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HESI MED SURG EXAM REAL EXAM 160 QUESTIONS AND DETAILED ANSWERS WITH RATIONALES(AGRADE)
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HESI MED SURG EXAM REAL EXAM 160 QUESTIONS AND DETAILED ANSWERS WITH RATIONALES(AGRADE)
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HESI MedSurg ExamStudy online at https://quizlet.com/_8xnbkd
1. Which assessment is most · Respiratory effort.
important for the nurse to Guillain-Barre syndrome causes paralysis or
perform on a client who weakness that typically starts at the feet and
is hospitalized for Guil- progresses upwards. As the condition progress-
lain-Barre syndrome that es, the nurse must ensure that the client is able
is rapidly progressing? to breathe effectively.
· Respiratory effort.
· Unsteady gait. Heuther, Understanding Pathophysiology, 6th
· Intensity of pain. ed. p. 412
· Ability to eat.
2. A male client comes into · Collect a culture of the penile discharge.
the clinic with a history Penile discharge with painful urination is com-
of penile discharge with monly associated with gonorrhea. The nurse
painful, burning urination. should collect a culture of the penile discharge
Which action should the to determine the cause of these symptoms. The
nurse implement? cause must be determined or confirmed through
· Collect a culture of the pe- culture to identify the organism and ensure ef-
nile discharge. fective treatment.
· Palpate the inguinal
lymph nodes gently. Jarvis Physical Examination and Health As-
· Observe for scrotal sessment, 6th edition
swelling and redness.
· Express the discharge to
determine color.
3. A client with history of · Check for a pulse deficit.
atrial fibrillation is ad- A client with a past history of atrial fibrillation
mitted to the telemetry may return to that rhythm. Any signs of atrial
unit with sudden onset of fibrillation, such as sudden onset shortness of
shortness of breath. The breath, requires further investigation. The nurse
nurse observes a new ir- should assess this client for a pulse deficit be-
, HESI MedSurg Exam
Study online at https://quizlet.com/_8xnbkd
regular heart rhythm and cause this condition occurs with atrial fibrillation.
should perform which as-
sessment at this time? Jarvis. (2016); Physical Examination and Health
· Check for a pulse deficit. Assessment, (Chap 19) 7th ed., p. 481
· Palpate the apical im-
pulse.
· Inspect jugular vein
pulse.
· Examine for a carotid
bruit.
4. Which client should be fur- · A 24-year-old with shoulder and lower abdom-
ther assessed for an ec- inal quadrant pain.
topic pregnancy? A 24-year-old with sudden onset of lower ab-
· A 24-year-old with shoul- dominal quadrant pain should be assessed for
der and lower abdominal an ectopic pregnancy. The pain can also be
quadrant pain. referred to the shoulder and may be associated
· A 33-year-old with in- with vaginal bleeding.
termittent lower abdominal
cramping. Health Assessment for Nursing Practice, Wilson
· A 20-year-old with fever and Giddens. p.269
and right lower abdominal
colic.
· A 40-year-old with jaun-
dice and right lower ab-
dominal pain.
5. Which dietary assessment · Drinks a six pack of beer every day.
finding is most important Drinking six beers every day is the dietary as-
for the nurse to address sessment finding most important for the nurse
when caring for a client to address when caring for a client with dia-
with diabetic nephropa- betic nephropathy. The usual can of beer is 12
thy? ounces (355 mL). Clients with diabetes are rec-
· Drinks a six pack of beer ommended to drink no more than 12 ounces of
every day. beer per day because beer contains carbohy-
· Enjoys a hamburger once drates that can create unhealthy fluctuations in
a month. blood glucose and promote poor glucose con-
· Eats fortified breakfast trol. Nephropathy is exacerbated by poor blood
cereal daily. glucose control.
, HESI MedSurg Exam
Study online at https://quizlet.com/_8xnbkd
· Consumes beans and rice
every day.
6. Which assessment finding · Cough brought on by swallowing.
is of greatest concern to A cough brought on by swallowing is a sign
the nurse who is caring for of dysphagia, which is a finding of particular
a client with stomatitis? concern in a client with stomatitis. Dysphagia
· Cough brought on by can cause numerous problems, including air-
swallowing. way obstruction, and should be reported to the
· Sore throat caused by healthcare provider immediately.
speaking.
· Painful and dry oral cavi- Ignatavicius, (2016). Medical-surgical nursing:
ty. Patient-centered collaborative care, eight edi-
· Unintended weight loss. tion., Ch. 53, p. 1100.
7. The nurse is teaching a · Altered sexual response.
client diagnosed with pe- Peripheral arterial disease (PAD) is a cardio-
ripheral arterial disease. vascular condition characterized by narrowing
Which genitourinary sys- of the arteries and reduced blood flow to the
tem complication should extremities. PAD is known to alter the blood
the nurse include in the flow to the male's penis and is associated with
teaching? erectile dysfunction in men.
· Altered sexual response.
· Sterility. Ignatavicius,. (2016). Medical-surgical nursing:
· Urinary incontinence. Patient-centered collaborative care, eight edi-
· Decreased pelvic muscle tion., Ch. 69, p. 1452.
tone.
8. A 40-year-old female client · Oral contraceptives.
has a history of smoking. Women older than 35 years old who smoke and
Which finding should the take oral contraceptives have an increased risk
nurse identify as a risk fac- of myocardial infarction or stroke.
tor for myocardia infarc-
tion? Ignatavicius, (2013). Medical-surgical nursing:
· Oral contraceptives. Patient-centered collaborative care, 7th ed..,
· Senile osteopenia. Ch. 35, p. 694.
· Levothyroxine therapy.
· Pernicious anemia.
9.
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