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 with metastatic cancer reports a pain level of 10 on a scale of 0 to 10. Twenty minutes after the nurse administers an IV analgesic, the client reports no pain relief. Which intervention is most important for the nurse to include in this client's plan of care?
Correct Answer: C
Rationale: Persistent pain despite IV analgesia suggests breakthrough pain, requiring monitoring to adjust the pain management regimen promptly, addressing exacerbations effectively.
Question 3 of 5
A school-age child with bronchial asthma has a prescription for albuterol. The child's parent tells the nurse that the medication is used when the child is having difficulty breathing. Which is the best response by the nurse?
Correct Answer: D
Rationale: Albuterol is a quick-relief bronchodilator used as needed for breathing difficulties, confirming correct use. Other responses are inaccurate or unnecessary.
Question 4 of 5
The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?
Correct Answer: C
Rationale: Projectile vomiting is a hallmark of pyloric stenosis, indicated by the olive-like mass. Other symptoms are less specific or unrelated.
Question 5 of 5
A postoperative client reports incisional pain. The client has two prescriptions for PRN analgesia that accompanied the client from the postanesthesia unit. Before selecting which medication to administer, which action should the nurse implement?
Correct Answer: B
Rationale: Comparing the pain scale rating with prescribed dosing ensures the appropriate analgesic and dose are selected based on pain severity, promoting safe and effective pain management.