to a prolonged QT c
language that takes place with hypomagnesemia. Options A and D growth the QT
interval, that could cause the torsades to worsen. Option C is the antiarrhythmic
of desire in most cases of drug-prompted monomorphic VT, no longer torsades.
,3. A 55-yr-old male client has been admitted to the clinic with a clinical diagnosis of chronic
obstructive pulmonary disease (COPD). Which chance thing is the maximum
considerable inside the development of this consumer's COPD?
A.
The client's father become diagnosed with COPD in his 50s.
B.
A close family member contracted tuberculosis remaining yr.
C.
The client smokes one to two packs of cigarettes in keeping with day.
D.
The patron has been forty pounds obese for 15 years. - ANS -C
Rationale:Smoking, taken into consideration to be a modifiable risk factor, is the
maximum big chance factor for the improvement of COPD. The actual mechanism
of genetic and hereditary implications for the improvement of COPD is still below
investigation, despite the fact that exposure to comparable predisposing elements
(e.G., smoking or breathing in secondhand smoke) may additionally increase the
likelihood of COPD incidence among family individuals. Options B and D do not
exceed the dangers related to cigarette smoking in the improvement of COPD.
4. A fifty eight-year-antique purchaser who has no health problems asks the nurse
approximately receiving the pneumococcal vaccine. Which assertion given by using the
nurse would offer the customer accurate statistics approximately this vaccine?
A.
The vaccine is given yearly before the flu season to the ones older than 50 years.
B.
The immunization is run as soon as to older adults or the ones at danger for infection.
C.
The vaccine is for all ages and is given typically to those persons traveling foreign places
to regions of infection.
D.
The vaccine will save you the incidence of pneumococcal pneumonia for up to five
years. - ANS -B
Rationale:It is commonly advocated that humans older than sixty five years and
people with a history of persistent contamination must receive the vaccine as
soon as of their lifetime. Some propose receiving the vaccine at 50 years of age.
The influenza vaccine is given once a yr. Although the vaccine might be given to
someone travelling overseas, that is not the principle motive for administering the
vaccine. The vaccine is generally given once in an entire life, however with
immunosuppressed clients or clients with a history of pneumonia, revaccination
is on occasion required.
5. A sixty two-year-old client who lives alone tripped on a scatter rug ensuing in a fractured
hip. Which predisposing aspect maximum probable contributed to the fracture within the
proximal cease of her femur?
A.
Failing eyesight ensuing in an hazardous surroundings
, B.
Renal osteodystrophy resulting from persistent kidney disorder (CKD)
C.
Osteoporosis resulting from declining hormone ranges
D.
Cerebral vessel adjustments inflicting transient ischemic attacks - ANS -C
Rationale:The most common purpose of a fractured hip in older girls is
osteoporosis, as a result of reduced calcium in the bones because of hormonal
modifications within the perimenopausal years. Option A may additionally or may
not have contributed to the accident, but eye adjustments have been not involved
in selling the hip fracture. Option B isn't always a not unusual condition of older
human beings but is related to CKD. Although alternative D may also bring about
brief ischemic assaults (TIAs) or stroke, it'll now not bring about fragility of the
bones, as does osteoporosis.
6. A sixty three-12 months-antique purchaser with type 2 diabetes mellitus is admitted for
remedy of an ulcer on the heel of the left foot that has no longer healed with wound care.
The nurse observes that the complete left foot is darker in colour than the proper foot.
Which extra symptom must the nurse assume to locate?
A.
Pedal pulses could be weak or absent inside the left foot.
B.
The consumer will kingdom that the left foot is commonly warm.
C.
Flexion and extension of the left foot may be constrained.
D.
Capillary top off of the patron's left ft will be brisk. - ANS -A
Rationale:Symptoms associated with reduced blood supply are weak or absent
pedal and tibial pulses. The patron with diabetes studies vascular scarring due to
atherosclerotic modifications in the peripheral vessels. This consequences in
compromised perfusion to the structured extremities, which in addition delays
wound recuperation within the affected foot. Although flexion and extension can
be limited, relying on the diploma of damage, this is not continually the case.
Options B and D are signs of good enough perfusion of the foot, which could not
be predicted on this purchaser.
7. A seventy four-yr-old male client is admitted to the in depth care unit (ICU) with a
diagnosis of respiratory failure secondary to pneumonia. Currently, the patron is
ventilator-based, with settings of tidal volume (VT) of 750 mL and an intermittent
mandatory ventilation (IMV) charge of 10 breaths/min. Arterial blood fuel (ABG) effects
are as follows: pH, 7.Forty eight; PaCO2, 30 mm Hg; PaO2, sixty four mm Hg; HCO3, 25
mEq/L; and FiO2, 0.Eighty. Which movement must the nurse take first?
A.
Increase the ventilator VT to 850 mL.
B.
Decrease the ventilator IMV to a fee of eight breaths/min.
, C.
Reduce the FiO2 to zero.70 and redraw ABGs.
D.
Add five cm high quality stop-expiratory stress (PEEP). - ANS -D
Rationale:Adding PEEP allows enhance oxygenation even as decreasing FiO2 to a
much less toxic degree. Options A, B, and C will not result in improved
oxygenation and could purpose similarly headaches for this patron, who's
experiencing respiration failure.
8. A seventy seven-12 months-old consumer is admitted to the medical institution with
confusion and anorexia of numerous days' period. Additional signs said are nausea and
vomiting, and present day court cases of a headache. The patron's pulse price is forty
three beats/min. The nurse is most worried approximately the consumer's history related
to which medicinal drug?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin - ANS -D
Rationale:Older people are particularly susceptible to the buildup of cardiac
glycosides, together with digoxin or digitoxin (medicines derived from digitalis), to
a poisonous degree in their systems. Toxicity can purpose anorexia, nausea,
vomiting, diarrhea, headache, and fatigue. Options A, B, and C are not likely to
result in the symptoms defined.
9. A vital venous catheter has been inserted via a jugular vein, and a radiograph has
showed placement of the catheter. A prescription has been obtained for a medicinal drug
STAT, however IV fluids have no longer yet been began. Which action should the nurse
take prior to administering the prescribed medicinal drug?
A.
Assess for symptoms of jugular venous distention.
B.
Obtain the wished intravenous solution.
C.
Flush the line with heparinized answer.
D.
Flush the line with normal saline. - ANS -D
Rationale:Medication can be administered thru a central line without extra IV
fluids. The line ought to first be flushed with a regular saline way to ensure
patency. Insufficient evidence exists on the effectiveness of flushing catheters
with heparin. Option A will now not have an effect on the selection to manage the
medication and isn't always a priority. Administration of the drugs STAT is of more
precedence than alternative B.
ANSWERS
1. A 25-yr-vintage customer changed into admitted the day before today after a motor
automobile collision. Neurodiagnostic research have shown a basal skull fracture in the
center fossa. Assessment on admission found out both halo and Battle signs. Which new
symptom shows that the customer is probably to be experiencing a not unusual
existence-threatening hassle associated with a basal skull fracture?
A.
Bilateral jugular venous distention
B.
Oral temperature of 102°F
C.
Intermittent focal motor seizures
D.
Intractable pain in the cervical place - ANS -B
Rationale:Clients with basilar skull fractures are at excessive danger for
contamination of the brain, as indicated through an extended oral temperature,
because the fracture leaves the meninges open to bacterial invasion. Clients may
also experience options C and D, however those findings do now not pose as
brilliant a existence-threatening danger as contamination. Jugular distention isn't
always an average worry of basal skull fractures.
2. A 43-year-old homeless, malnourished client with a history of alcoholism is transferred to
the ICU. The nurse palpates a heart charge of one hundred sixty beats/min, and the
customer's blood strain is 90/54 mm Hg. Based on those findings, which IV medication
should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl) - ANS -B
Rationale:The client with continual alcoholism is likely to have hypomagnesemia.
Option B is the endorsed drug for torsades de pointes, that is a form of
polymorphic ventricular tachycardia (VT) generally related to a prolonged QT c
language that takes place with hypomagnesemia. Options A and D growth the QT
interval, that could cause the torsades to worsen. Option C is the antiarrhythmic
of desire in most cases of drug-prompted monomorphic VT, no longer torsades.
,3. A 55-yr-old male client has been admitted to the clinic with a clinical diagnosis of chronic
obstructive pulmonary disease (COPD). Which chance thing is the maximum
considerable inside the development of this consumer's COPD?
A.
The client's father become diagnosed with COPD in his 50s.
B.
A close family member contracted tuberculosis remaining yr.
C.
The client smokes one to two packs of cigarettes in keeping with day.
D.
The patron has been forty pounds obese for 15 years. - ANS -C
Rationale:Smoking, taken into consideration to be a modifiable risk factor, is the
maximum big chance factor for the improvement of COPD. The actual mechanism
of genetic and hereditary implications for the improvement of COPD is still below
investigation, despite the fact that exposure to comparable predisposing elements
(e.G., smoking or breathing in secondhand smoke) may additionally increase the
likelihood of COPD incidence among family individuals. Options B and D do not
exceed the dangers related to cigarette smoking in the improvement of COPD.
4. A fifty eight-year-antique purchaser who has no health problems asks the nurse
approximately receiving the pneumococcal vaccine. Which assertion given by using the
nurse would offer the customer accurate statistics approximately this vaccine?
A.
The vaccine is given yearly before the flu season to the ones older than 50 years.
B.
The immunization is run as soon as to older adults or the ones at danger for infection.
C.
The vaccine is for all ages and is given typically to those persons traveling foreign places
to regions of infection.
D.
The vaccine will save you the incidence of pneumococcal pneumonia for up to five
years. - ANS -B
Rationale:It is commonly advocated that humans older than sixty five years and
people with a history of persistent contamination must receive the vaccine as
soon as of their lifetime. Some propose receiving the vaccine at 50 years of age.
The influenza vaccine is given once a yr. Although the vaccine might be given to
someone travelling overseas, that is not the principle motive for administering the
vaccine. The vaccine is generally given once in an entire life, however with
immunosuppressed clients or clients with a history of pneumonia, revaccination
is on occasion required.
5. A sixty two-year-old client who lives alone tripped on a scatter rug ensuing in a fractured
hip. Which predisposing aspect maximum probable contributed to the fracture within the
proximal cease of her femur?
A.
Failing eyesight ensuing in an hazardous surroundings
, B.
Renal osteodystrophy resulting from persistent kidney disorder (CKD)
C.
Osteoporosis resulting from declining hormone ranges
D.
Cerebral vessel adjustments inflicting transient ischemic attacks - ANS -C
Rationale:The most common purpose of a fractured hip in older girls is
osteoporosis, as a result of reduced calcium in the bones because of hormonal
modifications within the perimenopausal years. Option A may additionally or may
not have contributed to the accident, but eye adjustments have been not involved
in selling the hip fracture. Option B isn't always a not unusual condition of older
human beings but is related to CKD. Although alternative D may also bring about
brief ischemic assaults (TIAs) or stroke, it'll now not bring about fragility of the
bones, as does osteoporosis.
6. A sixty three-12 months-antique purchaser with type 2 diabetes mellitus is admitted for
remedy of an ulcer on the heel of the left foot that has no longer healed with wound care.
The nurse observes that the complete left foot is darker in colour than the proper foot.
Which extra symptom must the nurse assume to locate?
A.
Pedal pulses could be weak or absent inside the left foot.
B.
The consumer will kingdom that the left foot is commonly warm.
C.
Flexion and extension of the left foot may be constrained.
D.
Capillary top off of the patron's left ft will be brisk. - ANS -A
Rationale:Symptoms associated with reduced blood supply are weak or absent
pedal and tibial pulses. The patron with diabetes studies vascular scarring due to
atherosclerotic modifications in the peripheral vessels. This consequences in
compromised perfusion to the structured extremities, which in addition delays
wound recuperation within the affected foot. Although flexion and extension can
be limited, relying on the diploma of damage, this is not continually the case.
Options B and D are signs of good enough perfusion of the foot, which could not
be predicted on this purchaser.
7. A seventy four-yr-old male client is admitted to the in depth care unit (ICU) with a
diagnosis of respiratory failure secondary to pneumonia. Currently, the patron is
ventilator-based, with settings of tidal volume (VT) of 750 mL and an intermittent
mandatory ventilation (IMV) charge of 10 breaths/min. Arterial blood fuel (ABG) effects
are as follows: pH, 7.Forty eight; PaCO2, 30 mm Hg; PaO2, sixty four mm Hg; HCO3, 25
mEq/L; and FiO2, 0.Eighty. Which movement must the nurse take first?
A.
Increase the ventilator VT to 850 mL.
B.
Decrease the ventilator IMV to a fee of eight breaths/min.
, C.
Reduce the FiO2 to zero.70 and redraw ABGs.
D.
Add five cm high quality stop-expiratory stress (PEEP). - ANS -D
Rationale:Adding PEEP allows enhance oxygenation even as decreasing FiO2 to a
much less toxic degree. Options A, B, and C will not result in improved
oxygenation and could purpose similarly headaches for this patron, who's
experiencing respiration failure.
8. A seventy seven-12 months-old consumer is admitted to the medical institution with
confusion and anorexia of numerous days' period. Additional signs said are nausea and
vomiting, and present day court cases of a headache. The patron's pulse price is forty
three beats/min. The nurse is most worried approximately the consumer's history related
to which medicinal drug?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin - ANS -D
Rationale:Older people are particularly susceptible to the buildup of cardiac
glycosides, together with digoxin or digitoxin (medicines derived from digitalis), to
a poisonous degree in their systems. Toxicity can purpose anorexia, nausea,
vomiting, diarrhea, headache, and fatigue. Options A, B, and C are not likely to
result in the symptoms defined.
9. A vital venous catheter has been inserted via a jugular vein, and a radiograph has
showed placement of the catheter. A prescription has been obtained for a medicinal drug
STAT, however IV fluids have no longer yet been began. Which action should the nurse
take prior to administering the prescribed medicinal drug?
A.
Assess for symptoms of jugular venous distention.
B.
Obtain the wished intravenous solution.
C.
Flush the line with heparinized answer.
D.
Flush the line with normal saline. - ANS -D
Rationale:Medication can be administered thru a central line without extra IV
fluids. The line ought to first be flushed with a regular saline way to ensure
patency. Insufficient evidence exists on the effectiveness of flushing catheters
with heparin. Option A will now not have an effect on the selection to manage the
medication and isn't always a priority. Administration of the drugs STAT is of more
precedence than alternative B.
