2022 HESI Med Surg Version 1 (v1) exit exam – Brand
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A 20-year-old female client calls the nurse to report a lump she found in her breast.
Which response is the best for the nurse to provide?
A) Check it again in one month, and if it is still there schedule an appointment.
B) Most lumps are benign, but it is always best to come in for an examination.
C) Try not to worry too much about it, because usually, most lumps are benign.
D) If you are in your menstrual period it is not a good time to check for lumps. -
ANSWER: B) Most lumps are benign, but it is always best to come in for an
examination.
(B) provides the best response because it addresses the client's anxiety most
effectively and encourages prompt and immediate action for a potential problem.
(A) postpones treatment if the lump is malignant, and does not relieve the client's
anxiety. (C and D) provide false reassurance and do not help relieve anxiety.
The nurse should be correct in withholding a dose of digoxin in a client with
congestive heart failure without specific instruction from the healthcare provider if
the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min. - ANSWER: C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which
will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5 to
5.5 mEq/L). The therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels= >2
ng/ml); (A) is within this range. (B) would not warrant the nurse withholding the
digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min
(D).
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects
the laboratory test results to indicate a decreased serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose. - ANSWER: C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the serum levels of
potassium (C) (hypokalemia)--hypertension is the most prominent and universal sign.
(A) is normal or elevated, depending on the amount of water reabsorbed with the
sodium. (B) is decreased with diabetes insipidus. (D) is not affected by primary
aldosteronism.
,Based on the analysis of the client's atrial fibrillation, the nurse should prepare the
client for which treatment protocol?
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
D) Cardiac catheterization. - ANSWER: C) Anticoagulation therapy.
The client is experiencing atrial fibrillation, and the nurse should prepare the client
for anticoagulation therapy (C) which should be prescribed before rhythm control
therapies to prevent cardioembolic events which result from blood pooling in the
fibrillating atria. (A, B, and D) are not indicated.
Which information about mammograms is most important to provide a post-
menopausal female client?
A) Breast self-examinations are not needed if annual mammograms are obtained.
B) Radiation exposure is minimized by shielding the abdomen with a lead-lined
apron.
C) Yearly mammograms should be done regardless of previous normal x-rays.
D) Women at high risk should have annual routine and ultrasound mammograms. -
ANSWER: C) Yearly mammograms should be done regardless of previous normal x-
rays.
The current breast screening recommendation is a yearly mammogram after age 40
(C). Breast self-exam (A) continues to be a priority recommendation for all women
because a small lump (or tumor) is often first felt by a woman before a mammogram
is obtained. The radiation exposure from a mammogram is low, so (B) is not normally
provided. The frequency of using routine and ultrasound mammograms (D) in
women with high-risk variables, such as a history of breast cancer, the presence of
BRC1 and BRC2 genes, or 2 first-degree relatives with breast cancer, should be
recommended and followed closely by the healthcare provider.
In assessing cancer risk, the nurse identifies which woman as being at greatest risk of
developing breast cancer?
A) A 35-year-old multipara who never breastfed.
B) A 50-year-old whose mother had unilateral breast cancer.
C) A 55-year-old whose mother-in-law had bilateral breast cancer.
D) A 20-year-old whose menarche occurred at age 9. - ANSWER: B) A 50-year-old
whose mother had unilateral breast cancer.
The most predictive risk factors for development of breast cancer are over 40 years
of age and a positive family history (occurrence in the immediate family, i.e., mother
or sister). Other risk factors include nulliparity, no history of breastfeeding, early
menarche and late menopause. Although all of the women described have one of
the risk factors for developing breast cancer, (B) has the greater risk over (A, C, and
D).
, Which reaction should the nurse identify in a client who is responding to stimulation
of the sympathetic nervous system?
A) Pupil constriction.
B) Increased heart rate.
C) Bronchial constriction.
D) Decreased blood pressure. - ANSWER: B) Increased heart rate.
Any stressor that is perceived as threatening to homeostasis acts to stimulate the
sympathetic nervous system and manifests as a flight-or-fight response, which
includes an increase in heart rate (B). (A, C, and D) are responses of the
parasympathetic nervous system.
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated
for what vitamin deficiency?
A) K.
B) B12.
C) B6.
D) C. - ANSWER: A) K.
Clients should be monitored for an increased prothrombin time and prolonged
bleeding times which would alert the nurse to a vitamin K deficiency (A). These drugs
reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are
not fat soluble vitamins.
A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit.
What initial medication should the nurse anticipate administering to the client?
A) Xylocaine (Lidocaine).
B) Procainamide (Pronestyl).
C) Phenytoin (Dilantin).
D) Digoxin (Lanoxin). - ANSWER: D) Digoxin (Lanoxin).
Digoxin (Lanoxin) (D) is administered for uncontrolled, symptomatic atrial fibrillation
resulting in a decreased cardiac output. Digoxin slows the rate of conduction by
prolonging the refractory period of the AV node, thus slowing the ventricular
response, decreasing the heart rate, and effecting cardiac output. (A, B, and C) are
not indicated in the initial treatment of uncontrolled atrial fibrillation.
What instruction should the nurse give a client who is diagnosed with fibrocystic
changes of the breast?
A) Observe cyst size fluctuations as a sign of malignancy.
B) Use estrogen supplements to reduce breast discomfort.
C) Notify the healthcare provider if whitish nipple discharge occurs.
D) Perform a breast self-exam (BSE) procedure monthly. - ANSWER: D) Perform a
breast self-exam (BSE) procedure monthly.
Fibrocystic changes in the breast are related to excess fibrous tissue, proliferation of
mammary ducts and cyst formation that cause edema and nerve irritation. These
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