Exam (elaborations)
MS4 HESI MED SURG FINAL EXAM FOR 2024
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MS4 HESI MED SURG FINAL EXAM FOR 2024
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MS4 HESI MED SURG FINAL EXAM FOR 20241. Following long-term administration of warfarin sodium to a client with a medical
diagnosis of deep vein thrombosis, the nurse should expect which treatment?
a. The hemoglobin will be greater than 10 g/dl
The hematocrit will be less than 35%
c. The PT will be 1.5 times the normal
d. The PTT will be 1.5 times the normal
2. A client who has been taking finasteride, an enzyme (5 alpha reductase) inhibitor used to
shrink the prostate gland, is admitted because of continuing benign prostate prostatic
hypertrophy (BPH) symptoms when planning care. Which nursing problem should the
nurseaddress first?
a. Chronic pain
b. Urinary
c. Risk for infection
d. Disturbed sleep pattern
3. An older client has been diagnosed with chronic venous insufficiency. To prevent
venousreturn, which action should the nurse encourage the client to
a. Wear cotton socks and enclosed toe shoes whenever outside
b. Drink 8 to 10 ounces of water a day
c. Sit at the side of the bed for 15 minutes before standing
d. Lie down in bed 2 times a day
,4. When caring for a client with a full thickness burn covering 40% of the body, the nurse
observes pertinent drainage at the wound. Before reporting this finding to the healthcare
provider, the nurse should review which of the client’s laboratory values?
a. Hematocrit
b. Platelet count
c. White blood cell (WBC)
d. Blood pH level
5. An older client arrives at the outpatient eye surgery clinic for a right cataract extraction
and implant. During the immediate postoperative period, which intervention should the nurse
implement
a. Provide an eye shield to be worn while sleeping
b. Obtain vital signs every 2 hours during hospitalization
c. Encourage deep breathing and coughing exercises
d. Teach a family member to administer eye drops
6. After several days of coughing and taking acetaminophen to treat temperatures of 101 F
(38.3 C), a client with DI is admitted to the hospital with an upper respiratory infection. Several
hours after admission, the client reports having a severe headache and freezing dizzy. Which
intervention should the nurse implement first?
a. Reassess vital signs
b. Obtain sputum for culture
c. Obtain a fingerstick glucose
d. Administer an antipyretic
7.a client takes daily supplemental iron tablets for iron deficiency anemia reports feeling
increasingly fatigued. Which laboratory values should the nurse review?
a. Serum electrolytes
,b. Complete blood count
c. Liver enzymes
d. Platelet count
8. The nurse is caring for a client post anesthesia care unit (PACU) who underwent a
thoracotomy two hours ago. The nurse observes the following vital signs: heart rate
140beats/minute, respirations 26 breaths/minute, and blood pressure 140/90 mmHg.
Whichintervention is most important for the nurse to implement?
a. Administer IV fluid bolus as prescribed by the healthcare provider
b. Medicate for pain and monitor vital signs according to protocol
c. Encourage the client to splint the incision with a pillow to cough and deep breathe
d. Apply oxygen at 10 L via non-rebreather mask and monitor pulse oximeter
9. A client who was involved in a motor vehicle collision is admitted with a fractured left
femur which is immobilized using a fracture traction splint in preparation for an open reduction
internalfraction (ORIF). The nurse determines that the client’s distal pulses are diminished in the
left foot. Which interventions should the nurse implement? (SATA)
a. Offer ice chips and oral clear liquids
b. Verify pedal pulses using a doppler pulse device
c. Monitor left leg for pain, pallor, paresthesia, paralysis, pressure
d. Evaluate the application of the splint to the left
e. Administer oral antispasmodics and narcotics analgesics
10. A nurse is caring for a client with Diabetes Insipidus (DI). which data warrants the
mostimmediate intervention by the nurse?
a. Dry skin with inelastic turgor
. Apical rate of 110 beats per minute
c. Polyuria and excessive thirst
, d. Serum sodium of 185 mEq/L
11. The nurse assesses a client with petechiae and ecchymosis scattered across the arms
andlegs. Which laboratory result should the nurse review?
a. Platelet
b. Red blood cell count
c. Hemoglobin levels white blood cell count
12. A male client is admitted to the emergency department with vomiting of dark brown,
foul-smelling emesis. He reports he had a surgical repair of a recurrent inguinal hernia one
weekago and complains of intense abdominal pain. After assessing that his bowel sounds are
hyperactive, which prescription should the nurse implement first
• Insert a nasogastric tube (NGT) and attach to low intermittent suction
13. A client is admitted to the hospital for shortness of breath and chest pain after an episode
ofsyncope. Which laboratory finding is most important for the nurse to report to the healthcare
provider?
a. Hematocrit
b. Blood glucose
c. Oxygen saturation
d. Troponin I
14. A client is hospitalized after experiencing a myocardial infarction (MI) to reduce
cardiacworkload, which intervention should the nurse include in the client’s plan of care?
a. Teach to sleep in a side-lying position
b. Encourage active range of motion exercises
c. Provide a bedside commode for
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