HESI RN
HESI RN Medical Surgical Exam I Questions
Extract:
Question 1 of 5
The healthcare provider prescribes 100 mL of 0.9% normal saline to be infused within 15 minutes. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)
Correct Answer: A
Rationale: Calculation: 100 mL ÷ 0.25 hours (15 minutes) = 400 mL/hr.
Question 2 of 5
The healthcare provider (HCP) prescribes diazepam 8 mg IM every 4 hours PRN for 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: A
Rationale: Calculation: 10 mg/2 mL = 0.2 mL/mg, 8 mg × 0.2 mL/mg = 1.6 mL.
Extract:
Vital Signs
Nurses' Notes
History and Physical
Orders
1030
• Temperature: 99.8°F
• Heart rate: 98 beats/minute
• Respirations: 20 breaths/minute
• Blood pressure: 178/89 mmHg
• Oxygen saturation: 96% on room air
Question 3 of 5
Complete the diagram by choosing from the choices below to specify which condition the client is most likely experiencing, two actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the client's progress.
| Hypoglycemia |
| Hemorrhagic stroke |
| Urinary tract infection |
| Transient ischemic stroke |
| Actions to take Choices A. Start administering 0.9% sodium chloride IV at a rate of 100 ml/hr B. Administer oxygen at 2 l/min via nasal cannula C. Request a prescription to administer the client's home medication of aspirin D. Request a prescription for a computerized tomography (CT) scan of the client's head and neck E. Perform a National Institute of Health Stroke Scale (NIHSS) assessment |
| Parameters to Monitor Choices A. Neurological status B. Respiratory rate C. Blood pressure D. Urine output E. Oxygen saturation |
Correct Answer: D
Rationale: Condition: Transient ischemic stroke (
D). Actions: Request CT scan (
D), perform NIHSS assessment (E). Parameters: Neurological status (
A), blood pressure (
C).
Rationale: Symptoms and history suggest TIA, requiring imaging and neurological monitoring.
Extract:
Nurse's Notes
History and Physical
Orders
Vital Signs
Laboratory Results
Day 2, 0730:
Tolerated the surgical procedure well and has been stable since surgery.
Day 3, 0700:
Client is postoperative below-the-knee amputation of the right leg, sitting up with the right residual limb hanging off the bed. Morphine on demand in the left hand area; there is no redness or drainage at the site, with 50 mL per hour infusing. Assessment.
Exhibits
Data is evaluated to determine possible condition and appropriate interventions. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.
Question 4 of 5
Data is evaluated to determine possible condition and appropriate interventions. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
| Surgical rash. |
| Contractures. |
| Postoperative infection. |
| Deep vein thrombosis (DVT). |
| Actions to take Choices A. Culture wound drainage. B. Request NPO prescription. C. Administer prescribed antibiotics. D. Elevate residual limb to reduce swelling. E. Educate on incentive spirometer use. |
| Parameters to monitor Choices A. Adherence to activity prescription. B. Temperature. C. White blood cell count. D. Residual limb redness or swelling. E. Pain intensity and characteristics. |
Correct Answer: C
Rationale: Condition: Postoperative infection (
C). Actions: Administer antibiotics (
C), culture wound drainage (
A). Parameters: Temperature (
B), white blood cell count (
C).
Rationale: Elevated WBC and temperature suggest infection, requiring antibiotics and monitoring.
Extract:
History and Physical
A 34-year-old male client presents to the emergency department (ED) for an asthma attack that began after jogging through a local park. The client is able to answer questions every few words to catch his breath. He reports using his rescue inhaler three times, but he couldn't catch his breath. He reports that his symptoms are worse when outdoors and when exercising, and episodes like this make him extremely nervous. He says that it has been a couple of months since his last asthma attack, and he came to the ED today because he noticed his inhaler was expired and was worried the medication was not working.
Question 5 of 5
The nurse reviews the client's history of the presenting illness in the electronic medical record. Highlight the pieces of key subjective data which indicate the client is in need of health interventions.
Correct Answer: A,B,C
Rationale: Key data: difficulty speaking, ineffective inhaler use, and expired inhaler indicate severe asthma requiring intervention.