HESI Med-Surg Proctored Exam 2 Herzing University

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Sample questions from HESI Med-Surg Proctored Exam 2 Herzing University

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, an adult with a traumatic brain injury becomes increasingly difficult to arouse over 30 minutes. Which finding, considered with this trend, is the strongest indication of worsening neurologic status?

   • A.The client has a decreasing level of consciousness and a newly unequal pupil response
   • B.The client reports nausea after receiving an analgesic
   • C.The client has a heart rate of 88/min and a blood pressure of 138/82 mm Hg
   • D.The client reports a headache rated 6 out of 10

   Rationale: A declining level of consciousness with a new pupil asymmetry suggests neurologic deterioration and possible increasing intracranial pressure. Headache and nausea require assessment but are less specific when considered without a worsening trend or focal finding. The listed heart rate and blood pressure alone do not indicate deterioration. Serial neurologic assessments are more informative than relying on one isolated finding.

2. 2.The provider prescribes mannitol for a client with increased intracranial pressure. Which assessment is most important for evaluating the medication's safety and response?

   • A.Measure temperature and inspect the oral mucosa
   • B.Measure urine output and assess serum osmolality and renal function
   • C.Assess peripheral pulses and capillary refill in both feet
   • D.Check bowel sounds and measure abdominal girth

   Rationale: Mannitol is an osmotic diuretic that can reduce cerebral edema but also cause diuresis, intravascular volume changes, and renal stress. Urine output, renal function, and serum osmolality help evaluate response and identify potential harm. Bowel findings and oral mucosa do not directly monitor mannitol's principal risks. Peripheral perfusion matters to overall assessment, but it does not replace monitoring renal function and osmolality.

3. 3.A client is receiving 3% sodium chloride for elevated intracranial pressure after a head injury. Which nursing actions are appropriate during this therapy? Select all that apply.

   • A.Monitor the infusion site and use the prescribed infusion method
   • B.Trend serum sodium and serum osmolality as prescribed
   • C.Stop the infusion whenever the client reports thirst
   • D.Assess fluid status and monitor for signs of pulmonary edema
   • E.Monitor neurologic status and compare findings with prior assessments
   • F.Administer the solution rapidly through any available peripheral line

   Rationale: Hypertonic saline draws water into the intravascular space and may increase serum sodium, so sodium, osmolality, neurologic findings, and fluid status require close monitoring. Pulmonary edema is a potential complication of intravascular volume expansion, and the infusion should be administered using the prescribed method with site monitoring. Rapid administration through any line is not a safe general rule because concentration, access, and rate must follow the order and policy. Thirst alone is not an indication to stop the infusion; assess the client and relevant laboratory and volume trends.

4. 4.A client with a head injury receives an opioid analgesic and then becomes difficult to arouse. Which action best supports safe evaluation of the client's neurologic status?

   • A.Withhold all further neurologic checks until the opioid has worn off
   • B.Give another analgesic dose to determine whether the behavior is pain-related
   • C.Document the finding as an expected medication effect and reassess at the next scheduled check
   • D.Compare the current neurologic assessment with baseline, assess ventilation and oxygenation, and report the change promptly

   Answer and rationale are in the full material.

5. 5.At change of shift, a client with traumatic brain injury has a new blood pressure of 86/50 mm Hg and an SpO2 of 89% on room air. Which immediate concern is the priority?

   • A.Reducing stimulation by dimming the lights
   • B.Scheduling the next neurologic assessment for 2 hours later
   • C.Preventing secondary brain injury by addressing hypoxia and hypotension
   • D.Determining whether the client can tolerate oral fluids

   Answer and rationale are in the full material.