Page 1 of 22
HESI MEDICAL SURGICAL EXAM WITH DETAILED SOLUTIONS
A client receives a new prescription for pentazocine (Talwin), a mixed opioid
agonist-antagonist, after an opioid agonist is discontinued. What is the
advantage for the client when the new prescription is implemented?
Tolerance does not occur.
Less agitation is experienced.
The analgesic ceiling is higher.
Respiratory depression is less.
Rationale
Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as
antagonists or partial agonists on the mu receptor, which produces less
respiratory depression than opioid agonists that are pure mu agonists.
A client who has Trichomonas vaginalis receives a prescription for metronidazole
(Flagyl). Which instruction should the nurse provide during client education? Do
not ingest with diary products.
Notify the clinic if the urine changes color.
Obtain liver function tests every 3 months.
Avoid over-the-counter antitussives.
Rationale
Flagyl can produce a disulfiram (Antabuse)-like reaction when combined with
products containing alcohol, such as over-the-counter cough remedies, so the
client should be informed to avoid ingesting any alcohol product during the use
of Flagyl.
A client receives a new prescription for an angiotensin-converting enzyme (ACE)
inhibitor. What client history contraindicates its use? Asthma.
Heart failure.
Renal artery stenosis.
Coronary artery disease.
Rationale
Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal
insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery
to a single remaining kidney.
Which side effects should the nurse monitor for a client who is receiving
dexamethasone (Decadron) following neurosurgery? (Select all that apply.)
Select all that apply
Some correct answers were not selected
Mood swings.
, lOMoARcPSD|5422489
Decreased appetite.
Increased weight gain.
Serum glucose level of 65 mg/dl.
Delayed incisional wound healing.
Serum hemoglobin level of 9 mg/dl.
Rationale
Dexamethasone (Decadron) is a long-acting glucocorticoid prescribed for
neurosurgical procedures because it suppresses inflammation and has a low
sodium-retaining ability, which is important in averting cerebral edema. However
though the medication does produce the following side effects such as: mood
swings; an increase in appetite, resulting in weight gain; hyperglycemia (serum
glucose level above 120 mg/dl) which is related to the gluconeogenesis
properties of corticosteroids; delayed in wound healing related to immune
suppression properties; and complete blood count resulting in a decreased in
WBC and hemoglobin (less than 12mg/dl). When a client is receiving
dexamethasone, they should be monitor for these side effects.
The healthcare provider prescribes a medication for an older adult client who is
complaining of insomnia, and instructs the client to return in two weeks. The
nurse should question which prescription?
Zolpidem (Ambien) 10 milligrams orally at bedtime.
Eszopiclone (Lunesta) 10 milligrams orally at bedtime.
Temazepam (Restoril) 7.5 milligrams orally at bedtime.
Ramelteon (Rozerem) 8 milligrams orally at bedtime.
Rationale
The prescription for eszopiclone (Lunesta) 10mg at bedtime is too high for this
client. The dosing of this medication is usually a client is started off at 1mg at
bedtime and may advance up to 3mg maximum if needed.
When assessing a client prior to the administration of digoxin (Lanoxin,
APODigoxin), which data is most important for the nurse to consider?
Presence of a grade 2 murmur.
Nailbed capillary refill of 5 seconds.
Irregular apical pulse with a rate of 87.
Bilateral lower extremity dependent rubor.
Rationale
The action of digoxin is to slow the heart rate and strengthen the force of
contraction, so it is essential for the nurse to auscultate the apical pulse for a full
minute and that the apical pulse is grater then 60 beats per minute for an adult or
greater then 90 beats per minute for an infant prior to administration. If apical
pulse is below the desired parameters, hold the dose and recheck the rate in one
hour.
, Page 3 of 22
A client receives a new prescription for ciprofloxacin (Cipro), a synthetic
quinolone. When teaching about this drug, which information in the client's
history requires special emphasis by the nurse?
Snacks on dairy products such as yogurt or ice cream.
Previously had a mild allergic reaction to a cephalosporin.
Consumes alcoholic drinks occasionally on the weekends.
Works twenty hours a week as a lifeguard at the local pool.
Rationale
Cipro can cause both dizziness and photosensitivity. Since the client works as a
lifeguard outdoors, measures related to these adverse effects should be
addressed.
What action should the nurse implement to provide analgesic titration for a client
in pain?
Teach the client to increase the time range between doses of pain medication.
Monitor the effects of continuous intravenous infusion of narcotic analgesics.
Plan with the client how to use a specific total dose of analgesic over a 24-hour period.
Determine the optimal analgesic dosage required that causes the least side effects.
Rationale
No given dosage of an analgesic provides the same level of pain relief for every
patient, and so titration upward or downward is determined based on the client's
response, so that the optimal dosage achieves adequate pain relief with minimal
side effects for the client. An individual's response to the medication dosage is
the assessment for titration, and the titration dose should be implemented as
long as analgesia is needed.
Which common side effect should the nurse alert a female client about when
medroxyprogesterone (Depo-Provera) is prescribed? Leg or calf pain.
Headaches or visual changes.
Vaginal bleeding after discontinuing the medication.
Jaundice during the first 3 weeks of administration.
Rationale
Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a
female client may experience withdrawal vaginal bleeding.
A resident of a long-term care facility is taking lithium carbonate (Eskalith) to
treat bipolar disorder. Which instruction should the nurse provide to this client's
caregivers?
Offer the morning dose of the medicine before breakfast.
Have the client chew the pill if it is difficult to swallow.
Encourage high energy fluid intake by providing sports drinks or sodas. Report
symptoms of hypothyroidism such as fatigue and constipation.
HESI MEDICAL SURGICAL EXAM WITH DETAILED SOLUTIONS
A client receives a new prescription for pentazocine (Talwin), a mixed opioid
agonist-antagonist, after an opioid agonist is discontinued. What is the
advantage for the client when the new prescription is implemented?
Tolerance does not occur.
Less agitation is experienced.
The analgesic ceiling is higher.
Respiratory depression is less.
Rationale
Mixed agonist-antagonists bind as an agonist at the Kappa receptor and as
antagonists or partial agonists on the mu receptor, which produces less
respiratory depression than opioid agonists that are pure mu agonists.
A client who has Trichomonas vaginalis receives a prescription for metronidazole
(Flagyl). Which instruction should the nurse provide during client education? Do
not ingest with diary products.
Notify the clinic if the urine changes color.
Obtain liver function tests every 3 months.
Avoid over-the-counter antitussives.
Rationale
Flagyl can produce a disulfiram (Antabuse)-like reaction when combined with
products containing alcohol, such as over-the-counter cough remedies, so the
client should be informed to avoid ingesting any alcohol product during the use
of Flagyl.
A client receives a new prescription for an angiotensin-converting enzyme (ACE)
inhibitor. What client history contraindicates its use? Asthma.
Heart failure.
Renal artery stenosis.
Coronary artery disease.
Rationale
Angiotensin-converting enzyme (ACE) inhibitors can cause severe renal
insufficiency in clients with bilateral renal artery stenosis or stenosis in the artery
to a single remaining kidney.
Which side effects should the nurse monitor for a client who is receiving
dexamethasone (Decadron) following neurosurgery? (Select all that apply.)
Select all that apply
Some correct answers were not selected
Mood swings.
, lOMoARcPSD|5422489
Decreased appetite.
Increased weight gain.
Serum glucose level of 65 mg/dl.
Delayed incisional wound healing.
Serum hemoglobin level of 9 mg/dl.
Rationale
Dexamethasone (Decadron) is a long-acting glucocorticoid prescribed for
neurosurgical procedures because it suppresses inflammation and has a low
sodium-retaining ability, which is important in averting cerebral edema. However
though the medication does produce the following side effects such as: mood
swings; an increase in appetite, resulting in weight gain; hyperglycemia (serum
glucose level above 120 mg/dl) which is related to the gluconeogenesis
properties of corticosteroids; delayed in wound healing related to immune
suppression properties; and complete blood count resulting in a decreased in
WBC and hemoglobin (less than 12mg/dl). When a client is receiving
dexamethasone, they should be monitor for these side effects.
The healthcare provider prescribes a medication for an older adult client who is
complaining of insomnia, and instructs the client to return in two weeks. The
nurse should question which prescription?
Zolpidem (Ambien) 10 milligrams orally at bedtime.
Eszopiclone (Lunesta) 10 milligrams orally at bedtime.
Temazepam (Restoril) 7.5 milligrams orally at bedtime.
Ramelteon (Rozerem) 8 milligrams orally at bedtime.
Rationale
The prescription for eszopiclone (Lunesta) 10mg at bedtime is too high for this
client. The dosing of this medication is usually a client is started off at 1mg at
bedtime and may advance up to 3mg maximum if needed.
When assessing a client prior to the administration of digoxin (Lanoxin,
APODigoxin), which data is most important for the nurse to consider?
Presence of a grade 2 murmur.
Nailbed capillary refill of 5 seconds.
Irregular apical pulse with a rate of 87.
Bilateral lower extremity dependent rubor.
Rationale
The action of digoxin is to slow the heart rate and strengthen the force of
contraction, so it is essential for the nurse to auscultate the apical pulse for a full
minute and that the apical pulse is grater then 60 beats per minute for an adult or
greater then 90 beats per minute for an infant prior to administration. If apical
pulse is below the desired parameters, hold the dose and recheck the rate in one
hour.
, Page 3 of 22
A client receives a new prescription for ciprofloxacin (Cipro), a synthetic
quinolone. When teaching about this drug, which information in the client's
history requires special emphasis by the nurse?
Snacks on dairy products such as yogurt or ice cream.
Previously had a mild allergic reaction to a cephalosporin.
Consumes alcoholic drinks occasionally on the weekends.
Works twenty hours a week as a lifeguard at the local pool.
Rationale
Cipro can cause both dizziness and photosensitivity. Since the client works as a
lifeguard outdoors, measures related to these adverse effects should be
addressed.
What action should the nurse implement to provide analgesic titration for a client
in pain?
Teach the client to increase the time range between doses of pain medication.
Monitor the effects of continuous intravenous infusion of narcotic analgesics.
Plan with the client how to use a specific total dose of analgesic over a 24-hour period.
Determine the optimal analgesic dosage required that causes the least side effects.
Rationale
No given dosage of an analgesic provides the same level of pain relief for every
patient, and so titration upward or downward is determined based on the client's
response, so that the optimal dosage achieves adequate pain relief with minimal
side effects for the client. An individual's response to the medication dosage is
the assessment for titration, and the titration dose should be implemented as
long as analgesia is needed.
Which common side effect should the nurse alert a female client about when
medroxyprogesterone (Depo-Provera) is prescribed? Leg or calf pain.
Headaches or visual changes.
Vaginal bleeding after discontinuing the medication.
Jaundice during the first 3 weeks of administration.
Rationale
Approximately 3 to 7 days after the last cyclic dose of medroxyprogesterone, a
female client may experience withdrawal vaginal bleeding.
A resident of a long-term care facility is taking lithium carbonate (Eskalith) to
treat bipolar disorder. Which instruction should the nurse provide to this client's
caregivers?
Offer the morning dose of the medicine before breakfast.
Have the client chew the pill if it is difficult to swallow.
Encourage high energy fluid intake by providing sports drinks or sodas. Report
symptoms of hypothyroidism such as fatigue and constipation.
