Hesi Exam Med Surge 2021

A client is hospitalized for an exacerbation of emphysema. The client is experiencing a fever, chills, and difficulty breathing on exertion. Which is an important nursing action?

Encouraging increased fluid intake Fluids will replace fluid loss from fever and decrease viscosity of secretions. Capillary refill relates to peripheral tissue perfusion. There are no data to suggest that secretions are blocking the airway; there is no support that suctioning is needed. High concentrations of oxygen generally are not administered to clients with chronic obstructive pulmonary disease (COPD); traditionally, the reason given for this was that clients with COPD become desensitized to carbon dioxide as a respiratory stimulus so that reduced oxygen levels act as the stimulus and high concentrations of oxygen levels may actually depress respirations. The newer theory suggests that the hypoxic drive is valid for a small number. The majority of cases involve the Haldane effect; as hemoglobin molecules become more saturated with oxygen, they are unable to transport carbon dioxide out of the body, leading to hypercapnia.

When the nurse is reviewing statin therapy for hyperlipidemia in a female of childbearing age, which client statement indicates a need for further education?

"I will take my medication with grapefruit juice." Statin medication should not be taken with grapefruit juice because the furanocoumarins in grapefruit inactivate the enzyme CYP3A4, leading to metabolism issues and possible toxicity. Muscle myalgias are a side effect of statin therapy that should be reported because they may indicate medication toxicity. Statin therapy should be avoided during pregnancy. Liver function should be monitored during statin therapy. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A nurse reviews the medication charts of four clients. Which medication prescription will cause the nurse to notify the primary health care provider?

Client A has acromegaly, which is a result of increased growth hormone production. This condition should be treated with octreotide and lanreotide instead of conivaptan; conivaptan is used to treat syndrome of inappropriate antidiuretic hormone (SIADH). The treatment of Cushing's syndrome involves the administration of aminoglutethimide. SIADH is treated with vasopressin receptor antagonists such as tolvaptan. Pheochromocytoma is treated with adrenergic blockers such as phenoxybenzamine. Test-Taking Tip: Recall the treatment strategies employed in the treatment of the conditions listed above. This may help you in selecting the right choice.

A client who has had right upper quadrant pain for several months now experiences clay-colored stools. Laboratory results reveal elevated liver enzymes, and a needle biopsy of the liver is scheduled. What should the nurse include in the client's teaching about the procedure? 1. The procedure is painless because general anesthesia is used.2.Disfiguring scars are minimal because a small incision is made.3. Lying on the right side after the procedure is required because it will decrease the risk of hemorrhage.4. A light meal should be eaten two hours before the procedure because it stimulates gastrointestinal secretion.

1. Lying on the right side after the procedure is required because it will decrease the risk of hemorrhage. Because of the vascularity of the liver, compression of the needle insertion site limits the risk of hemorrhage; also, it decreases the risk of bile leakage. The procedure is performed under local anesthesia, and some discomfort may be felt during instillation of the anesthetic as well as when the needle enters the liver. There is no scarring because a surgical incision is not necessary for a needle biopsy. The client is kept nothing by mouth for at least 6 hours before the procedure to prevent nausea and vomiting. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory, so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

The nurse provides discharge instructions about dietary restrictions for a client who had a cholecystectomy. The nurse evaluates that the teaching is understood when the client makes which statement to a family member?

I need to eat smaller amounts of food at a time, and they should contain low to moderate amounts of fats. The response is individual, but ultimately most people can eat anything they want. Eating small, more frequent, and moderate to low amounts of fats allows the readily available bile to mix with the food bolus and prevent gas, bloating, diarrhea, or undigested foods. Fats may have to be gradually reintroduced, but most people tolerate them after this surgery. Foods that caused gastric distress before surgery usually are tolerated after surgery. Increased protein is needed only until healing has occurred. Sodium restriction is not necessary.

The nurse is assessing a client with a suspected thyroid disorder. Which diagnostic studies will be used to confirm that the thyroid disorder is autoimmune in origin? Select all that apply. One, some, or all responses may be correct.

Thyroglobulin antibody Thyroid peroxidase antibody Thyroid-stimulating antibody Thyroglobulin, thyroid peroxidase, and thyroid-stimulating antibodies are assessed in a thyroid antibody test. This test helps differentiate other forms of thyroiditis from autoimmune thyroid disease. An active component of total T4 is measured by free thyroxine but cannot differentiate the origin. Thyroid-stimulating hormone levels are used to evaluate a thyroid dysfunction but cannot differentiate the origin. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Arrange the series of reactions that occurs when plasma volume and osmolarity are disturbed.

1.Blood loss 2.Conversion of angiotensinogen to angiotensin I 3.Formation of active form of angiotensin 4. Increased reabsorption of water and sodium 5.Increased blood volume Extracellular fluid volume decreases during conditions such as posture changes and blood loss. This results in release of renin enzyme, which converts angiotensinogen to angiotensin I. In the presence of angiotensin-converting enzyme, angiotensin I is converted to angiotensin II, which is an active form of angiotensin. Angiotensin II stimulates the adrenal secretion of aldosterone, which increases the reabsorption of water and sodium. This results in increased blood volume.

A health care provider prescribes oropharyngeal suctioning as needed for a client in a coma. Which assessment made by the nurse indicates the need for suctioning?

Gurgling sounds with each breath Secretions in the upper airway produce gurgling sounds that interfere with the free flow of air with each breath. Oropharyngeal suction will not address fine crackles at the base of the lungs. Cyanosis can result from a variety of problems unrelated to the presence of secretions; suctioning should be done only when secretions are blocking the airway. For a dry cough, suctioning is not needed in the absence of accumulated oropharyngeal secretions.

Which meal on the client's dietary record provides the most calcium?

Lunch Lunch provides the best dietary sources of calcium: 1 oz of cheddar cheese contains 204 mg; two slices of bread contain 64 mg; 1 cup of milk contains 300 mg; and 1 cup of raw, chopped spinach contains 54 mg, for a total of 622 mg of calcium. Breakfast is lower in calcium than lunch: two eggs contain 50 mg, a slice of toast contains 32 mg, and a 6-oz cup of coffee contains 4 mg, for a total of 88 mg. Dinner is lower in calcium than lunch: a half breast of chicken contains 13 mg, 1 cup of sliced cooked carrots contains 41 mg, a baked potato contains 20 mg, and 1 cup of applesauce contains 17 mg, for a total of 91 mg. The snack is lower in calcium than the lunch: 8 oz of strawberry yogurt contains 345 mg and an apple contains 10 mg, for a total of 355 mg of calcium.

Which diagnostic test result will the nurse review after noticing large U waves on the electrocardiogram (ECG) for a client who was just admitted to the cardiac unit?

Serum potassium Large U waves suggest possible hypokalemia, which should be corrected to decrease dysrhythmia risk. The nurse may also review the other values, but these are unrelated to the presence of U waves. Troponin T levels increase with myocardial infarction. Oxygen saturation changes do not cause U waves. C-reactive protein elevations indicate inflammation but will not cause changes in the ECG. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.