HESI RN
HESI RN Med Surg Questions
Extract:
Question 1 of 5
The clinic nurse receives a call from a parent of a 10-year-old who reports that their child just returned from summer camp and has developed an expanding circular red rash on the arm. The parent asks the nurse which over-the-counter (OTC) product is safe to use. How should the nurse respond?
Correct Answer: D
Rationale: An expanding circular rash may indicate Lyme disease, requiring urgent medical evaluation. OTC products may be ineffective or harmful.
Question 2 of 5
After administering varicella vaccine to a five-year-old child, which instruction should the nurse provide the child's parent?
Correct Answer: A
Rationale: Applying a cool pack reduces discomfort at the injection site. Other instructions are incorrect or unnecessary.
Question 3 of 5
The healthcare provider prescribes diazepam 8 mg IM every 4 hours PRN muscle spasms for a client with a fractured femur. The available vial is labeled, 'Diazepam Injection, USP 10 mg/2 mL.' How many mL should the nurse administer to the client? (Enter numerical value only. If rounding is required round to the nearest tenth.)
Correct Answer: 1.6 mL
Rationale: The vial provides 5 mg/mL (10 mg/2 mL). For an 8 mg dose, the nurse should administer 1.6 mL (8 mg ÷ 5 mg/mL), calculated to meet the prescribed dose.
Question 4 of 5
A client who had a biliopancreatic diversion procedure (BDP) 3 months ago is admitted with severe dehydration. Which assessment finding warrants immediate intervention by the nurse?
Correct Answer: B
Rationale: Occult positive emesis indicates vomiting, which can exacerbate dehydration through significant fluid loss, requiring immediate intervention in a post-BDP client already dehydrated.
Question 5 of 5
Lactulose was prescribed two days ago for a client who was recently diagnosed with hepatic encephalopathy. The client is confused and experiencing frequent loose stools. Laboratory findings show an elevated serum ammonia (NH) level of 220 μg/dL (157.1 μmol/dL). Which action should the nurse take?
Correct Answer: B
Rationale: Lactulose reduces ammonia levels by promoting its excretion, and the elevated ammonia level indicates the need to continue therapy. Loose stools are an expected effect, and continuing the dose addresses the underlying hepatic encephalopathy.