HESI RN
HESI RN Med Surg Questions
Extract:
Question 1 of 5
A client with draining skin lesions of the lower extremity is admitted with possible methicillin resistant Staphylococcus aureus (MRSA). What nursing intervention(s) should the nurse include in the plan of care? Select all that apply.
Correct Answer: A,C,E
Rationale: Standard precautions with a mask, culturing wound drainage for MRSA confirmation, and contact precautions prevent transmission and guide treatment, critical for managing potential MRSA infections.
Question 2 of 5
A client presents with the onset of a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. The nurse recognizes the client is exhibiting symptoms of which condition?
Correct Answer: A
Rationale: Severe headache, fever, nuchal rigidity, and petechial rash are classic symptoms of meningococcal meningitis, caused by Neisseria meningitidis, requiring urgent recognition and treatment.
Question 3 of 5
The nurse is caring for a client who had a cholecystectomy two days ago. The client is febrile, reporting upper abdominal pain radiating to the back, and has had three episodes of vomiting in the last 8 hours. The nurse reviews the client's serum amylase and lipase level results which are twice the normal value. Based on these findings, the nurse should recognize the client is exhibiting symptoms of which condition?
Correct Answer: B
Rationale: Elevated amylase and lipase with fever, vomiting, and upper abdominal pain radiating to the back indicate acute pancreatitis, a potential post-cholecystectomy complication.
Question 4 of 5
A client with chronic kidney disease on peritoneal dialysis exhibits redness, tenderness, and drainage around the catheter site on the abdominal wall. While planning care, the nurse is most concerned about preventing which complication related to these findings?
Correct Answer: B
Rationale: Redness, tenderness, and drainage suggest an exit site infection, a common peritoneal dialysis complication, which must be prevented to avoid progression to peritonitis.
Question 5 of 5
A client is hospitalized with an inflammatory bowel disease (IBD) exacerbation and is being treated with a corticosteroid. The client develops a rigid abdomen with rebound tenderness. Which action should the nurse take?
Correct Answer: D
Rationale: A rigid abdomen with rebound tenderness suggests a surgical emergency like bowel perforation. Obtaining vital signs assesses hemodynamic stability, guiding urgent intervention.