RN Medical Surgical Hesi Exam

RN Medical Surgical Hesi Exam Related

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History and Physical
Nurses notes
Orders
Flow Sheets
Laboratory Test
The client is a 68-year-old with a history of diabetes, hypertension (HTN), coronary artery disease (CAD), and recently diagnosed with end-stage renal disease (ESRD). She has been placed on hemodialysis three times a week for one month. She presents to the emergency department (ED) with fatigue, generalized weakness, muscle cramps, tingling sensation in arms and legs, and lightheadedness following 3 days of illness during which her husband reports she has complained of nausea and had a poor appetite and was not able to go for her scheduled dialysis.

The nurse is reviewing the physician orders for a 68-year-old client with end-stage renal disease (ESRD) presenting with fatigue, weakness, muscle cramps, tingling, and lightheadedness after missing dialysis. Which of the following physician's orders requires priority attention from the nurse? Select all that apply.

  • A. Basic metabolic panel
  • B. Echocardiogram
  • C. CT scan of abdomen
  • D. Blood cultures times 2 sets
  • E. Chest X-ray
  • F. Placing the client on a continuous cardiac monito
  • G. 12 lead EKG
Correct Answer: F,G

Rationale: Placing the client on a continuous cardiac monitor and performing a 12-lead EKG are priority orders due to the client's history of CAD, HTN, and symptoms suggestive of a possible myocardial infarction or arrhythmia.

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A client with acquired immune deficiency syndrome (AIDS) and Pneumocystis jiroveci pneumonia has a CD4+ T cell count of 200 cells/mm³ (20%). The client asks the nurse why they have these recurring massive infections. Which pathophysiologic mechanism should the nurse describe in response to this client's question?

  • A. The humoral immune response lacks B cells that form antibodies and opportunistic infections result.
  • B. Inadequate numbers of T lymphocytes are available to initiate cellular immunity and macrophages.
  • C. Bone marrow suppression of white blood cells causes insufficient cells to phagocytize organisms.
  • D. Exposure to multiple environmental infectious agents overburdens the immune system until it fails.
Correct Answer: B

Rationale: Inadequate numbers of CD4+ T cells, due to HIV infection, impair cellular immunity, leading to susceptibility to opportunistic infections like Pneumocystis jiroveci pneumonia.

A patient is admitted to the hospital with symptoms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse?

  • A. Pupillary changes to ipsilateral dilation.
  • B. Left-sided facial drooping and dysphagia.
  • C. Orientation to person and place only.
  • D. Unequal bilateral hand grip strengths.
Correct Answer: A

Rationale: Pupillary changes to ipsilateral dilation indicate increased intracranial pressure, which is a life-threatening complication of stroke. The nurse should notify the physician and prepare for emergency measures.

The healthcare provider prescribes 1 liter of 0.9% sodium chloride, USP intravenously (IV) to be infused over 10 hours for a client. How many mL/hr should the nurse program the infusion pump to deliver? (Enter numerical value only.)

  • A. 100
Correct Answer: 100

Rationale: To deliver 1000 mL over 10 hours, the rate is calculated as 1000 mL / 10 hr = 100 mL/hr.

The nurse is preparing an older client for a magnetic resonance imaging (MRI) with contrast. Which laboratory value should the nurse report to the healthcare provider before the scan is performed?

  • A. Fasting blood sugar of 200 mg/dL (11.1 mmol/L).
  • B. Glycosylated hemoglobin A1c of 8%.
  • C. Blood urea nitrogen of 22 mg/dL (7.9 mmol/L).
  • D. Serum creatinine of 1.9 mg/dL (169 umol/L).
Correct Answer: D

Rationale: Serum creatinine of 1.9 mg/dL (169 umol/L) indicates moderate renal insufficiency, which can increase the risk of contrast-induced nephropathy, a sudden deterioration of kidney function after exposure to contrast media used for imaging studies such as MRI. This should be reported to the healthcare provider to assess the risk and benefit of the procedure and to take preventive measures such as hydration or alternative imaging modalities.

A patient experiences residual effects following an acute attack of Ménière's disease and receives a new prescription for an antihistamine. Which assessment finding indicates that the medication is effective?

  • A. Headache rated at 0 on 0 to 10 scale.
  • B. Oxygen saturation level of 99%.
  • C. Ambulates easily without vertigo.
  • D. Blood pressure of 120/80 mm Hg.
Correct Answer: C

Rationale: Ambulating easily without vertigo indicates the antihistamine is effective, as it reduces fluid buildup in the inner ear, relieving vertigo, a common symptom of Ménière's disease.

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