hesi evolve questions (integumentary & musculoskeletal)
Which recommendations would the nurse include in a client's discharge instructions regarding a home skincare program for psoriasis? - "Shower twice a day with mild soap and warm water." - "Soak the affected areas in hot water on a daily basis." - "Apply an alcohol free, moisturizing lotion several times a day." - "Cover affected areas when in contact with others."
"Apply an alcohol free, moisturizing lotion several times a day." (rationale: they provide an occlusive film on the skin surface so usual water loss through the skin is limited) (82% nationwide answered correctly)
Which instruction would the nurse give a client returning to work as a carpenter after surgery for carpal tunnel syndrome of the right hand? - "Avoid carrying tools with the arms." - "Learn to hammer with the left hand." - "Do stretching exercises during breaks." - "Avoid power tools such as drills or screwdrivers."
"Do stretching exercises during breaks." (rationale: stretching exercises will assist in keeping the muscles and tendons supple and pliable, thus reducing the traumatic consequences of repetitive activity) (73% nationwide answered correctly)
Which statement by a client with a new non-weight-bearing long leg cast indicates the need for additional discharge teaching? - "The cast can be wrapped in plastic when I take a shower." - "I called my office to let them know I will be back at work next week." - "The physical therapist is going to teach me how to walk with crutches." - "I am going to give myself a pedicure with red nail polish when I get home."
"I am going to give myself a pedicure with red nail polish when I get home." (rationale: red nail polish or any opaque color will interfere with the ability to assess the toes for capillary refill) (60% nationwide answered correctly)
A client who is in skin traction while awaiting surgery for repair of a fractured femur asks the nurse to release the traction because of leg pain. Which response would the nurse make? - "I can't do that because the weights are needed to keep the bone aligned." - "I will remove half of the weights and notify your primary health care provider." - "I'll get your prescribed pain medication increased to help relieve your discomfort." - "I follow the primary health care provider's directions, and that is not prescribed."
"I can't do that because the weights are needed to keep the bone aligned." (rationale: explains why the traction may not be released, a continuous pull must be maintained) (58% nationwide answered correctly)
The registered nurse is teaching a student nurse about the use of a suction pump in negative-pressure wound therapy. Which statement by the student nurse indicates the need for further teaching? - "The wound site should be monitored at least every 2 hours." - "This treatment is used mostly for areas of skin cancer." - "The foam dressing should be changed every 48 to 72 hours." - "A continuous low-negative pressure should be maintained."
"This treatment is used mostly for areas of skin cancer." (rationale: used in neg-pressure wound therapy to reduce chronic ulcers by removing fluids to enhance granulation. Shouldn't be used on skin cancer because it may cause serious bleeding & death) (77% nationwide answered correctly)
Which client statement indicates the need for further teaching about the traction device after a major fracture? - "Traction must be applied continuously to be effective." - "Weights of 5 to 45 pounds are used to apply the counterweight." - "The risks of skeletal traction include infection at the pin insertion site." - "Traction pushes the fractured ends together to prevent them from pulling apart."
"Traction pushes the fractured ends together to prevent them from pulling apart." (rationale: traction uses counterweights to gently pull - not push - the affected extremity to realign it) (51% nationwide answered correctly)
Which statement is correct regarding negative pressure wound therapy? Select all that apply. One, some, or all responses may be correct. - a suction pump is used - necrotizing infections are treated - oxygen is administered under high pressure - a low-voltage current is applied to a wound area - chronic ulcers are reduced by removing fluids from the wound
- a suction pump is used - chronic ulcers are reduced by removing fluids from the wound (39% nationwide answered correctly)
Which roles could the nurse assign to unlicensed assistive personnel (UAP) in caring for a client with a cast? Select all that apply. One, some, or all responses may be correct. - applying ice to the cast - positioning the casted extremity above heart level - marking the circumference of any drainage on the cast - looking for clinical manifestations of compartment syndrome - teaching range-of-motion exercises to the client and caregiver
- applying ice to the cast - positioning the casted extremity above heart level (44% nationwide answered correctly)
Arrange the steps of applying negative pressure wound therapy in order of implementation. - apply a large occlusive dressing - clean the wound - make a small hole in the occlusive dressing over the foam dressing near the tubing attachment - connect the tubing to a pump - cut the foam dressing to the dimensions of the wound
- clean the wound - cut the foam dressing to the dimensions of the wound - apply a large occlusive dressing - make a small hole in the occlusive dressing over the foam dressing near the tubing attachment - connect the tubing to a pump (39% nationwide answered correctly)
Which medications used for the treatment of plaque psoriasis will the nurse administer subcutaneously? Select all that apply. One, some, or all responses may be correct. - alefacept - infliximab - etanercept - adalimumab - ustekinumab
- etanercept - adalimumab - ustekinumab (40% nationwide answered correctly)
The nurse is completing the health history of a client admitted to the hospital with osteoarthritis. Which joints would the nurse expect the client will report as having been involved first? Select all that apply. One, some, or all responses may be correct. - hips - knees - ankles - shoulders - metacarpals
- hips - knees (rationale: affects weight bearing joints. even though ankles are weight bearing joints & eventually affected, the motion in the ankles is not as great, therefore less degeneration) (43% nationwide answered correctly)
Which actions could the registered nurse (RN) assign to a licensed practical nurse (LPN) caring for the client with a cast or traction? Select all that apply. One, some, or all responses may be correct. - monitoring skin integrity around the cast - marking circumference of any drainage on the cast - teaching the client and caregiver range-of-motion (ROM) exercises - instructing family members on assisting the client with cast care - checking color, temperature, capillary refill, and pulses distal to the cast
- monitoring skin integrity around the cast - marking circumference of any drainage on the cast - checking color, temperature, capillary refill, and pulses distal to the cast (41% nationwide answered correctly)
Which intervention would the nurse use for a client with full-thickness burns to the chest and anterior right arm? Select all that apply. One, some, or all responses may be correct. - monitoring vital signs - cutting off the clothing - inserting a urinary catheter - removing the client's jewelry - establishing an intravenous line
- monitoring vital signs - cutting off the clothing - inserting a urinary catheter - removing the client's jewelry - establishing an intravenous line (50% nationwide answered correctly)
Which findings for a client who has a cast applied to the lower extremity indicate a complication? Select all that apply. One, some, or all responses may be correct. - warmth - numbness - skin desquamation - generalized discomfort - prolonged capillary refill
- numbness - prolonged capillary refill (rationale: numbness is a neurological sign that should be reported immediately indicating pressure on nerves & blood vessels. compression of arterial vessels results in prolonged return of blood to periphery) (18% nationwide answered correctly)
While caring for a client in traction, which actions could the nurse delegate to a licensed practical nurse (LPN)? Select all that apply. One, some, or all responses may be correct. - padding traction connections - determining correct body alignment - assessing complications associated with immobility - teaching the client about range-of-motion (ROM) exercises - assisting the client with passive and active range-of-motion (ROM) exercises
- padding traction connections - assisting the client with passive and active range-of-motion (ROM) exercises (36% nationwide answered correctly)
Which clinical findings would the nurse expect to observe in a client with a diagnosis of psoriasis? Select all that apply. One, some, or all responses may be correct. - scaly lesions - pruritic pustules - reddened papules - multiple petechiae - erythematous macules
- scaly lesions - reddened papules (30% nationwide answered correctly)
A client is admitted for treatment of partial- and full-thickness burns of the entire right lower leg extremity and the anterior portion of the right upper arm. The nurse performs an immediate appraisal of the percentage of body surface area burned using the rule of nines. What percentage of body surface area does the nurse determine is affected? Record the answer to one decimal place. _______%
22.5 (rationale: entire right lower extremity is 18% & the anterior portion of the right upper extremity is 4.5%.) (48% nationwide answered correctly)
The nurse uses the rule of nines to estimate the percentage of the burn surface area (BSA) on a client who has burns covering the entire surface of both arms, the posterior trunk, the genitals, and the entire left leg. What is the percentage of burn injury for this client? Record your answer as a whole number. ________%
55 (51% nationwide answered correctly)
Which wound care is given to a client with severe burn injuries during the acute phase? - assess extent and depth of burns - provide daily shower and wound care - remove dead and contaminated tissue - assess the wound daily and adjust the dressing
assess the wound daily and adjust the dressing (45% nationwide answered correctly)
Which action would be the nurse's first priority when receiving a client with major burns? - assessing airway patency - checking the client from head to toe - administering oxygen as needed - elevating the extremities if no fractures are noticed
assessing airway patency (96% nationwide answered correctly)
The wound characteristics of four different clients with burns are mentioned below. Which client most likely suffers skin injury from sunburn? - client 1: pink to red, mild edema, pain, no blisters or eschar, 3-6 days healing time - client 2: red to white, moderate edema, pain, rare blisters, no eschar, about 2 weeks healing time - client 3: black brown, severe edema, no pain or blisters, hard and inelastic eschar, weeks to months healing time - client 4: black, no edema, pain, or blisters, hard and inelastic eschar, weeks to months healing time
client 1: pink to red, mild edema, pain, no blisters or eschar, 3-6 days healing time (85% nationwide answered correctly)
Which client has second-degree burns? - client A: waxy white, dark brown appearance - client B: redness, pain, minimal edema - client C: moist blebs, blisters, severe pain - client D: dry, leathery eschar, absence of pain
client C: moist blebs, blisters, severe pain (84% nationwide answered correctly)
The nurse reviews the assessment findings of four clients with burns. Which client's findings are consistent with chemical burns? - client A: cardiac arrest - client B: minimal to absent pain - client C: paralysis - client D: hoarseness
client C: paralysis (rationale: paralysis is most likely related to chemical fumes) (52% nationwide answered correctly)
Which client has findings consistent with rheumatoid arthritis? - client A: uric acid at 8.5 mg/dL - client B: CRP at 800 mcg/dL - client C: anti DNA antibody at 90 IU/mL - client D: ESR at 65 mm/hr
client D: ESR at 65 mm/hr (rationale: ESR is a nonspecific index of inflammation. normal value is < 30 mm/hr) (45% nationwide answered correctly)
When developing the plan of care for a client with rheumatoid arthritis, which client consideration would the nurse include? - surgery - comfort - education - motivation
comfort (84% nationwide answered correctly)
The nurse recommends that, when in bed, a client who has osteoarthritis should lie in the supine or prone position. The client states that these positions are uncomfortable for the knees and hips. Which action would the nurse take? - encourage the client to maintain extension for specific periods of time - urge the client to lie in whatever position is most comfortable - insert a pillow under the client's knees to relieve discomfort - place the client in the semi-Fowler position most of the time
encourage the client to maintain extension for specific periods of time (rationale: flexion contractures of the hips and knees can develop unless some periods of full extension are maintained) (33% nationwide answered correctly)
A client admitted with a burn injury has erythema and mild swelling. Which type of burn would the nurse suspect? - first-degree burn - third-degree burn - fourth-degree burn - second-degree burn
first-degree burn (85% nationwide answered correctly)
Which factor that contributes to the incidence of hip fractures is a higher risk for older adults? - carelessness - fragility of bone - sedentary existence - rheumatoid diseases
fragility of bone (91% nationwide answered correctly)
The client who sustained a burn asks, "What is the difference between my full-thickness and deep partial-thickness burns?" Which information will the nurse share with the client? - full-thickness burns extend into the subcutaneous tissue; deep partial-thickness burns affect only the epidermis - full-thickness burns involve superficial layers of the epidermis; deep partial-thickness burns extend through the epidermis - full-thickness burns extend through the epidermis and only part of the dermis; deep partial-thickness burns extend into the subcutaneous tissue - full-thickness burns extend into the subcutaneous tissue; deep partial-thickness burns extend through the epidermis and involve only part of the dermis
full-thickness burns extend into the subcutaneous tissue; deep partial-thickness burns extend through the epidermis and involve only part of the dermis (75% nationwide answered correctly)
Which task regarding the care of a client with Buck's traction is appropriate to delegate to the unlicensed assistive personnel (UAP)? - check body positioning - check the distal pulses and capillary refill - teach the client about potential complications - help the client with range-of-motion (ROM) exercises
help the client with range-of-motion (ROM) exercises (rationale: checking body position is a type of assessment) (50% nationwide answered correctly)
Which condition would the nurse question using a negative-pressure wound treatment device? - chronic ulcer - upper thigh wound - hip wound with slight bleeding - treated osteomyelitis within the vicinity of the wound
hip wound with slight bleeding (rationale: bleeding indicates exposed blood vessels and neg-pressure wound treatment is contraindicated) (46% nationwide answered correctly)
The nurse presents discharge instructions to a client for self-care after application of a cast to their fractured right ulna and radius. Which clinical manifestation would the nurse instruct the client to immediately report to their primary health care provider? - slight stiffness of the fingers - increasing pain at the injury site - small amount of dark, bloody drainage on the cast - bounding radial pulse in the affected extremity
increasing pain at the injury site (rationale: indicates cast pressure on a nerve and requires further investigation) (54% nationwide answered correctly)
A client has closed fractures of the right femur and tibia with multiple soft-tissue contusions. Which action would the nurse plan to take? - perform a neurovascular assessment of the extremity - reassure the client that these injuries are not that serious - gather equipment needed for the application of skeletal traction - prepare the client for a surgical reduction of the injured extremity
perform a neurovascular assessment of the extremity (86% nationwide answered correctly)
A regimen of rest, exercise, and physical therapy is prescribed for a client with rheumatoid arthritis. Which purpose of the regimen would the nurse teach to the client? - treating the arthritic pain - halting the inflammatory process - preventing additional joint damage - providing for the return of lost joint motion
preventing additional joint damage (rationale: ROM exercises are instituted to maintain mobility of joints) (59% nationwide answered correctly)
Which benign condition shows silver scaly plaques on the skin? - nevi - psoriasis - urticaria - acne vulgaris
psoriasis (84% nationwide answered correctly)
Which assessment finding is associated with chronic eczema? - localized edema - rough, thick skin - decreased skin turgor - increased skin temperature
rough, thick skin (88% nationwide answered correctly)
Which individual's activities increase the risk of developing carpal tunnel syndrome? - housekeeper - software engineer - health care worker - professional athlete
software engineer (80% nationwide answered correctly)
The nurse identifies silvery scales on a client's elbows and knees. Which finding in the client's history will help the nurse identify the origin of this rash? - stress in recent months - usage of harsh, irritating soap - excursions into uncultivated, weedy areas - infection with the human immunodeficiency virus (HIV)
stress in recent months (68% nationwide answered correctly)
Which suggestion would the nurse make to a client with rheumatoid arthritis who asks about ways to decrease morning stiffness? - wear loose but warm clothing - plan a short rest break periodically - avoid excessive physical stress and fatigue - take a hot bath or shower in the morning
take a hot bath or shower in the morning (rationale: moist heat increases circulation and decreases muscle tension, which can help relieve chronic stiffness) (79% nationwide answered correctly)
The nurse is evaluating the actions of a caregiver for a client with a lower extremity cast. Which action of the caregiver indicates the nurse needs to provide additional instruction? - using a towel to blot dry the cast - moving joints above and below the cast regularly - elevating the injured part above heart level for 48 hours - wrapping the client's cast with a plastic cover for 36 hours
wrapping the client's cast with a plastic cover for 36 hours (rationale: covering the cast in plastic for a prolonged period of time may lead to discomfort and needs to be corrected by the nurse) (60% nationwide answered correctly)
