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HESI MED SURG #1 TEST
1. The nurse is providing care to a client after a percutaneous
transluminal coronary angioplasty (PTCA). What actions will the nurse
include in the client's plan of care? (Select all that apply.): A.Frequent vital
signs. B.Determine if the client is allergic to aspirin.
D.Offer fluids of choice.
F.Monitor infusion of IV nitroglycerine.
2. In assessing a client diagnosed with primary aldosteronism, the nurse
expects the laboratory test results to indicate a decreased serum level of
which substance?: C.Potassium
Clients with primary aldosteronism exhibit a profound decline in serum levels of
potassium; hypokalemia; hypertension is the most prominent and universal sign.
3. The nurse is providing care for a client diagnosed with trigeminal
neuralgia (tic douloureux). Which symptoms will the nurse be looking for
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in the focused assessment related to this condition? (Select all that
apply.): A.Facial muscle spasms
B.Sudden facial pain
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 (cranial V).
4. A 74-year-old male client is admitted to the intensive care unit (ICU)
with a diagnosis of respiratory failure secondary to pneumonia. Currently,
the client is ventilator-dependent, with settings of tidal volume (VT) of 750
mL and an intermittent mandatory ventilation (IMV) rate of 10 breaths/min.
Arterial blood gas (ABG) results are as follows: pH, 7.48; PaCO2, 30 mm
Hg; PaO2, 64 mm Hg; HCO3, 25 mEq/L; and FiO2, 0.80. Which action
should the nurse take first?: D.Add 5 cm positive end-expiratory pressure
(PEEP)
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Adding PEEP helps improve oxygenation while reducing FiO2 to a less toxic
level
5. The clinic nurse is providing post-operative teaching for a client
scheduled for a myringoplasty. Which client statements indicate to the
nurse that the teaching has been effective? (Select all that apply.): B."I will
avoid forceful and deep coughing until my post-op checkup.
C."I must lay flat on my non-operative side for the first 12 hours after surgery."
D."My hearing may be less or muffled until the packing comes out."
The client must keep the ear bandage clean and dry until the packing is
removed. Showering and hair washing is discouraged.
6. During the shift report, the charge nurse informs a nurse of a
reassignment to another unit for the day. The nurse begins to sigh deeply
and tosses about her belongings when preparing to leave. What is the best
immediate action for the charge nurse to take?: A.