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NURS 6512 HESI Med Surg Exit Exam (V1 Version 1) Created for 2022/2023 (Answers and Explanation on page 44)

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1. While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth on the client's legs. What additional assessment provides further data to support this finding? a. Pal... pate for the presence of femoral pulses bilaterally. b. Assess for the presence of a positive Homan's sign. c. Observe the appearance of the skin on the client's legs. d. Watch the client's posture and balance during ambulation. 2. The healthcare provider prescribes 15 mg/kg of Streptomycin for an infant weighing 4 pounds. The drug is diluted in 25 ml of D5W to run over 8 hours. How much Streptomycin will the infant receive? a. 9 mg. b. 18 mg. c. 27 mg. d. 36 mg. 3. In assessing a client with preeclampsia who is receiving magnesium sulfate, the nurse determines that her deep tendon reflexes are 1+; respiratory rate is 12 breaths/minute; urinary output is 90 ml in 4 hours; magnesium sulfate level is 9 mg/dl. Based on these findings, what intervention should the nurse implement? a. Continue the magnesium sulfate infusion as prescribed. b. Decrease the magnesium sulfate infusion by one-half. c. Stop the magnesium sulfate infusion immediately. d. Administer calcium gluconate immediately. 4. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective? a. The client’s expremities are paralyzed. b. The peripheral nerve stimulator causes twitching. c. The client clinches fist upon command. d. The client’s Glagow Coma Scale score is 14. 5. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report? a. Look at last quarter's hemoglobin and hematocrit, expecting an increase today due to dehydration. b. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage. c. Expect to find an increase in today's APTT as compared to last quarter's due to bleeding. d. Determine if there is a decrease in serum potassium due to renal compromise 6. Aspirin is prescribed for a 9-year-old child with rheumatic fever to control the inflammatory process, promote comfort, and reduce fever. What intervention is most important for the nurse to implement? a. Instruct the parents to hold the aspirin until the child has first had a tepid sponge bath. b. Administer the aspirin with at least two ounces of water or juice. c. Notify the healthcare provider if the child complains of ringing in the ears. d. Advise the parents to question the child about seeing yellow halos around objects. 7. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome? a. Husky voice and complaints of hoarseness. b. Warm, soft, moist, salmon-colored skin. c. Visible swelling of the neck, with no pain. d. Central-type obesity, with thin extremities. 8. A charge nurse agrees to cover another nurse’s assignment during a lunch break. Based on the status report provided by the nurse who is leaving for lunch, which client should be checked first by the charge nurse? The client a. admitted yesterday with diabetec ketoacidosis whose blood glucose level is now 195 mg/dl. b. with an ileal conduit created two days ago with a scant amount of blood in the drainage pouch. c. post-triple coronary bypass four days ago who has serosanguinous drainage in the chest tube. d. with a pneumothorax secondary to a gunshot wound with a current pulse oximeter reading of 90%. 9. An outcome for treatment of peripheral vascular disease is, "The client will have decreased venous congestion." What client behavior would indicate to the nurse that this outcome has been met? a. Avoids prolonged sitting or standing. b. Avoids trauma and irritation to skin. c. Wears protective shoes. d. Quits smoking. 10. The healthcare provider performs a paracentesis on a client with ascites and 3 liters of fluid are removed. Which assessment parameter is most critical for the nurse to monitor following the procedure? a. Pedal pulses. b. Breath sounds. c. Gag reflex. d. Vital signs. 11. The nurse is administering sevelamer (RenaGel) during lunch to a client with end stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals? a. Prevents indigestion associated with ingestion of spicy foods. b. Binds with phosphorus in foods and prevents absorption. c. Promotes stomach emptying and prevents gastric reflux. d. Buffers hydrochloric acid and prevents gastric erosion. 12. The nurse formulates a nursing diagnosis of, "High risk for ineffective airway clearance" for a client with myasthenia gravis. What is the most likely etiology for this nursing diagnosis? a. Pain when coughing. b. Diminished cough effort. c. Thick dry secretions. d. Excessive inflammation. 13. Following a CVA, the nurse assess that a client developed dysphagia, hypoactive bowel sounds and firm, distended abdomen. Which prescription for the client should the nurse question? a. Continous tube feeding at 65 ml/hr via gastrostomy. b. Total parenteral nutrition to be infused at 125 ml/hour. c. Nasogastric tube connected to low intermittent suction. d. Metoclopramide (Reglan) intermittent piggyback. 14. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate? a. Bounding erratic pulse. b. Regularly irregular pulse. c. Thready irregular pulse. d. No palpable pulse. 15. In assessing a 70-year-old female client with Alzheimer's disease, the nurse notes that she has deep inflamed cracks at the corners of her mouth. What intervention should the nurse include in this client's plan of care? a. Scrub the lesions with warm soapy water. b. Encourage the client to drink orange juice for added vitamin C. c. Notify the healthcare provider of the need for oral antibiotics. d. Ensure that the client gets adequate B vitamins in foods or supplements. 16. A young adult female client is seen in the emergency department for a minor injury following a motor vehicle collision. She states she is very angry at the person who hit her car. What is the best nursing response? a. "You are lucky to be alive. Be grateful no one was killed." b. "I understand your car was not seriously damaged." c. "You are upset that this incident has brought you here." d. "Have you ever been in the emergency department before?" 17. An 85-year-old male resident of an extended care facility reaches for the hand of the unlicensed assistive personnel (UAP) and tries to kiss her hand several times during his morning care. The UAP reports the incident to the charge nurse. What is the best assessment of the situation? a. This is sexual harassment and needs to be reported to the administration immediately. b. The UAP needs to be reassigned to another group of residents, preferably females only. c. The client may be suffering from touch deprivation and needs to know appropriate ways to express his need. d. The resident needs to know the rules concerning unwanted touching of the staff and the consequences. 18. The parents of a newborn infant with hypospadias are concerned about when the surgical correction should occur. What information should the nurse provide? a. Repair should be done by one month to prevent bladder infections. b. Repairs typically should be done before the child is potty-trained. c. Delaying the repair until school age reduces castration fears. d. To form a proper urethra repair, it should be done after sexual maturity. 19. In evaluating teaching of a client about wearing a Holter monitor, which statement made by the client would indicate to the nurse that the client understands the procedure? a. “I must record any symptoms occurring with my activity.” b. “I am not looking forward to staying in bed for 24 hours.” c. “I really am dreading the frequent blood drawing.” d. “I know that I shouldn’t get close to my microwave oven.” 20. A 9-year-old female client was recently diagnosed with diabetes mellitus. Which symptom will her parents most likely report? a. Refuses to eat her favorite meals at home. b. Drinks more soft drinks than previously. c. Voids only one or two times per day. d. Gained 10 pounds within one month. 21. The nurse is caring for four clients: Client A, who has emphysema and whose oxygen saturation is 94%; Client B, with a postoperative hemoglobin of 8.7 mg/dl; Client C, newly admitted with a potassium level of 3.8 mEq/L; and Client D, scheduled for an appendectomy who has a white blood cell count of 15,000 mm3. What intervention should the nurse implement? a. Increase Client A's oxygen to 4 liters per minute via nasal cannula. b. Determine if Client B has two units of packed cells available in the blood bank. c. Ask the dietician to add a banana to Client C's breakfast tray. d. Inform Client D that surgery is likely to be delayed until the infection is treated. 22. A recently widowed middle-aged female client presents to the psychiatric clinic for evaluation and tells the nurse that she has "little reason to live." She describes one previous suicidal gesture and admits to having a gun in her home. To maintain the client's confidentiality and to help ensure her safety, which action is best for the nurse to implement? a. Encourage the client to remove the gun from her possession. b. Notify the client's healthcare provider of the availability of the weapon. c. Contact a person of the client's choosing to remove the weapon from the home. d. Call the local police department and have the weapon removed from the home. 23. It is most important for the registered nurse (RN) who is working on a medical unit to provide direct supervision in which situation? a. A graduate nurse needs to access a client's implanted port to start an infusion of Ringer's Lactate. b. A postpartum nurse pulled to the unit needs to start a transfusion of packed red blood cells. c. A practical nurse is preparing to assist the healthcare provider with a lumbar puncture at the bedside. d. An unlicensed assistive personnel is preparing to weigh an obese bedfast client using a bed scale. 24. A nurse is completing the health history for a 25-year-old male client who reports that he is allergic to penicillin. Which question should the nurse ask after receiving this information? a. "Are you allergic to any other medications?" b. "How often have you taken penicillin in the past?" c. "Is anyone else in your family allergic to penicillin?" d. "What happens to you when you take penicillin?" 25. A 10-year-old child with meningitis is suspected of having diabetes insipidus. In evaluating the child's laboratory values, which finding is indicative of diabetes insipidus? a. Decreased urine specific gravity. b. Elevated urine glucose. c. Decreased serum potassium. d. Increased serum sodium. 26. A client with myelogenous leukemia is receiving an autologous bone marrow transplantation (BMT). What is the priority intervention that the nurse should implement when the bone marrow is repopulating? a. Administer sargramostim (Leukine, Prokine). b. Infuse PRBC and platelet transfusions. c. Give parental prophylactic antibiotics. d. Maintain a protective isolation environment. 27. A 38-year-old male client collapsed at his outside construction job in Texas in July. His admitting vital signs to ICU are, BP 82/70, heart rate 140 beats/minute, urine output 10 ml/hr, skin cool to the touch. Pulmonary artery (PA) pressures are, PAWP 1, PAP 8/2, RAP -1, SVR 1600. What nursing action has the highest priority? a. Apply a hypothermia b. unit to stabilize core temperature. c. Increase the client's IV fluid rate to 200 ml/hr. d. Call the hospital chaplain to counsel the family. e. Draw blood cultures x 3 to detect infection. 28. A client who has Type 1 diabetes and is at 10-weeks gestation comes to the prenatal clinic complaining of a headache, nausea, sweating, feeling shaky, and being tired all the time. What action should the nurse take first? a. Check the blood glucose level. b. Draw blood for a Hemoglobin A1C. c. Assess urine for ketone levels. d. Provide the client with a protein snack. 29. A client in labor states, "I think my water just broke!" The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first? a. Administer oxygen via face mask. c. Notify the operating room team. b. Place the client in Trendelenburg. c. Administer a fluid bolus of 500 ml. 30. The nurse is planning care for a non-potty-trained child with nephrotic syndrome. Which intervention provides the best means of determining fluid retention? a. Weigh the child daily. b. Observe the lower extremities for pitting edema. c. Measure the child's abdominal girth weekly. d. Weigh the child's wet diapers. 31. The mother of a 9-month-old who was diagnosed with respiratory syncytial virus (RSV) yesterday calls the clinic to inquire if it will be all right to take her infant to the first birthday party of a friend's child the following day. What response should the nurse provide this mother? a. The child can be around other children but should wear a mask at all times. b. The child will no longer be contagious, no need to take any further precautions. c. Make sure there are no children under the age of 6 months around the infected child. d. Do not expose other children. RSV is very contagious even without direct oral contact. 32. A client from a nursing home is admitted with urinary sepsis and has a single-lumen, peripherally-inserted central catheter (PICC). Four medications are prescribed for 9:00 a.m. and the nurse is running behind schedule. Which medication should the nurse administer first? a. Piperacillin/tazobactam (Zosyn) in 100 ml D5W, IV over 30 minutes q8 hours. b. Vancomycin (Vancocin) 1 gm in 250 ml D5W, IV over 90 minutes q12 hours. c. Pantoprazole (Protonix) 40 mg PO daily d. Enoxaparin (Lovenox) 40 mg subq q24 hours. 33. Which action should the nurse implement to reduce the risk of vesicant extravasation in the client who is receiving intravenous chemotherapy? a. Administer an antiemetic before starting the chemotherapy. b. Instruct the client to drink plenty of fluids during the treatment. c. Keep the head of the bed elevated until the treatment is completed. d. Monitor the client's intravenous site hourly during the treatment. 34. An elderly male client reports to the clinic nurse that he is experiencing increasing nocturia with difficulty initiating his urine stream. He reports a weak urine flow and frequent dribbling after voiding. Which nursing action should be implemented? a. Obtain a urine specimen for culture and sensitivity. b. Encourage the client to schedule a digital rectal exam. c. Advise the client to maintain a voiding diary for one week. d. Instruct the client in effective techniques to cleanse the glans penis. 35. The nurse is performing an admission physical assessment of a newborn who is small for gestational age (SGA). Which finding should the nurse report immediately to the pediatric healthcare provider? a. Heel stick glucose of 65 mg/dl. b. Head circumference of 35 cm (14 inches). c. Widened, tense, bulging fontanel. d. High-pitched shrill cry. 36. Which client's laboratory value requires immediate intervention by a nurse? a. A client with GI bleeding who is receiving a blood transfusion and has a hemoglobin of 7 grams. b. A client with pancreatitis who has a fasting glucose of 190 mg/dl today and had 160 mg/dl yesterday. c. A client with hepatitis who is jaundiced and has a bilirubin level that is 4 times the normal value. d. A client with cancer who has an absolute count of neutrophils < 500 today and had 2,000 yesterday. 37. In planning the turning schedule for a bedfast client, it is most important for the nurse to consider what assessment finding? a. 4+ pitting edema of both lower extremities. b. A Braden risk assessment scale rating score of ten. c. Warm, dry skin with a fever of 100° F. d. Hypoactive bowel sounds with infrequent bowel movements. 38. The healthcare provider prescribes naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, "The pills don't seem to be working. They are not helping the pain at all." Which factor should influence the nurse's response? a. Noncompliance is probably affecting optimum medication effectiveness. b. Drug dosage is inadequate and needs to be increased to four times a day. c. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream. d. NSAID response is variable and another NSAID may be more effective. 39. A nurse is interested in studying the incidence of infant death in a particular city and wants to compare that city's rate to the state's rate. What state resource is most likely to provide this information? a. Disease registry. b. Department of Health. c. Bureau of Vital Statistics. d. Census data. 40. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client? a. Glasgow coma scale. b. Pulses, paresthesia, paralysis distal to the right knee. c. Pulses, paresthesia, paralysis proximal to the right knee. d. Optic nerve using an ophthalmoscope. 41. A highly successful businessman presents to the community mental health center complaining of sleeplessness and anxiety over his financial status. What action should the nurse take to assist this client in diminishing his anxiety? a. Encourage him to initiate daily rituals. b. Reinforce the reality of his financial situation. c. Direct him to drink a glass of red wine at bedtime. d. Teach him to limit sugar and caffeine intake. 42. What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum? a. Soft, spongy fundus. b. Saturating two perineal pads per hour. c. Pulse rate of 56 BPM. d. Unilateral lower leg pain. 43. The nurse plans to educate a client about the purpose for taking the prescribed antipsychotic medication clozapine (Clozaril). Which statement should the nurse provide? a. "It will help you function better in the community." b. "The medication will help you think more clearly." c. "You will be able to cope with your symptoms." d. "It will improve your grooming and hygiene." 44. A male client is admitted to the neurological unit. He has just sustained a C-5 spinal cord injury. Which assessment finding of this client warrants immediate intervention by the nurse? a. Is unable to feel sensation in the arms and hands. b. Has flaccid upper and lower extremities. c. Blood pressure is 110/70 and the apical pulse is 68. d. Respirations are shallow, labored, and 14 breaths/minute. 45. A male infant born at 30-weeks gestation at an outlying hospital is being prepared for transport to a Level IV neonatal facility. His respirations are 90/min, and his heart rate is 150 beats per minute. Which drug is the transport team most likely to administer to this infant? a. Ampicillin (Omnipen) 25 mg/kg slow IV push. b. Gentamicin sulfate (Garamycin) 2.5 mg/kg IV. c. Digoxin (Lanoxin) 20 micrograms/kg IV. d. Beractant (Survanta) 100 mg/kg per endotracheal tube. 46. Because the census is currently low in the Obstetrics (OB) unit, one of the nurses is sent to work on a medical-surgical unit for the day, or until the OB unit becomes busy. Which client assessment is best for the charge nurse to assign to the OB nurse? a. An adult who had a colon resection yesterday and has an IV. b. An older adult who has a fever of unknown origin. c. A woman who had an acute brain attack (stroke, CVA) 6 hours ago. d. A teenager with a femoral fracture who is in traction. 47. A primipara at 38-weeks gestation is admitted to labor and delivery for a biophysical profile (BPP). The nurse should prepare the client for what procedures? a. Chorionic villi sampling under ultrasound. b. Amniocentesis and fetal monitoring. c. Ultrasonography and nonstress test. d. Oxytocin challenge test and fetal heart rates. 48. A male client who is in the day room becomes increasingly angry and aggressive when he is denied a day-pass. Which action should the nurse implement? a. Tell him he can have a day pass if he calms down. b. Put the client's behavior on extinction. c. Decrease the volume on the television set. d. Instruct the client to sit down and be quiet. 49. A client is discussing feelings related to a recent loss with the nurse. The nurse remains silent when the client says, "I don't know how I will go on." What is the most likely reason for the nurse's behavior? a. The nurse is stating disapproval of the statement. b. The nurse is respecting the client's loss. c. Silence is reflecting the client's sadness. d. Silence allows the client to reflect on what was said. 50. An unlicensed assistive personnel (UAP) reports to the charge nurse that a client who delivered a 7-pound infant 12 hours ago is complaining of a severe headache. The client's blood pressure is 110/70, respiratory rate is 18 breaths/minute, heart rate is 74 beats/minute, and temperature is 98.6º F. The client's fundus is firm and one fingerbreadth above the umbilicus. What action should the charge nurse implement first? a. Notify the healthcare provider of the assessment findings. b. Determine if the client received anesthesia during delivery. c. Assign a practical nurse (PN) to reassess the client's vital signs. d. Obtain a STAT hemoglobin and hematocrit. 51. In developing a care plan for a client that has a chest tube due to a hemothorax, the nurse should recognize that which intervention is essential? a. Keep the arm and shoulder of the affected side immobile at all times. b. Ensure that there is no fluctuation in the water-seal chamber. c. Encourage the client to breathe deeply and cough at frequent intervals. d. Maintain the Pleuravac® slightly above the chest level. 52. Immediate postoperative nursing care for a client who has had a surgical repair of an abdominal aortic aneurysm should include which interventions? a. Assessing pedal pulses frequently and monitoring the nasogastric drainage. b. Maintaining strict bedrest for 72 hours and assessing radial pulses. c. Monitoring an infusion of IV heparin and checking the PTT level daily. d. Assessing the right flank dressing and monitoring the suprapubic Foley catheter. 53. A nurse is teaching a client postoperative breathing techniques using an incentive spirometer (IS). What should the nurse encourage this client to do to maintain sustained maximal inspiration? a. Exhale forcefully into the tubing for 3 to 5 seconds. b. Inspire deeply and slowly over 3 to 5 seconds. c. Breathe into the spirometer using normal breath volumes. d. Perform IS breathing exercises every 6 hours. 54. A 65-year-old female client arrives in the emergency department with shortness of breath and chest pain. The nurse accidentally administers 10 mg of morphine sulfate instead of 4 mg as prescribed by the healthcare provider. Later, the client's respiratory rate is 10 breaths/minute, oxygen saturation is 98%, and she states that her pain has subsided. What is the legal status of the nurse? a. The nurse is guilty of negligence and will be sued. b. The client would not be able to prove malpractice in court. c. The nurse is protected by the Good Samaritan Act. d. The healthcare provider should have given the morphine sulfate dose. 55. A client with which problem requires the most immediate intervention by the nurse? a. Finger paresthesias related to carpal tunnel syndrome. b. Increasing sharp pain related to compartment syndrome. c. Increasing burning pain related to a Morton's neuroma. d. Increasing sharp pain related to plantar fascitis. 56. The charge nurse should intervene when what behavior is observed? a. Two staff members are overheard talking about a cure for AIDS outside a client's room. b. A hospital transporter is reading a client's history and physical while waiting for an elevator. c. A UAP tells a client, "It's hard to quit drinking but Alcoholic Anonymous helped me." d. Two visitors are discussing a hospitalized client's history of drug abuse in the visitor's lounge. 57. Which assessment finding indicates a client's readiness to leave the nursing unit for a bronchoscopy? a. Client denies allergies to contrast media. b. Skin prep to insertion site completed. c. On-call sedation administered. d. Oxygen at 2 L/minute per [Show More]

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