HESI Exit Practice Questions and Rationale (2)
Musculoskeletal and Integumentary System Nursing
Total Joint Replacement (TJR) - Knee
Key Concept: Post-operative care and understanding of discharge instructions are crucial for
preventing complications.
Question 1: A client post-total knee replacement with a metal prosthetic system needs to demonstrate
understanding of discharge instructions. Which statement indicates correct understanding?
Correct Answer: 3. "All caregivers should be told about the metal implant."
Rationale:
It is essential for the client to inform all healthcare providers about the metal implant due to
potential contraindications with certain tests and procedures.
Incorrect Options:
o Changes in knee shape and signs of infection (fever, redness, increased pain) are not
expected and should be reported.
o Bleeding gums or black stools are not normal and could indicate complications, especially
if the client is on anticoagulant therapy.
Important Considerations:
o TJR is also known as Total Joint Arthroplasty (TJA).
o Clients should report any signs and symptoms of infection and changes in knee shape.
o If on anticoagulant therapy, clients must report any adverse effects, including bleeding.
o Antibiotic prophylaxis is often needed for invasive procedures due to the metal implant.
Fractured Radius with Plaster Cast
Key Concept: Recognizing neurovascular compromise is vital after casting.
Question 2: Which findings indicate potential neurovascular impairment in a client with a plaster cast
for a fractured left radius? (Select all that apply)
Correct Answers: 3. Client report of severe, deep, unrelenting pain; 4. Client report of pain as
nurse assesses finger movement; 5. Client report of numbness and tingling sensation in the fingers
Rationale:
, These symptoms are indicative of potential compartment syndrome, a serious condition caused
by increased pressure within a muscle compartment.
Compartment Syndrome:
o Unrelieved pressure can lead to permanent nerve and muscle damage, potentially
causing necrosis, contractures, deformity, and functional impairment.
Normal Findings:
o Capillary refill less than 3 seconds indicates adequate blood flow.
o Present pulses and swollen, pink fingers also suggest adequate circulation, although
some swelling is expected post-fracture.
Lumbar Vertebral Fracture and Muscle Spasms
Key Concept: Interventions for relieving muscle spasms in vertebral fractures.
Question 3: Which interventions can aid in relieving muscle spasms in a client with a 4-day-old lumbar
vertebral fracture? (Select all that apply)
Correct Answers: 2. Heat; 3. Analgesics; 4. Muscle relaxers; 5. Intermittent traction
Rationale:
Heat, analgesics, muscle relaxers, and intermittent traction can help alleviate pain associated
with muscle spasms in this context.
Ice:
o Typically applied for the first 48-72 hours after an injury to reduce inflammation.
o Application to the spine may be uncomfortable and cause chilling.
Hip Precautions Following Posterior Hip Repair
Key Concept: Understanding and implementing hip precautions to prevent dislocation.
Question 4: Following a posterior hip repair, which action should the nurse teach the client to avoid as
part of hip precautions?
Correct Answer: 1. Crossing legs at the ankle
Rationale:
Crossing the legs can lead to hip adduction and internal rotation, increasing the risk of
dislocation after a posterior approach.
Hip Precautions (Posterior Approach):
o Avoid crossing legs at the ankle or knee.
o Use an elevated toilet seat.
o Place a pillow between the legs while lying down for the first 6 weeks.
, o Keep the legs abducted (away from the midline).
o Maintain the hip in a neutral position at all times.
Osteoporosis
Key Concept: Recognizing the primary risk associated with osteoporosis.
Question 5: An older client with osteoporosis is most at risk for which problem?
Correct Answer: 2. Fractures
Rationale:
Osteoporosis is a condition characterized by decreased bone density and increased bone
fragility, making fractures the greatest concern.
Incorrect Options:
o Anemia and infection are associated with bone marrow disorders, not primarily
osteoporosis.
o Muscle sprains are unrelated to the bone weakening caused by osteoporosis.
Allopurinol for Gout
Key Concept: Understanding the mechanism of action of allopurinol.
Question 6: A client asks how allopurinol works for gout. The nurse's reply should be based on which
medication action?
Correct Answer: 1. Allopurinol decreases uric acid production.
Rationale:
Allopurinol is an antigout medication that works by inhibiting the xanthine oxidase enzyme,
thus reducing the production of uric acid in both serum and urine.
Incorrect Options:
o Allopurinol does not primarily affect fibrinogen production, sulfa crystal formation, or
calcium ion influx.
Osteitis Deformans (Paget's Disease)
Key Concept: Identifying the underlying cause of skeletal deformities in Paget's disease.
Question 7: What is the cause of stooped posture and bowing of lower extremities in a client with
Paget's disease?
, Correct Answer: 2. Bone resorption and regeneration
Rationale:
Paget's disease is characterized by abnormal bone resorption followed by abnormal
regeneration, leading to structurally disorganized and deformed bones.
Incorrect Options:
o The condition is not primarily caused by issues with muscle metabolism, nervous system
impulse transmission, or joint integrity and synovial fluid production.
Dietary Instructions for Gout
Key Concept: Identifying foods high in purines that should be avoided in a gout diet.
Question 8: A client with gout needs additional teaching if they state it is acceptable to eat which food?
Correct Answer: 4. Chicken liver
Rationale:
Liver and other organ meats are high in purines, which break down into uric acid,
exacerbating gout symptoms. These should be omitted from the diet.
Acceptable Foods: Carrots, tapioca, and chocolate contain negligible amounts of purines and can
be consumed in moderation.
Diagnostic Studies for Paget's Disease
Key Concept: Recognizing key laboratory findings indicative of Paget's disease.
Question 9: Which laboratory study would the nurse expect to be prescribed for a client with suspected
Paget's disease?
Correct Answer: 2. Alkaline phosphatase
Rationale:
Paget's disease involves excessive bone breakdown and reformation, leading to an elevated
serum alkaline phosphatase level. Elevated urinary hydroxyproline excretion is another key
finding.
Incorrect Options: Platelet count, white blood cell count, and complete blood cell count are not
primary diagnostic indicators for Paget's disease.
Methocarbamol Education
Musculoskeletal and Integumentary System Nursing
Total Joint Replacement (TJR) - Knee
Key Concept: Post-operative care and understanding of discharge instructions are crucial for
preventing complications.
Question 1: A client post-total knee replacement with a metal prosthetic system needs to demonstrate
understanding of discharge instructions. Which statement indicates correct understanding?
Correct Answer: 3. "All caregivers should be told about the metal implant."
Rationale:
It is essential for the client to inform all healthcare providers about the metal implant due to
potential contraindications with certain tests and procedures.
Incorrect Options:
o Changes in knee shape and signs of infection (fever, redness, increased pain) are not
expected and should be reported.
o Bleeding gums or black stools are not normal and could indicate complications, especially
if the client is on anticoagulant therapy.
Important Considerations:
o TJR is also known as Total Joint Arthroplasty (TJA).
o Clients should report any signs and symptoms of infection and changes in knee shape.
o If on anticoagulant therapy, clients must report any adverse effects, including bleeding.
o Antibiotic prophylaxis is often needed for invasive procedures due to the metal implant.
Fractured Radius with Plaster Cast
Key Concept: Recognizing neurovascular compromise is vital after casting.
Question 2: Which findings indicate potential neurovascular impairment in a client with a plaster cast
for a fractured left radius? (Select all that apply)
Correct Answers: 3. Client report of severe, deep, unrelenting pain; 4. Client report of pain as
nurse assesses finger movement; 5. Client report of numbness and tingling sensation in the fingers
Rationale:
, These symptoms are indicative of potential compartment syndrome, a serious condition caused
by increased pressure within a muscle compartment.
Compartment Syndrome:
o Unrelieved pressure can lead to permanent nerve and muscle damage, potentially
causing necrosis, contractures, deformity, and functional impairment.
Normal Findings:
o Capillary refill less than 3 seconds indicates adequate blood flow.
o Present pulses and swollen, pink fingers also suggest adequate circulation, although
some swelling is expected post-fracture.
Lumbar Vertebral Fracture and Muscle Spasms
Key Concept: Interventions for relieving muscle spasms in vertebral fractures.
Question 3: Which interventions can aid in relieving muscle spasms in a client with a 4-day-old lumbar
vertebral fracture? (Select all that apply)
Correct Answers: 2. Heat; 3. Analgesics; 4. Muscle relaxers; 5. Intermittent traction
Rationale:
Heat, analgesics, muscle relaxers, and intermittent traction can help alleviate pain associated
with muscle spasms in this context.
Ice:
o Typically applied for the first 48-72 hours after an injury to reduce inflammation.
o Application to the spine may be uncomfortable and cause chilling.
Hip Precautions Following Posterior Hip Repair
Key Concept: Understanding and implementing hip precautions to prevent dislocation.
Question 4: Following a posterior hip repair, which action should the nurse teach the client to avoid as
part of hip precautions?
Correct Answer: 1. Crossing legs at the ankle
Rationale:
Crossing the legs can lead to hip adduction and internal rotation, increasing the risk of
dislocation after a posterior approach.
Hip Precautions (Posterior Approach):
o Avoid crossing legs at the ankle or knee.
o Use an elevated toilet seat.
o Place a pillow between the legs while lying down for the first 6 weeks.
, o Keep the legs abducted (away from the midline).
o Maintain the hip in a neutral position at all times.
Osteoporosis
Key Concept: Recognizing the primary risk associated with osteoporosis.
Question 5: An older client with osteoporosis is most at risk for which problem?
Correct Answer: 2. Fractures
Rationale:
Osteoporosis is a condition characterized by decreased bone density and increased bone
fragility, making fractures the greatest concern.
Incorrect Options:
o Anemia and infection are associated with bone marrow disorders, not primarily
osteoporosis.
o Muscle sprains are unrelated to the bone weakening caused by osteoporosis.
Allopurinol for Gout
Key Concept: Understanding the mechanism of action of allopurinol.
Question 6: A client asks how allopurinol works for gout. The nurse's reply should be based on which
medication action?
Correct Answer: 1. Allopurinol decreases uric acid production.
Rationale:
Allopurinol is an antigout medication that works by inhibiting the xanthine oxidase enzyme,
thus reducing the production of uric acid in both serum and urine.
Incorrect Options:
o Allopurinol does not primarily affect fibrinogen production, sulfa crystal formation, or
calcium ion influx.
Osteitis Deformans (Paget's Disease)
Key Concept: Identifying the underlying cause of skeletal deformities in Paget's disease.
Question 7: What is the cause of stooped posture and bowing of lower extremities in a client with
Paget's disease?
, Correct Answer: 2. Bone resorption and regeneration
Rationale:
Paget's disease is characterized by abnormal bone resorption followed by abnormal
regeneration, leading to structurally disorganized and deformed bones.
Incorrect Options:
o The condition is not primarily caused by issues with muscle metabolism, nervous system
impulse transmission, or joint integrity and synovial fluid production.
Dietary Instructions for Gout
Key Concept: Identifying foods high in purines that should be avoided in a gout diet.
Question 8: A client with gout needs additional teaching if they state it is acceptable to eat which food?
Correct Answer: 4. Chicken liver
Rationale:
Liver and other organ meats are high in purines, which break down into uric acid,
exacerbating gout symptoms. These should be omitted from the diet.
Acceptable Foods: Carrots, tapioca, and chocolate contain negligible amounts of purines and can
be consumed in moderation.
Diagnostic Studies for Paget's Disease
Key Concept: Recognizing key laboratory findings indicative of Paget's disease.
Question 9: Which laboratory study would the nurse expect to be prescribed for a client with suspected
Paget's disease?
Correct Answer: 2. Alkaline phosphatase
Rationale:
Paget's disease involves excessive bone breakdown and reformation, leading to an elevated
serum alkaline phosphatase level. Elevated urinary hydroxyproline excretion is another key
finding.
Incorrect Options: Platelet count, white blood cell count, and complete blood cell count are not
primary diagnostic indicators for Paget's disease.
Methocarbamol Education
