HESI RN
HESI RN Med Surg Questions
Extract:
Question 1 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 2 of 5
A preschool-aged child who is experiencing respiratory distress is brought to the emergency department by the parents. The child is anxious, has a temperature of 102.8° F (39.3° C), and is drooling from the mouth while leaning forward when sitting. Which action should the nurse prepare the child for next?
Correct Answer: C
Rationale: Symptoms suggest epiglottitis, requiring urgent intubation or tracheotomy to secure the airway. Other actions are not immediate priorities.
Question 3 of 5
The parents of a child with acute lymphoblastic leukemia (ALL) are learning to care for their child at home. Which statement made by the parents should the nurse recognize as correct monitoring for early signs of an infection in the child?
Correct Answer: C
Rationale: Notifying for a temporal temperature above 100°F is accurate and timely for detecting infections in ALL. Other methods are less reliable or risky.
Question 4 of 5
The nurse is caring for a client receiving thrombolytic therapy following an acute myocardial infarction (MI). Which nursing problem should the nurse identify as priority for this client?
Correct Answer: A
Rationale: Thrombolytic therapy increases bleeding risk, making the risk for injury due to bleeding the priority, as it can lead to severe complications like hemorrhage, requiring immediate monitoring and intervention.
Question 5 of 5
A preschool-age boy in a daycare facility scratches his head frequently, and the nurse confirms the presence of head lice. The nurse washes the child's hair with permethrin shampoo and calls his parents. Which instruction should the nurse provide to the parents about treatment for head lice?
Correct Answer: C
Rationale: Washing linens and clothing in hot water kills lice and eggs, preventing reinfestation. Other instructions are ineffective or unnecessary.