HESI RN
HESI RN Med Surg Questions
Extract:
Question 1 of 5
The nurse calls the healthcare provider because a client diagnosed with an abdominal aortic aneurysm (AAA) is reporting low back pain. Which additional information about the client would be important for the nurse to tell the healthcare provider?
Correct Answer: B
Rationale: Low back pain in AAA may suggest aneurysm expansion or rupture. Hematocrit and blood pressure indicate potential bleeding or hemodynamic instability, critical for the provider's assessment.
Question 2 of 5
A school-aged child is admitted to the hospital with a diagnosis of acute rheumatic fever. In obtaining a health history from the child's parent, the recent occurrence of which illness is most significant?
Correct Answer: B
Rationale: A recent sore throat, often caused by group A streptococcus, is the primary trigger for acute rheumatic fever if untreated. Other illnesses are not linked.
Question 3 of 5
After initiating a steroid nebulizer treatment for a client with asthma in respiratory distress, which intervention is most important for the nurse to implement?
Correct Answer: C
Rationale: Elevating the head of the bed to 90 degrees improves lung expansion and breathing mechanics, critical for a client in respiratory distress, addressing immediate respiratory needs.
Question 4 of 5
A client with a cervical spinal injury (C7) is experiencing autonomic dysreflexia. The nurse should first assess the client for which precipitating factor?
Correct Answer: A
Rationale: Autonomic dysreflexia is often triggered by a distended bladder, which sends signals to the spinal cord that cannot pass the injury level, causing uncontrolled sympathetic activation. Assessing for this common precipitating factor is the priority to address the underlying cause.
Question 5 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.