HESI Medical-Surgical Practice Test
Which finding is an early indication that a recently applied leg plaster cast is causing compartment syndrome? A) Client states the cast is warm. B) Pain rated "7" at fracture site. C) Paresthesia. D) Pulselessness.
C) Paresthesia.
A male client who arrives at the clinic for an eye examination tells the practical nurse (PN) that he has recently experienced blurred vision. Which finding is most important for the PN to report to the healthcare provider? A) Inability to identify the colors of numbers on an eye chart. B) Left pupil consensual response to pen light exposure in right eye. C) Small rapid, rhythmic, oscillating movements of eyeballs. D) Pupils constrict when focusing on a distant object that moves to the face.
C) Small rapid, rhythmic, oscillating movements of eyeballs.
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/minute. During the bed bath, the client complains of shortness of breath. Which action should the practical nurse (PN) implement? A) Increase the flow of oxygen by 2 L/min. B) Suction the trachea for several minutes. C) Document the symptoms after the bath. D) Assist the client into a Fowler's position.
D) Assist the client into a Fowler's position.
A client who experienced a thrombolic stroke has received recombinant tissue plasminogen activator (TPA)( Alteplase) two hours ago in the emergency center. Which priority precaution should the practical nurse implement for this client on admission to the medical unit? A) Disuse syndrome. B) Risk for infection. C) Fall precautions. D) Bleeding precautions.
D) Bleeding precautions.
When performing a focused neurological assessment for an adult client, which finding should the practical nurse report to the charge nurse? A) Bilateral tendon reflexes are 2+. B) Pupils are equal and reactive. C) Negative Babinski reflex. D) Flexion decorticate posturing.
D) Flexion decorticate posturing.
The practical nurse (PN) is obtaining deep tendon reflexes for a client with type 1 diabetes mellitus. Which finding indicates to the PN that the client has peripheral neuropathy? A) Clonus noted at each ankle. B) Asymmetric reflex response. C) Hyperactive reflexes at the knee. D) Hypoactive reflexes at the Achilles tendon.
D) Hypoactive reflexes at the Achilles tendon.
What action should the practical nurse (PN) implement for a client who has a banana allergy? A) Wear an isolation gown. B) Give a mask to the client. C) Move the client to a negative airflow room. D) Place a box of latex-free gloves in the room.
D) Place a box of latex-free gloves in the room.
What is the priority data that the practical nurse (PN) should obtain for a client with a cervical spinal cord injury (SCI)? A) Mental status and pupil reaction. B) Heart rate and rhythm. C) Muscle strength and reflexes. D) Respiratory pattern and airway.
D) Respiratory pattern and airway.
A male client with diabetes mellitus calls the clinic to report left calf pain after walking around the block. Which additional information should the PN report to the healthcare provider? A) Muscle cramps occur at night when sleeping. B) Muscles are deconditioned from lack of regular exercise. C) Shooting pain occurs down the back of one leg when walking. D) The pain is immediately relieved when he sits down.
D) The pain is immediately relieved when he sits down.
Which information should the practical nurse (PN) reinforce with a female client who has a history of frequent urinary tract infections (UTI)? A) Drink a glass of cranberry juice daily. B) Use unscented soap for a bubble bath. C) Void every 8 hours while awake. D) Empty bladder before showering.
A) Drink a glass of cranberry juice daily.
The practical nurse (PN) is caring for a client with trigeminal neuralgia associated with Cranial Nerve V pathology. While reinforcing the discharge teaching instructions, the PN should include which information? A) Encourage a soft diet to minimize chewing. B) Instruct the client to thicken all oral liquids. C) Take deep breaths to minimize respiratory effort. D) Ambulate with a walker to reduce the risk of falling.
A) Encourage a soft diet to minimize chewing.
A client with chronic obstructive pulmonary disease (COPD) is using pursed-lip breathing while he is sitting up in a chair by the bedside. The practical nurse (PN) obtains his respiratory rate at 20 breaths/minute and his pulse oximetry is 91% on room air. What action should the PN implement? A) Encourage the client to sit up and lean forward. B) Give oxygen 15 liters/minute per non-rebreather mask. C) Reinforce the use of an incentive spirometer. D) Obtain a prescription for arterial blood gases (ABGs).
A) Encourage the client to sit up and lean forward.
An older client is seen in the clinic for an annual physical exam. Which finding should the practical nurse report to the healthcare provider for follow-up? A) Hemoglobin 9.1 grams/dl with positive occult blood in stool. B) Serum carcinoembryonic antigen (CEA) level is low. C) Bowel sounds auscultated with occasional borborygmi. D) Abdominal tympany with negative rebound tenderness.
A) Hemoglobin 9.1 grams/dl with positive occult blood in stool.
The practical nurse (PN) receives shift report about a client whose chest x-ray reveals "free air under the right diaphragm." What action should the PN take? A) Maintain the client NPO. B) Position the client on the left side. C) Encourage ambulation to expel flatus. D) Administer a PRN antacid.
A) Maintain the client NPO.
The practical nurse (PN) is implementing a focused assessment of a client's musculoskeletal system. Which family history finding should the PN identify as an increased risk factor for the client? A) Osteoporosis. B) Osteomalacia. C) Osteomyelitis. D) Bony tuberculosis.
A) Osteoporosis.
An adult client with otitis media has thick, yellow drainage from the right ear canal. What additional findings should the practical nurse (PN) expect to identify? A) Pain relief after ear drainage begins. B) Periauricle skin excoriation. C) Increased sensitivity to sound. D) Increased pain with movement of the pinna.
A) Pain relief after ear drainage begins.
A client who is one-day post-thyroidectomy begins to develop a stridor. Which priority action should the practical nurse implement? A) Prepare for emergency tracheotomy at the bedside. B) Insert a large bore needle for IV access. C) Give the client oxygen per face mask. D) Assess the client for signs of hypocalcemia.
A) Prepare for emergency tracheotomy at the bedside.
Which client should the practical nurse consider at greatest risk for bacterial cystitis? A) A middle-aged female who has never been pregnant. B) An older female who does not use estrogen replacement. C) An older male with heart failure. D) A male who uses sildenafil (Viagra).
B) An older female who does not use estrogen replacement.
Which information should the practical nurse (PN) offer a female client who is at risk for recurrent urinary tract infection (UTI)? (Select all that apply.) A) Use vinegar solution douche regularly. B) Avoid wearing tight-fitting jeans. C) Limit caffeine and alcohol. D) Void before and after intercourse. E) Wipe the perineum from front to back.
B) Avoid wearing tight-fitting jeans. C) Limit caffeine and alcohol. D) Void before and after intercourse. E) Wipe the perineum from front to back.
An older female client with heart failure (HF) calls the clinic and tells the practical nurse (PN) that she has been coughing after starting the prescription, captopril (Capoten). Which information by the client requires further investigation by the PN? A) Feels tired after a shopping trip. B) Complains her shoes are too snug to wear. C) Sees floaters in her visual fields at times. D) Takes an over-the-counter cough syrup.
B) Complains her shoes are too snug to wear.
A client who had an abdominal cholecystectomy today has a T-tube that has drained 200 ml of greenish-brown fluid in the past 12 hours. What action should the practical nurse (PN) take? A) Irrigate the T-tube with 100 ml of warm normal saline. B) Document the findings in the electronic medical record. C) Clamp the T-tube and notify the healthcare provider. D) Assess the client's vital signs for early signs of shock.
B) Document the findings in the electronic medical record.
A client's results for this morning's platelet count is 30,000/mm 3 . What action should the practical nurse (PN) implement first? A) Notify the healthcare provider. B) Institute bleeding precautions. C) Observe intravenous access sites. D) Take vital signs as soon as possible.
B) Institute bleeding precautions.
The practical nurse (PN) notes an irregular radial pulse for a client who has an implanted pacemaker. What action should the PN do first? A) Document the finding in the client's record. B) Measure the apical-radial pulse with another nurse. C) Ask the client if symptoms of dizziness are present. D) Report findings to the healthcare provider.
B) Measure the apical-radial pulse with another nurse.
A client who has vomiting, dysuria, and urinary tract infection (UTI) arrives in the clinic and receives an IV antiemetic and a liter of IV fluids. The healthcare provider prescribes oral antibiotics for the client's discharge. Which finding is essential for the practical nurse to determine before the client is discharged? A) Temperature below 100.4 F (38 C). B) No vomiting with oral fluid intake. C) White blood cell (WBC) count below 13,000 mm3. D) Minimal dysuria with voiding.
B) No vomiting with oral fluid intake.
An older male client with osteoarthritis complains of stiffness and pain in his hips, knees, and feet each morning and asks the practical nurse (PN) why just these joints bother him. Which explanation should the PN provide? A) Advanced age eventually causes generalized joint pain. B) Poor circulation may cause pain in the lower extremities. C) Joint damage can occur from years of weight-bearing stress. D) Cartilage of the lower extremities is more likely to wear out.
C) Joint damage can occur from years of weight-bearing stress.
An adult male presents in the Emergency Center with "tearing" chest pain that has moved into his back. Which finding by the practical nurse in the client's history is relevant to the client's chest pain? A) Smokes three packs of cigarettes a day. B) Drinks three cans of beer daily. C) Has a family history of diabetes. D) Experienced a bowel obstruction 10 years ago.
A) Smokes three packs of cigarettes a day.
The practical nurse (PN) is monitoring a client with a comminuted fracture of the left femur. Which finding should the PN report to the healthcare provider immediately? A) Rising creatine phosphokinase (CPK). B) Elevated white blood count (WBC). C) Leg pain of "10" unrelieved by opioids. D) Weak left pedal pulses palpated.
C) Leg pain of "10" unrelieved by opioids.
Which assessment is most important for the practical nurse (PN) to implement for a client who returns from surgery for an arthroscopic repair of the right knee? A) Evaluation of pain symptoms. B) Auscultation of bowel sounds. C) Palpation of both pedal pulses. D) Observation of body temperature.
C) Palpation of both pedal pulses.
After a stroke, a male client with left hemiplegia ignores his left leg and arm. He is unable to use his right arm to assist with moving his left arm or leg. Which descriptor should the practical nurse (PN) document to describe this behavior? A) Mood changes. B) Sensory deficits. C) Unilateral neglect. D) Behavioral changes.
C) Unilateral neglect.
A client arrives at the oncology clinic for the next treatment in the prescribed course of chemotherapy (CT). The practical nurse (PN) reviews the client's laboratory results: white blood cells 700/mm 3 , red blood cells 2.8 million/mm 3 , hemoglobin 7.9 grams/dl, hematocrit 25.5%, and platelet count 14,000/mm 3 . Which action should the PN take first? A) Obtain the CT from the pharmacy for administration. B) Place an isolation mask on the client. C) Collect a blood sample for type and crossmatch. D) Notify the charge nurse of the client's results.
B) Place an isolation mask on the client.
A male client with increased intracranial pressure (ICP) due to a skull fracture is in the supine position with his legs elevated. What should the practical nurse (PN) do first? A) Obtain the client's vital signs. B) Raise the head 30 degrees and lower the feet. C) Complete a Glasgow Coma Scale. D) Check the IV infusion rate and urinary output.
B) Raise the head 30 degrees and lower the feet.
A client is scheduled for a transurethral resection of the prostate (TURP). What statement by the client reveals to the practical nurse that the client needs additional information? A) "I need to drink a lot after surgery." B) "My urine should be red after surgery." C) "My incision will probably be painful." D) "I should have a catheter after surgery."
C) "My incision will probably be painful."
A client with chronic kidney disease (CKD) has a serum potassium level of 7.0 mEq/L. Which prescription should the practical nurse administer? A) Diuretics and IV fluids at keep open rate. B) Oral phosphate binders with meals. C) 50% dextrose and regular insulin IV. D) Synthetic erythropoietin subcutaneously.
C) 50% dextrose and regular insulin IV.
A male client returns to the surgical nursing unit after having a thyroidectomy. Which action is most important for the practical nurse to implement? A) Check the back of the neck for bleeding. B) Determine whether the client can speak. C) Assess the client's respiratory status. D) Ask the client if he has pain.
C) Assess the client's respiratory status.
An adult client presents to the emergent care center with hives and laryngeal edema after being stung by a bee. Following successful treatment, what information is most important for the practical nurse to reinforce with the client upon discharge? A) Avoid bees. B) Keep oral benadryl accessible. C) Carry an epinephrine pen. D) Obtain medical alert bracelet.
C) Carry an epinephrine pen.
A client who is 3 days postoperative after a laminectomy is coughing up thick green sputum and wheezing. What action is most important for the practical nurse (PN) to implement? A) Review need for consistent use of incentive spirometer. B) Encourage intake of oral fluids up to 3,000 ml daily. C) Reinforce the technique for effective coughing. D) Report the change in condition to the healthcare provider.
D) Report the change in condition to the healthcare provider.
The practical nurse (PN) is caring for a male client who is in the rehabilitation unit following an acute brain attack (cerebral vascular accident (CVA) or stroke). The PN notes that the client eats food from only the right side of the plate. Which action should the PN take? A) Assess function of cranial nerve (CN) II. B) Observe pupillary responses to light. C) Ask the family if the client wears glasses. D) Teach to turn head to scan visual areas.
D) Teach to turn head to scan visual areas.
An older client who is at a health fair goes to the First Aid station and reports feeling tired after a recent screening test revealed a hemoglobin of 10.1 grams. The client asks the practical nurse (PN) what could he do to feel better. What information should the PN offer? A) Eat food high in iron, for example red meat. B) Take an over-the-counter iron supplement. C) Practice daily stress-relieving measures. D) Make appointment with healthcare provider.
D) Make appointment with healthcare provider.
A male client with peptic ulcer disease complains of feeling weak and dizzy. The practical nurse (PN) observes that the client is diaphoretic, has a firm abdomen, thready pulse at 104 beats/minute, and blood pressure of 90/50. Which action should the PN implement? A) Place the client in a left side-lying position. B) Obtain vital signs every 2 hours. C) Increase the client's oral fluid intake. D) Notify the healthcare provider.
D) Notify the healthcare provider.
When making morning assessments, the practical nurse finds a client who is exhibiting a new finding of right-sided facial drooping. Which assessment is most important for the PN to implement first? A) Instruct to squeeze the eyes shut and check for complete closure. B) Test all four extremities for movement and strength. C) Ask the client to smile, frown, and puff out cheeks. D) Use a wisp of cotton to check for corneal reflex.
B) Test all four extremities for movement and strength.
An older male resident of an extended care facility, who had no obvious injuries after a fall a couple of weeks earlier, has become increasingly confusion over the last 4-5 days. Which complication should the practical nurse suspect as a result of the recent fall? A) Intracerebral hemorrhage. B) Acute concussion. C) Chronic subdural hematoma. D) Epidural hematoma.
C) Chronic subdural hematoma.
A client with Parkinson's disease asks the practical nurse (PN) to explain how this disease causes his muscles to malfunction. Which underlying pathophysiology should the PN use as a basis for the explanation? A) Synaptic levels of norepinephrine decrease in the neuromuscular junction. B) Cerebellar levels of acetylcholine rise and inhibit voluntary movement. C) Degeneration of the basal ganglia leads to a decrease in dopamine levels. D) Neuronal signals from the cerebral cortex increase acetylcholine.
C) Degeneration of the basal ganglia leads to a decrease in dopamine levels.
A male client with pancreatic cancer who received morphine and midazalom (Versed) during an endoscopic retrograde cholangiopancreatography (ERCP) returns to the unit. His vital signs are pulse 80 beats/minute, 16 breaths/minute, blood pressure 120/80, and pulse oximeter 98%. Which action should the practical nurse (PN) implement? A) Give naloxone (Narcan) and flumazenil (Ramazicon) per protocol. B) Arouse the client to give warm oral fluids to sooth a sore throat. C) Determine client's fingerstick glucose level. D) Administer a 500-ml intravenous fluid bolus.
C) Determine client's fingerstick glucose level.
A client with type 2 diabetes mellius (DM) presents in the clinic with a leg laceration that has not healed in two weeks. Which client data is most important for the practical nurse to collect? A) Serum electrolyte results. B) Use of vitamin C supplements. C) Daily administration of insulin. D) Fingerstick glucose level.
D) Fingerstick glucose level.
A client who is 12 hours postoperative for a right total knee replacement (TKR) is receiving epidural pain management. Which finding requires additional follow-up by the practical nurse (PN)? A) Reports knee pain as a "6" on a 10 point scale. B) Nonproductive cough after incentive spirometer use. C) Feet are cool to touch and covered with 2 blankets. D) Right dorsal pedal pulse absent upon palpation.
D) Right dorsal pedal pulse absent upon palpation.
A client with heart failure (HF) takes a daily tablet of furosemide (Lasix) and lisinopril (Zestril). Which finding during the clinic visit should indicate to the practical nurse that the client's condition is worsening? A) Dizziness when changing position. B) Reports urgency with urination. C) Sharp chest pain with arm movement. D) Sleeps with two additional pillows.
D) Sleeps with two additional pillows.
The practical nurse (PN) is reviewing the plan of care for a client scheduled for a surgical amputation of the left lower leg. Which nursing diagnosis should the PN use as the highest priority for this client after the surgery? A) Impaired walking. B) Impaired adjustment. C) Disturbed body image. D) Ineffective health maintenance.
C) Disturbed body image.
A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the practical nurse to report to the healthcare provider? A) Pain radiating to the right shoulder. B) Clay-colored stool. C) Hard, rigid abdomen. D) Vomiting bile-stained emesis.
C) Hard, rigid abdomen.
The practical nurse (PN) performs a Glasgow Coma Scale (GCS) assessment for a client who experienced an acute brain attack (stroke) yesterday and obtains a score of "12." What assessment should the PN do next? A) Verbal responses and speech patterns. B) Extremity movements in response to commands. C) Ability to open eyes to stimuli. D) Comparison of GCS score with previous checks.
D) Comparison of GCS score with previous checks.
The practical nurse (PN) is caring for an elderly client with a history of heart failure (HF) who suddenly wakes up in the middle of the night complaining of being unable to breathe. What action should the (PN) implement? A) Provide a bedside fan. B) Give an antianxiety medication. C) Assess the pain level. D) Listen to bilateral lung fields.
D) Listen to bilateral lung fields.
