HESI RN Med Surg | Nurselytic

Questions 176

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HESI RN Med Surg Questions

Extract:


Question 1 of 5

A 1-year-old child with respiratory syncytial virus (RSV) is admitted to the pediatric unit. The nurse observes that the child presents with a fever, rhinorrhea, frequent coughing, and sneezing. Which additional finding should alert the nurse that the child is in acute respiratory distress?

Correct Answer: A

Rationale: Nasal flaring indicates increased work of breathing, a sign of acute respiratory distress. Other findings are normal or unrelated.

Question 2 of 5

The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?

Correct Answer: A

Rationale: A high-pitched sound (stridor) upon inspiration suggests airway obstruction, a life-threatening emergency requiring immediate action to ensure airway patency and adequate oxygenation post-surgery.

Question 3 of 5

An infant born 2 days ago has not passed a meconium stool and begins to vomit bilious secretions. Which action should the nurse take first?

Correct Answer: B

Rationale: Gathering IV supplies addresses the risk of dehydration and shock from vomiting and possible bowel obstruction, which is the priority. Other actions are less urgent.

Extract:

History and Physical
Nurses’ Notes
Flow sheet
Orders
Imaging Studies
A 19-year-old female client presents to the emergency department reporting tightness in her chest and difficulty breathing. The client's friend, who accompanied the client to the emergency department, reports she was at a park playing soccer with a group of college friends when the symptoms started. The park is close to a residential area where a fire was burning and there was a moderate breeze in the air. The client reported itching eyes and coughing. Approximately 15 minutes into the game, the client stopped running and held her hand on her chest, saying it felt tight. The client had difficulty catching her breath.
Home Medications
Albuterol/ipratropium every 4 hours by inhaler PRN for shortness of breath, last dose 2 days ago
Fluticasone/vilanterol 100/25 mcg inhaled daily, last dose 3 days ago
Ibuprofen 600 mg PO PRN for pain, last dose this morning for headache


Question 4 of 5

What finding(s) are cues for a respiratory problem? Select all that apply.

Correct Answer: A,B,D,E,F,G

Rationale: Sitting upright, chest tightness, tachypnea, restlessness, dyspnea, and low pulse oxygenation (85%) are direct indicators of respiratory distress, unlike medication compliance which is not a symptom.

Extract:


Question 5 of 5

The nurse is admitting a client with possible tuberculosis (TB). The client is placed in a private room with airborne precautions pending diagnostic test results. Which diagnostic test should the nurse review to confirm the diagnosis of TB?

Correct Answer: A

Rationale: A sputum culture positive for Mycobacterium tuberculosis is the gold standard for confirming TB diagnosis, as it directly identifies the causative bacterium, unlike other tests which may suggest but not confirm TB.

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