Medical Surgical Practice HESI Exam

The wife of a client with a large brain tumor asks the PN to explain why the tumor should be surgically removed. What is the best response for the PN to provide?

Brain tumors increase cerebral mass, resulting in increased intracranial pressure

The PN is performing a focused assessment for a post op client who returns to the unit after receiving general anesthesia...

Breath sounds are clear bilaterally

The PN is performing a focused assessment for a post-op client who returns to the unit after receiving general anesthesia. Which finding should the PN identify as an indicator that the client is free of resp complication?

Breath sounds are clear bilaterally

Which instructions should the PN reinforce with a client who is preparing for dishcharge *S.A.T.A*

- Request the use of special hand scanning - Do not lean against the car - Keep regularly scheduled appts

Which findings should the PN identify in a client with anemia due to a vitamin B12 deficiency?

- Smooth, beefy-red oral cavity - Paresthesia of hands and feet

The PN is completing focused assessments for four clients. Which client finding should be the PNs first priority?

A client with asthma

While completing pre-op prep for a client is admitted for same-day surgery, what eval statement should the PN identify as an important outcome?

Asks questions regarding the surgical experience

A male client returns to the surgical nursing unit after having a thyroidectomy. Which action is most important for the PN to implement?

Assess the client's resp status

A client with COPD is receiving 02 at 2L/min. During the bed bath, the client complains of SOB. Which action should the PN implement?

Assist the client into a Fowler's position

Which instruction should the PN reinforce with a female client about skin care after her first radiotherapy treatment?

Avoid using ice packs on the exposed area

The PN receives a report on a group of clients assigned for the day. Which priority assessment should the PN implement?

Check the pulse ox for a client with myasthenia gravis

A client is admitted with a C4 spinal cord injury after falling from a roof at a construction site. After returning to the unit for a CT scan to confirm the vertebral fracture, which assessment by the PN has the highest priority?

Check the resp effort and pulse ox reading

Which finding for a client with HF should the PN report to the charge nurse

Distended neck veins

The PN is caring for a client who is admitted with signs of possible acute brain attack (stroke) 3 hrs ago. The clients BP is 170/96

Continue to monitor client's BP

A male client is one day post-op for surgical repair of a fractured femur when he suddenly experiences dyspnea, coughing, chest pain, and hemoptysis. Based on this data, what nursing diagnosis should the practical nurse address for this client?

Impaired gas exchanged R/T altered blood flow to alveoli

A client with Parkinson's disease asks the PN to explain how this disease causes his muscles to malfunction. Which underlying pathophysiology should the PN use as a basis for explanation?

Degeneration of the basal ganglia

What info should the PN reinforce with a client who is recently diagnosed with DM?

Diabetes increase the risk for cardiovascular disease

The PN is visiting a male client with diabetes who has a new cast on his arm. The client's fingers are pale, cool, slightly swollen.

Elevate the arm above heart level

The PN is reviewing the admission lab results for a client with cirrhosis of the liver. Which finding should the PN report to the MD?

Elevated serum ammonia

The PN is assisting the occpational health nurse with employee health screening. Which technique should the PN use to determine a client's visual acuity?

Have the client read the snellen eye chart

Which finding should the PN identify as typical for a client who is hypoxic?

Hemoglobin of 10 grams/dL

Which finding for a client who is 1-day post op for a partial thyroidectomy requires immediate follow-up by the PN?

High pitched expiratory sound

Which actions should the PN implement for a client whose fractured tibia is causing swelling of the lower leg?

Ice application and elevation

What complication is most important for the PN to monitor for in a client who has a total hip replacement?

Infection

A client's prescription for warfarin (Coumadin) therapy was d/c 3 weeks ago and returns to the clinic for follow-up lab tests. Which results should indicate to the PN that the meds has been eliminated from the body?

International normalized ratio (INR) or 0.9

An older female client with osteoporosis asks the PN to explain why she is now 2 inches shorter than when she was younger. What info is best for the PN to provide?

It is a combo of wear and tear and calcium loss that causes the damage

A male client is admitted with lower right abdominal pain for the past two days. During the focused assessment, the PN observes that the client's abdomen is rigid with tense positioning. Which action should the PN implement?

Keep the client NPO for possible surgery

A client who is 2 days post op for *abd* surgery has an NGT to low continuous suction. Which imbalance?

Metabolic alkalosis

A client who has vomiting, dysuria, and UTI...

No vomiting with oral fluid intake

A male client who had a stroke is incontinent of urine. Which action should the P implement in providing bladder training?

Offer the client the commode or urinal every 2 hrs

The PN is reviewing discharge instructions with a client after out-patient. Which client response indicates to the PN the need for teaching reinforcement?

Pain meds every day

An adult client with otitis media has thick, yellow drainage from the right ear canal. What additional findings should the PN expect to identify?

Pain relief after ear drainage begins

Which assessment is most important for the practical nurse to implement for a client who returns from surgery for an arthroscopic repair of the right knee?

Palpation of both pedal pulses

The practical nurse is reviewing pre-op instructions with a male client who is having surgery today. What question should the PN ask the client to best evaluate his understanding of the surgery?

What do you know about the surgery you are having?

Which factor should the PN identify that indicates a client needs to be screened for an aggressive breast cancer?

Pre-menopausal breast cancer in her mother

A male client with ICP due to a skull fracture is in the supine position with his legs elevated. What should the PN do first?

Raise the HOB 30 degrees

During the daily assessment of a client with emphysema, the PN identifies that the client's chest is barrel-shaped and he is demonstrating pursed-lip breathing. Which additional finding requires follow up by the PN?

Rales auscultated bilaterally

A client who is 3 days post after a laminectomy is coughing up thick green sputum and wheezing. What action is most important for the PN to implement?

Report the change in condition

A client who was hit in the head with a baseball is admitted to the hosp for observation. Which finding requires the PN to follow-up with further assessment?

Reports the hospital room is an office

A client who received several units of blood for a hemorrhagic event...

Review lab results

A male client with metastatic gastric cancer is being discharged

Suggest hospice care

An older client who has had a cataract in the right eye for several years tells the PN, "Now i have lost the sight in my right eye because I waited too long for treatment." What info should the PN provide?

Surgery can restore vision with corrective lens implants or glasses

A male client who has been taking a 4-drug regimen for TB tells the PN that he has finished the first drug, *isoniazid*, and will start taking *rifampin* next. How should the PN respond?

The 4 drug protocol should be taken concurrently

Which finding prompts the PN to check the NG placement?

The client has vomited

A male client with DM calls the clinic to report left calf pain after walking around the block..

The pain immediately relieved when he sits down

The PN is evaluating the self-care of a client who is recovering at home after a laryngectomy. Which finding indicates to the PN that the client needs additional info?

The salt water solution is dated 3 days ago

The PN is caring for a client who is receiving radiotherapy for cancer of the larynx. Which info should the PN provide the client to reduce effects of radiation?

Use sugarless gum

Which client should the PN question a PRN Imitrex?

50 year old with prinzmetals angina

Which client should the PN question the PRN prescription for *sumatriptan (Imitrax)* for migraine headaches?

50-year-old with Prinzmetal's angina

A male client is having an IOP using a tonometer...

A topical anesthetic will be used on the eye surface

The PN is reviewing the health hx of a client with CAD Which finding should the PN identify that places the client at risk for a stroke

Afib

A 60 year old with BPH has been up to the bathroom 6 times...

An indwelling catheter

An older male with a hx of emphysema...

Apply 02 per nasal cannula at 2L/min