266 Med Surg Hesi Exam Questions and
Complete Solutions
A nurse is reinforcing teaching with a client who has HIV
and is being discharged to home. Which of the following
instructions should the nurse include in the teaching? - -A Take temperature once a day.
A nurse is caring for a client who is postoperative following
a tracheostomy, and has copious and tenacious secre-
tions. Which of the following is an acceptable method for
the nurse to use to thin this client's secretions? - -A Provide humidified oxygen.
Following admission, a client with a vascular occlusion
of the right lower extremity calls the nurse and reports
difficulty sleeping because of cold feet. Which of the fol-
lowing nursing actions should the nurse take to promote
the client's comfort? - -B4 Obtain a pair of slipper socks for the client
A nurse is caring for a client is who is 4 hr postoperative
following a transurethral resection of the prostate (TURP).
Which of the following is the priority finding for the nurse
report to the provider? - -C4 Thick, red-colored urine
A nurse is caring for a client who has a temperature
of 39.7° C (103.5° F) and has a prescription for a hy-
pothermia blanket. The nurse should monitor the client for
which of the following adverse effects of the hypothermia
blanket? - -A Shivering
,A nurse is reinforcing teaching about exercise with a client
who has type 1 diabetes mellitus. Which of the following
statements by the client indicates an understanding of the
teaching? - -D4 "I will not exercise if my urine is positive for ketones."
A nurse notes a small section of bowel protruding from
the abdominal incision of a client who
is postoperative. After calling for assistance, which of the
following actions should the nurse take first - -A Cover the client's wound with a moist, sterile
dressing.
A nurse is collecting data from a client who has alco-
hol use disorder and is experiencing metabolic acidosis.
Which of the following manifestations should the nurse
expect? - -B4 Hyperventilation
A nurse is reinforcing discharge teaching with a client fol-
lowing a cataract extraction. Which of the following should
the nurse include in the teaching? - -A Avoid bending at the waist.
A nurse is caring for a client who has heart failure and
has been taking digoxin 0.25 mg daily. The client refuses
breakfast and reports nausea. Which of the following ac-
tions should the nurse take first - -C Check the client's vital signs.
A nurse is caring for a client who is 3 days postoper-
ative following a cholecystectomy. The nurse suspects
, the client's wound is infected because the drainage from
the dressing is yellow and thick. Which of the following
findings should the nurse report as the type of drainage
found? - -D4 Purulent
A nurse is reinforcing discharge teaching to a client follow-
ing arthroscopic surgery. To prevent postoperative compli-
cations which of the following actions should be reinforced
during the teaching? - -Administer an opioid analgesic to the client 30 min prior
to initiating CPM exercises
A nurse is collecting data from a client who has emphy-
sema. Which of the following findings should the nurse
expect? (Select all that apply.) - -1) Dyspnea
2) Barrel chest
3) Clubbing of the fingers
4) Shallow respirations
A nurse is caring for a client who sustained a basal
skull fracture. When performing morning hygiene care,
the nurse notices a thin stream of clear drainage coming
from out of the client's right nostril. - -4) Test the drainage for glucose.
A nurse is caring for a client who has a spinal cord
injury at T-4. The nurse should recognize that the client
is at risk for autonomic dysreflexia. Which of the following
interventions should the nurse take to prevent autonomic
dysreflexia? - -3) Prevent bladder distention.
Complete Solutions
A nurse is reinforcing teaching with a client who has HIV
and is being discharged to home. Which of the following
instructions should the nurse include in the teaching? - -A Take temperature once a day.
A nurse is caring for a client who is postoperative following
a tracheostomy, and has copious and tenacious secre-
tions. Which of the following is an acceptable method for
the nurse to use to thin this client's secretions? - -A Provide humidified oxygen.
Following admission, a client with a vascular occlusion
of the right lower extremity calls the nurse and reports
difficulty sleeping because of cold feet. Which of the fol-
lowing nursing actions should the nurse take to promote
the client's comfort? - -B4 Obtain a pair of slipper socks for the client
A nurse is caring for a client is who is 4 hr postoperative
following a transurethral resection of the prostate (TURP).
Which of the following is the priority finding for the nurse
report to the provider? - -C4 Thick, red-colored urine
A nurse is caring for a client who has a temperature
of 39.7° C (103.5° F) and has a prescription for a hy-
pothermia blanket. The nurse should monitor the client for
which of the following adverse effects of the hypothermia
blanket? - -A Shivering
,A nurse is reinforcing teaching about exercise with a client
who has type 1 diabetes mellitus. Which of the following
statements by the client indicates an understanding of the
teaching? - -D4 "I will not exercise if my urine is positive for ketones."
A nurse notes a small section of bowel protruding from
the abdominal incision of a client who
is postoperative. After calling for assistance, which of the
following actions should the nurse take first - -A Cover the client's wound with a moist, sterile
dressing.
A nurse is collecting data from a client who has alco-
hol use disorder and is experiencing metabolic acidosis.
Which of the following manifestations should the nurse
expect? - -B4 Hyperventilation
A nurse is reinforcing discharge teaching with a client fol-
lowing a cataract extraction. Which of the following should
the nurse include in the teaching? - -A Avoid bending at the waist.
A nurse is caring for a client who has heart failure and
has been taking digoxin 0.25 mg daily. The client refuses
breakfast and reports nausea. Which of the following ac-
tions should the nurse take first - -C Check the client's vital signs.
A nurse is caring for a client who is 3 days postoper-
ative following a cholecystectomy. The nurse suspects
, the client's wound is infected because the drainage from
the dressing is yellow and thick. Which of the following
findings should the nurse report as the type of drainage
found? - -D4 Purulent
A nurse is reinforcing discharge teaching to a client follow-
ing arthroscopic surgery. To prevent postoperative compli-
cations which of the following actions should be reinforced
during the teaching? - -Administer an opioid analgesic to the client 30 min prior
to initiating CPM exercises
A nurse is collecting data from a client who has emphy-
sema. Which of the following findings should the nurse
expect? (Select all that apply.) - -1) Dyspnea
2) Barrel chest
3) Clubbing of the fingers
4) Shallow respirations
A nurse is caring for a client who sustained a basal
skull fracture. When performing morning hygiene care,
the nurse notices a thin stream of clear drainage coming
from out of the client's right nostril. - -4) Test the drainage for glucose.
A nurse is caring for a client who has a spinal cord
injury at T-4. The nurse should recognize that the client
is at risk for autonomic dysreflexia. Which of the following
interventions should the nurse take to prevent autonomic
dysreflexia? - -3) Prevent bladder distention.
