PN HESI Review Questions Med Surge
The practical nurse (PN) is assigned to care for a group of four clients. Based on priority of need, arrange the clients in order from first to be assessed at the top to the last to be assessed on the bottom.
1.The client with aphasia and right hemiplegia who is scheduled for gastrostomy tube (GT) placement today 2.The client who has chronic renal disease who is scheduled for hemodialysis today and three times weekly 3.The client who has had GI bleeding but had a negative guaiac test for the last three stools 4.The client who is recovering from a left total knee replacement and who ambulates with a walker
The practical nurse (PN) is reviewing the health histories of the following individuals. Which client has the greatest potential for development of head and neck cancer?
An alcoholic, tobacco-chewing auctioneer
A 70-year-old male client is discharged to an assistive living center to convalesce following a hip replacement. Which physical characteristic of aging should the practical nurse (PN) expect to contribute to this client's risk for developing skin breakdown?
Thinning of the skin with loss of elasticity
A practical nurse (PN) prepares to administer 5 units of Regular insulin and 15 units of NPH insulin to a diabetic client. In which order should the actions be implemented when preparing the injection? (Arrange from first on top to last on bottom).
1.Perform hand hygiene according to facility policy. 2.Inspect insulin vials for type and expiration dates. 3.Inject 15 units of air into NPH insulin vial. 4.Inject 5 units of air into Regular insulin vial. 5.Withdraw 5 units of Regular insulin from vial. 6.Withdraw 15 units of NPH insulin from vial.
A female client with diabetes mellitus type 2 has a plantar foot ulcer. What information should the practical nurse (PN) obtain first from this client when implementing a diabetic foot care teaching plan?
How the client examines her feet
An adult client is admitted to the hospital with partial-thickness and full-thickness burns over 40% of the body surface area. What should the practical nurse (PN) remember about full-thickness burns and the potential for skin regeneration?
Regenerative function of the skin is absent because the dermal layer has been destroyed.
Which action by the nurse is consistent with culturally competent care?
Understanding one's own world views in addition to the client's
Which client statement indicates to the practical nurse (PN) that instruction regarding the transmission of the HIV virus has been effective?
"I may still contract HIV even though I am 62 years old."
The practical nurse (PN) plans to help an 18-year-old developmentally disabled female client ambulate on the first postoperative day. When the PN tells her it is time to get out of bed, the client becomes angry and yells at the nurse, "Get out of here! I'll get up when I'm ready." Which response should the PN provide?
"I'll be back in 30 minutes to help you get out of bed and walk around the room."
At the time of the first dressing change, a client refuses to look at her mastectomy incision. The practical nurse (PN) tells her that the incision is healing well, but she refuses to talk about it. What is the best response to this client's silence?
"It is okay if you don't want to talk about your surgery. I will be available when you are ready."
A client with chronic obstructive pulmonary disease complains of extreme fatigue after coughing. Which self-care measures should the practical nurse (PN) suggest to minimize dyspnea? (Select all that apply.)
1.Assume a sitting position with shoulders relaxed and knees flexed. 2.Support forearms with a pillow and place both feet flat on the floor. 3.Slightly drop the head, bend forward, and slowly exhale with pursed lips. 4.Resume sitting up straight, using diaphragmatic breathing to inhale slowly and deeply
The health care provider prescribes codeine USP 60 mg every 4 hours for a client who is 3 days postoperative. The pharmacy has available codeine USP 30 mg/tablet. How many tablets should the practical nurse administer? Fill in the blank. (Type numbers only as your answer.)
2 tabs
The practical nurse (PN) is caring for a client with acute diverticulitis. Which assessment data warrant immediate nursing intervention?
A rigid hard abdomen and elevated white blood cell count
The practical nurse is caring for a client with a serum potassium level of 3 mEq/L. Which findings should the nurse report to the charge nurse? (Select all that apply.)
Abnormal heart rhythms Muscle cramps
A female client sustained a burn injury greater than 25% of her total body surface during a house fire. During the acute phase of care, which intervention is most important for the practical nurse to implement?
Administer 0.5 mL of tetanus toxoid IM.
The practical nurse (PN) recognizes which of the following characteristics considered high-risk factors for developing type 2 diabetes? (Select all that apply.)
Age 40 years or older African American Obesity Hispanic
An adult resident in a long-term care facility is diagnosed with hepatitis B virus (HBV) infection. The practical nurse (PN) should recognize which precaution before caring for this client?
All health care providers should have received the hepatitis B vaccine series.
Three days after surgery, a male client suddenly grabs his right chest and becomes short of breath, pale, and diaphoretic. The practical nurse (PN) immediately assesses his vital signs and obtains 100/80 mm Hg blood pressure, 110 beats/min heart rate, and 36 breaths/min respiratory rate. What action is most important for the PN to take next?
Apply oxygen at 2 liters per nasal cannula.
A male client with a diagnosed malignancy states, "I have a malignancy, but it is not cancerous." What is the best initial nursing action?
Ask the client to explain his understanding of the term malignancy.
Twelve hours after chest tube insertion for hemothorax, the practical nurse (PN) observes that the client's drainage has decreased from 50 to 5 mL/hour. What is the best initial action for the PN to take?
Assess for kinks or dependent loops in the tubing.
An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. The practical nurse (PN) notices that his tongue is somewhat cracked and his eyeballs appear sunken into his head. What nursing intervention is indicated?
Assist the client to determine ways to increase his fluid intake.
The practical nurse (PN) initiates neuro checks for a client who is at risk for neurological compromise. Which manifestation typically provides the first indication of altered neurological function?
Change in level of consciousness
An elderly female client with dementia is transferred from a long-term care unit to an acute care unit. The client's children express concern that their mother's confusion is worsening. How should the practical nurse (PN) respond?
Confusion in an older person often follows relocation to new surroundings."
The practical nurse (PN) is assisting the registered nurse (RN) with the transfusion of 4 units of packed red blood cells (RBCs) for a client with acute hemorrhagic anemia. Which nursing intervention is most important for the PN to verify with the RN before administering the blood?
Ensure the accuracy of the blood type match.
A client who has sustained a head injury following a motor vehicle collision is admitted to the unit. Which sign should the practical nurse (PN) report immediately?
Converses but is confused
The nurse hears a series of long-duration, discontinuous, low-pitched sounds on auscultation of a client's lower lung fields. Which documentation of this finding is correct?
Course crackles
When caring for a client hospitalized with Guillain-Barré syndrome, which information is most important for the nurse to report to the primary health care provider?
Decrease in cognitive status of the client
A client with viral influenza is receiving vitamin C 1000 mg PO daily and acetaminophen elixir 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate?
Decrease the dose of vitamin C.
A female client comes to the clinic and reports the presence of a painful lesion in the genital area; she describes it as a blister 2 days earlier that is now crusty. Which intervention should the practical nurse (PN) implement first?
Determine if the client has had unprotected sex.
The practical nurse (PN) is interviewing a male client with hypertension. Which additional medical diagnosis in the client's history presents the greatest risk for development of a cerebral vascular accident (CVA)?
Diabetes mellitus
An older female client is admitted to the hospital. She is confused, anorexic, and nauseated, and she has vomited several times since admission. She is now complaining of a headache. Her pulse rate is 43 beats/min. About which medication in the client's history should the practical nurse (PN) be most concerned?
Digitalis (Lanoxin)
In assessing a client following indirect herniorrhaphy, the practical nurse (PN) observes that the client is experiencing scrotal swelling. What action should the PN implement?
Elevate the scrotum on a soft pillow.
A 55-year-old male client is admitted to the Coronary Care Unit with chest pain. Within the first 24 hours, which diagnostic laboratory value should the practical nurse (PN) expect to be indicative of an acute myocardial infarction (MI)?
Elevated creatine kinase-MB (CK-MB) level
The nurse is conducting an osteoporosis screening clinic at a health fair. What information should the nurse provide to individuals who are at risk for osteoporosis? (Select all that apply.)
Encourage alcohol and smoking cessation. Promote regular weight-bearing exercises. Implement a home safety plan to prevent falls.
After a permanent pacemaker is inserted, a client's discharge teaching plan includes the client goal of "The client will verbalize symptoms of pacemaker failure." Which symptoms are most important for the practical nurse (PN) to reinforce with the client?
Feelings of dizziness
Which assessment finding in a client with an acute small bowel obstruction requires the most immediate intervention by the practical nurse (PN)?
Fever of 102° F
A client returns from interventional radiology after radioactive seed implantation for prostate cancer. What is the most important information for the practical nurse (PN) to provide to this client's family?
Follow radiation exposure precautions.
A practical nurse (PN) is monitoring a client with diabetes. The nurse recognizes which of the following symptoms as possible signs of diabetic ketoacidosis (DKA)? (Select all that apply.)
Fruity breath odor Rapid, weak pulse Extreme thirst Urinary frequency
A male client asks the practical nurse to help choose dinner from the menu so that he eats a diet that is rich in potassium. Which food should the nurse encourage the client to choose? (Select all that apply.)
Green beans Milk Flounder Sweet potatoes Cantaloupe
Which client finding is the best indication that postoperative nursing interventions have prevented respiratory complications?
Has a 95% pulse oximeter value on room air
A client is returning to the oncology unit after receiving radiation to the brain. The practical nurse (PN) should observe this client for which problem during the early posttherapy days?
Headache
A client has a seizure disorder that has been managed with phenobarbital (Luminal Nembutal) for several years. Lately, the client has become more difficult to arouse and frequently wants to take a nap. What intervention should the nurse implement?
Hold the medication and notify the health care provider
Three days following surgery, a male client observes his colostomy for the first time. He becomes quite upset and tells the practical nurse (PN) that it is much bigger than he expected. What is the best response by the PN?
Inform the client that the stoma will become smaller when the initial swelling diminishes.
An elderly female client diagnosed with osteoarthritis is complaining of pain in her hips. Which intervention is most important for the practical nurse to implement?
Instruct the client to take an analgesic before walking daily.
In which location should the practical nurse (PN) place the hands for manual chest compressions during cardiopulmonary resuscitation (CPR) on an adult client?
Just above the xiphoid process on the lower third of the sternum
An adult client with a fracture of the radius is being discharged from the fast-track clinic after the application of a plaster cast. The practical nurse (PN) should reinforce instruction for the client to use which method to dry the cast over the next 24 hours?
Keep the cast surfaces exposed to circulating air.
A client's infusion of normal saline infiltrated earlier today, and approximately 500 mL of saline infused into the subcutaneous tissue. The client is now complaining of excruciating arm pain and demanding "stronger pain medications." What initial action is most important for the practical nurse (PN) to take?
Measure the pulse volume and capillary refill distal to the infiltration.
Which abnormal laboratory finding should the practical nurse (PN) identify that indicates that a client with diabetes needs further evaluation for diabetic nephropathy?
Microalbuminuria
A client with end-stage renal disease (ESRD) and diabetic ketoacidosis (DKA) is admitted to the medical unit from the Emergency Department. This client had surgery the previous week to create an AV (arteriovenous) fistula in the right forearm. Which nursing measure is essential in promoting safe, effective care for the client?
Put a sign in client's room stating no BPs or needle sticks in right arm
During a clinic visit, a male client reports to the practical nurse (PN) that he felt a solid testicular mass during self-examination, but it was not painful. What instruction should the PN reinforce with the client?
Schedule an appointment with the health care provider for prompt evaluation.
A client is diagnosed with ulcerative colitis (UC) and is prescribed a low-residue diet. Which breakfast does the nurse help the client select?
Scrambled eggs, white toast, and margarine
Which technique should the practical nurse (PN) include when reinforcing instruction with a client about self-examination for melanoma?
Observe skin moles for changes
A hospitalized client suddenly has a seizure. What intervention should the practical nurse (PN) implement?
Observe the length and activity of the seizure.
An older male resident in a skilled nursing facility who has a history of diabetes tells the nurse, "I just don't feel right." What action should the practical nurse take first?
Obtain a finger stick blood glucose test.
An elderly client with severe Parkinson's disease is hospitalized with anorexia, dysphagia, drooling, generalized weakness, and slurred speech. Which nursing strategy has the highest priority for this client?
Preventing aspiration
A splint is prescribed for nighttime use by a client with rheumatoid arthritis. Which statement by the practical nurse (PN) provides the most accurate explanation for use of the splints?
Prevention of deformities
A 75-year-old client is in the clinic for a routine physical examination. The client has decreased pupillary accommodation to light. Based on this finding, which nursing action is indicated?
Record the finding on the assessment notes.
A client with a vaginal yeast infection (candidiasis) has a prescription for a 7-day course of an intravaginal antifungal agent. What information should the practical nurse provide to the client about using this form of medication?
Remain recumbent for 30 minutes after insertion of the medication
The practical nurse is caring for a client who is 3 days postoperative. Which intervention should the nurse implement to decrease the possibility of the client developing hypercalcemia? (Select all that apply.)
Remind the client to ambulate around the room at least three times daily. Increase fluid intake.
A client with a nasogastric tube to achieve low intermittent suction complains of nausea. The practical nurse (PN) observes that there has been no drainage through the nasogastric tube in the last 2 hours. What action should the PN take first?
Reposition the client on her side.
A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most important for the practical nurse (PN) to reinforce for this client?
Restrict salt and fluid intake.
A practical nurse (PN) has reinforced teaching a client with asthma to use a metered-dose inhaler (MDI). Which of the following actions determines that the client understands the correct procedure? (Select all that apply.)
Sit or stand. Shake the inhaler. Attach the canister of medication to the mouthpiece. Use a spacer attachment and place the mouthpiece in the mouth. Close the lips around the mouthpiece. After inhaling the medication, hold the breath 10 seconds.
The practical nurse (PN) is evaluating a client's understanding of a low-sodium diet. Which meal selection indicates to the PN that this client understands the dietary restrictions?
Skim milk, turkey salad, roll, vanilla ice cream
After attending a class on reducing cancer risk factors, a client selects bran flakes, 2% milk, and orange slices from a breakfast menu. In evaluating the client's learning, the practical nurse (PN) affirms that the client has made good choices and makes what additional recommendation?
Switch to skim milk.
The practical nurse receives a shift report that the client is experiencing fluid volume deficit. Which findings that are consistent with fluid volume deficit should the nurse document? (Select all that apply.)
Tachycardia Cool skin Decreased urine output Increased thirst
The nurse enters the examination room of a client who has been told by her health care provider that she has advanced ovarian cancer. Which response by the nurse is likely to be most supportive for the client?
Tell me about what you are feeling right now."
A 65-year-old male client has been admitted to the hospital with a medical diagnosis of chronic obstructive pulmonary disease (COPD). Which risk factor should the practical nurse determine is most significant in the development of this client's COPD?
The client smokes one to two packs of cigarettes per day.
The practical nurse (PN) assigns an unlicensed assistive personnel (UAP) to provide personal hygiene for a female client with a hemoglobin of 6 g/dL secondary to chemotherapy. What instruction should the PN provide to the UAP?
The client will be weak and will tire easily.
The women's health nurse practitioner and the clinic practical nurse (PN) are developing a plan of care for a 56-year-old female client who has been diagnosed with osteopenia. The plan is focused on preventing further bone resorption and increasing bone mass. Which outcome statement should be included in the plan of care?
The client will decrease the number of cigarettes smoked by 50% within 2 weeks.
Based on the change of shift report, which situation should the practical nurse (PN) follow up first?
There is no Hemovac output from the abdominal incision of a client who had surgery yesterday.
A hospitalized client is receiving continuous nasogastric tube feedings via a small-bore tube and an enteral infusion pump. The client begins to cough and produces a moderate amount of white sputum. Which action should the practical nurse (PN) take first?
Turn off the continuous feeding pump.
The nurse walks into a room and observes the client experiencing a tonic-clonic seizure. Which intervention should the nurse implement first?
Turn the client on his or her side to aid ventilation.
The health clinic plans to purchase a variety of educational materials that focus on primary, secondary, and tertiary prevention. Which educational materials should the practical nurse select for secondary prevention? (Select all that apply.)
Video that teaches client to do a breast self-examination Pamphlets describing how to do testicular self-examinations Postcard reminders for clients to get papanicolaou (Pap) smears and mammograms
The Centers for Disease Control and Prevention (CDC) issued guidelines for health care workers in relation to protection from HIV. The practical nurse (PN) should implement which recommendation?
Wear gloves when coming in contact with the blood or body fluids of any client
A 52-year-old client is admitted to the hospital for possible duodenal ulcers. The health care provider prescribes ranitidine hydrochloride (Zantac) 150 mg bid PO. Which data would indicate that this medication is effective?
Within 4 hours after meals, the client denies having pain.
