HESI Med-Surg 266

Free preview · Original latest version

Sample questions from HESI Med-Surg 266

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 36-year-old reports sudden chest pressure and nausea while climbing stairs. The client is diaphoretic; the first ECG shows no ST elevation, and the initial troponin is within the reference range. Which action is the priority?

   • A.Repeat the ECG and troponin as prescribed while maintaining cardiac monitoring
   • B.Reassure the client that a normal initial troponin rules out myocardial infarction
   • C.Give an antacid and reassess the discomfort in 1 hour
   • D.Have the client walk to determine whether the discomfort recurs

   Rationale: Early ECG and troponin results can be nondiagnostic, so ongoing monitoring and serial testing are needed to detect evolving acute coronary syndrome. A normal initial troponin does not exclude myocardial injury. Ambulation could worsen ischemia, and treating presumed indigestion could delay time-sensitive evaluation.

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

   • A.Obtain a 12-lead ECG while another team member assesses the client
   • B.Apply oxygen and titrate to maintain the prescribed saturation goal
   • C.Administer the scheduled oral beta blocker before reassessing blood pressure
   • D.Assist the client to walk to determine whether chest pressure worsens
   • E.Activate the facility's rapid response or emergency response process

   Rationale: The chart shows new chest pressure, diaphoresis, falling blood pressure from 138/82 to 96/60 mm Hg, tachycardia, and new ST depression, which signal possible acute myocardial ischemia with hemodynamic deterioration. Activating the emergency response, supporting oxygenation, and obtaining a 12-lead ECG are appropriate immediate actions. Giving an oral beta blocker before evaluating the hypotension could worsen perfusion, and ambulation is unsafe during suspected acute ischemia.

3. 3.A client at 30 weeks of pregnancy with a history of rheumatic mitral stenosis reports new breathlessness when lying flat. The client is speaking in full sentences, has an SpO2 of 95% on room air, and has no chest pain. Which position should the nurse use while arranging prompt evaluation?

   • A.Supine with the legs elevated above the heart
   • B.Left lateral with the head of the bed elevated
   • C.Prone with a pillow under the abdomen
   • D.Trendelenburg to increase venous return

   Rationale: Left lateral positioning with the head elevated can reduce aortocaval compression and ease breathing while the client is evaluated for worsening cardiac symptoms. Supine or Trendelenburg positioning can impair ventilation and increase venous return, potentially stressing a stenotic mitral valve. Prone positioning is not appropriate late in pregnancy and does not address the immediate concern.

4. 4.Refer to the client's chart. Which findings support the nurse's concern that the client has worsening heart failure with pulmonary congestion? Select all that apply.

   • A.Weight loss of 0.8 kg since yesterday
   • B.Increasing oxygen requirement and falling SpO2
   • C.Urine output of 20 mL/hr over the past 2 hours
   • D.New crackles extending to the mid-lung fields
   • E.A heart rate of 104/min in a client taking a beta blocker

   Answer and rationale are in the full material.

5. 5.At a community clinic, a 4-year-old on day 6 of fever has bilateral nonpurulent conjunctival redness, cracked lips, and swollen hands. The caregiver says the child is less active today. Which action is most important?

   • A.Recommend acetaminophen and routine follow-up after the fever resolves
   • B.Encourage vigorous play to assess the child's exercise tolerance
   • C.Arrange urgent evaluation for Kawasaki disease and possible IV immunoglobulin treatment
   • D.Apply warm compresses and begin topical antibiotic eye drops

   Answer and rationale are in the full material.