Med Surg HESI Practice Questions with 100% correct answers 2022

Which 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. - ANSWER-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 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. - ANSWER-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. - ANSWER-D) Allow the client to sit with the bed in a high Fowler's position. The first step is to raise the head of the bed to a high Fowler's position (D), which allow venous return to compensate from lying flat and vasodilating effects of perioperative drugs. (A, B, and C) are implemented after (D). A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the best for the nurse to provide? A) Check it again in one month, and if it is still there schedule an appointment. B) Most lumps are benign, but it is always best to come in for an examination. C) Try not to worry too much about it, because usually, most lumps are benign. D) If you are in your menstrual period it is not a good time to check for lumps. - ANSWER-B) Most lumps are benign, but it is always best to come in for an examination. (B) provides the best response because it addresses the client's anxiety most effectively and encourages prompt and immediate action for a potential problem. (A) postpones treatment if the lump is malignant, and does not relieve the client's anxiety. (C and D) provide false reassurance and do not help relieve anxiety. 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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-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. - ANSWER-C) Yearly mammograms should be done regardless of previous normal xrays. The current breast screening recommendation is a yearly mammogram after age 40 (C). Breast self-exam (A) continues to be a priority recommendation for all women because a small lump (or tumor) is often first felt by a woman before a mammogram is obtained. The radiation exposure from a mammogram is low, so (B) is not normally provided. The frequency of using routine and ultrasound mammograms (D) in women with high-risk variables, such as a history of breast cancer, the presence of BRC1 and BRC2 genes, or 2 first-degree relatives with breast cancer, should be recommended and followed closely by the healthcare provider. In assessing cancer risk, the nurse identifies which woman as being at greatest risk of developing breast cancer? A) A 35-year-old multipara who never breastfed. B) A 50-year-old whose mother had unilateral breast cancer. C) A 55-year-old whose mother-in-law had bilateral breast cancer. D) A 20-year-old whose menarche occurred at age 9. - ANSWER-B) A 50-year-old whose mother had unilateral breast cancer. The most predictive risk factors for development of breast cancer are over 40 years of age and a positive family history (occurrence in the immediate family, i.e., mother or sister). Other risk factors include nulliparity, no history of breastfeeding, early menarche and late menopause. Although all of the women described have one of the risk factors for developing breast cancer, (B) has the greater risk over (A, C, and D). A client with multiple sclerosis has experienced an exacerbation of symptoms, including paresthesias, diplopia, and nystagmus. Which instruction should the nurse provide? A) Stay out of direct sunlight. B) Restrict intake of high protein foods. C) Schedule extra rest periods. D) Go to the emergency room immediately. - ANSWER-C) Schedule extra rest periods. Exacerbations of the symptoms of MS occur most commonly as the result of fatigue and stress. Extra rest periods should be scheduled (C) to reduce the symptoms. (A, B, and D) are not necessary. Which reaction should the nurse identify in a client who is responding to stimulation of the sympathetic nervous system? A) Pupil constriction. B) Increased heart rate. C) Bronchial constriction. D) Decreased blood pressure. - ANSWER-B) Increased heart rate. Any stressor that is perceived as threatening to homeostasis acts to stimulate the sympathetic nervous system and manifests as a flight-or-fight response, which includes an increase in heart rate (B). (A, C, and D) are responses of the parasympathetic nervous system. A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what vitamin deficiency? A) K. B) B12. C) B6. D) C. - ANSWER-A) K. Clients should be monitored for an increased prothrombin time and prolonged bleeding times which would alert the nurse to a vitamin K deficiency (A). These drugs reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are not fat soluble vitamins. The nurse is caring for a client with a stroke resulting in right-sided paresis and aphasia. The client attempts to use the left hand for feeding and other self-care activities. The spouse becomes frustrated and insists on doing everything for the client. Based on this data, which nursing diagnosis should the nurse document for this client? A) Situational low self-esteem related to functional impairment and change in role function. B) Disabled family coping related to dissonant coping style of significant person. C) Interrupted family processes related to shift in health status of family membe