HESI-RN MED-SURG TEST
QUESTIONS AND ANSWERS
The17nurse17is17assessing17a17client17with17acute17pancreatitis.17Which17finding17require
s17the17most17immediate17intervention17by17the17nurse?
A.17
The17client's17amylase17level17is17three17times17higher17than17the17normal17level.
17B.
The17client17has17a17carpal17spasm17when17taking17a17blood17pressure.
17C.
On17a17117to171017scale,17the17client17tells17the17nurse17that17her17epigastric17pain17is17a
t177.
17D.
The17client17states17that17she17will17continue17to17drink17alcohol17after17going17home.17-
17ans-B
The17nurse17is17assessing17a17client17with17acute17pancreatitis.17Which17finding17require
s17the17most17immediate17intervention17by17the17nurse?
Rationale:A17positive17Trousseau17sign17indicates17hypocalcemia17and17always17require
s17further17assessment17and17intervention,17regardless17of17the17cause17(40%17to1775%
17of17those17with17acute17pancreatitis17experience17hypocalcemia,17which17can17have17s
erious,17systemic17effects).17A17key17diagnostic17finding17of17pancreatitis17is17serum17a
mylase17and17lipase17levels17that17are17two17to17five17times17higher17than17the17normal1
7value.17Severe17boring17pain17is17an17expected17symptom17for17this17diagnosis,17but17d
ealing17with17the17hypocalcemia17is17a17priority17over17administering17an17analgesic.17L
ong-
term17planning17and17teaching17do17not17have17the17same17immediate17importance17as1
7a17positive17Trousseau17sign.
A1755-year-
old17male17client17has17been17admitted17to17the17hospital17with17a17medical17diagnosis17
of17chronic17obstructive17pulmonary17disease17(COPD).17Which17risk17factor17is17the17m
ost17significant17in17the17development17of17this17client's17COPD?
A.
The17client's17father17was17diagnosed17with17COPD17in17his1750s.
17B.
A17close17family17member17contracted17tuberculosis17last17year.
17C.
The17client17smokes17one17to17two17packs17of17cigarettes17per17day.
17D.
,The17client17has17been174017pounds17overweight17for171517years.17-17ans-C
Rationale:Smoking,17considered17to17be17a17modifiable17risk17factor,17is17the17most17sig
nificant17risk17factor17for17the17development17of17COPD.17The17exact17mechanism17of17
genetic17and17hereditary17implications17for17the17development17of17COPD17is17still17und
er17investigation,17although17exposure17to17similar17predisposing17factors17(e.g.,17smoki
ng17or17inhaling17secondhand17smoke)17may17increase17the17likelihood17of17COPD17inci
dence17among17family17members.17Options17B17and17D17do17not17exceed17the17risks17a
ssociated17with17cigarette17smoking17in17the17development17of17COPD.
In17assessing17a17client17diagnosed17with17primary17aldosteronism,17the17nurse17expect
s17the17laboratory17test17results17to17indicate17a17decreased17serum17level17of17which17s
ubstance?
A.
Sodium
17B.
Phosphate
17C.
Potassium
17D.
Glucose17-17ans-C
Rationale:Clients17with17primary17aldosteronism17exhibit17a17profound17decline17in17seru
m17levels17of17potassium;17hypokalemia;17hypertension17is17the17most17prominent17and1
7universal17sign.17The17serum17sodium17level17is17normal17or17elevated,17depending17on
17the17amount17of17water17resorbed17with17the17sodium.17Option17B17is17influenced17by17
parathyroid17hormone17(PTH).17Option17D17is17not17affected17by17primary17aldosteronis
m.
The17nurse17is17completing17an17admission17interview17for17a17client17with17Parkinson17
disease.17Which17question17will17provide17additional17information17about17manifestation
s17that17the17client17is17likely17to17experience?
A.
"Have17you17ever17experienced17any17paralysis17of17your17arms17or17legs?"
17B.
"Do17you17have17frequent17blackout17spells?"
17C.
"Have17you17ever17been17frozen17in17one17spot,17unable17to17move?"
17D.
"Do17you17have17headaches,17especially17ones17with17throbbing17pain?"17-17ans-C
Rationale:Clients17with17Parkinson17disease17frequently17experience17difficulty17in17initia
ting,17maintaining,17and17performing17motor17activities.17They17may17even17experience1
7being17rooted17to17the17spot17and17unable17to17move.17Parkinson17disease17does17not1
7typically17cause17option17A,17B,17or17D.
Client17census17is17often17used17to17determine17staffing17needs.17Which17method17of17o
btaining17census17determination17for17a17particular17unit17provides17the17best17formula17
for17determining17long-range17staffing17patterns?
,A.
Midnight17census
17B.
Oncoming17shift17census
17C.
Average17daily17census
17D.
Hourly17census17-17ans-C
Rationale:An17average17daily17census17is17determined17by17trend17data17and17takes17int
o17account17seasonal17and17daily17fluctuations,17so17it17is17the17best17method17for17dete
rmining17staffing17needs.17Options17A17and17B17provide17data17at17a17certain17point17in17
time,17and17that17data17could17change17quickly.17It17is17unrealistic17to17expect17to17obtai
n17an17hourly17census,17and17such17data17would17only17provide17information17about17a17
certain17point17in17time.
A17male17client17has17just17undergone17a17laryngectomy17and17has17a17cuffed17tracheos
tomy17tube17in17place.17When17initiating17bolus17tube17feedings17postoperatively,17when
17should17the17nurse17inflate17the17cuff?
A.
Immediately17after17feeding
17B.
Just17prior17to17tube17feeding
17C.
Continuous17inflation17is17required
17D.
Inflation17is17not17required17-17ans-B
Rationale:The17cuff17should17be17inflated17before17the17feeding17to17block17the17trachea
17and17prevent17food17from17entering17if17oral17feedings17are17started17while17a17cuffed17
tracheostomy17tube17is17in17place.17It17should17remain17inflated17throughout17the17feedin
g17to17prevent17aspiration17of17food17into17the17respiratory17system.17Options17A17and17
D17place17the17client17at17risk17for17aspiration.17Option17C17places17the17client17at17risk17
for17tracheal17wall17necrosis.
A17client17with17a17nasogastric17tube17attached17to17low17suction17states17that17she17is17
nauseated.17The17nurse17assesses17that17there17has17been17no17drainage17through17th
e17nasogastric17tube17in17the17last17217hours.17Which17action17should17the17nurse17take1
7first?
A.
Irrigate17the17nasogastric17tube17with17sterile17normal17saline.
17B.
Reposition17the17client17on17her17side.
17C.
Advance17the17nasogastric17tube17517cm.
17D.
Administer17an17intravenous17antiemetic17as17prescribed.17-17ans-B
, Rationale:The17immediate17priority17is17to17determine17if17the17tube17is17functioning17cor
rectly,17which17would17then17relieve17the17client's17nausea.17The17least17invasive17interv
ention,17repositioning17the17client,17should17be17attempted17first,17followed17by17options1
7A17and17C,17unless17either17of17these17interventions17is17contraindicated.17If17these17m
easures17are17unsuccessful,17the17client17may17require17option17D.
The17nurse17is17conducting17an17osteoporosis17screening17clinic17at17a17health17fair.17W
hat17information17should17the17nurse17provide17to17individuals17who17are17at17risk17for17o
steoporosis?17(Select17all17that17apply.)
A.
Encourage17alcohol17and17smoking17cessation.
17B.
Suggest17supplementing17diet17with17vitamin17E.
17C.
Promote17regular17weight-bearing17exercises.
17D.
Implement17a17home17safety17plan17to17prevent17falls.
17E.
Propose17a17regular17sleep17pattern17of17817hours17nightly.17-17ans-A,17C,17D
Rationale:Options17A,17C,17and17D17are17factors17that17decrease17the17risk17for17develo
ping17osteoporosis.17Vitamin17D17and17calcium17are17important17supplements17to17aid17i
n17the17decrease17of17bone17loss.17Regular17sleep17patterns17are17important17to17overall
17health17but17are17not17identified17with17a17decreasing17risk17for17osteoporosis.
Which17nursing17action17would17be17appropriate17for17a17client17who17is17newly17diagno
sed17with17Cushing17syndrome?
A.
Monitor17blood17glucose17levels17daily.
17B.
Increase17intake17of17fluids17high17in17potassium.
17C.
Encourage17adequate17rest17between17activities.
17D.
Offer17the17client17a17sodium-enriched17menu.17-17ans-A
Rationale:Cushing17syndrome17results17from17a17hypersecretion17of17glucocorticoids17in
17the17adrenal17cortex.17Clients17with17Cushing17syndrome17often17develop17diabetes17
mellitus.17Monitoring17of17serum17glucose17levels17assesses17for17increased17blood17glu
cose17levels17so17that17treatment17can17begin17early.17A17common17finding17in17Cushing
17syndrome17is17generalized17edema.17Although17potassium17is17needed,17it17is17genera
lly17obtained17from17food17intake,17not17by17offering17potassium-
enhanced17fluids.17Fatigue17is17usually17not17an17overwhelming17factor17in17Cushing17sy
ndrome,17so17an17emphasis17on17the17need17for17rest17is17not17indicated.17A17low-
calorie,17low-carbohydrate,17low-sodium17diet17is17not17recommended.
A1758-year-
old17client17who17has17no17health17problems17asks17the17nurse17about17receiving17the17
QUESTIONS AND ANSWERS
The17nurse17is17assessing17a17client17with17acute17pancreatitis.17Which17finding17require
s17the17most17immediate17intervention17by17the17nurse?
A.17
The17client's17amylase17level17is17three17times17higher17than17the17normal17level.
17B.
The17client17has17a17carpal17spasm17when17taking17a17blood17pressure.
17C.
On17a17117to171017scale,17the17client17tells17the17nurse17that17her17epigastric17pain17is17a
t177.
17D.
The17client17states17that17she17will17continue17to17drink17alcohol17after17going17home.17-
17ans-B
The17nurse17is17assessing17a17client17with17acute17pancreatitis.17Which17finding17require
s17the17most17immediate17intervention17by17the17nurse?
Rationale:A17positive17Trousseau17sign17indicates17hypocalcemia17and17always17require
s17further17assessment17and17intervention,17regardless17of17the17cause17(40%17to1775%
17of17those17with17acute17pancreatitis17experience17hypocalcemia,17which17can17have17s
erious,17systemic17effects).17A17key17diagnostic17finding17of17pancreatitis17is17serum17a
mylase17and17lipase17levels17that17are17two17to17five17times17higher17than17the17normal1
7value.17Severe17boring17pain17is17an17expected17symptom17for17this17diagnosis,17but17d
ealing17with17the17hypocalcemia17is17a17priority17over17administering17an17analgesic.17L
ong-
term17planning17and17teaching17do17not17have17the17same17immediate17importance17as1
7a17positive17Trousseau17sign.
A1755-year-
old17male17client17has17been17admitted17to17the17hospital17with17a17medical17diagnosis17
of17chronic17obstructive17pulmonary17disease17(COPD).17Which17risk17factor17is17the17m
ost17significant17in17the17development17of17this17client's17COPD?
A.
The17client's17father17was17diagnosed17with17COPD17in17his1750s.
17B.
A17close17family17member17contracted17tuberculosis17last17year.
17C.
The17client17smokes17one17to17two17packs17of17cigarettes17per17day.
17D.
,The17client17has17been174017pounds17overweight17for171517years.17-17ans-C
Rationale:Smoking,17considered17to17be17a17modifiable17risk17factor,17is17the17most17sig
nificant17risk17factor17for17the17development17of17COPD.17The17exact17mechanism17of17
genetic17and17hereditary17implications17for17the17development17of17COPD17is17still17und
er17investigation,17although17exposure17to17similar17predisposing17factors17(e.g.,17smoki
ng17or17inhaling17secondhand17smoke)17may17increase17the17likelihood17of17COPD17inci
dence17among17family17members.17Options17B17and17D17do17not17exceed17the17risks17a
ssociated17with17cigarette17smoking17in17the17development17of17COPD.
In17assessing17a17client17diagnosed17with17primary17aldosteronism,17the17nurse17expect
s17the17laboratory17test17results17to17indicate17a17decreased17serum17level17of17which17s
ubstance?
A.
Sodium
17B.
Phosphate
17C.
Potassium
17D.
Glucose17-17ans-C
Rationale:Clients17with17primary17aldosteronism17exhibit17a17profound17decline17in17seru
m17levels17of17potassium;17hypokalemia;17hypertension17is17the17most17prominent17and1
7universal17sign.17The17serum17sodium17level17is17normal17or17elevated,17depending17on
17the17amount17of17water17resorbed17with17the17sodium.17Option17B17is17influenced17by17
parathyroid17hormone17(PTH).17Option17D17is17not17affected17by17primary17aldosteronis
m.
The17nurse17is17completing17an17admission17interview17for17a17client17with17Parkinson17
disease.17Which17question17will17provide17additional17information17about17manifestation
s17that17the17client17is17likely17to17experience?
A.
"Have17you17ever17experienced17any17paralysis17of17your17arms17or17legs?"
17B.
"Do17you17have17frequent17blackout17spells?"
17C.
"Have17you17ever17been17frozen17in17one17spot,17unable17to17move?"
17D.
"Do17you17have17headaches,17especially17ones17with17throbbing17pain?"17-17ans-C
Rationale:Clients17with17Parkinson17disease17frequently17experience17difficulty17in17initia
ting,17maintaining,17and17performing17motor17activities.17They17may17even17experience1
7being17rooted17to17the17spot17and17unable17to17move.17Parkinson17disease17does17not1
7typically17cause17option17A,17B,17or17D.
Client17census17is17often17used17to17determine17staffing17needs.17Which17method17of17o
btaining17census17determination17for17a17particular17unit17provides17the17best17formula17
for17determining17long-range17staffing17patterns?
,A.
Midnight17census
17B.
Oncoming17shift17census
17C.
Average17daily17census
17D.
Hourly17census17-17ans-C
Rationale:An17average17daily17census17is17determined17by17trend17data17and17takes17int
o17account17seasonal17and17daily17fluctuations,17so17it17is17the17best17method17for17dete
rmining17staffing17needs.17Options17A17and17B17provide17data17at17a17certain17point17in17
time,17and17that17data17could17change17quickly.17It17is17unrealistic17to17expect17to17obtai
n17an17hourly17census,17and17such17data17would17only17provide17information17about17a17
certain17point17in17time.
A17male17client17has17just17undergone17a17laryngectomy17and17has17a17cuffed17tracheos
tomy17tube17in17place.17When17initiating17bolus17tube17feedings17postoperatively,17when
17should17the17nurse17inflate17the17cuff?
A.
Immediately17after17feeding
17B.
Just17prior17to17tube17feeding
17C.
Continuous17inflation17is17required
17D.
Inflation17is17not17required17-17ans-B
Rationale:The17cuff17should17be17inflated17before17the17feeding17to17block17the17trachea
17and17prevent17food17from17entering17if17oral17feedings17are17started17while17a17cuffed17
tracheostomy17tube17is17in17place.17It17should17remain17inflated17throughout17the17feedin
g17to17prevent17aspiration17of17food17into17the17respiratory17system.17Options17A17and17
D17place17the17client17at17risk17for17aspiration.17Option17C17places17the17client17at17risk17
for17tracheal17wall17necrosis.
A17client17with17a17nasogastric17tube17attached17to17low17suction17states17that17she17is17
nauseated.17The17nurse17assesses17that17there17has17been17no17drainage17through17th
e17nasogastric17tube17in17the17last17217hours.17Which17action17should17the17nurse17take1
7first?
A.
Irrigate17the17nasogastric17tube17with17sterile17normal17saline.
17B.
Reposition17the17client17on17her17side.
17C.
Advance17the17nasogastric17tube17517cm.
17D.
Administer17an17intravenous17antiemetic17as17prescribed.17-17ans-B
, Rationale:The17immediate17priority17is17to17determine17if17the17tube17is17functioning17cor
rectly,17which17would17then17relieve17the17client's17nausea.17The17least17invasive17interv
ention,17repositioning17the17client,17should17be17attempted17first,17followed17by17options1
7A17and17C,17unless17either17of17these17interventions17is17contraindicated.17If17these17m
easures17are17unsuccessful,17the17client17may17require17option17D.
The17nurse17is17conducting17an17osteoporosis17screening17clinic17at17a17health17fair.17W
hat17information17should17the17nurse17provide17to17individuals17who17are17at17risk17for17o
steoporosis?17(Select17all17that17apply.)
A.
Encourage17alcohol17and17smoking17cessation.
17B.
Suggest17supplementing17diet17with17vitamin17E.
17C.
Promote17regular17weight-bearing17exercises.
17D.
Implement17a17home17safety17plan17to17prevent17falls.
17E.
Propose17a17regular17sleep17pattern17of17817hours17nightly.17-17ans-A,17C,17D
Rationale:Options17A,17C,17and17D17are17factors17that17decrease17the17risk17for17develo
ping17osteoporosis.17Vitamin17D17and17calcium17are17important17supplements17to17aid17i
n17the17decrease17of17bone17loss.17Regular17sleep17patterns17are17important17to17overall
17health17but17are17not17identified17with17a17decreasing17risk17for17osteoporosis.
Which17nursing17action17would17be17appropriate17for17a17client17who17is17newly17diagno
sed17with17Cushing17syndrome?
A.
Monitor17blood17glucose17levels17daily.
17B.
Increase17intake17of17fluids17high17in17potassium.
17C.
Encourage17adequate17rest17between17activities.
17D.
Offer17the17client17a17sodium-enriched17menu.17-17ans-A
Rationale:Cushing17syndrome17results17from17a17hypersecretion17of17glucocorticoids17in
17the17adrenal17cortex.17Clients17with17Cushing17syndrome17often17develop17diabetes17
mellitus.17Monitoring17of17serum17glucose17levels17assesses17for17increased17blood17glu
cose17levels17so17that17treatment17can17begin17early.17A17common17finding17in17Cushing
17syndrome17is17generalized17edema.17Although17potassium17is17needed,17it17is17genera
lly17obtained17from17food17intake,17not17by17offering17potassium-
enhanced17fluids.17Fatigue17is17usually17not17an17overwhelming17factor17in17Cushing17sy
ndrome,17so17an17emphasis17on17the17need17for17rest17is17not17indicated.17A17low-
calorie,17low-carbohydrate,17low-sodium17diet17is17not17recommended.
A1758-year-
old17client17who17has17no17health17problems17asks17the17nurse17about17receiving17the17
