HESI RN
HESI RN Medical Surgical Questions
Extract:
Question 1 of 5
Methotrexate is prescribed for a client with rheumatoid arthritis (RA) who is also taking aspirin. Which is the best explanation for the nurse to provide as to why a second medication has been added?
Correct Answer: A
Rationale: Methotrexate slows the progression of rheumatoid arthritis by suppressing immune responses, while aspirin provides symptomatic relief from pain and inflammation.
Question 2 of 5
The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?
Correct Answer: C
Rationale: Uneven hair distribution, such as decreased hair growth, is indicative of compromised peripheral arterial circulation due to reduced blood flow to the area.
Extract:
History and Physical Nurses' Notes
A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue Inhaler three times, but he just couldn't catch his breath. The client reports that symptoms seem worse when outdoors and when exercising and that episodes like this make him extremely nervous. The client reports that it has been a couple of months since he had an asthma attack, and he came to the ED today because he noticed that his inhaler was expired and was worried the medication was not working.
Initial Assessment
Temperature 98.9° F (37.1° C)
Heart rate 112 beats/minute
Respirations 28 breaths/minute
Blood pressure 130/86 mm Hg
Oxygen saturation 88% on room air
Lung sounds reveal expiratory wheezes
Capillary refill time 2 seconds
Orders
Administer albuterol 2.5 mg/ipratropium bromide 0.5 mg in 3 mL solution via nebulizer four times a day and PRN.
Administer prednisone 60 mg PO
Administer oxygen to keep oxygen saturation greater than 94%, titrate as needed.
Question 3 of 5
The nurse has implemented additional needed actions. Click the assessment data which indicates the interventions were successful and which assessment data provides no indication that the interventions were successful.
| Options | Indicates the Interventions Were Successful | No Indication that the Interventions Were Successful |
|---|---|---|
| Decrease in heart rate from 112 to 105 beats per minute. | ||
| Client able to speak in full sentences without pausing. | ||
| Clear lung sounds. | ||
| Reduction in respiratory rate to 16 breaths per minute. | ||
| Client reports breathing is eased. | ||
| Blood pressure within normal limits. |
Correct Answer: A,B,C,D,E,F
Rationale: The assessment data showing decreased heart rate, ability to speak in full sentences, clear lung sounds, reduced respiratory rate, eased breathing, and stable blood pressure all indicate successful interventions for the asthma attack.
Extract:
Question 4 of 5
A client arrives to the medical-surgical unit 4 hours after a transurethral resection of the prostate (TURP). A triple-lumen catheter for continuous bladder irrigation with 0.9% sodium chloride is infusing and the nurse observes dark, pink-tinged outflow with blood clots in the tubing and collection bag. Which action should the nurse take?
Correct Answer: C
Rationale: Monitoring catheter drainage allows the nurse to assess the effectiveness of bladder irrigation and the presence of clot formation, ensuring adequate drainage.
Question 5 of 5
A client with leukemia is receiving chemotherapy. The nurse observes the client is weak, pale, and febrile. After reviewing the client's most recent laboratory data which reveals a platelet count of 25,000/mm3, which intervention should the nurse include in the plan of care?
Correct Answer: D
Rationale: Monitoring urine and stool for occult blood is crucial for thrombocytopenic patients at increased risk of bleeding, allowing early detection and management.