HESI RN
HESI RN Med Surg Questions
Extract:
Question 1 of 5
While assisting a client to the toilet, the client begins to have a seizure and the nurse eases the client to the floor. The nurse calls for help and monitors the client until the seizing stops. Which intervention should the nurse implement first?
Correct Answer: A
Rationale: Prolonged apnea during a seizure can lead to hypoxia or cardiac arrest, making it the priority to monitor to ensure respiratory status and client safety post-seizure.
Question 2 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 3 of 5
The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?
Correct Answer: C
Rationale: Projectile vomiting is a hallmark of pyloric stenosis, indicated by the olive-like mass. Other symptoms are less specific or unrelated.
Question 4 of 5
A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?
Correct Answer: A
Rationale: Elevated rheumatoid factor is an autoantibody indicating the autoimmune nature of rheumatoid arthritis, confirming the disease process, not necessarily its severity or organ involvement.
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.