RN Medical Surgical Hesi Exam | Nurselytic

Questions 38

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RN Medical Surgical Hesi Exam Questions

Extract:


Question 1 of 5

A client with a closed head injury demonstrates signs of syndrome of inappropriate antidiuretic hormone (SIADH). Which additional finding should the nurse expect to obtain?

Correct Answer: A

Rationale: Weight gain of 2 pounds (0.91 kg) in one day is a sign of fluid retention, which occurs in SIADH due to excessive secretion of antidiuretic hormone (ADH). ADH causes the kidneys to reabsorb water and reduce urine output, leading to hyponatremia and hypervolemia.

Question 2 of 5

While completing a health assessment for a young adult female with acute appendicitis, the client informs the nurse that there is a chance that she may be pregnant. The operating team is preparing to take the client to surgery. Which intervention should the nurse implement immediately?

Correct Answer: A

Rationale: Performing a bedside pregnancy test is critical to confirm or rule out pregnancy, as surgery could pose risks to the fetus, informing the surgical team's approach.

Question 3 of 5

Following a motor vehicle accident, a client with chest trauma receives a chest tube to relieve a hemothorax. Two hours following the chest tube insertion, the nurse observes the water level in the water-seal chamber is rising during inspiration and falling during expiration. Which action should the nurse implement?

Correct Answer: C

Rationale: Continuing to monitor the drainage system is the best action for the nurse to implement, as the water level fluctuations are normal and expected in a water-seal drainage system. The water level should rise during inspiration and fall during expiration, reflecting the changes in intrathoracic pressure.

Extract:

History and physical
Flow sheet
Nurses’ Notes
Imaging studies 1935
A 70-year-old female presents to the emergency department through triage with a noticeable facial droop and garbled speech. After having a few drinks at a local seafood restaurant, the patient’s husband noticed his wife’s speech became difficult to understand


Question 4 of 5

Specify which findings indicate early interventions for an ischemic stroke were effective? Focused assessment area: Neurological, Muscoskeletal, Psychosocial

Neurological: Drinks with repetitive cough, Speaks in short sentences, Decorticate posturing; Muscoskeletal: Flaccidity of left arm, Ambulates with a walker, Passive range of motion on left leg; Psychosocial: Fits of laughter, Tearful sharing of stories, Angry outburst
Neurological: Speaks in short sentences; Muscoskeletal: Ambulates with a walker; Psychosocial: Tearful sharing of stories

Correct Answer: B,B,B

Rationale: Neurological: Speaking in short sentences indicates improved speech from garbled to intelligible. Muscoskeletal: Ambulating with a walker shows regained mobility. Psychosocial: Tearful sharing of stories reflects normal emotional expression and preserved memory, indicating effective early interventions.

Extract:


Question 5 of 5

After performing a head-to-toe assessment for a client with Addison's disease, the nurse reports findings to the healthcare provider. The findings include moist mucous membranes, strong palpable peripheral pulses, and blood pressure 132/88 mm Hg. The client verbalizes understanding of the illness and importance of taking medications every day. Which action should the nurse implement?

Correct Answer: C

Rationale: Preparing the client for discharge home is the best action for the nurse to implement, as the client has no signs of complications or deterioration from Addison's disease. The client should be able to manage the condition at home with regular follow-up and medication adherence.

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