HESI RN: Med-Surg - Version 2 EXAM 2025 LATEST UPDATED 100 REAL
EXAM QUESTIONS WITH 100% RATED CORRECT ANSWERS 100%
ACCURATE GET IT CORRECT!!
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit.
The client, who exercises regularly, reports having pain in the calf
during exercise that disappears at rest. Which of the following findings requires further
evaluation?
1. Heart rate 57 bpm.
2. SpO2 of 94% on room air.
3. Blood pressure 134/82.
4. Ankle-brachial index of 0.65. - 心的坚强决定了我们的命运。当
(Correct Answer)4. Ankle-brachial index of 0.65.
我们面对挫折时，是一颗不屈的
An Ankle-Brachial Index of 0.65 suggests
心让我们勇敢前行 moderate arterial vascular disease in a client who is
experiencing intermittent claudication. Normal ABI 1-1.4. A Doppler ultrasound is indicated for
further evaluation. The bradycardic heart rate is acceptable in an athletic client with a normal
blood pressure. The SpO2 is acceptable; the client has a smoking history.
A client with peripheral vascular disease has undergone a right femoral popliteal bypass graft.
The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess first?
1. IV fluid solution.
2. Pedal pulses.
3. Nasal cannula flow rate.
4. Capillary refill. - (Correct Answer)2. Pedal pulses.
,With each set of vital signs, the nurse should assess the dorsalis pedis and posterior tibial pulses.
The nurse needs to ensure adequate perfusion to the lower
extremity with the drop in blood pressure. IV fluids, nasal cannula setting, and capillary refill are
important to assess; however, priority is to determine the cause of drop in blood pressure and that
adequate perfusion through the new graft is maintained.
CN: Reduction of risk potential; CL: Analyze
An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood
flow. What should the nurse instruct the client to do? Select all that apply.
1. Apply lanolin or petroleum jelly to intact skin.
2. Follow a reduced-calorie, reduced-fat diet.- promote circulation by reducing weight.
3. Inspect the involved areas daily for new ulcerations.
4. Instruct the client to limit activities of daily living (ADLs). 5. Use an electric razor to shave. -
心的坚强决定了我们的命运。当
(Correct Answer)1. Apply lanolin or petroleum jelly to intact skin.
我们面对挫折时，是一颗不屈的
2. Follow a reduced-calorie, reduced-fat diet.- promote circulation by reducing weight.
心让我们勇敢前行
3. Inspect the involved areas daily for new ulcerations.
5. Use an electric razor to shave.
1, 2, 3, 5. Maintaining skin integrity is important in preventing chronic ulcers and infections. The
client should be taught to inspect the skin on a daily basis. The client should reduce weight to
promote circulation; a diet lower in calories and fat is appropriate. Because the client is receiving
Coumadin, the client is at risk for bleeding from cuts. To decrease the risk of cuts, the nurse
should suggest that the client use an electric razor. The client with decreased arterial blood flow
should be encouraged to participate in ADLs. In fact, the client should be encouraged to consult
an exercise physiologist for an exercise program that enhances the aerobic capacity of the body.
CN: Health promotion and maintenance; CL: Synthesize
The nurse is caring for a client with peripheral artery disease who has recently been prescribed
clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client
states which of the following:
,1. "I should not be surprised if I bruise easier or if my gums bleed a little when brushing my
teeth."
2. "It doesn't really matter if I take this medicine with or without food, whatever works best for
my stomach."
3. "I should stop taking Plavix if it makes me feel weak and dizzy."
4. "The doctor prescribed this medicine to make my platelets less likely to stick together and help
prevent clots from forming." - (Correct Answer)3. "I should stop taking Plavix if it makes me
feel weak and dizzy."
Weakness, dizziness, and headache are common adverse effects of Plavix and the client should
report these to the physician if they are problematic; in order to decrease risk of clot formation,
Plavix must be taken regularly and should not be
stopped or taken intermittently. The main adverse effect of Plavix is bleeding, which often occurs
as increased bruising or bleeding when brushing teeth. Plavix is well absorbed, and while food
may help decrease potential gastrointestinal upset, Plavix may be taken with or without food.
Plavix is an antiplatelet agent used心的坚强决定了我们的命运。当
to prevent clot formation in clients who have experienced or
are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary
我们面对挫折时，是一颗不屈的
syndrome.
心让我们勇敢前行
CN: Pharmacological and parenteral therapies; CL: Evaluate
A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent
claudication. The nurse determines this medication is effective when the client reports which of
the following?
1. "I am having fewer aches and pains."
2. "I do not have headaches anymore."
3. "I am able to walk further without leg pain."
4. "My toes are turning grayish black in color." - (Correct Answer)3. "I am able to walk further
without leg pain."
Cilostazol is indicated for management of intermittent claudication. Symptoms usually improve
within 2 to 4 weeks of therapy. Intermittent claudication prevents clients from walking for long
periods of time. Cilostazol inhibits platelet aggregation induced by various stimuli and
, improving blood flow to the muscles and allowing the client to walk long distances without pain.
Peripheral arterial disease causes pain
mainly of the leg muscles. "Aches and pains" does not specify exactly where the pain is
occurring. Headaches may occur as a side effect of this drug, and the client should report this
information to the health care provider. Peripheral arterial disease causes
decreased blood supply to the peripheral tissues and may cause gangrene of the toes; the drug is
effective when the toes are warm to the touch and the color of the toes is similar
to the color of the body.
CN: Pharmacological and parenteral therapies; CL: Evaluate
The client admitted with peripheral vascular disease (PVD) asks the nurse why
her legs hurt when she walks. The nurse bases a response on the knowledge that the main
characteristic of PVD is:
1. Decreased blood flow.
心的坚强决定了我们的命运。当
2. Increased blood flow.
我们面对挫折时，是一颗不屈的
3. Slow blood flow.
心让我们勇敢前行
4. Thrombus formation. - (Correct Answer)1. Decreased blood flow.
Decreased blood flow is a common characteristic of all PVD. When the demand for oxygen to
the working muscles becomes greater than the supply, pain is the outcome. Slow blood flow
throughout the circulatory system may suggest pump failure. Thrombus formation can result
from stasis or damage to the intima of the vessels.
The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD)
and has a history of heart failure. The nurse should develop a plan of care that is based on the
fact that the client may have a low tolerance for exercise related to:
1. Decreased blood flow.
EXAM QUESTIONS WITH 100% RATED CORRECT ANSWERS 100%
ACCURATE GET IT CORRECT!!
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit.
The client, who exercises regularly, reports having pain in the calf
during exercise that disappears at rest. Which of the following findings requires further
evaluation?
1. Heart rate 57 bpm.
2. SpO2 of 94% on room air.
3. Blood pressure 134/82.
4. Ankle-brachial index of 0.65. - 心的坚强决定了我们的命运。当
(Correct Answer)4. Ankle-brachial index of 0.65.
我们面对挫折时，是一颗不屈的
An Ankle-Brachial Index of 0.65 suggests
心让我们勇敢前行 moderate arterial vascular disease in a client who is
experiencing intermittent claudication. Normal ABI 1-1.4. A Doppler ultrasound is indicated for
further evaluation. The bradycardic heart rate is acceptable in an athletic client with a normal
blood pressure. The SpO2 is acceptable; the client has a smoking history.
A client with peripheral vascular disease has undergone a right femoral popliteal bypass graft.
The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess first?
1. IV fluid solution.
2. Pedal pulses.
3. Nasal cannula flow rate.
4. Capillary refill. - (Correct Answer)2. Pedal pulses.
,With each set of vital signs, the nurse should assess the dorsalis pedis and posterior tibial pulses.
The nurse needs to ensure adequate perfusion to the lower
extremity with the drop in blood pressure. IV fluids, nasal cannula setting, and capillary refill are
important to assess; however, priority is to determine the cause of drop in blood pressure and that
adequate perfusion through the new graft is maintained.
CN: Reduction of risk potential; CL: Analyze
An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood
flow. What should the nurse instruct the client to do? Select all that apply.
1. Apply lanolin or petroleum jelly to intact skin.
2. Follow a reduced-calorie, reduced-fat diet.- promote circulation by reducing weight.
3. Inspect the involved areas daily for new ulcerations.
4. Instruct the client to limit activities of daily living (ADLs). 5. Use an electric razor to shave. -
心的坚强决定了我们的命运。当
(Correct Answer)1. Apply lanolin or petroleum jelly to intact skin.
我们面对挫折时，是一颗不屈的
2. Follow a reduced-calorie, reduced-fat diet.- promote circulation by reducing weight.
心让我们勇敢前行
3. Inspect the involved areas daily for new ulcerations.
5. Use an electric razor to shave.
1, 2, 3, 5. Maintaining skin integrity is important in preventing chronic ulcers and infections. The
client should be taught to inspect the skin on a daily basis. The client should reduce weight to
promote circulation; a diet lower in calories and fat is appropriate. Because the client is receiving
Coumadin, the client is at risk for bleeding from cuts. To decrease the risk of cuts, the nurse
should suggest that the client use an electric razor. The client with decreased arterial blood flow
should be encouraged to participate in ADLs. In fact, the client should be encouraged to consult
an exercise physiologist for an exercise program that enhances the aerobic capacity of the body.
CN: Health promotion and maintenance; CL: Synthesize
The nurse is caring for a client with peripheral artery disease who has recently been prescribed
clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client
states which of the following:
,1. "I should not be surprised if I bruise easier or if my gums bleed a little when brushing my
teeth."
2. "It doesn't really matter if I take this medicine with or without food, whatever works best for
my stomach."
3. "I should stop taking Plavix if it makes me feel weak and dizzy."
4. "The doctor prescribed this medicine to make my platelets less likely to stick together and help
prevent clots from forming." - (Correct Answer)3. "I should stop taking Plavix if it makes me
feel weak and dizzy."
Weakness, dizziness, and headache are common adverse effects of Plavix and the client should
report these to the physician if they are problematic; in order to decrease risk of clot formation,
Plavix must be taken regularly and should not be
stopped or taken intermittently. The main adverse effect of Plavix is bleeding, which often occurs
as increased bruising or bleeding when brushing teeth. Plavix is well absorbed, and while food
may help decrease potential gastrointestinal upset, Plavix may be taken with or without food.
Plavix is an antiplatelet agent used心的坚强决定了我们的命运。当
to prevent clot formation in clients who have experienced or
are at risk for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary
我们面对挫折时，是一颗不屈的
syndrome.
心让我们勇敢前行
CN: Pharmacological and parenteral therapies; CL: Evaluate
A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent
claudication. The nurse determines this medication is effective when the client reports which of
the following?
1. "I am having fewer aches and pains."
2. "I do not have headaches anymore."
3. "I am able to walk further without leg pain."
4. "My toes are turning grayish black in color." - (Correct Answer)3. "I am able to walk further
without leg pain."
Cilostazol is indicated for management of intermittent claudication. Symptoms usually improve
within 2 to 4 weeks of therapy. Intermittent claudication prevents clients from walking for long
periods of time. Cilostazol inhibits platelet aggregation induced by various stimuli and
, improving blood flow to the muscles and allowing the client to walk long distances without pain.
Peripheral arterial disease causes pain
mainly of the leg muscles. "Aches and pains" does not specify exactly where the pain is
occurring. Headaches may occur as a side effect of this drug, and the client should report this
information to the health care provider. Peripheral arterial disease causes
decreased blood supply to the peripheral tissues and may cause gangrene of the toes; the drug is
effective when the toes are warm to the touch and the color of the toes is similar
to the color of the body.
CN: Pharmacological and parenteral therapies; CL: Evaluate
The client admitted with peripheral vascular disease (PVD) asks the nurse why
her legs hurt when she walks. The nurse bases a response on the knowledge that the main
characteristic of PVD is:
1. Decreased blood flow.
心的坚强决定了我们的命运。当
2. Increased blood flow.
我们面对挫折时，是一颗不屈的
3. Slow blood flow.
心让我们勇敢前行
4. Thrombus formation. - (Correct Answer)1. Decreased blood flow.
Decreased blood flow is a common characteristic of all PVD. When the demand for oxygen to
the working muscles becomes greater than the supply, pain is the outcome. Slow blood flow
throughout the circulatory system may suggest pump failure. Thrombus formation can result
from stasis or damage to the intima of the vessels.
The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD)
and has a history of heart failure. The nurse should develop a plan of care that is based on the
fact that the client may have a low tolerance for exercise related to:
1. Decreased blood flow.
