HESI RN Med-Surg Exam

HESI RN Med-Surg Exam

VERSION 15

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• A nurse in the emergency department is assessing a client. Which of the following actions

should the nurse take first (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)

• Obtain a sputum sample for culture

• Prepare the client for a chest x-ray

• Initiate airborne precautions

• Administer ondansetron.

Rationale: No idea what the Exhibit is all about; won’t be able to answer

it.

• A nurse is contacting the provider for a client who has cancer and is experiencing

breakthrough pain. Which of the following prescriptions should the nurse anticipate?

• Transmucosal fentanyl

• Intramuscular meperidine

• Oral acetaminophen

• Intravenous dexamethasone

Rationale: ATI pg. 27 Morphine sulfate and fentanyl are opioid

agents used to treat moderate to severe pain. A short-acting pain medication is administered for breakthrough pain.

• A nurse is admitting a client who reports chest pain and has been placed on a telemetry

monitor. Which of the following should the nurse analyze to determine whether the client is experiencing a myocardial infarction?

• PR interval

• QRS duration

• T wave 2 / 4

• ST segment

Rationale: ST elevation indicates MI. ST depression indicates ischemia

• A nurse is teaching a client who has ovarian cancer about skin care following radiation

treatment. Which of the following instructions should the nurse include?

• Pat the skin on the radiation site to dry it

• Apply OTC moisturizer to the radiation site

• Cover the radiation site loosely with a gauze wrap before dressing

• Use a soft washcloth to clean the area around the radiation site

Rationale: pg. 584. Dry the area thoroughly using patting motions.

• A nurse is caring for a client who is receiving a blood transfusion. The nurse observes

that the client has bounding peripheral pulses, hypertension, and distended jugular veins.The nurse should anticipate administering which of the following prescribed medications?

• Diphenhydramine

• Acetaminophen

• Pantoprazole

• Furosemide

Rationale: S/S may indicate fluid retention or heart failure. It is

important to administer diuretics to prevent cardiovascular/respiratory distress.

• A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of

hypomagnesemia. Which of the following findings indicates effectiveness of the medication?

• Lungs clear

• Apical pulse 82/min

• Hyperactive bowel sounds 3 / 4

• Blood pressure 90/50 mm Hg

Rationale: pg. 278 Confirmed on answer sheet

A nurse is reviewing a client’s ABG results pH 7.42, PaC02 30 mm Hg, and HCO3 21 mEq/L. The nurse should recognize these findings as indication of which of the following conditions?

• Metabolic acidosis

• Metabolic alkalosis

• Compensated respiratory alkalosis

• Uncompensated respiratory acidosis

Rationale: because the HCO3 21 trying to compensate for respiratory

alkalosis.

A nurse is caring for a client who has a deep partial thickness burns over 15% of her body which of the following labs should the nurse expect during the first 24 hours Decreased BUN (elevated due to fluid loss) Hypoglycemia (High due to stress) Hypoalbuminemia (Low due to fluid loss)

• Decreased Hematocrit (Elevated due to 3rd spacing during resuscitation

phase)

Rationale: Pg. 481 ATI. Total protein and albumin- low due to fluid loss.

A nurse is caring for a client who has dumping syndrome following a gastrectomy, which of the following actions should the nurse takes?

• Offer the client high carbohydrate meal options (High fat, high protein, low fiber, low to

moderate carbs page 317, chapter 49 Peptic ulcer disease med surg ATI PDF 10.0)

• Provide the client with four full meals a day (Small frequent meals)
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