HESI RN Med-Surg NGN Test Bank

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Sample questions from HESI RN Med-Surg NGN Test Bank

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a client with a history of heart failure reports increasing shortness of breath. Which finding requires the nurse to intervene first?

   • A.Bilateral ankle edema that is worse in the evening
   • B.Oxygen saturation of 86% on room air with new confusion
   • C.A 1.5-kg weight gain over the past 3 days
   • D.Bilateral crackles that extend to the mid-lung fields

   Rationale: An oxygen saturation of 86% accompanied by new confusion signals impaired oxygenation with possible cerebral hypoxia and requires immediate action. Crackles and rapid weight gain indicate worsening fluid volume, but neither takes priority over evidence of acute hypoxemia. Evening ankle edema is a less acute finding. Address airway and breathing first, then evaluate and treat the underlying congestion.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the client's changing condition? Select all that apply.

   • A.Obtain a 12-lead ECG and promptly report the new rhythm change.
   • B.Assist the client to ambulate to reduce dependent edema.
   • C.Administer the scheduled oral furosemide and reassess in 4 hours.
   • D.Place the client in high-Fowler position and apply oxygen as prescribed by protocol.
   • E.Activate the rapid response team for worsening respiratory distress.
   • F.Encourage oral fluids to improve renal perfusion.

   Rationale: High-Fowler positioning and protocol-directed oxygen support breathing, while rapid response activation is appropriate for worsening distress and falling oxygenation. The new irregular tachycardia warrants an ECG and prompt reporting because it may further compromise cardiac output. Giving an oral diuretic and waiting 4 hours delays escalation when the client is acutely deteriorating. Extra fluids may worsen pulmonary congestion, and ambulation is unsafe during respiratory distress.

3. 3.A client's potassium is 6.2 mEq/L (reference range 3.5-5.0 mEq/L), and the telemetry monitor shows peaked T waves. The client takes digoxin and has an apical pulse of 58/min. Which action should the nurse take first?

   • A.Give the prescribed oral potassium supplement with food.
   • B.Recheck the potassium level with the next routine morning laboratory draw.
   • C.Administer the scheduled digoxin to improve cardiac contractility.
   • D.Hold digoxin and immediately notify the provider about the hyperkalemia and ECG changes.

   Rationale: Severe hyperkalemia with peaked T waves can progress to a fatal dysrhythmia, and bradycardia increases concern about cardiac conduction. The nurse should hold digoxin and urgently notify the provider so emergency treatment can be initiated. Administering digoxin or potassium could worsen the situation, and waiting for routine laboratory testing is unsafe. ECG changes make this an immediate safety issue, not a finding to monitor passively.

4. 4.A client states, 'My chest feels tight, but it usually goes away when I rest.' Today the discomfort began at rest and has lasted 15 minutes. Which response is most appropriate?

   • A.Treat the symptoms as possible acute coronary syndrome and activate emergency evaluation.
   • B.Advise the client to take an antacid and call back if symptoms persist.
   • C.Arrange an outpatient stress test because the discomfort resembles stable angina.
   • D.Ask the client to walk briefly to determine whether exertion reproduces the discomfort.

   Answer and rationale are in the full material.

5. 5.At change of shift, the nurse receives report on four clients. Which client should be assessed first?

   • A.A client taking a beta blocker whose HR is 58/min and who denies dizziness or weakness
   • B.A client with chronic atrial fibrillation whose ventricular rate is 94/min and who requests assistance to the bathroom
   • C.A client 1 day after femoral cardiac catheterization who reports new back pain and has a BP decrease from 138/78 to 98/60 mm Hg
   • D.A client with stable angina who reports the usual brief discomfort after walking to the dining room

   Answer and rationale are in the full material.