HESI Med Surg practice questions 2024
The52nurse52is52assessing52a5248-year-
old52client52with52a52history52of52smoking52during52a52routine52clinic52visit.52The52clie
nt,52who52exercises52regularly,52reports52having52pain52in52the52calf
during52exercise52that52disappears52at52rest.52Which52of52the52following52findings52requir
es52further52evaluation?
1. Heart52rate525752bpm.
2. SpO252of5294%52on52room52air.
3. Blood52pressure52134/82.
4. Ankle-brachial52index52of520.65.52-524
An52Ankle-
Brachial52Index52of520.6552suggests52moderate52arterial52vascular52disease52in5
2a52client52who52is52experiencing52intermittent52claudication.52A52Doppler52ultra
sound52is
indicated52for52further52evaluation.52The52bradycardic52heart52rate52is52acceptable52in5
2an52athletic52client52with52a52normal52blood52pressure.52The52SpO252is52acceptable;52
the52client52has52a52smoking52history.
An52 overweight52 client52 taking52 warfarin52 (Coumadin)52 has52 dry52 skin52due52 to52decr
eased5 2 arterial52blood52flow.52What52should52the52nurse52instruct52the52client52to52do?5
2Select52all52that52apply.
1. Apply52lanolin52or52petroleum52jelly52to52intact52skin.
2. Follow52a52reduced-calorie,52reduced-fat52diet.
3. Inspect52the52involved52areas52daily52for52new52ulcerations.
4. Instruct52the52client52to52limit52activities52of52daily52living52(ADLs).
5. Use52an52electric52razor52to52shave52-521,2,3,5
Maintaining52skin52integrity52is52important52in52preventing52chronic52ulcers52and
infections.52The52client52should52be52taught52to52inspect52the52skin52on52a52daily52basis.5
2The52client52should52reduce52weight52to52promote52circulation;52a52diet52lower52in52calo
ries52and52fat52is52appropriate.52Because52the52client52is52receiving52Coumadin,52the52cli
ent52is52at52risk52for52bleeding52from52cuts.52To52decrease52the52risk52of52cuts,52the52nurs
e52should52suggest52that52the52client52use52an52electric52razor.52The52client52with52decre
ased52arterial52blood52flow52should52be52encouraged52to52participate52in52ADLs.52In52fac
t,52the52client52should52be52encouraged52to52consult52an52exercise52physiologist52for52an
52exercise52program52that52enhances52the52aerobic52capacity52of52the52body.
A52client52with52peripheral52vascular52disease52has52undergone52a52right52femoral-
popliteal52bypass52graft.52The52blood52pressure52has52decreased52from52124/8052t
o5294/62.52What52should52the52nurse52assess52first?
1. IV52fluid52solution.
2. Pedal52pulses.
3. Nasal52cannula52flow52rate.
4. Capillary52refill52-522
With52each52set52of52vital52signs,52the52nurse52should52assess52the52dorsalis52pedi
s52and52posterior52tibial52pulses.52The52nurse52needs52to52ensure52adequate52perfu
sion52to52the52lower
extremity52with52the52drop52in52blood52pressure.52IV52fluids,52nasal52cannula52setting,52
and52capillary52refill52are52important52to52assess;52however,52priority52is52to52determine
52the52cause52of52drop52in52blood52pressure52and52that52adequate52perfusion52through5
,2the52new52graft52is52maintained.
,The52nurse52is52caring52for52a52client52with52peripheral52artery52disease52who52has
52recently52been52prescribed52clopidogrel52(Plavix).52The52nurse52understands52tha
t52more52teaching52is52necessary52when52the52client52states52which52of52the52follow
ing:
1. "I52should52not52be52surprised52if52I52bruise52easier52or52if52my52gums52blee
d52a52little52when52brushing52my52teeth."
2. "It52doesn't52really52matter52if52I52take52this52medicine52with52or52without52fo
od,52whatever52works52best52for52my52stomach."
3. "I52should52stop52taking52Plavix52if52it52makes52me52feel52weak52and52dizzy."
4. "The52doctor52prescribed52this52medicine52to52make52my52platelets52less52likely52to52s
tick52together52and52help52prevent52clots52from52forming."52-523
Weakness,52dizziness,52and52headache52are52common52adverse52effects52of52P
lavix52and52the52client52should52report52these52to52the52physician52if52they52are52
problematic;52in52order52to52decrease52risk52of52clot52formation,52Plavix52must52b
e52taken52regularly52and52should52not52be
stopped52or52taken52intermittently.52The52main52adverse52effect52of52Plavix52is52bleedin
g,52which52often52occurs52as52increased52bruising52or52bleeding52when52brushing52teet
h.52Plavix52is52well52absorbed,52and52while52food52may52help52decrease52potential52gas
trointestinal52upset,52Plavix52may
be52taken52with52or52without52food.52Plavix52is52an52antiplatelet52agent52used52to52preve
nt52clot52formation52in52clients52who52have52experienced52or52are52at52risk52for52myocardi
al52infarction,52ischemic52stroke,52peripheral52artery52disease,52or52acute52coronary52syn
drome.
A52client52is52receiving52Cilostazol52(Pletal)52for52peripheral52arterial52disease52causing
52intermittent52claudication.52The52nurse52determines52this52medication52is52effective52w
hen52the52client52reports52which52of52the52following?
1. "I52am52having52fewer52aches52and52pains."
2. "I52do52not52have52headaches52anymore."
3. "I52am52able52to52walk52further52without52leg52pain."
4. "My52toes52are52turning52grayish52black52in52color."52-523
Cilostazol52is52indicated52for52management52of52intermittent52claudication.52Sympto
ms52usually52improve52within52252to52452weeks52of52therapy.52Intermittent52claudicat
ion52prevents52clients52from52walking52for52long52periods52of52time.52Cilostazol52inhi
bits52platelet52aggregation52induced52by52various52stimuli52and52improving52blood52fl
ow52to52the52muscles52and52allowing52the52client52to52walk52long52distances52without
52pain.52Peripheral52arterial52disease52causes52pain
mainly52of52the52leg52muscles.52"Aches52and52pains"52does52not52specify52exactly52wher
e52the52pain52is52occurring.52Headaches52may52occur52as52a52side52effect52of52this52drug
,52and52the52client52should52report52this52information52to52the52health52care52provider.52P
eripheral52arterial52disease52causes52decreased52blood52supply52to52the52peripheral52tis
sues52and52may52cause52gangrene52of52the52toes;52the
drug52is52effective52when52the52toes52are52warm52to52the52touch52and52the52color52of52the
52toes52is52similar52to52the52color52of52the52body.
The52client52admitted52with52peripheral52vascular52disease52(PVD)52asks52the52nurse52wh
y
her52legs52hurt52when52she52walks.52The52nurse52bases52a52response52on52the52knowled
ge52that52the52main52characteristic52of52PVD52is:
, 1. Decreased52blood52flow.
2. Increased52blood52flow.
3. Slow52blood52flow.
4. Thrombus52formation.52-521
Decreased52blood52flow52is52a52common52characteristic52of52all52PVD.52When52the
demand52for52oxygen52to52the52working52muscles52becomes52greater52than52the52supply,
52pain52is52the52outcome.52Slow52blood52flow52throughout52the52circulatory52system52ma
y52suggest52pump52failure.52Thrombus52formation52can52result52from52stasis52or52damag
e52to52the52intima52of52the52vessels.
The52nurse52is52planning52care52for52a52client52who52is52diagnosed52with52peripheral52v
ascular52disease52(PVD)52and52has52a52history52of52heart52failure.52The52nurse52should5
2develop52a52plan52of52care52that52is52based52on52the52fact52that52the52client52may52hav
e52a52low52tolerance52for52exercise52related52to:
1. Decreased52blood52flow.
2. Increased52blood52flow.
3. Decreased52pain.
4. Increased52blood52viscosity.52-521
A52client52with52PVD52and52heart52failure52will52experience52decreased52blood52flow.52In
this52situation,52low52exercise52tolerance52(oxygen52demand52becomes52greater52than52t
he52oxygen52supply)52may52be52related52to52less52blood52being52ejected52from52the52left
52ventricle52into52the52systemic52circulation.52Decreased52blood52supply52to52the52tissue
s52results52in52pain.52Increased52blood52viscosity52may52be52a52component,52but52it52is52
of52much52less52importance52than52the52disease52processes.
When52assessing52the52lower52extremities52of52a52client52with52peripheral52vas
cular52disease52(PVD),52the52nurse52notes52bilateral52ankle52edema.52The52ede
ma52is52related52to:
1. Competent52venous52valves.
2. Decreased52blood52volume.
3. Increase52in52muscular52activity.
4. Increased52venous52pressure.52-524
In52PVD,52decreased52blood52flow52can52result52in52increased52venous52pressure.52
The52increase52in52venous52pressure52results52in52an52increase52in52capillary52hydro
static52pressure,52which52causes52a52net52filtration52of52fluid52out52of52the52capillarie
s52into52the52interstitial52space,
resulting52in52edema.52Valves52often52become52incompetent52with52PVD.52Blood52volu
me52is52not52decreased52in52this52condition.52Decreased52muscular52action52would52co
ntribute52to52the52formation52of52edema52in52the52lower52extremities.
The52nurse52is52obtaining52the52pulse52of52a52client52who52has52had52a52femora
l-
popliteal52bypass52surgery52652hours52ago.52(See52below)52Which52assessment
52provides52the52most52accurate
information52about52the52client's52postoperative52status?
1. radial52pulse
2. femoral52pulse
3. apical52pulse
The52nurse52is52assessing52a5248-year-
old52client52with52a52history52of52smoking52during52a52routine52clinic52visit.52The52clie
nt,52who52exercises52regularly,52reports52having52pain52in52the52calf
during52exercise52that52disappears52at52rest.52Which52of52the52following52findings52requir
es52further52evaluation?
1. Heart52rate525752bpm.
2. SpO252of5294%52on52room52air.
3. Blood52pressure52134/82.
4. Ankle-brachial52index52of520.65.52-524
An52Ankle-
Brachial52Index52of520.6552suggests52moderate52arterial52vascular52disease52in5
2a52client52who52is52experiencing52intermittent52claudication.52A52Doppler52ultra
sound52is
indicated52for52further52evaluation.52The52bradycardic52heart52rate52is52acceptable52in5
2an52athletic52client52with52a52normal52blood52pressure.52The52SpO252is52acceptable;52
the52client52has52a52smoking52history.
An52 overweight52 client52 taking52 warfarin52 (Coumadin)52 has52 dry52 skin52due52 to52decr
eased5 2 arterial52blood52flow.52What52should52the52nurse52instruct52the52client52to52do?5
2Select52all52that52apply.
1. Apply52lanolin52or52petroleum52jelly52to52intact52skin.
2. Follow52a52reduced-calorie,52reduced-fat52diet.
3. Inspect52the52involved52areas52daily52for52new52ulcerations.
4. Instruct52the52client52to52limit52activities52of52daily52living52(ADLs).
5. Use52an52electric52razor52to52shave52-521,2,3,5
Maintaining52skin52integrity52is52important52in52preventing52chronic52ulcers52and
infections.52The52client52should52be52taught52to52inspect52the52skin52on52a52daily52basis.5
2The52client52should52reduce52weight52to52promote52circulation;52a52diet52lower52in52calo
ries52and52fat52is52appropriate.52Because52the52client52is52receiving52Coumadin,52the52cli
ent52is52at52risk52for52bleeding52from52cuts.52To52decrease52the52risk52of52cuts,52the52nurs
e52should52suggest52that52the52client52use52an52electric52razor.52The52client52with52decre
ased52arterial52blood52flow52should52be52encouraged52to52participate52in52ADLs.52In52fac
t,52the52client52should52be52encouraged52to52consult52an52exercise52physiologist52for52an
52exercise52program52that52enhances52the52aerobic52capacity52of52the52body.
A52client52with52peripheral52vascular52disease52has52undergone52a52right52femoral-
popliteal52bypass52graft.52The52blood52pressure52has52decreased52from52124/8052t
o5294/62.52What52should52the52nurse52assess52first?
1. IV52fluid52solution.
2. Pedal52pulses.
3. Nasal52cannula52flow52rate.
4. Capillary52refill52-522
With52each52set52of52vital52signs,52the52nurse52should52assess52the52dorsalis52pedi
s52and52posterior52tibial52pulses.52The52nurse52needs52to52ensure52adequate52perfu
sion52to52the52lower
extremity52with52the52drop52in52blood52pressure.52IV52fluids,52nasal52cannula52setting,52
and52capillary52refill52are52important52to52assess;52however,52priority52is52to52determine
52the52cause52of52drop52in52blood52pressure52and52that52adequate52perfusion52through5
,2the52new52graft52is52maintained.
,The52nurse52is52caring52for52a52client52with52peripheral52artery52disease52who52has
52recently52been52prescribed52clopidogrel52(Plavix).52The52nurse52understands52tha
t52more52teaching52is52necessary52when52the52client52states52which52of52the52follow
ing:
1. "I52should52not52be52surprised52if52I52bruise52easier52or52if52my52gums52blee
d52a52little52when52brushing52my52teeth."
2. "It52doesn't52really52matter52if52I52take52this52medicine52with52or52without52fo
od,52whatever52works52best52for52my52stomach."
3. "I52should52stop52taking52Plavix52if52it52makes52me52feel52weak52and52dizzy."
4. "The52doctor52prescribed52this52medicine52to52make52my52platelets52less52likely52to52s
tick52together52and52help52prevent52clots52from52forming."52-523
Weakness,52dizziness,52and52headache52are52common52adverse52effects52of52P
lavix52and52the52client52should52report52these52to52the52physician52if52they52are52
problematic;52in52order52to52decrease52risk52of52clot52formation,52Plavix52must52b
e52taken52regularly52and52should52not52be
stopped52or52taken52intermittently.52The52main52adverse52effect52of52Plavix52is52bleedin
g,52which52often52occurs52as52increased52bruising52or52bleeding52when52brushing52teet
h.52Plavix52is52well52absorbed,52and52while52food52may52help52decrease52potential52gas
trointestinal52upset,52Plavix52may
be52taken52with52or52without52food.52Plavix52is52an52antiplatelet52agent52used52to52preve
nt52clot52formation52in52clients52who52have52experienced52or52are52at52risk52for52myocardi
al52infarction,52ischemic52stroke,52peripheral52artery52disease,52or52acute52coronary52syn
drome.
A52client52is52receiving52Cilostazol52(Pletal)52for52peripheral52arterial52disease52causing
52intermittent52claudication.52The52nurse52determines52this52medication52is52effective52w
hen52the52client52reports52which52of52the52following?
1. "I52am52having52fewer52aches52and52pains."
2. "I52do52not52have52headaches52anymore."
3. "I52am52able52to52walk52further52without52leg52pain."
4. "My52toes52are52turning52grayish52black52in52color."52-523
Cilostazol52is52indicated52for52management52of52intermittent52claudication.52Sympto
ms52usually52improve52within52252to52452weeks52of52therapy.52Intermittent52claudicat
ion52prevents52clients52from52walking52for52long52periods52of52time.52Cilostazol52inhi
bits52platelet52aggregation52induced52by52various52stimuli52and52improving52blood52fl
ow52to52the52muscles52and52allowing52the52client52to52walk52long52distances52without
52pain.52Peripheral52arterial52disease52causes52pain
mainly52of52the52leg52muscles.52"Aches52and52pains"52does52not52specify52exactly52wher
e52the52pain52is52occurring.52Headaches52may52occur52as52a52side52effect52of52this52drug
,52and52the52client52should52report52this52information52to52the52health52care52provider.52P
eripheral52arterial52disease52causes52decreased52blood52supply52to52the52peripheral52tis
sues52and52may52cause52gangrene52of52the52toes;52the
drug52is52effective52when52the52toes52are52warm52to52the52touch52and52the52color52of52the
52toes52is52similar52to52the52color52of52the52body.
The52client52admitted52with52peripheral52vascular52disease52(PVD)52asks52the52nurse52wh
y
her52legs52hurt52when52she52walks.52The52nurse52bases52a52response52on52the52knowled
ge52that52the52main52characteristic52of52PVD52is:
, 1. Decreased52blood52flow.
2. Increased52blood52flow.
3. Slow52blood52flow.
4. Thrombus52formation.52-521
Decreased52blood52flow52is52a52common52characteristic52of52all52PVD.52When52the
demand52for52oxygen52to52the52working52muscles52becomes52greater52than52the52supply,
52pain52is52the52outcome.52Slow52blood52flow52throughout52the52circulatory52system52ma
y52suggest52pump52failure.52Thrombus52formation52can52result52from52stasis52or52damag
e52to52the52intima52of52the52vessels.
The52nurse52is52planning52care52for52a52client52who52is52diagnosed52with52peripheral52v
ascular52disease52(PVD)52and52has52a52history52of52heart52failure.52The52nurse52should5
2develop52a52plan52of52care52that52is52based52on52the52fact52that52the52client52may52hav
e52a52low52tolerance52for52exercise52related52to:
1. Decreased52blood52flow.
2. Increased52blood52flow.
3. Decreased52pain.
4. Increased52blood52viscosity.52-521
A52client52with52PVD52and52heart52failure52will52experience52decreased52blood52flow.52In
this52situation,52low52exercise52tolerance52(oxygen52demand52becomes52greater52than52t
he52oxygen52supply)52may52be52related52to52less52blood52being52ejected52from52the52left
52ventricle52into52the52systemic52circulation.52Decreased52blood52supply52to52the52tissue
s52results52in52pain.52Increased52blood52viscosity52may52be52a52component,52but52it52is52
of52much52less52importance52than52the52disease52processes.
When52assessing52the52lower52extremities52of52a52client52with52peripheral52vas
cular52disease52(PVD),52the52nurse52notes52bilateral52ankle52edema.52The52ede
ma52is52related52to:
1. Competent52venous52valves.
2. Decreased52blood52volume.
3. Increase52in52muscular52activity.
4. Increased52venous52pressure.52-524
In52PVD,52decreased52blood52flow52can52result52in52increased52venous52pressure.52
The52increase52in52venous52pressure52results52in52an52increase52in52capillary52hydro
static52pressure,52which52causes52a52net52filtration52of52fluid52out52of52the52capillarie
s52into52the52interstitial52space,
resulting52in52edema.52Valves52often52become52incompetent52with52PVD.52Blood52volu
me52is52not52decreased52in52this52condition.52Decreased52muscular52action52would52co
ntribute52to52the52formation52of52edema52in52the52lower52extremities.
The52nurse52is52obtaining52the52pulse52of52a52client52who52has52had52a52femora
l-
popliteal52bypass52surgery52652hours52ago.52(See52below)52Which52assessment
52provides52the52most52accurate
information52about52the52client's52postoperative52status?
1. radial52pulse
2. femoral52pulse
3. apical52pulse
