Exam (elaborations)
MED SURG HESI PRACTICE QUESTIONS & ANSWERS
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MED SURG HESI PRACTICE QUESTIONS & ANSWERS
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MED SURG HESI PRACTICE QUESTIONS & ANSWERSWhich description of symptoms is characteristic of a client diagnosed with trigeminal
neuralgia (tic douloureux)?
A) Tinnitus, vertigo, and hearing difficulties.
B) Sudden, stabbing, severe pain over the lip and chin.
C) Facial weakness and paralysis.
D) Difficulty in chewing, talking, and swallowing. - Answers -B) Sudden, stabbing,
severe pain over the lip and chin.
Trigeminal neuralgia is characterized by paroxysms of pain, similar to an electric shock,
in the area innervated by one or more branches of the trigeminal nerve (5th cranial) (B).
(A) would be characteristic of Méniére's disease (8th cranial nerve). (C) would be
characteristic of Bell's palsy (7th cranial nerve). (D) would be characteristic of disorders
of the hypoglossal cranial nerve (12th).
A female client is brought to the clinic by her daughter for a flu shot. She has lost
significant weight since the last visit. She has poor personal hygiene and inadequate
clothing for the weather. The client states that she lives alone and denies problems or
concerns. What action should the nurse implement?
A) Notify social services immediately of suspected elderly abuse.
B) Discuss the need for mental health counseling with the daughter.
C) Explain to the client that she needs to take better care of herself.
D) Collect further data to determine whether self-neglect is occurring. - Answers -D)
Collect further data to determine whether self-neglect is occurring.
Changes in weight and hygiene may be indicators of self-neglect or neglect by family
members. Further assessment is needed (D) before notifying social services (A) or
discussing a need for counseling (B). Until further information is obtained, explanations
about the client's needs are premature (C).
A client is admitted to the medical intensive care unit with a diagnosis of myocardial
infarction. The client's history indicates the infarction occurred ten hours ago. Which
laboratory test result should the nurse expect this client to exhibit?
A) Elevated LDH.
B) Elevated serum amylase.
C) Elevated CK-MB.
D) Elevated hematocrit. - Answers -C) Elevated CK-MB.
The cardiac isoenzyme CK-MB (C) is the most sensitive and most reliable indicator of
myocardial damage of all the cardiac enzymes. It peaks within 12 to 20 hours after
myocardial infarction (MI). (A) is a cardiac enzyme that peaks around 48 hours after an
MI. (B) is expected with acute pancreatitis. (D) would be expected in a client with a fluid
volume deficit, which is not a typical finding in MI.
,A splint is prescribed for nighttime use by a client with rheumatoid arthritis. Which
statement by the nurse provides the most accurate explanation for use of the splints?
A) Prevention of deformities.
B) Avoidance of joint trauma.
C) Relief of joint inflammation.
D) Improvement in joint strength. - Answers -A) Prevention of deformities.
Splints may be used at night by clients with rheumatoid arthritis to prevent deformities
(A) caused by muscle spasms and contractures. Splints are not used for (B). (C) is
usually treated with medications, particularly those classified as non-steroidal
antiinflammatory drugs (NSAIDs). For (D), a prescribed exercise program is indicated.
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. - Answers -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).
During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest
is not moving. What action should the nurse take first?
A) Use a laryngoscope to check for a foreign body lodged in the esophagus.
B) Reposition the head to validate that the head is in the proper position to open the
airway.
C) Turn the client to the side and administer three back blows.
D) Perform a finger sweep of the mouth to remove any vomitus. - Answers -B)
Reposition the head to validate that the head is in the proper position to open the
airway.
The most frequent cause of inadequate aeration of the client's lungs during CPR is
improper positioning of the head resulting in occlusion of the airway (B). A foreign body
can occlude the airway, but this is not common unless choking preceded the cardiac
emergency, and (A, C and D) should not be the nurse's first action.
Despite several eye surgeries, a 78-year-old client who lives alone has persistent vision
problems. The visiting nurse is discussing painting the house with the client. The nurse
suggests that the edge of the steps should be painted which color?
A) Black.
B) White.
C) Light green.
,D) Medium yellow. - Answers -D) Medium yellow.
Yellow is the easiest for a person with failing vision to see (D). (A) will be almost
impossible to see at night because the shadows of the steps will be too difficult to
determine, and would pose a safety hazard. (B) is very hard to see with a glare from the
sun and it could hurt the eyes in the daytime to look at them. (C) is a pastel color and is
difficult for elderly clients to see.
The nurse is assessing a client with bacterial meningitis. Which assessment finding
indicates the client may have developed septic emboli?
A) Cyanosis of the fingertips.
B) Bradycardia and bradypnea.
C) Presence of S3 and S4 heart sounds.
D) 3+ pitting edema of the lower extremities. - Answers -A) Cyanosis of the fingertips.
Septic emboli secondary to meningitis commonly lodge in the small arterioles of the
extremities, causing a decrease in circulation to the hands (A) which may lead to
gangrene. (B, C, and D) are abnormal findings, but do not indicate the development of
septic emboli.
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. - Answers -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.
A client with diabetes mellitus is experiencing polyphagia. Which outcome statement is
the priority for this client?
A) Fluid and electrolyte balance.
B) Prevention of water toxicity.
C) Reduced glucose in the urine.
D) Adequate cellular nourishment. - Answers -D) Adequate cellular nourishment.
Diabetes mellitus Type 1 is characterized by hyperglycemia that precipitates glucosuria
and polyuria (frequent urination), polydipsia (excessive thirst), and polyphagia
(excessive hunger). Polyphagia is a consequence of cellular malnourishment when
insulin deficiency prevents utilization of glucose for energy, so the outcome statement
should include stabilization of adequate cellular nutrition (D). (A, B, and C) relate to
subsequent osmolar fluid shifts related to glucosuria, polyuria, and polydipsia.
, 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. - Answers -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. -
Answers -C) Yearly mammograms should be done regardless of previous normal x-
rays.
A 67-year-old woman who lives alone is admitted after tripping on a rug in her home
and fractures her hip. Which predisposing factor probably led to the fracture in the
proximal end of her femur?
A) Failing eyesight resulting in an unsafe environment.
B) Renal osteodystrophy resulting from chronic renal failure.
C) Osteoporosis resulting from hormonal changes.
D) Cardiovascular changes resulting in small strokes which impair mental acuity. -
Answers -C) Osteoporosis resulting from hormonal changes.
The most common cause of a fractured hip in elderly women is osteoporosis, resulting
from reduced calcium in the bones as a result of hormonal changes in later life (C). (A)
may or may not have contributed to the accident, but it had nothing to do with the hip
being involved. (B) is not a common condition of the elderly; it is common in chronic
renal failure. (D) may occur in some people, but does not affect the fragility of the bones
as osteoporosis does.
The nurse is assisting a client out of bed for the first time after surgery. What action
should the nurse do first?
A) Place a chair at a right angle to the bedside.
B) Encourage deep breathing prior to standing.
C) Help the client to sit and dangle legs on the side of the bed.
D) Allow the client to sit with the bed in a high Fowler's position. - Answers -D) Allow the
client to sit with the bed in a high Fowler's position.
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