RN HESI Herzing NSG233

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Sample questions from RN HESI Herzing NSG233

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

1. 1.A 68-year-old client on a medical-surgical unit has pneumonia and suddenly becomes confused. Temperature is 39.2 C, heart rate is 124/min, respiratory rate is 30/min, blood pressure is 82/46 mm Hg, oxygen saturation is 89% on room air, and lactate is 4.6 mmol/L. The nurse activates the rapid response team. Which action should the nurse take next?

   • A.Administer prescribed acetaminophen before beginning other treatments.
   • B.Apply supplemental oxygen and begin prescribed rapid isotonic crystalloid resuscitation.
   • C.Obtain a sputum specimen before administering oxygen or fluids.
   • D.Place the client upright and restrict fluids to prevent pulmonary edema.

   Rationale: Hypoxemia and hypotension with an elevated lactate indicate sepsis with severe hypoperfusion, requiring immediate oxygenation and circulatory support. Acetaminophen may improve comfort but does not correct these life-threatening problems. A sputum specimen should not delay resuscitation, and fluid restriction would worsen hypoperfusion without evidence of fluid overload. The exam takeaway is to prioritize oxygen delivery and perfusion while implementing the sepsis treatment bundle.

2. 2.A 24-year-old client arrives in the emergency department with vomiting, deep respirations, and fruity-smelling breath. Glucose is 486 mg/dL, arterial pH is 7.18, bicarbonate is 12 mEq/L, and potassium is 3.0 mEq/L. Isotonic IV fluid replacement has begun. Which prescription should the nurse clarify before implementation?

   • A.Continuous cardiac monitoring.
   • B.Hourly point-of-care glucose testing.
   • C.IV potassium replacement.
   • D.Immediate initiation of an IV regular insulin infusion.

   Rationale: Insulin drives potassium into cells and can cause a lethal dysrhythmia when significant hypokalemia is already present, so potassium must be corrected before starting insulin. Cardiac monitoring is appropriate because the potassium level is low. Hourly glucose testing and prescribed potassium replacement are both indicated during diabetic ketoacidosis treatment. The exam takeaway is to check potassium before initiating insulin for a hyperglycemic crisis.

3. 3.A 73-year-old client on a telemetry unit develops severe dyspnea and pink, frothy sputum. The client has heart failure, a respiratory rate of 34/min, oxygen saturation of 82%, and blood pressure of 174/96 mm Hg. While another nurse activates the rapid response team, which action should the primary nurse perform first?

   • A.Place the client in high-Fowler position and administer oxygen.
   • B.Obtain a daily weight using the standing scale.
   • C.Administer the scheduled oral beta blocker.
   • D.Encourage the client to drink water to loosen secretions.

   Rationale: The findings indicate acute pulmonary edema, and upright positioning with oxygen immediately supports ventilation and oxygenation. A standing weight is useful for fluid trending but is unsafe during severe respiratory distress. An oral beta blocker does not rapidly relieve the emergency, and additional oral fluid may worsen congestion. The exam takeaway is to address breathing before routine heart failure management.

4. 4.A 59-year-old client in the emergency department reports crushing chest pain that began 40 minutes ago. An ECG shows ST-segment elevation in contiguous leads, blood pressure is 138/84 mm Hg, and oxygen saturation is 96% on room air. The client has no aspirin allergy or active bleeding. Which action should the nurse anticipate while the reperfusion team is mobilized?

   • A.Administer oxygen at 10 L/min solely because the client has chest pain.
   • B.Wait for the troponin result before beginning acute coronary treatment.
   • C.Administer chewable aspirin as prescribed.
   • D.Encourage ambulation to determine whether the pain increases.

   Answer and rationale are in the full material.

5. 5.A 70-year-old client arrives at a stroke center 75 minutes after sudden right arm weakness and expressive aphasia. Blood pressure is 176/94 mm Hg and bedside glucose is 108 mg/dL. Which action has the highest priority?

   • A.Give oral aspirin immediately.
   • B.Prepare the client for an urgent noncontrast head CT.
   • C.Offer water to evaluate the ability to swallow.
   • D.Lower the systolic blood pressure to below 120 mm Hg.

   Answer and rationale are in the full material.