NCLEX-RN MEDSURG HESI LATEST 2024 EXAM

pg. 1

NCLEX-RN MED/SURG HESI LATEST 2024 EXAM/

COMPLETE 180 ACTUAL EXAM QUESTIONS

WITH CORRECT DETAILED ANSWERS (VERIFIED

ANSWERS) GRADED A+/ NEW!!

• When a nurse assesses a client receiving total parenteral nutrition (TPN), which

laboratory value is most important for the nurse to monitor regularly?

• Albumin
• Calcium
• Glucose
• Alkaline phosphatase- Correct Answer – C

Rationale:

TPN solutions contain high concentrations of glucose, so the blood glucose level is often monitored as often as q6h because of the risk for hyperglycemia (C). (A) is monitored periodically because an increase in the albumin level, a serum protein, is generally a desired effect of TPN. (B) may be added to TPN solutions, but calcium imbalances are not generally a risk during TPN administration. (D) may be decreased in the client with malnutrition who receives TPN, but abnormal values, reflecting liver or bone disorders, are not a common complication of TPN administration.

• A 62-year-old woman who lives alone tripped on a rug in her home and fractured her

hip. Which predisposing factor most likely contributed to the fracture in the proximal end of her femur?

• Failing eyesight resulting in an unsafe environment
• Renal osteodystrophy resulting from chronic kidney disease (CKD)
• Osteoporosis resulting from declining hormone levels
• Cerebral vessel changes causing transient ischemic attacks - Correct Answer – C 1 / 4

pg. 2

Rationale:

The most common cause of a fractured hip in older women is osteoporosis, resulting from reduced calcium in the bones as a result of hormonal changes in the perimenopausal years (C). (A) may or may not have contributed to the accident, but eye changes were not involved in promoting the hip fracture. (B) is not a common condition of older people but is associated with CKD. Although (D) may result in transient ischemic attacks (TIAs) or stroke, it will not result in fragility of the bones, as does osteoporosis.

• The nurse receives the client's next scheduled bag of TPN labeled with the additive

NPH insulin. Which action should the nurse implement?

• Hang the solution at the current rate.
• Refrigerate the solution until needed.
• Prepare the solution with new tubing.
• Return the solution to the pharmacy. - Correct Answer – D

Rationale:

Only regular insulin is administered by the IV route, so the TPN solution containing NPH insulin should be returned to the pharmacy (D). (A, B, and C) are not indicated because the solution should not be administered.

• A male client has just undergone a laryngectomy and has a cuffed tracheostomy tube

in place. When initiating bolus tube feedings postoperatively, when should the nurse inflate the cuff?

• Immediately after feeding
• Just prior to tube feeding
• Continuous inflation is required
• Inflation is not required- Correct Answer – B

Rationale:

The cuff should be inflated before the feeding to block the trachea and prevent food from entering (B) if oral feedings are started while a cuffed tracheostomy tube is in place. It should remain inflated throughout the feeding to prevent aspiration of food into the respiratory system. (A and D) place the client at risk for aspiration. (C) places the client at risk for tracheal wall necrosis. 2 / 4

pg. 3

• A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid

ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment?

• Administer lidocaine,75 mg intravenous push.
• Perform synchronized cardioversion.
• Defibrillate the client as soon as possible.
• Administer atropine, 0.4 mg intravenous push. - Correct Answer – B

Rationale:

With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion (B) to convert the cardiac rhythm back to normal sinus rhythm. (A) is a medication used for ventricular dysrhythmias. (C) is not for a client with atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as ventricular fibrillation and unstable ventricular tachycardia. (D) is the drug of choice in symptomatic sinus bradycardia, not atrial fibrillation.

• A 63-year-old client with type 2 diabetes mellitus is admitted for treatment of an ulcer

on the heel of the left foot that has not healed with wound care. The nurse observes that the entire left foot is darker in color than the right foot. Which additional symptom should the nurse expect to find?

• Pedal pulses will be weak or absent in the left foot.
• The client will state that the left foot is usually warm.
• Flexion and extension of the left foot will be limited.
• Capillary refill of the client's left toes will be brisk. - Correct Answer – A

Rationale:

Symptoms associated with decreased blood supply are weak or absent pedal and tibial pulses (A). The client with diabetes experiences vascular scarring as a result of atherosclerotic changes in the peripheral vessels. This results in compromised perfusion to the dependent extremities, which further delays wound healing in the affected foot. Although flexion and extension may be limited (C), depending on the degree of damage, this is not always the case. (B and D) are signs of adequate perfusion of the foot, which would not be expected in this client.

• / 4

pg. 4

• A client with cirrhosis develops increasing pedal edema and ascites. Which dietary

modification is most important for the nurse to teach this client?

• Avoid high-carbohydrate foods.
• Decrease intake of fat-soluble vitamins.
• Decrease caloric intake.
• Restrict salt and fluid intake. - Correct Answer – D

Rationale:

Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as manifested by edema and ascites (D). (A, B, and C) will not affect fluid retention.

• During report, the nurse learns that a client with tumor lysis syndrome is receiving an

IV infusion containing insulin. Which assessment should the nurse complete first?

• Review the client's history for diabetes mellitus.
• Observe the extremity distal to the IV site.
• Monitor the client's serum potassium and blood glucose levels.
• Evaluate the client's oxygen saturation and breath sounds. - Correct Answer -C

Rationale:

Clients with tumor lysis syndrome may experience hyperkalemia, requiring the addition of insulin to the IV solution to reduce the serum potassium level. It is most important for the nurse to monitor the client's serum potassium and blood glucose levels to ensure that they are not at dangerous levels (C). (A, B, and D) provide valuable assessment data but are of less priority than (C).

• A client is admitted to the hospital with a diagnosis of severe acute diverticulitis.

Which nursing intervention has the highest priority?

• Place the client on NPO status.
• Assess the client's temperature.
• Obtain a stool specimen.
• Administer IV fluids. - Correct Answer -A
• / 4