HESI RN
HESI Medical Surgical Practice Exam Quizlet
1. When planning activities for a socialization group for older residents of a long-term facility, what information would be most useful for the nurse?
- A. The length of time each resident has resided at the facility.
- B. A brief description of each resident's family life.
- C. The age of each resident.
- D. The usual activity patterns of each resident.
Correct answer: D
Rationale: The most useful information for the nurse when planning activities for a socialization group for older residents of a long-term facility would be the usual activity patterns of each resident. An older person's level of activity is a determining factor in adjustment to aging, as described by the Activity Theory of Aging. By understanding the usual activity patterns of each resident, the nurse can tailor activities that cater to their interests and abilities, promoting social engagement and overall well-being. The other options, such as the length of time residing at the facility, a brief description of family life, or the age of each resident, may provide some insights but do not directly relate to planning activities that support adjustment to aging and socialization within the group.
2. A 49-year-old female client arrives at the clinic for an annual exam and asks the nurse why she becomes excessively diaphoretic and feels warm during nighttime. What is the nurse's best response?
- A. Explain the effects of follicle-stimulating and luteinizing hormones.
- B. Discuss perimenopause and related comfort measures.
- C. Assess lung fields and check for a cough productive of blood-tinged mucus.
- D. Inquire if a fever above 101°F (38.3°C) has occurred in the last 24 hours.
Correct answer: B
Rationale: The correct answer is B. The symptoms described by the client, excessive diaphoresis and feeling warm at night, are characteristic of perimenopause. During this period, lower estrogen levels lead to surges in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), resulting in vasomotor instability, night sweats, and hot flashes. Therefore, discussing perimenopause and related comfort measures with the client is essential to provide education and support. Choice A is incorrect because explaining the effects of FSH and LH alone does not directly address the client's current symptoms. Choice C is irrelevant as it focuses on assessing lung fields and cough symptoms, which are not related to the client's menopausal symptoms. Choice D is not the best response as it is more focused on ruling out fever as a cause, which is not typically associated with the symptoms described by the client.
3. The nurse is providing discharge instructions to a client who is receiving prednisone 5 mg PO daily for a rash due to contact with poison ivy. Which symptoms should the nurse tell the client to report to the healthcare provider?
- A. Rapid weight gain
- B. Abdominal striae
- C. Moon faces
- D. Gastric irritation
Correct answer: A
Rationale: Rapid weight gain can indicate fluid retention, which is a serious side effect of prednisone and should be reported.
4. A nurse is preparing for intershift report when a nurse’s aide pulls an emergency call light in a client’s room. Upon answering the light, the nurse finds a client who returned from surgery earlier in the day experiencing tachycardia and tachypnea. The client’s blood pressure is 88/60 mm Hg. Which action should the nurse take first?
- A. Calling the physician
- B. Checking the hourly urine output
- C. Checking the IV site for infiltration
- D. Placing the client in a modified Trendelenburg position
Correct answer: D
Rationale: The client is exhibiting signs of shock, indicated by tachycardia, tachypnea, and hypotension. Placing the client in a modified Trendelenburg position is the initial action to improve venous return, cardiac output, and subsequently increase blood pressure. This position helps redistribute blood flow to vital organs. Calling the physician should follow once immediate intervention has been initiated. Checking the hourly urine output and IV site are important assessments but are secondary to addressing the client's hemodynamic instability and potential for shock.
5. A patient presents with severe chest pain radiating to the left arm. Which of the following diagnostic tests is the priority?
- A. Complete blood count (CBC)
- B. Electrocardiogram (ECG)
- C. Chest X-ray
- D. Serum electrolytes
Correct answer: B
Rationale: In a patient presenting with severe chest pain radiating to the left arm, the priority diagnostic test is an Electrocardiogram (ECG) to assess for myocardial infarction. An ECG can quickly identify changes indicative of ischemia or infarction, guiding prompt management. A Complete Blood Count (CBC) may provide some information but is not the primary test for evaluating chest pain related to myocardial infarction. A Chest X-ray can be useful in assessing lung pathologies or certain cardiac conditions; however, it does not provide immediate information on myocardial infarction, making it a secondary option in this scenario. Serum electrolytes may become important in later stages but do not offer immediate insights into myocardial infarction. Therefore, they are a lower priority compared to obtaining an ECG for timely diagnosis and intervention.
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