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Med Surg 2023/24 Hesi practice questions
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The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings requires further evaluation? 1. Heart rate 57 bpm. ...

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  • August 4, 2023
  • 53
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • med surg 2023 hesi practice questions
  • med surg 202324 hesi practice questions

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Med Surg 2023/24 Hesi practice
questions

The nurse is assessing a 48-year-old client with a history of smoking during a

routine clinic visit. The client, who exercises regularly, reports having pain in the calf

during exercise that disappears at rest. Which of the following findings requires further

evaluation?

1. Heart rate 57 bpm.

2. SpO2 of 94% on room air.

3. Blood pressure 134/82.

4. Ankle-brachial index of 0.65. - 4

An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in

a client who is experiencing intermittent claudication. A Doppler ultrasound is

indicated for further evaluation. The bradycardic heart rate is acceptable in an athletic

client with a normal blood pressure. The SpO2 is acceptable; the client has a smoking

history.



An overweight client taking warfarin (Coumadin) has dry skin due to decreased

arterial blood flow. What should the nurse instruct the client to do? Select all that apply.

1. Apply lanolin or petroleum jelly to intact skin.

2. Follow a reduced-calorie, reduced-fat diet.

3. Inspect the involved areas daily for new ulcerations.

4. Instruct the client to limit activities of daily living (ADLs).

5.Use an electric razor to shave - 1,2,3,5

Maintaining skin integrity is important in preventing chronic ulcers and

infections. The client should be taught to inspect the skin on a daily basis. The client

should reduce weight to promote circulation; a diet lower in calories and fat is

,appropriate. Because the client is receiving Coumadin, the client is at risk for bleeding

from cuts. To decrease the risk of cuts, the nurse should suggest that the client use an

electric razor. The client with decreased arterial blood flow should be encouraged to

participate in ADLs. In fact, the client should be encouraged to consult an exercise

physiologist for an exercise program that enhances the aerobic capacity of the body.



A client with peripheral vascular disease has undergone a right femoral-popliteal

bypass graft. The blood pressure has decreased from 124/80 to 94/62. What

should the nurse assess first?

1. IV fluid solution.

2. Pedal pulses.

3. Nasal cannula flow rate.

4. Capillary refill - 2

With each set of vital signs, the nurse should assess the dorsalis pedis and

posterior tibial pulses. The nurse needs to ensure adequate perfusion to the lower

extremity with the drop in blood pressure. IV fluids, nasal cannula setting, and capillary

refill are important to assess; however, priority is to determine the cause of drop in

blood pressure and that adequate perfusion through the new graft is maintained.



The nurse is caring for a client with peripheral artery disease who has recently

been prescribed clopidogrel (Plavix). The nurse understands that more teaching is

necessary when the client states which of the following:

1. "I should not be surprised if I bruise easier or if my gums bleed a little when

brushing my teeth."

2. "It doesn't really matter if I take this medicine with or without food, whatever

works best for my stomach."

3. "I should stop taking Plavix if it makes me feel weak and dizzy."

4. "The doctor prescribed this medicine to make my platelets less likely to stick together and help
prevent clots from forming." - 3

,Weakness, dizziness, and headache are common adverse effects of Plavix and

the client should report these to the physician if they are problematic; in order to

decrease risk of clot formation, Plavix must be taken regularly and should not be

stopped or taken intermittently. The main adverse effect of Plavix is bleeding, which

often occurs as increased bruising or bleeding when brushing teeth. Plavix is well

absorbed, and while food may help decrease potential gastrointestinal upset, Plavix may

be taken with or without food. Plavix is an antiplatelet agent used to prevent clot

formation in clients who have experienced or are at risk for myocardial infarction,

ischemic stroke, peripheral artery disease, or acute coronary syndrome.



A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing

intermittent claudication. The nurse determines this medication is effective when the

client reports which of the following?

1. "I am having fewer aches and pains."

2. "I do not have headaches anymore."

3. "I am able to walk further without leg pain."

4. "My toes are turning grayish black in color." - 3



Cilostazol is indicated for management of intermittent claudication. Symptoms

usually improve within 2 to 4 weeks of therapy. Intermittent claudication prevents

clients from walking for long periods of time. Cilostazol inhibits platelet aggregation

induced by various stimuli and improving blood flow to the muscles and allowing the

client to walk long distances without pain. Peripheral arterial disease causes pain

mainly of the leg muscles. "Aches and pains" does not specify exactly where the pain is

occurring. Headaches may occur as a side effect of this drug, and the client should

report this information to the health care provider. Peripheral arterial disease causes

decreased blood supply to the peripheral tissues and may cause gangrene of the toes; the

drug is effective when the toes are warm to the touch and the color of the toes is similar

, to the color of the body.



The client admitted with peripheral vascular disease (PVD) asks the nurse why

her legs hurt when she walks. The nurse bases a response on the knowledge that the

main characteristic of PVD is:

1. Decreased blood flow.

2. Increased blood flow.

3. Slow blood flow.

4. Thrombus formation. - 1



Decreased blood flow is a common characteristic of all PVD. When the

demand for oxygen to the working muscles becomes greater than the supply, pain is the

outcome. Slow blood flow throughout the circulatory system may suggest pump failure.

Thrombus formation can result from stasis or damage to the intima of the vessels.



The nurse is planning care for a client who is diagnosed with peripheral vascular

disease (PVD) and has a history of heart failure. The nurse should develop a plan of

care that is based on the fact that the client may have a low tolerance for exercise

related to:

1. Decreased blood flow.

2. Increased blood flow.

3. Decreased pain.

4. Increased blood viscosity. - 1

A client with PVD and heart failure will experience decreased blood flow. In

this situation, low exercise tolerance (oxygen demand becomes greater than the oxygen

supply) may be related to less blood being ejected from the left ventricle into the

systemic circulation. Decreased blood supply to the tissues results in pain. Increased

blood viscosity may be a component, but it is of much less importance than the disease

processes.

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