Hesi Med Surg Questions And Answers
2023
A nurse is showing a student nurse how to care for Tonisha Bennete, a 32-year-old female who has
pneumonia. The student nurse asks the nurse to explain why Ms. Bennete is placed in Fowler position.
What is the nurse's best response to the student nurs...
Hesi Med Surg Questions And Answers
2023
A nurse is showing a student nurse how to care for Tonisha Bennete, a 32-year-old female who has
pneumonia. The student nurse asks the nurse to explain why Ms. Bennete is placed in Fowler position.
What is the nurse's best response to the student nurse?
"It is an intervention for activity intolerance."
"It is an intervention for ineffective airway clearance."
"It is the position in which the client will be most comfortable."
"It is an intervention for ineffective breathing pattern."
"It is an intervention for ineffective airway clearance."
Rationale
Placing Ms. Bennete in Fowler position is an intervention for ineffective airway clearance. It is not an
intervention for activity intolerance or ineffective breathing pattern. Ms. Bennete's comfort level is not
the reason to place her in Fowler position.
1. What instruction should the nurse include in the discharge teaching plan of a client who had a
cataract extraction today?
a. Sexual activities may be resumed upon return home
b. Light housekeeping is permitted but avoid heavy lifting
c. Use a metal eye shield on operative eye during the day
d. Administer eye ointment before applying eye drops
b. Light housekeeping is permitted but avoid heavy lifting
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2. A male adult comes to the urgent care clinic 5 days after being diagnose with influenza. He is short of
breath, febrile, and coughing green colored sputum. Which intervention should the nurse implement
first?
a. Obtain a sputum sample for culture
b. Check his oxygen saturation level
c. Administer an oral antipyretic
d. Auscultate bilateral lung sound
a. Obtain a sputum sample for culture
3. An elder male client tells the nurse that he is loosing sleep because he has to get up several times at
night to go to the bathroom that he has trouble starting his urinary stream and that he does not feel like
his bladder is ever completely empty. Which intervention should the nurse implement?
a. collect a urine specimen for culture analysis
b. obtain a fingerstick blood glucose level
c. palpate the bladder above the symphysis pubis
d. review the client fluid intake
,c. palpate the bladder above the symphysis pubis
4. An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI)
Prescriptions for intravenous antibiotics and insulin infusion are initiated. Which serum laboratory value
warrants the most immediate intervention by the nurse?
a. blood ph of 7.30
b. glucose of 350 mg /dl
c. white blood cell count of 15000mm
d. potassium of 2.5 meq/l
d. potassium of 2.5 meq/l
5. A client with sickle cell anemia develops a fever during the last hour of administration of a unit of
packed red blood cell. When notifying the healthcare provider what information should the nurse
provide first using the SBAR communication process?
a. explain specific reason for urgent notification
b. preface the report by stating the clients name and admitting diagnosis
c. communicate the pre-transfusion temperatures
d. optain prn prescription for acetaminophen for fever 101f
a. explain specific reason for urgent notification
6. An adult male client is admitted for pneumocystis carinil pneumonia (PCP) secondary to aids. While
hospitalize he receives IV pentamidine isethionate therapy. In preparing this client for discharge what
important aspect regarding his medication therapy should the nurse explain?
a. AZT therapy must be stopped when IV aerosol pentamine is being used.
b. IV pentamine will be given until oral pentamine can be tolerated
c. It will be necessary to continue prophylactic doses of IV or aerosol pentamine every month
d. Iv pentamine may offer protection to others aids related conditions such as kaposis sarcoma
c. It will be necessary to continue prophylactic doses of IV or aerosol pentamine every month
7. A client subjective data includes dysuria, urgency, and urinary frequency. What action should the
nurse implement next?
a. collect a clean catch specimen
b. palpate the suprapubic region
c. instruct to wipe from front to back
d. inquire about recent sexual activity
a. collect a clean catch specimen
8. A client tells the nurse that her biopsy results indicate that the cancer cells are well differentiated
How should the nurse respond?
a. offer the client reassurance that this information indicates that the clients cancer cells are benign
b. explain that these tissue cells often respond more effectively to radiation than to chemotherapy
c. ask the client in the healthcare provider has giving her any information about the classification of her
cancer
d. help the client make plans to begin inmediate treatment since her cancer is likely to spread quickly
, c. ask the client in the healthcare provider has giving her any information about the classification of her
cancer
9. A client with a chronic kidney disease is treated on hemodialysis. During the 1 treatment clients blood
pressure drops from 150/90 to 80/30 Which action should the nurse take first?
a. monitor bp q45 minutes
b. lower the head of the chair and elevate feet
c. stop dialysis treatment
d. administer 5%albumin IV
c. stop dialysis treatment
10.A client with deep vain thrombosis (DVT) is receiving a continues infusion of heparin sodium 25,000
unit in 5% dextrose injection 250ml. The prescription indicates the dosage should be increase 900
units/hr. The nurse should program the infusion pump to deliver how many ml/hr?
=9ml/hr
11.The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD).
Which subjective data reported by the client supports this diagnosis?
a. upper mid abdominal gnawing and burning pain
b. severe abdominal cramps and diarrhea after eating spicy foods
c. marked loss of weight and appetite over the last few months
d. use of chewable and liquid antacids for indigestion
a. upper mid abdominal gnawing and burning pain
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12.The nurse is providing preoperative education for a jewish client schedule to receive a xenograft graft
to promote burn healing. Which information should the nurse provide this client?
a. the xenograft is taken from nonhuman sources
b. grafting increases the risk for bacterial infection
c. as the burn heals the graft permanently attaches
d. grafts are later removed by debriding procedure
a. the xenograft is taken from nonhuman sources
13.A client who took a camping vacation two weeks ago in a country with a tropical climate comes to
the clinic describing vague symptoms and diarrhea for the past week. Which finding is most important
for the nurse to report?
a. jaundice sclera
b. intestinal cramping
c. weakness and fatigue
d. weight loss
a. jaundice sclera
14.During a home visit the nurse assesses the skin of a client with eczema who reports than an
exacerbation of symptoms has occurred during the last week. Which information is most useful in
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