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Exam (elaborations)

MED SURG HESI EXIT EXAM/Latest 2022/Test Bank

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Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink plenty of dairy products, such as milk, to help coat and protect his ulcer. What is the best follow-up action by the nurse? (ANS- Review with the client the need to avoid foods that are rich in milk a...

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  • February 13, 2023
  • 442
  • 2022/2023
  • Exam (elaborations)
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MED SURG HESI EXIT EXAM/Latest
2022/Test Bank


Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink
plenty of dairy products, such as milk, to help coat and protect his ulcer. What is the best
follow-up action by the nurse?
(ANS- Review with the client the need to avoid foods that are rich in milk and cream


A male client with hypertension, who received new antihypertensive prescriptions at his last
visit returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106
and he admits that he has not been taking the prescribed medication because the drugs make
him "feel bad". In explaining the need for hypertension control, the nurse should stress that an
elevated BP places the client at risk for which pathophysiological condition?
(ANS- Stroke secondary to hemorrhage


The nurse observes an unlicensed assistive personnel (UAP) positioning a newly admitted client
who has a seizure disorder. The client is supine and the UAP is placing soft pillows along the
side rails. What action should the nurse implement? (ANS- Instruct the UAP to obtain soft
blankets to secure to the side rails instead of pillows.


An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for
the past 12 days. Which assessment finding requires immediate follow-up?
(ANS- Describes life without purpose




MED SURG HESI EXIT EXAM/Latest
2022/Test Bank

, MED SURG HESI EXIT EXAM/Latest
2022/Test Bank
A client who recently underwear a tracheostomy is being prepared for discharge to home.
Which instructions is most important for the nurse to include in the discharge plan?
(ANS- Teach tracheal suctioning techniques


In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen
reservoir bag does not deflate completely during inspiration and the client's respiratory rate is 14
breaths / minute. What action should the nurse implement? (ANS- Document the assessment
data


Rationale: reservoir bag should not deflate completely during inspiration and the client's
respiratory rate is within normal limits.


During shift report, the central electrocardiogram (EKG) monitoring system alarms. Which
client alarm should the nurse investigate firs?
(ANS- Respiratory apnea of 30 seconds


During a home visit, the nurse observed an elderly client with diabetes slip and fall. What
action should the nurse take first?
(ANS- Check the client for lacerations or fractures


At 0600 while admitting a woman for a schedule repeat cesarean section (C- Section), the client
tells the nurse that she drank a cup a coffee at 0400 because she wanted to avoid getting a
headache. Which action should the nurse take first? (ANS- Inform the anesthesia care provider


After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart sounds.
To determine if an S3 heart sound is present, what action should the nurse take first?
(ANS- Listen with the bell at the same location


MED SURG HESI EXIT EXAM/Latest
2022/Test Bank

, MED SURG HESI EXIT EXAM/Latest
2022/Test Bank
A 66-year-old woman is retiring and will no longer have a health insurance through her place of
employment. Which agency should the client be referred to by the employee health nurse for
health insurance needs?
(ANS- Medicare


A 60-year-old female client with a positive family history of ovarian cancer has developed an
abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap)
smear results are negative. What information should the nurse include in the client's teaching
plan?
(ANS- Further evaluation involving surgery may be needed




MED SURG HESI EXIT EXAM/Latest
2022/Test Bank

, MED SURG HESI EXIT EXAM/Latest
2022/Test Bank

A client who is taking an oral dose of a tetracycline complains of gastrointestinal upset. What
snack should the nurse instruct the client to take with the tetracycline? (ANS- Toasted wheat
bread and jelly


Following a lumbar puncture, a client voices several complaints. What complaint indicated to
the nurse that the client is experiencing a complication?
(ANS- "I have a headache that gets worse when I sit up"
"I am having pain in my lower back when I move my legs" "My throat
hurts when I swallow"
"I feel sick to my stomach and am going to throw up"


An elderly client seems confused and reports the onset of nausea, dysuria, and urgency with
incontinence. Which action should the nurse implement?
(ANS- Obtain a clean catch mid-stream specimen


The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are
in keeping with the child's dietary restrictions. Which foods are contraindicated for this child?
(ANS- Foods sweetened with aspartame


Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the
circulating nurse if a 3 minute surgical hand scrub is adequate preparation for this client. Which
response should the circulating nurse provide? (ANS- Direct the nurse to continue the surgical
hand scrub for a 5 minute duration


Which breakfast selection indicates that the client understands the nurse's instructions about the
dietary management of osteoporosis?


MED SURG HESI EXIT EXAM/Latest
2022/Test Bank

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