HESI Comprehensive Medical Surgical Exit Exam with Answers (839 Solved Questions)

Name: HESI Comprehensive Medical Surgical Exit Exam with Answers (839 Solved Questions)
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COMPREHENSIVE MED SURG HESI EXIT
EXAM LATEST TEST BANK
Following discharge teaching, a male client with duodenal ulcer tells the nurse the
he will drink plenty of dairy products, such as milk, to help coat and protect his
ulcer. What is the best follow-up action by the nurse?
(ANS- Review with the client the need to avoid foods that are rich in milk and
cream
A male client with hypertension, who received new antihypertensive prescriptions
at his last visit returns to the clinic two weeks later to evaluate his blood pressure
(BP). His BP is 158/106 and he admits that he has not been taking the prescribed
medication because the drugs make him "feel bad". In explaining the need for
hypertension control, the nurse should stress that an elevated BP places the client
at risk for which pathophysiological condition?
(ANS- Stroke secondary to hemorrhage
The nurse observes an unlicensed assistive personnel (UAP) positioning a newly
admitted client who has a seizure disorder. The client is supine and the UAP is
placing soft pillows along the side rails. What action should the nurse implement?
(ANS- Instruct the UAP to obtain soft blankets to secure to the side rails instead of
pillows.
An adolescent with major depressive disorder has been taking duloxetine
(Cymbalta) for the past 12 days. Which assessment finding requires immediate
follow-up?
(ANS- Describes life without purpose
A 60-year-old female client with a positive family history of ovarian cancer has
developed an abdominal mass and is being evaluated for possible ovarian cancer.
Her Papanicolau (Pap) smear results are negative. What information should the
nurse include in the client's teaching plan?
(ANS- Further evaluation involving surgery may be needed

A client who recently underwear a tracheostomy is being prepared for discharge to
home. Which instructions is most important for the nurse to include in the
discharge plan?
(ANS- Teach tracheal suctioning techniques
In assessing an adult client with a partial rebreather mask, the nurse notes that the
oxygen reservoir bag does not deflate completely during inspiration and the client's
respiratory rate is 14 breaths / minute. What action should the nurse implement?
(ANS- Document the assessment data
Rationale: reservoir bag should not deflate completely during inspiration and the
client's respiratory rate is within normal limits.
During shift report, the central electrocardiogram (EKG) monitoring system
alarms. Which client alarm should the nurse investigate firs?
(ANS- Respiratory apnea of 30 seconds
During a home visit, the nurse observed an elderly client with diabetes slip and
fall. What action should the nurse take first?
(ANS- Check the client for lacerations or fractures
At 0600 while admitting a woman for a schedule repeat cesarean section (C-
Section), the client tells the nurse that she drank a cup a coffee at 0400 because she
wanted to avoid getting a headache. Which action should the nurse take first?
(ANS- Inform the anesthesia care provider
After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2
heart sounds. To determine if an S3 heart sound is present, what action should the
nurse take first?
(ANS- Listen with the bell at the same location
A 66-year-old woman is retiring and will no longer have a health insurance
through her place of employment. Which agency should the client be referred to by
the employee health nurse for health insurance needs?
(ANS- Medicare

A client who is taking an oral dose of a tetracycline complains of gastrointestinal
upset. What snack should the nurse instruct the client to take with the tetracycline?
(ANS- Toasted wheat bread and jelly
Following a lumbar puncture, a client voices several complaints. What complaint
indicated to the nurse that the client is experiencing a complication?
(ANS- "I have a headache that gets worse when I sit up"
"I am having pain in my lower back when I move my legs"
"My throat hurts when I swallow"
"I feel sick to my stomach and am going to throw up"
An elderly client seems confused and reports the onset of nausea, dysuria, and
urgency with incontinence. Which action should the nurse implement?
(ANS- Obtain a clean catch mid-stream specimen
The nurse is assisting the mother of a child with phenylketonuria (PKU) to select
foods that are in keeping with the child's dietary restrictions. Which foods are
contraindicated for this child?
(ANS- Foods sweetened with aspartame
Before preparing a client for the first surgical case of the day, a part-time scrub
nurse asks the circulating nurse if a 3 minute surgical hand scrub is adequate
preparation for this client. Which response should the circulating nurse provide?
(ANS- Direct the nurse to continue the surgical hand scrub for a 5 minute duration
Which breakfast selection indicates that the client understands the nurse's
instructions about the dietary management of osteoporosis?
(ANS- Bagel with jelly and skim milk
The charge nurse of a critical care unit is informed at the beginning of the shift that
less than the optimal number of registered nurses will be working that shift. In
planning assignments, which client should receive the most care hours by a
registered nurse (RN)?

(ANS- An 82-year-old client with Alzheimer's disease newly-fractures femur who
has a Foley catheter and soft wrist restrains applied
A mother brings her 6-year-old child, who has just stepped on a rusty nail, to the
pediatrician's office. Upon inspection, the nurse notes that the nail went through
the shoe and pierced the bottom of the child's foot. Which action should the nurse
implement first?
-Cleanse the foot with soap and water and apply an antibiotic ointment
-Provide teaching about the need for a tetanus booster within the next 72hours.
-have the mother check the child's temperature q4h for the next 24 hours
-transfer the child to the emergency department to receive a gamma globulin
injection
(ANS- Cleanse the foot with soap and water and apply an antibiotic ointment
The mother of an adolescent tells the clinic nurse, "My son has athlete's foot, I
have been applying triple antibiotic ointment for two days, but there has been no
improvement." What instruction should the nurse provide?
(ANS- Stop using the ointment and encourage complete drying of the feet and
wearing clean socks.
A 26-year-old female client is admitted to the hospital for treatment of a simple
goiter, and levothyroxine sodium (Synthroid) is prescribed. Which symptoms
indicate to the nurse that the prescribed dosage is too high for this client? The
client experiences
Bradycardia and constipation
Lethargy and lack of appetite
Muscle cramping and dry, flushed skin
Palpitations and shortness of breath
(ANS- Palpitations and shortness of breath
A client with a history of heart failure presents to the clinic with nausea, vomiting,
yellow vision and palpitations. Which finding is most important for the nurse to
assess to the client?

(ANS- Obtain a list of medications taken for cardiac history
The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg
in 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pump
to deliver how many ml/hour? (Enter numeric value only.)
(ANS- 75
Rationale: Convert mg to mcg and use the formula D/H x Q. 300 mcg/hour / 1,000
mcg x 250 ml = 3/1 x 25 = 75 ml/hour
The pathophysiological mechanisms that are responsible for ascites related to liver
failure? (Select all that apply)
(ANS- Fluid shifts from intravascular to interstitial area due to decreased serum
protein
Increased hydrostatic pressure in portal circulation increases fluid shifts into
abdomen
Increased circulating aldosterone levels that increase sodium and water retention
The nurse is auscultating a client's heart sounds. Which description should the
nurse use to document this sound? (Please listen to the audio first to select the
option that applies)
(ANS- Murmur
Rationale: A murmur is auscultated as a swishing sound that is associated with the
blood turbulence created by the heart or valvular defect.
The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IM
for an infant. The 500 mg vial is labeled with the instruction to add 5.3 ml diluent
to provide a concentration of 100 mg/ml. How many ml should the nurse
administered for each dose? (Enter numeric value only. If rounding is required,
round to the nearest tenth)
(ANS- 0.4
Rationale: 35mg/100mg x 1 = 0.35 = 0.4 ml

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The nurse notes that a client has been receiving hydromorphone (Dilaudid) every
six hours for four days. What assessment is most important for the nurse to
complete?
Auscultate the client's bowel sounds
Observe for edema around the ankles
Measure the client's capillary glucose level
Count the apical and radial pulses simultaneously
(ANS- Auscultate the client's bowel sounds
Rationale: hydromorphone is a potent opioid analgesic that slows peristalsis and
frequently causes constipation, so it is most important to Auscultate the client's
bowel sounds
A female client is admitted with end stage pulmonary disease is alert, oriented, and
complaining of shortness of breath. The client tells the nurse that she wants "no
heroic measures" taken if she stops breathing, and she asks the nurse to document
this in her medical record. What action should the nurse implement?
(ANS- Ask the client to discuss "do not resuscitate" with her healthcare provider
A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour
and has developed diarrhea. The client has a new prescription to change the
feeding to half strength. What intervention should the nurse implement?
(ANS- Add equal amounts of water and feeding to a feeding bag and infuse at
50ml/hour
A female client reports that her hair is becoming coarse and breaking off, that the
outer part of her eyebrows have disappeared, and that her eyes are all puffy. Which
follow-up question is best for the nurse to ask?
(ANS- Have you noticed any changes in your fingernails?
Rationale: The pattern of reported manifestations is suggestive of hypothyroidism
After a third hospitalization 6 months ago, a client is admitted to the hospital with
ascites and malnutrition. The client is drowsy but responding to verbal stimuli and

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reports recently spitting up blood. What assessment finding warrants immediate
intervention by the nurse?
Capillary refill of 8 seconds
Bruises on arms and legs
Round and tight abdomen
Pitting edema in lower legs
(ANS- Capillary refill of 8 seconds
After the nurse witnesses a preoperative client sign the surgical consent form, the
nurse signs the form as a witness. What are the legal implications of the nurse's
signature on the client's surgical consent form? (Select all that apply)
(ANS- The client voluntarily grants permission for the procedure to be done
The client is competent to sign the consent without impairment of judgment
The client understands the risks and benefits associated with the procedure
Following surgery, a male client with antisocial personality disorder frequently
requests that a specific nurse be assigned to his care and is belligerent when
another nurse is assigned. What action should the charge nurse implement?
(ANS- Advise the client that assignments are not based on clients requests
A client with cervical cancer is hospitalized for insertion of a sealed internal
cervical radiation implant. While providing care, the nurse finds the radiation
implant in the bed. What action should the nurse take?
(ANS- Place the implant in a lead container using long-handled forceps
The client with which type of wound is most likely to need immediate intervention
by the nurse?
Laceration
Abrasion
Contusion
Ulceration
(ANS- Laceration

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Rationale: A laceration is a wound that is produced by the tearing of soft body
tissue. This type of wound is often irregular and jagged. A laceration wound is
often contaminated with bacteria and debris from whatever object caused the cut.
The nurse is planning care for a client admitted with a diagnosis of
pheochromocytoma. Which intervention has the highest priority for inclusion in
this client's plan of care? (ANS- Monitor blood pressure frequently
Rationale: A pheochromocytoma is a rare, catecholamine-secreting tumor that may
precipitate life-threatening hypertension. The tumor is malignant in 10% of cases
but may be cured completely by surgical removal. Although pheochromocytoma
has classically been associated with 3 syndromes—von Hippel-Lindau (VHL)
syndrome, multiple endocrine neoplasia type 2 (MEN 2), and neurofibromatosis
type 1 (NF1)—there are now 10 genes that have been identified as sites of
mutations leading to pheochromocytoma.
When caring for a client who has acute respiratory distress syndrome (ARDS), the
nurse elevates the head of the bed 30 degrees. What is the reason for this
intervention?
To reduce abdominal pressure on the diaphragm
To promote retraction of the intercostal accessory muscle of respiration
To promote bronchodilation and effective airway clearance
To decrease pressure on the medullary center which stimulates breathing (ANS- To
reduce abdominal pressure on the diaphragm
Rationale: a semi-sitting position is the best position for matching ventilation and
perfusion and for decreasing abdominal pressure on the diaphragm, so that the
client can maximize breathing.
When assessing a mildly obese 35-year-old female client, the nurse is unable to
locate the gallbladder when palpating below the liver margin at the lateral border
of the rectus abdominal muscle. What is the most likely explanation for failure to
locate the gallbladder by palpation?

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The client is too obese
Palpating in the wrong abdominal quadrant
Deeper palpation technique is needed
The gallbladder is normal (ANS- The gallbladder is normal
Rationale: a normal healthy gallbladder is not palpable
A woman with an anxiety disorder calls her obstetrician's office and tells the nurse
of increased anxiety since the normal vaginal delivery of her son three weeks ago.
Since she is breastfeeding, she stopped taking her antianxiety medications, but
thinks she may need to start taking them again because of her increased anxiety.
What response is best for the nurse to provide this woman?
Describe the transmission of drugs to the infant through breast milk
Encourage her to use stress relieving alternatives, such as deep breathing exercises
Inform her that some antianxiety medications are safe to take while breastfeeding
Explain that anxiety is a normal response for the mother of a 3-week-old. (ANS-
Inform her that some antianxiety medications are safe to take while breastfeeding
Rationale: there are several antianxiety medications that are not contraindicated for
breastfeeding mothers.
An older male client with a history of type 1 diabetes has not felt well the past few
days and arrives at the clinic with abdominal cramping and vomiting. He is
lethargic, moderately, confused, and cannot remember when he took his last dose
of insulin or ate last. What action should the nurse implement first?
Start an intravenous (IV) infusion of normal saline
Obtain a serum potassium level
Administer the client's usual dose of insulin
Assess pupillary response to light (ANS- Start an intravenous (IV) infusion of
normal saline
Rationale: the nurse should first start an intravenous infusion of normal saline to
replace the fluids and electrolytes because the client has been vomiting, and it is

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unclear when he last ate or took insulin. The symptoms of confusion, lethargy,
vomiting, and abdominal cramping are all suggestive of hyperglycemia, which also
contributes to diuresis and fluid electrolyte imbalance.
A client who received multiple antihypertensive medications experiences syncope
due to a drop in blood pressure to 70/40. What is the rationale for the nurse's
decision to hold the client's scheduled antihypertensive medication?
Increased urinary clearance of the multiple medications has produced diuresis and
lowered the blood pressure.
The antagonistic interaction among the various blood pressure medications has
reduced their effectiveness.
The additive effect of multiple medications has caused the blood pressure to drop
too low.
The synergistic effect of the multiple medications has resulted in drug toxicity and
resulting hypotension. (ANS- The additive effect of multiple medications has
caused the blood pressure to drop too low
Which client is at the greatest risk for developing delirium?
An adult client who cannot sleep due to constant pain.
An older client who attempted 1 month ago
A young adult who takes antipsychotic medications twice a day
A middle-aged woman who uses a tank for supplemental oxygen (ANS- An adult
client who cannot sleep due to constant pain.
Which intervention should the nurse include in a long-term plan of care for a client
with Chronic Obstructive Pulmonary Disease (COPD)?
Reduce risks factors for infection
Administer high flow oxygen during sleep
Limit fluid intake to reduce secretions
Use diaphragmatic breathing to achieve better exhalation (ANS- Reduce risks
factors for infection

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Which location should the nurse choose as the best for beginning a screening
program for hypothyroidism?
A business and professional women's group.
An African-American senior citizens center
A daycare center in a Hispanic neighborhood
An after-school center for Native-American teens (ANS- A business and
professional women's group.
A female client has been taking a high dose of prednisone, a corticosteroid, for
several months. After stopping the medication abruptly, the client reports feeling
"very tired". Which nursing intervention is most important for the nurse to
implement?
Measure vital signs
Auscultate breath sounds
Palpate the abdomen
Observe the skin for bruising (ANS- Measure vital signs
A male client reports the onset of numbness and tingling in his fingers and around
his mouth. Which lab is important for the nurse to review before contacting the
health care provider?
Capillary glucose
Urine specific gravity
Serum calcium
White blood cell count (ANS- Serum calcium
What explanation is best for the nurse to provide a client who asks the purpose of
using the log-rolling technique for turning?
Working together can decrease the risk for back injury
The technique is intended to maintain straight spinal alignment.
Using two or three people increases client safety.

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Turning instead of pulling reduces the likelihood of skin damage (ANS- The
technique is intended to maintain straight spinal alignment.
A client receiving chemotherapy has severe neutropenia. Which snack is best for
the nurse to recommend to the client? (ANS- Baked apples topped with dried
raisins
Which action should the school nurse take first when conducting a screening for
scoliosis? (ANS- Inspect for symmetrical shoulder height.
An unlicensed assistive personnel (UAP) assigned to obtain client vital signs
reports to the charge nurse that a client has a weak pulse with a rate of 44 beat/
minutes. What action should the charge nurse implement? (ANS- Assign a
practical nurse (LPN) to determine if an apical radial deficit is present
After a sudden loss of consciousness, a female client is taken to the ED and initial
assessment indicate that her blood glucose level is critically low. Once her glucose
level is stabilized, the client reports that was recently diagnosed with anorexia
nervosa and is being treated at an outpatient clinic. Which intervention is more
important to include in this client's discharge plan? (ANS- Encourage a low-
carbohydrate and high-protein diet
A client with a peripherally inserted central catheter (PICC) line has a fever. What
client assessment is most important for the nurse to perform? (ANS- Observe the
antecubital fossa for inflammation.
The nurse administers an antibiotic to a client with respiratory tract infection. To
evaluate the medication's effectiveness, which laboratory values should the nurse
monitor? Select all that apply (ANS- White blood cell (WBC) count
Sputum culture and sensitivity
A client is admitted to isolation with the diagnosis of active tuberculosis. Which
infection control measures should the nurse implement?
Negative pressure environment

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Contact precautions
Droplet precautions
Protective environment (ANS- Negative pressure environment
A school nurse is called to the soccer field because a child has a nose bleed
(epistaxis). In what position should the nurse place the child? (ANS- Sitting up and
leaning forward
A young adult who is hit with a baseball bat on the temporal area of the left skull is
conscious when admitted to the ED and is transferred to the Neurological Unit to
be monitored for signs of closed head injury. Which assessment finding is
indicative of a developing epidural hematoma? (ANS- Altered consciousness
within the first 24 hours after injury.
A female client with breast cancer who completed her first chemotherapy treatment
today at an out-patient center is preparing for discharge. Which behavior indicates
that the client understands her care needs (ANS- Rented movies and borrowed
books to use while passing time at home
Which instruction should the nurse provide a pregnant client who is complaining
of heartburn? (ANS- Eat small meal throughout the day to avoid a full stomach.
A client is admitted to the intensive care unit with diabetes insipidus due to a
pituitary gland tumor. Which potential complication should the nurse monitor
closely?
Hypokalemia
Ketonuria.
Peripheral edema
Elevated blood pressure (ANS- Hypokalemia
Rationale: pituitary tumors that suppress antidiuretic hormone (ADH) result in
diabetes insipidus, which causes massive polyuria and serum electrolyte
imbalances, including hypokalemia, which can lead to lethal arrhythmias.

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A female client reports she has not had a bowel movement for 3 days, but now is
defecating frequent small amount of liquid stool. Which action should the nurse
implement? (ANS- Digitally check the client for a fecal impaction
After changing to a new brand of laundry detergent, an adult male reports that he
has a fine itchy rash. Which assessment finding warrants immediate intervention
by the nurse? (ANS- Bilateral Wheezing.
The nurse should teach the parents of a 6 year-old recently diagnosed with asthma
that the symptom of acute episode of asthma are due to which physiological
response? (ANS- Inflammation of the mucous membrane & bronchospasm
A 10 year old who has terminal brain cancer asks the nurse, "What will happen to
my body when I die?" How should the nurse respond? (ANS- "The heart will stop
beating & you will stop breathing."
The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. This
child should be medicated for pain based on which findings? Select all that apply:
Restlessness
Clenched Fist
Increased pulse rate
Increased respiratory rate.
Increased temperature
Peripheral pallor of the skin (ANS- Restlessness
Clenched Fist
Increased pulse rate
Increased respiratory rate.
The nurse is preparing to administer an oral antibiotic to a client with unilateral
weakness, ptosis, mouth drooping and, aspiration pneumonia. What is the priority
nursing assessment that should be done before administering this medication?
(ANS- Determine which side of the body is weak.

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The nurse who is working on a surgical unit receives change of shift report on a
group of clients for the upcoming shift. A client with which condition requires the
most immediate attention by the nurse?
Gunshot wound three hours ago with dark drainage of 2 cm noted on the dressing.
Mastectomy 2 days ago with 50 ml bloody drainage noted in the Jackson-pratt
drain.
Collapsed lung after a fall 8h ago with 100 ml blood in the chest tube collection
container
Abdominal-perineal resection 2 days ago with no drainage on dressing who has
fever and chills. (ANS- Abdominal-perineal resection 2 days ago with no drainage
on dressing who has fever and chills.
Rationale: the client with an abdominal- perineal resection is at risk for peritonitis
and needs to be immediately assessed for other signs and symptoms for sepsis.
The nurse is caring for a client who had gastric bypass surgery yesterday. Which
intervention is most important for the nurse to implement during the first 24
postoperative hours? (ANS- Measure hourly urinary output.
Rationale: a serious early complications of gastric bypass surgery is an
anastomoses leak, often resulting in death.
When preparing to discharge a male client who has been hospitalized for an
adrenal crisis, the client expresses concern about having another crisis. He tells the
nurse that he wants to stay in the hospital a few more days. Which intervention
should the nurse implement? (ANS- Schedule an appointment for an out-patient
psychosocial assessment.
An adult female client tells the nurse that though she is afraid her abusive
boyfriend might one day kill her, she keeps hoping that he will change. What
action should the nurse take first? (ANS- Explore client's readiness to discuss the
situation.

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HESI Comprehensive Medical Surgical Exit Exam with Answers (839 Solved Questions)

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