MedSurg Hesi 2018, 2019 V1 and V2, 2020 Hesi Medsurg

Medsurg Hesi 2019 V1

• 1. A client with a productive cough has obtained a sputum specimen for culture as instructed.

What is the best initial nursing action?

o A. Administer the first dose of prescribed antibiotic therapy

o B. Observe the color, consistency, and amount of sputum.

o C. Encourage the client to consume plenty of warm liquids

o D. Send the specimen to the lab for analysis immediately

• Correct answer is B

• 2. A client is brought to the Emergency Department by ambulance in cardiac arrest with

cardiopulmonary resuscitation (CPR) in progress. The client is intubated and is receiving

100% oxygen per self-inflating (ambu) bag. The nurse determines that the client is cyanotic,

cold, and diaphoretic. Which assessment is most important for the nurse to obtain?

• A. breath sounds over bilateral lung fields

• B. Carotid pulsation during compression

• C. deep tendon reflexes

• D. Core body temperature

• A

• 3. After a hospitalization of inappropriate antidiuretic hormone (SIADH), a client develops

positive myelinolysis. Which intervention should the nurse implement first?

• A. Reorient client to his room

• B. Place a patch on one eye

• C. evaluate client‟s ability to swallow

• D. perform range of motion exercises

• A

• Different quizlet says: A client who is admitted to the intensive care unit

with syndrome of inappropriate antidiuretic hormone (SIADH) has developed

osmotic demyelination. Which intervention should the nurse implement first?

▪ Evaluate swallow.

▪ Rational: Osmotic demyelination, also known as central pontine

myelinolysis, is nerve damage caused by the destruction of the myelin

sheath covering nerve cells in the brainstem. The most common cause is a

rapid, drastic change in sodium levels when a client is being treated for

hyponatremia, a common occurrence in SIADH.

▪ Difficulty swallowing due to brainstem nerve damage should be

care, but determining the client's risk for aspiration is most important.

4. A male client with heart failure (HF) calls the clinic and reports that he cannot put his

shoes on because they are too tight. Which additional information should the nurse obtain?

• A. What time did he take his medication?

• B. Has his weight changed in the last several days?

• C. Is he still able to tighten his belt buckle?

 1 / 4

• D. How many hours did he sleep last night?

• Correct answer is B

5. An older adult woman with a long history of chronic obstructive pulmonary disease

(COPD) is admitted with progressive shortness of breath and a persistent cough. She is

anxious and is complaining of a dry mouth. Which intervention should the nurse implement?

• A. administer a prescribed sedative

• B. encourage client to drink water

• C. Apply a high-flow venturi mask

• D. Assist her to an upright position

• Correct answer is C

6. A client with a history of asthma and bronchitis arrives at the clinic with shortness of

breath, productive cough with thickened, tenacious mucous, and the inability to walk up a

flight of stairs without experiencing breathlessness. Which action is most important for the

nurse to instruct the client about self-care?

• A. increase the daily intake of oral fluids to liquefy secretions

• B. avoid crowded enclosed areas to reduce pathogen exposure

• C. call the clinic if undesirable side effects of medication occur

• D. Teach anxiety reduction methods for feelings of suffocation

• A

7. A cardiac catheterization of a client with heart disease indicates the following blockages:

95% proximal left anterior descending (LAD), 99% proximal circumflex, and ? % proximal

right coronary artery (RCA). The client later asks the nurse "what does all this mean for me?"

What information should the nurse provide?

• A. Blood supply to the heart is diminished by atherosclerotic lesions, which

necessitate lifestyle changes.

B. Blood vessels supplying the pumping chamber have blockages indicating a past

heart attack.

C. Three main arteries have major blockages, with only 1 to 5% of blood flow getting

through to the heart muscle.

D. The heart is not receiving enough blood, so there is a risk of heart failure and fluid

retention.

• C

9. What information should the nurse include in the teaching plan of a client diagnosed with

gastroesophageal reflux disease (GERD)?(2020)

• A. Sleep without pillows at night to maintain neck alignment

• B. Adjust food intake to three full meals per day and no snacks

• C. Minimize symptoms by wearing loose, comfortable clothing

• D. avoid participation in any aerobic exercise programs.

• Correct answer is C

▪ From the internet: Wear loose-fitting pants, shirts, and other types

of clothing to give yourself ample room to encourage proper digestive

function. These styles may help prevent reflux, too.

8. A client who weighs 175 pounds is receiving IV bolus dose of heparin 80 units/kg. The

heparin is available in a 2 ml vial, labeled 10,000 units/ml. How many ml should the nurse

administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

• 0.6 mL

 2 / 4

• With GERD, eating substances that decrease lower esophageal sphincter

pressure causes heartburn. A decrease in the lower esophageal sphincter pressure

allows gastric contents to reflux into the lower end of the esophagus. Foods that

can cause a decrease in esophageal sphincter pressure include fatty foods,

chocolate, caffeinated beverages, peppermint, and alcohol.

• Clients with GERD can develop pulmonary symptoms such as coughing,

wheezing, and dyspnea, that are caused by the aspiration of gastric contents.

• Bethanechol this is a cholinergic drug that may be used in GERD to

increase lower esophageal sphincter pressure and facilitate gastric emptying.

Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal

cramping, hypotension, and increased salivation

• Decrease intake of fat

• Bending, especially after eating, can cause GERD. Lifting heavy objects

increases intra-abdominal pressure. Assessing the client's lifting techniques

enables the nurse to evaluate the client's knowledge of factors contributing to

hiatal hernia and how to prevent complications.

10. The nurse is caring for a client with a lower left lobe pulmonary abscess. Which position

should the nurse instruct the client to maintain?

• A. left lateral

• B. supine, knees flexed

• C. dorsal recumbent

• D. knee-chest

• The correct answer is A

11. A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable

to eat or drink without becoming nausea and vomiting. Which finding should the nurse report

to the healthcare provider?

• A. Belching

• B. Amber urine

• C. Yellow sclera

• D. Flatulence

• Correct answer is C

• Yellow sclerae are an early sign of jaundice, which occurs when the

common bile duct is obstructed. Urine normally is light amber. Circumoral pallor

and black, tarry stools don't occur in common bile duct obstruction; they are

signs of hypoxia and GI bleeding, respectively

• A client is evaluated for severe pain in the right upper abdominal quadrant,

which is accompanied by nausea and vomiting. The physician diagnoses acute

cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top

priority?

▪ Acute pain related to biliary spasm

▪ The chief symptom of cholecystitis is abdominal pain or biliary

colic. Typically, the pain is so severe that the client is restless and changes

positions frequently to find relief. Therefore, the nursing diagnosis of Acute

pain related to biliary spasms takes highest priority. Until the acute pain is

relieved, the client can't learn about prevention, may continue to experience

anxiety, and can't address nutritional concerns.

 3 / 4

▪ They have clay-colored stools

• The nurse is planning care for a client following an incisional

cholecystectomy for cholelithiasis. Which intervention is the highest nursing

priority for this client?

▪ Assisting the client to turn, cough and deep breathe every 2 hours

▪ Assessment should focus on the client's respiratory status. If a

traditional surgical approach is planned, the high abdominal incision

required during surgery may interfere with full respiratory excursion. The

other nursing actions are also important, but are not as high a priority as

ensuring adequate ventilation

• The obstruction of bile flow due to cholelithiasis can interfere with the

absorption of Vitamin A (all fat-soluble vitamins A, D, E and K)

12. While caring for a client with Amyotrophic Lateral Sclerosis (ALS), a nurse performs a

neurological assessment every 4 hours. Which assessment finding warrants immediate

intervention by the nurse?

• A. inappropriate laughter

• B. increasing anxiety

• C. weakened cough effort

• D. asymmetrical weakness

• Correct answer is C

13. The nurse is providing preoperative education for a Jewish client scheduled to receive a

xenograft graft to promote burn healing. Which information should the nurse provide this

client?

• A. Grafting increases the risk for bacterial infections

• B. The xenograft is taken from nonhuman sources

• C. Grafts are later removed by a debriding procedure

• D. As the burn heals, the graft permanently attaches

• Correct answer is B

14. A male client who had colon surgery 3 days ago is anxious and requesting assistance to

reposition. While the nurse is turning him, the wound dehiscences and eviscerates. The nurse

moistens an available sterile dressing and places it over the wound. What intervention should

the nurse implement next?

• A. Bring additional sterile dressing supplies to the room

• B. Prepare the client to return to the operating room

• C. Obtain a sample of the drainage to send to the lab

• D. Auscultate the abdomen for bowel sound activity

• Correct answer is B

• The nurse should first place saline-soaked sterile dressings on the open

wound to prevent tissue drying and possible infection. Then the nurse should call

the physician and take the client's vital signs. The dehiscence needs to be

surgically closed, so the nurse should never try to close it.

15. A client with carcinoma of the lung is complaining of weakness and has a serum sodium

level 117 mEq/L. Which nursing problem should the nurse include in this client's plan of

care?

• A. Altered urinary elimination

• B. Impaired gas exchange

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