HESI Comprehensive Medical Surgical Exit Exam with Answers (839 Solved Questions)

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lOMoAR cPSD| 28769225COMPREHENSIVEMED SURG HESI EXITEXAM LATEST TEST BANKFollowing discharge teaching, a male client with duodenal ulcer tells the nurse thehe will drink plenty of dairy products, such as milk, to help coat and protect hisulcer. What is the best follow-up action by the nurse?(ANS-ReviewwiththeclienttheneedtoavoidfoodsthatarerichinmilkandcreamA male client with hypertension, who received new antihypertensive prescriptionsat his last visit returns to the clinic two weeks later to evaluate his blood pressure(BP). His BP is 158/106 and he admits that he has not been taking the prescribedmedication because the drugs make him "feel bad". In explaining the need forhypertension control, the nurse should stress that an elevated BP places the clientat risk for which pathophysiological condition?(ANS-StrokesecondarytohemorrhageThe nurse observes an unlicensed assistive personnel (UAP) positioning a newlyadmitted client who has a seizure disorder. The client is supine and the UAP isplacing soft pillows along the side rails. What action should the nurse implement?(ANS- Instruct the UAP to obtain soft blankets to secure to the side rails instead ofpillows.An adolescent with major depressive disorder has been taking duloxetine(Cymbalta) for the past 12 days. Which assessment finding requires immediatefollow-up?(ANS-DescribeslifewithoutpurposeA 60-year-old female client with a positive family history of ovarian cancer hasdeveloped an abdominal mass and is being evaluated for possible ovarian cancer.Her Papanicolau (Pap) smear results are negative. What information should thenurse include in the client's teaching plan?(ANS-Furtherevaluationinvolvingsurgerymaybeneeded

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A client who recently underwear a tracheostomy is being prepared for discharge tohome. Which instructions is most important for the nurse to include in thedischarge plan?(ANS-TeachtrachealsuctioningtechniquesIn assessing an adult client with a partial rebreather mask, the nurse notes that theoxygen reservoir bag does not deflate completely during inspiration and the client'srespiratory rate is 14 breaths / minute. What action should the nurse implement?(ANS- Document the assessment dataRationale:reservoirbagshouldnotdeflatecompletelyduringinspirationandtheclient's respiratoryrateiswithinnormallimits.During shift report, the central electrocardiogram (EKG) monitoring systemalarms. Which client alarm should the nurse investigate firs?(ANS-Respiratoryapneaof30secondsDuring a home visit, the nurse observed an elderly client with diabetes slip andfall. What action should the nurse take first?(ANS-ChecktheclientforlacerationsorfracturesAt 0600 while admitting a woman for a schedule repeat cesarean section (C-Section), the client tells the nurse that she drank a cup a coffee at 0400 because shewanted to avoid getting a headache. Which action should the nurse take first?(ANS- Inform the anesthesia care providerAfter placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2heart sounds. To determine if an S3 heart sound is present, what action should thenurse take first?(ANS-Listen withthebell atthesamelocationA 66-year-old woman is retiring and will no longer have a health insurancethrough her place of employment. Which agency should the client be referred to bythe employee health nurse for health insurance needs?(ANS- Medicare

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A client who is taking an oral dose of a tetracycline complains of gastrointestinalupset. What snack should the nurse instruct the client to take with the tetracycline?(ANS- Toasted wheat bread and jellyFollowing a lumbar puncture, a client voices several complaints. What complaintindicated to the nurse that the client is experiencing a complication?(ANS- "I have a headache that gets worse when I sit up""I am having pain in my lower back when I move my legs""My throat hurts when I swallow""I feel sick to my stomach and am going to throw up"An elderly client seems confused and reports the onset of nausea, dysuria, andurgency with incontinence. Which action should the nurse implement?(ANS-Obtain acleancatchmid-streamspecimenThe nurse is assisting the mother of a child with phenylketonuria (PKU) to selectfoods that are in keeping with the child's dietary restrictions. Which foods arecontraindicated for this child?(ANS-FoodssweetenedwithaspartameBefore preparing a client for the first surgical case of the day, a part-time scrubnurse asks the circulating nurse if a 3 minute surgical hand scrub is adequatepreparation for this client. Which response should the circulating nurse provide?(ANS- Direct the nurse to continue the surgical hand scrub for a 5 minute durationWhich breakfast selection indicates that the client understands the nurse'sinstructions about the dietary management of osteoporosis?(ANS-Bagelwith jellyandskimmilkThe charge nurse of a critical care unit is informed at the beginning of the shift thatless than the optimal number of registered nurses will be working that shift. Inplanning assignments, which client should receive the most care hours by aregistered nurse (RN)?

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(ANS-An 82-year-old client with Alzheimer's disease newly-fractures femur whohasa Foleycatheter andsoftwristrestrainsappliedA mother brings her 6-year-old child, who has just stepped on a rusty nail, to thepediatrician's office. Upon inspection, the nurse notes that the nail went throughthe shoe and pierced the bottom of the child's foot. Which action should the nurseimplement first?-Cleanse the foot with soap and water and apply an antibiotic ointment-Provide teaching about the need for a tetanus booster within the next 72hours.-have the mother check the child's temperature q4h for the next 24 hours-transfer the child to the emergency department to receive a gamma globulininjection(ANS-CleansethefootwithsoapandwaterandapplyanantibioticointmentThe mother of an adolescent tells the clinic nurse, "My son has athlete's foot, Ihave been applying triple antibiotic ointment for two days, but there has been noimprovement." What instruction should the nurse provide?(ANS-Stopusingtheointmentandencouragecompletedryingofthefeetandwearing cleansocks.A 26-year-old female client is admitted to the hospital for treatment of a simplegoiter, and levothyroxine sodium (Synthroid) is prescribed. Which symptomsindicate to the nurse that the prescribed dosage is too high for this client? Theclient experiencesBradycardia and constipationLethargy and lack of appetiteMuscle cramping and dry, flushed skinPalpitations and shortness of breath(ANS-PalpitationsandshortnessofbreathA client with a history of heart failure presents to the clinic with nausea, vomiting,yellow vision and palpitations. Which finding is most important for the nurse toassess to the client?

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(ANS-ObtainalistofmedicationstakenforcardiachistoryThe healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mgin 250 ml of D5W at 300 mcg/hour. The nurse should program the infusion pumpto deliver how many ml/hour? (Enter numeric value only.)(ANS-75Rationale:ConvertmgtomcgandusetheformulaD/HxQ.300mcg/hour/1,000mcgx250ml=3/1x25=75ml/hourThe pathophysiological mechanisms that are responsible for ascites related to liverfailure? (Select all that apply)(ANS-Fluid shifts from intravascular to interstitial area due to decreased serumproteinIncreasedhydrostaticpressureinportalcirculationincreasesfluidshiftsintoabdomenIncreasedcirculatingaldosteronelevelsthatincreasesodiumandwaterretentionThe nurse is auscultating a client's heart sounds. Which description should thenurse use to document this sound? (Please listen to the audio first to select theoption that applies)(ANS-MurmurRationale: A murmur is auscultated as a swishing sound that is associated with thebloodturbulence createdbytheheartorvalvulardefect.The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IMfor an infant. The 500 mg vial is labeled with the instruction to add 5.3 ml diluentto provide a concentration of 100 mg/ml. How many ml should the nurseadministered for each dose? (Enter numeric value only. If rounding is required,round to the nearest tenth)(ANS-0.4Rationale:35mg/100mgx1=0.35=0.4 ml

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The nurse notes that a client has been receiving hydromorphone (Dilaudid) everysix hours for four days. What assessment is most important for the nurse tocomplete?Auscultate the client's bowel soundsObserve for edema around the anklesMeasure the client's capillary glucose levelCount the apical and radial pulses simultaneously(ANS- Auscultate the client's bowel soundsRationale:hydromorphoneisapotentopioidanalgesicthatslowsperistalsisandfrequently causes constipation, so it is most important to Auscultate the client'sbowel soundsA female client is admitted with end stage pulmonary disease is alert, oriented, andcomplaining of shortness of breath. The client tells the nurse that she wants "noheroic measures" taken if she stops breathing, and she asks the nurse to documentthis in her medical record. What action should the nurse implement?(ANS-Asktheclienttodiscuss"donotresuscitate"withherhealthcareproviderA client is receiving a full strength continuous enteral tube feeding at 50 ml/hourand has developed diarrhea. The client has a new prescription to change thefeeding to half strength. What intervention should the nurse implement?(ANS-Add equalamountsofwaterandfeedingtoafeedingbagandinfuseat50ml/hourA female client reports that her hair is becoming coarse and breaking off, that theouter part of her eyebrows have disappeared, and that her eyes are all puffy. Whichfollow-up question is best for the nurse to ask?(ANS-Haveyounoticedanychangesinyourfingernails?Rationale: The pattern of reported manifestations is suggestive of hypothyroidismAfter a third hospitalization 6 months ago, a client is admitted to the hospital withascites and malnutrition. The client is drowsy but responding to verbal stimuli and

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reports recently spitting up blood. What assessment finding warrants immediateintervention by the nurse?Capillary refill of 8 secondsBruises on arms and legsRound and tight abdomenPitting edema in lower legs(ANS-Capillaryrefillof8secondsAfter the nurse witnesses a preoperative client sign the surgical consent form, thenurse signs the form as a witness. What are the legal implications of the nurse'ssignature on the client's surgical consent form? (Select all that apply)(ANS-The client voluntarily grants permission for the procedure to be doneThe client is competent to sign the consent without impairment of judgmentTheclientunderstandstherisksandbenefitsassociatedwiththeprocedureFollowing surgery, a male client with antisocial personality disorder frequentlyrequests that a specific nurse be assigned to his care and is belligerent whenanother nurse is assigned. What action should the charge nurse implement?(ANS- Advise the client that assignments are not based on clients requestsA client with cervical cancer is hospitalized for insertion of a sealed internalcervical radiation implant. While providing care, the nurse finds the radiationimplant in the bed. What action should the nurse take?(ANS-Placetheimplantina lead containerusinglong-handledforcepsThe client with which type of wound is most likely to need immediate interventionby the nurse?LacerationAbrasionContusionUlceration(ANS-Laceration

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Rationale: A laceration is a wound that is produced by the tearing of soft bodytissue. This type of wound is often irregular and jagged. A laceration wound isoften contaminated with bacteria and debris from whatever object caused the cut.The nurse is planning care for a client admitted with a diagnosis ofpheochromocytoma. Which intervention has the highest priority for inclusion inthis client's plan of care? (ANS- Monitor blood pressure frequentlyRationale: A pheochromocytoma is a rare, catecholamine-secreting tumor that mayprecipitate life-threatening hypertension. The tumor is malignant in 10% of casesbut may be cured completely by surgical removal. Although pheochromocytomahas classically been associated with 3 syndromes—von Hippel-Lindau (VHL)syndrome, multiple endocrine neoplasia type 2 (MEN 2), and neurofibromatosistype 1 (NF1)—there are now 10 genes that have been identified as sites ofmutations leading to pheochromocytoma.When caring for a client who has acute respiratory distress syndrome (ARDS), thenurse elevates the head of the bed 30 degrees. What is the reason for thisintervention?To reduce abdominal pressure on the diaphragmTo promote retraction of the intercostal accessory muscle of respirationTo promote bronchodilation and effective airway clearanceTo decrease pressure on the medullary center which stimulates breathing (ANS-ToreduceabdominalpressureonthediaphragmRationale: a semi-sitting position is the best position for matching ventilation andperfusion and for decreasing abdominal pressure on the diaphragm, so that theclient can maximize breathing.When assessing a mildly obese 35-year-old female client, the nurse is unable tolocate the gallbladder when palpating below the liver margin at the lateral borderof the rectus abdominal muscle. What is the most likely explanation for failure tolocate the gallbladder by palpation?

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The client is too obesePalpating in the wrong abdominal quadrantDeeper palpation technique is neededThe gallbladder is normal (ANS-The gallbladder is normalRationale:anormal healthygallbladderisnotpalpableA woman with an anxiety disorder calls her obstetrician's office and tells the nurseof increased anxiety since the normal vaginal delivery of her son three weeks ago.Since she is breastfeeding, she stopped taking her antianxiety medications, butthinks she may need to start taking them again because of her increased anxiety.What response is best for the nurse to provide this woman?Describe the transmission of drugs to the infant through breast milkEncourage her to use stress relieving alternatives, such as deep breathing exercisesInform her that some antianxiety medications are safe to take while breastfeedingExplain that anxiety is a normal response for the mother of a 3-week-old. (ANS-Inform her that some antianxiety medications are safe to take while breastfeedingRationale: there are several antianxiety medications that are not contraindicated forbreastfeeding mothers.An older male client with a history of type 1 diabetes has not felt well the past fewdays and arrives at the clinic with abdominal cramping and vomiting. He islethargic, moderately, confused, and cannot remember when he took his last doseof insulin or ate last. What action should the nurse implement first?Start an intravenous (IV) infusion of normal salineObtain a serum potassium levelAdminister the client's usual dose of insulinAssesspupillaryresponsetolight(ANS-Startanintravenous(IV)infusionofnormal salineRationale: the nurse should first start an intravenous infusion of normal saline toreplace the fluids and electrolytes because the client has been vomiting, and it is

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unclear when he last ate or took insulin. The symptoms of confusion, lethargy,vomiting, and abdominal cramping are all suggestive of hyperglycemia, which alsocontributes to diuresis and fluid electrolyte imbalance.A client who received multiple antihypertensive medications experiences syncopedue to a drop in blood pressure to 70/40. What is the rationale for the nurse'sdecision to hold the client's scheduled antihypertensive medication?Increased urinary clearance of the multiple medications has produced diuresis andlowered the blood pressure.The antagonistic interaction among the various blood pressure medications hasreduced their effectiveness.The additive effect of multiple medications has caused the blood pressure to droptoo low.The synergistic effect of the multiple medications has resulted in drug toxicity andresulting hypotension. (ANS- The additive effect of multiple medications hascaused the blood pressure to drop too lowWhich client is at the greatest risk for developing delirium?An adult client who cannot sleep due to constant pain.An older client who attempted 1 month agoA young adult who takes antipsychotic medications twice a dayA middle-aged woman who uses a tank for supplemental oxygen (ANS-An adultclient whocannot sleepdueto constantpain.Which intervention should the nurse include in a long-term plan of care for a clientwith Chronic Obstructive Pulmonary Disease (COPD)?Reduce risks factors for infectionAdminister high flow oxygen during sleepLimit fluid intake to reduce secretionsUse diaphragmatic breathing to achieve better exhalation (ANS-Reduce risksfactors forinfection

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Which location should the nurse choose as the best for beginning a screeningprogram for hypothyroidism?A business and professional women's group.An African-American senior citizens centerA daycare center in a Hispanic neighborhoodAn after-school center for Native-American teens (ANS-A business andprofessional women'sgroup.A female client has been taking a high dose of prednisone, a corticosteroid, forseveral months. After stopping the medication abruptly, the client reports feeling"very tired". Which nursing intervention is most important for the nurse toimplement?Measure vital signsAuscultate breath soundsPalpate the abdomenObservetheskin forbruising(ANS-MeasurevitalsignsA male client reports the onset of numbness and tingling in his fingers and aroundhis mouth. Which lab is important for the nurse to review before contacting thehealth care provider?Capillary glucoseUrine specific gravitySerum calciumWhitebloodcellcount(ANS-SerumcalciumWhat explanation is best for the nurse to provide a client who asks the purpose ofusing the log-rolling technique for turning?Working together can decrease the risk for back injuryThe technique is intended to maintain straight spinal alignment.Using two or three people increases client safety.

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Turning instead of pulling reduces the likelihood of skin damage (ANS-Thetechniqueisintended to maintain straight spinal alignment.A client receiving chemotherapy has severe neutropenia. Which snack is best forthe nurse to recommend to the client? (ANS- Baked apples topped with driedraisinsWhich action should the school nurse take first when conducting a screening forscoliosis? (ANS- Inspect for symmetrical shoulder height.An unlicensed assistive personnel (UAP) assigned to obtain client vital signsreports to the charge nurse that a client has a weak pulse with a rate of 44 beat/minutes. What action should the charge nurse implement? (ANS- Assign apractical nurse (LPN) to determine if an apical radial deficit is presentAfter a sudden loss of consciousness, a female client is taken to the ED and initialassessment indicate that her blood glucose level is critically low. Once her glucoselevel is stabilized, the client reports that was recently diagnosed with anorexianervosa and is being treated at an outpatient clinic. Which intervention is moreimportant to include in this client's discharge plan? (ANS- Encourage a low-carbohydrate and high-protein dietA client with a peripherally inserted central catheter (PICC) line has a fever. Whatclient assessment is most important for the nurse to perform? (ANS- Observe theantecubital fossa for inflammation.The nurse administers an antibiotic to a client with respiratory tract infection. Toevaluate the medication's effectiveness, which laboratory values should the nursemonitor? Select all that apply (ANS- White blood cell (WBC) countSputumcultureandsensitivityA client is admitted to isolation with the diagnosis of active tuberculosis. Whichinfection control measures should the nurse implement?Negative pressure environment

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Contact precautionsDroplet precautionsProtectiveenvironment(ANS-NegativepressureenvironmentA school nurse is called to the soccer field because a child has a nose bleed(epistaxis). In what position should the nurse place the child? (ANS- Sitting up andleaning forwardA young adult who is hit with a baseball bat on the temporal area of the left skull isconscious when admitted to the ED and is transferred to the Neurological Unit tobe monitored for signs of closed head injury. Which assessment finding isindicative of a developing epidural hematoma? (ANS- Altered consciousnesswithin the first 24 hours after injury.A female client with breast cancer who completed her first chemotherapy treatmenttoday at an out-patient center is preparing for discharge. Which behavior indicatesthat the client understands her care needs (ANS- Rented movies and borrowedbooks to use while passing time at homeWhich instruction should the nurse provide a pregnant client who is complainingof heartburn? (ANS- Eat small meal throughout the day to avoid a full stomach.A client is admitted to the intensive care unit with diabetes insipidus due to apituitary gland tumor. Which potential complication should the nurse monitorclosely?HypokalemiaKetonuria.Peripheral edemaElevatedbloodpressure(ANS-HypokalemiaRationale: pituitary tumors that suppress antidiuretic hormone (ADH) result indiabetes insipidus, which causes massive polyuria and serum electrolyteimbalances, including hypokalemia, which can lead to lethal arrhythmias.

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A female client reports she has not had a bowel movement for 3 days, but now isdefecating frequent small amount of liquid stool. Which action should the nurseimplement? (ANS- Digitally check the client for a fecal impactionAfter changing to a new brand of laundry detergent, an adult male reports that hehas a fine itchy rash. Which assessment finding warrants immediate interventionby the nurse? (ANS- Bilateral Wheezing.The nurse should teach the parents of a 6 year-old recently diagnosed with asthmathat the symptom of acute episode of asthma are due to which physiologicalresponse? (ANS- Inflammation of the mucous membrane & bronchospasmA 10 year old who has terminal brain cancer asks the nurse, "What will happen tomy body when I die?" How should the nurse respond? (ANS- "The heart will stopbeating & you will stop breathing."The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. Thischild should be medicated for pain based on which findings? Select all that apply:RestlessnessClenched FistIncreased pulse rateIncreased respiratory rate.Increased temperaturePeripheral pallor of the skin (ANS-RestlessnessClenched FistIncreased pulse rateIncreasedrespiratoryrate.The nurse is preparing to administer an oral antibiotic to a client with unilateralweakness, ptosis, mouth drooping and, aspiration pneumonia. What is the prioritynursing assessment that should be done before administering this medication?(ANS- Determine which side of the body is weak.

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The nurse who is working on a surgical unit receives change of shift report on agroup of clients for the upcoming shift. A client with which condition requires themost immediate attention by the nurse?Gunshot wound three hours ago with dark drainage of 2 cm noted on the dressing.Mastectomy 2 days ago with 50 ml bloody drainage noted in the Jackson-prattdrain.Collapsed lung after a fall 8h ago with 100 ml blood in the chest tube collectioncontainerAbdominal-perineal resection 2 days ago with no drainage on dressing who hasfever and chills. (ANS- Abdominal-perineal resection 2 days ago with no drainageon dressing who has fever and chills.Rationale: the client with an abdominal- perineal resection is at risk for peritonitisand needs to be immediately assessed for other signs and symptoms for sepsis.The nurse is caring for a client who had gastric bypass surgery yesterday. Whichintervention is most important for the nurse to implement during the first 24postoperative hours? (ANS- Measure hourly urinary output.Rationale: a serious early complications of gastric bypass surgery is ananastomoses leak, often resulting in death.When preparing to discharge a male client who has been hospitalized for anadrenal crisis, the client expresses concern about having another crisis. He tells thenurse that he wants to stay in the hospital a few more days. Which interventionshould the nurse implement? (ANS- Schedule an appointment for an out-patientpsychosocial assessment.An adult female client tells the nurse that though she is afraid her abusiveboyfriend might one day kill her, she keeps hoping that he will change. Whataction should the nurse take first? (ANS- Explore client's readiness to discuss thesituation.

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