MED SURG 2 HESI TEST BANK REAL
EXAM 200+ QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES|AGRADE
1.mAmclientmwithmCushing'smsyndromemismrecoveringmfrommanmelectivemlaparoscopicmprocedure.mW
hichmassessmentmfindingmwarrant'smimmediateminterventionmbymthemnurse?
a.mPurplemmarksmonmskinmofmthemabdomen
b.mIrregularmapicalmpulse
c.mQuartermsizembloodmspotmonmdressing
d.mPittingmanklemedemam-mCORRECTmANSWERmb.mIrregularmapicalmpulse
2.mAmclientmwithmlungmcancermwhomwearsmamsubcutaneousmmorphinemsulfatempatchmformpainmismsh
ortmofmbreathmandmismdifficultmtomarouse.mWhenmperformingmamheadmtomtoemassessment,mthemnurs
emdiscoversmfourmanalgesicmpatchesmonmthemclientsmbody.mWhichminterventionmshouldmthemnursemi
mplementmfirst?
a.mRemovemallmofmthemmorphinempatches
b.mAdministermamnarcoticmantagonist
c.mApplymoxygenmpermfacemmask
d.mMeasuremthemclient'smbloodmpressurem-
mCORRECTmANSWERmb.mAdministermamnarcoticmantagonist
3.mAmclientmreceivesmprescriptionsmformammultidrugmregimenmformthemtreatmentmofmtuberculosis.m
Whichminformationmshouldmthemnursemprioritize?
a.mAdherencemtomthemregimenmismimperative
,b.mMedicationsmshouldmbemtakenmwithmfood
c.mSerummlivermpanelsmaremcollectedmregularly
d.mEnhancedmsunmprotectionmmeasuresmwillmbemneededm-
mCORRECTmANSWERma.mAdherencemtomthemregimenmismimperative
4.mThemnursemismpreparingmamclientmformsurgerymwhomwasmadmittedmtomthememergencymcentermfoll
owingmammotormvehiclemcollision.mThemclientmhasmanmopenmfracturemofmthemfemurmandmismbleeding
mmoderatelymfrommthembonemprotrusionmsite.mDuringmthemprescriptivemassessment,mthemnursemde
terminesmthatmthemclientmcurrentlymreceivesmheparinmsodiumm5,000munitsmsubcutaneouslymdaily.m
Whatmismthemprioritymnursingmaction?
a.mNotifymthemhealthcaremprovidermofmthemclient'smmedicationmhistory
b.mObservemthemheparinminjectionsmsitesmformsignsmofmbruising
c.mHavemthemclientmsignmthemsurgicalmandmtransfusionmpermits
d.mEnsuremthatmthempotentialmformbleedingmismexplainedmtomthemclientm-
mCORRECTmANSWERma.mNotifymthemhealthcaremprovidermofmthemclient'smmedicationmhistory
5.mAmclientmwithmorthopneamexpressesmconcernmaboutmthemabilitymtom"getmenoughmair"mduringmams
cheduledmthoracentesis.mOnmwhichminformationmshouldmthemnurse'smresponsembembased?
a.mAmthoracentesismismambriefmprocessmthatmhasmminimalmdiscomfort
b.mOrthopneamismfrequentlymcausedmbymamclient'smuncontrolledmanxiety
c.mThemproceduremismperformedmwithmthemclientminmanmuprightmposition
d.mExtrampillowsmcanmbemusedmifmneededmtomelevatemthemclient'smheadm-
mCORRECTmANSWERmc.mThemproceduremismperformedmwithmthemclientminmanmuprightmposition
6.mWhatminformationmshouldmthemnursemincludeminmthemteachingmplanmofmamclientmdiagnosedmwith
mgastroesophagealmrefluxmdiseasem(GERD)?
,a.mSleepmwithoutmpillowsmatmnightmtommaintainmneckmalignment
b.mAdjustmfoodmintakemtomthreemfullmmealsmpermdaymandmnomsnacks
c.mMinimizemsymptomsmbymwearingmloose,mcomfortablemclothing
d.mAvoidmparticipationminmanymaerobicmexercisemprogramsm-
mCORRECTmANSWERmc.mMinimizemsymptomsmbymwearingmloose,mcomfortablemclothing
7.mThemnursemismprovidingmteachingmtomamclientmwithmTypem2mdiabetesmmellitusmandmperipheralmn
europathy.mWhichminformationmshouldmthemnursemprovide?
a.mFamilymmembersmcanmhelpmwithmregularmfootmexams
b.mHeatingmpadsmaremusefulmifmonmthemlowmsetting
c.mAchingmfeetmmaymbemsoakedminmlukewarmmwatermformonemhourmormmore
d.mShoesmshouldmbemwornmoutsidemthemhouse,mbutmitmismfinemtombembarefootminsidem-
mCORRECTmANSWERma.mFamilymmembersmcanmhelpmwithmregularmfootmexams
8.mAmclientminmthemoperatingmroommreceivedmsuccinylcholine.mThemclientmismexperiencingmmusclem
rigiditymandmhasmanmextremelymhighmtemperature.mWhatmactionmshouldmthemnursemimplement?
a.mHoldmamprescriptionmformdantrolenemuntilmfevermismreduced
b.mPreparemicempacksmformplacementminmthemclientsmaxillarymarea
c.mCallmthemPACUmnursemtompreparemformprolongedmventilatormsupport
d.mDeterminemifmprescribedmantibioticsmweremadministeredmpreoperativelym-
mCORRECTmANSWERmb.mPreparemicempacksmformplacementminmthemclientsmaxillarymarea
9.mThemnursemismdevelopingmamplanmofmcaremformamclientmwhomreportsmblurredmvisionmandmwhomism
newlymdiagnosedmwithmcardiovascularmdisease.mWhichmoutcomemshouldmthemnursemincludeminmth
emplanmofmcaremformthismclient?
, a.mThemnursemwillmencouragemthemclientmtomwalkmthirtymminutesmeverymday
b.mThemclientsmfamilymwillmstatemsignsmandmsymptomsmaboutmthemdisease
c.mThemclientsmdailymbloodmpressuremwillmbemlessmthanm140/80mthismmonth
d.mThemclientmbloodmpressuremreadingsmwillmbemlessmthanm160/90m-
mCORRECTmANSWERmc.mThemclientsmdailymbloodmpressuremwillmbemlessmthanm140/80mthismmonth
10.mThemfamilymsuspectsmthatmacquiredmimmunemdeficiencymsyndromem(AIDS)mdementiamismoccuri
ngminmtheirmsonmwhomismhumanmimmunodeficiencymvirusm(HIV)mpositive.mWhichmsymptomsmconfir
mmtheirmsuspicions?
a.mHemhasmbegunmtomsleepm18moutmofm24mhours
b.mAmchangemhasmrecentlymoccurredminmhismhandwriting
c.mHemrefusesmtomseemanymofmhismfriendsmormtomreturnmtheirmphonemcalls
d.mHemexhibitsmangrymoutburstmwhenmthemsubjectmofmdyingmismapproachedm-
mCORRECTmANSWERmb.mAmchangemhasmrecentlymoccurredminmhismhandwriting
11.mAmhospitalizedmclientmwithmperipheralmarterialmdiseasem(PAD)misminstructedmregardingmlegmand
mfootmcare.mWhichmstatementmbymthemclientmindicatesmtomthemnursemthatmlearningmhasmoccurred?
a.m"WhenevermImammsittingminmamchairmImwillmkeepmmymlegsmupmtomreducemswelling"
b.m"Imcanmusemammirrormtomcheckmthembottomsmofmmymfeetmformanymsignsmofmbreakdown"
c.m"Imwillmtrymtomkeepmmovingmifmlegmpainmoccursmtomhelpmpromotemgoodmcirculation"
d.m"Imwillmusemmymswimmingmpoolmearlyminmthemdaymwhilemthemwatermismstillmverymcool"m-
mCORRECTmANSWERmb.m"Imcanmusemammirrormtomcheckmthembottomsmofmmymfeetmformanymsignsmofm
breakdown"
12.mWhilemcompletingmamhealthmassessmentmformamclientmwithmmigrainemheadaches,mthemnursemas
sessesmbilateralmweaknessminmthemclient'smhandmgrips.mThemclientmreportsmjointmpainmandmtroublem
EXAM 200+ QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES|AGRADE
1.mAmclientmwithmCushing'smsyndromemismrecoveringmfrommanmelectivemlaparoscopicmprocedure.mW
hichmassessmentmfindingmwarrant'smimmediateminterventionmbymthemnurse?
a.mPurplemmarksmonmskinmofmthemabdomen
b.mIrregularmapicalmpulse
c.mQuartermsizembloodmspotmonmdressing
d.mPittingmanklemedemam-mCORRECTmANSWERmb.mIrregularmapicalmpulse
2.mAmclientmwithmlungmcancermwhomwearsmamsubcutaneousmmorphinemsulfatempatchmformpainmismsh
ortmofmbreathmandmismdifficultmtomarouse.mWhenmperformingmamheadmtomtoemassessment,mthemnurs
emdiscoversmfourmanalgesicmpatchesmonmthemclientsmbody.mWhichminterventionmshouldmthemnursemi
mplementmfirst?
a.mRemovemallmofmthemmorphinempatches
b.mAdministermamnarcoticmantagonist
c.mApplymoxygenmpermfacemmask
d.mMeasuremthemclient'smbloodmpressurem-
mCORRECTmANSWERmb.mAdministermamnarcoticmantagonist
3.mAmclientmreceivesmprescriptionsmformammultidrugmregimenmformthemtreatmentmofmtuberculosis.m
Whichminformationmshouldmthemnursemprioritize?
a.mAdherencemtomthemregimenmismimperative
,b.mMedicationsmshouldmbemtakenmwithmfood
c.mSerummlivermpanelsmaremcollectedmregularly
d.mEnhancedmsunmprotectionmmeasuresmwillmbemneededm-
mCORRECTmANSWERma.mAdherencemtomthemregimenmismimperative
4.mThemnursemismpreparingmamclientmformsurgerymwhomwasmadmittedmtomthememergencymcentermfoll
owingmammotormvehiclemcollision.mThemclientmhasmanmopenmfracturemofmthemfemurmandmismbleeding
mmoderatelymfrommthembonemprotrusionmsite.mDuringmthemprescriptivemassessment,mthemnursemde
terminesmthatmthemclientmcurrentlymreceivesmheparinmsodiumm5,000munitsmsubcutaneouslymdaily.m
Whatmismthemprioritymnursingmaction?
a.mNotifymthemhealthcaremprovidermofmthemclient'smmedicationmhistory
b.mObservemthemheparinminjectionsmsitesmformsignsmofmbruising
c.mHavemthemclientmsignmthemsurgicalmandmtransfusionmpermits
d.mEnsuremthatmthempotentialmformbleedingmismexplainedmtomthemclientm-
mCORRECTmANSWERma.mNotifymthemhealthcaremprovidermofmthemclient'smmedicationmhistory
5.mAmclientmwithmorthopneamexpressesmconcernmaboutmthemabilitymtom"getmenoughmair"mduringmams
cheduledmthoracentesis.mOnmwhichminformationmshouldmthemnurse'smresponsembembased?
a.mAmthoracentesismismambriefmprocessmthatmhasmminimalmdiscomfort
b.mOrthopneamismfrequentlymcausedmbymamclient'smuncontrolledmanxiety
c.mThemproceduremismperformedmwithmthemclientminmanmuprightmposition
d.mExtrampillowsmcanmbemusedmifmneededmtomelevatemthemclient'smheadm-
mCORRECTmANSWERmc.mThemproceduremismperformedmwithmthemclientminmanmuprightmposition
6.mWhatminformationmshouldmthemnursemincludeminmthemteachingmplanmofmamclientmdiagnosedmwith
mgastroesophagealmrefluxmdiseasem(GERD)?
,a.mSleepmwithoutmpillowsmatmnightmtommaintainmneckmalignment
b.mAdjustmfoodmintakemtomthreemfullmmealsmpermdaymandmnomsnacks
c.mMinimizemsymptomsmbymwearingmloose,mcomfortablemclothing
d.mAvoidmparticipationminmanymaerobicmexercisemprogramsm-
mCORRECTmANSWERmc.mMinimizemsymptomsmbymwearingmloose,mcomfortablemclothing
7.mThemnursemismprovidingmteachingmtomamclientmwithmTypem2mdiabetesmmellitusmandmperipheralmn
europathy.mWhichminformationmshouldmthemnursemprovide?
a.mFamilymmembersmcanmhelpmwithmregularmfootmexams
b.mHeatingmpadsmaremusefulmifmonmthemlowmsetting
c.mAchingmfeetmmaymbemsoakedminmlukewarmmwatermformonemhourmormmore
d.mShoesmshouldmbemwornmoutsidemthemhouse,mbutmitmismfinemtombembarefootminsidem-
mCORRECTmANSWERma.mFamilymmembersmcanmhelpmwithmregularmfootmexams
8.mAmclientminmthemoperatingmroommreceivedmsuccinylcholine.mThemclientmismexperiencingmmusclem
rigiditymandmhasmanmextremelymhighmtemperature.mWhatmactionmshouldmthemnursemimplement?
a.mHoldmamprescriptionmformdantrolenemuntilmfevermismreduced
b.mPreparemicempacksmformplacementminmthemclientsmaxillarymarea
c.mCallmthemPACUmnursemtompreparemformprolongedmventilatormsupport
d.mDeterminemifmprescribedmantibioticsmweremadministeredmpreoperativelym-
mCORRECTmANSWERmb.mPreparemicempacksmformplacementminmthemclientsmaxillarymarea
9.mThemnursemismdevelopingmamplanmofmcaremformamclientmwhomreportsmblurredmvisionmandmwhomism
newlymdiagnosedmwithmcardiovascularmdisease.mWhichmoutcomemshouldmthemnursemincludeminmth
emplanmofmcaremformthismclient?
, a.mThemnursemwillmencouragemthemclientmtomwalkmthirtymminutesmeverymday
b.mThemclientsmfamilymwillmstatemsignsmandmsymptomsmaboutmthemdisease
c.mThemclientsmdailymbloodmpressuremwillmbemlessmthanm140/80mthismmonth
d.mThemclientmbloodmpressuremreadingsmwillmbemlessmthanm160/90m-
mCORRECTmANSWERmc.mThemclientsmdailymbloodmpressuremwillmbemlessmthanm140/80mthismmonth
10.mThemfamilymsuspectsmthatmacquiredmimmunemdeficiencymsyndromem(AIDS)mdementiamismoccuri
ngminmtheirmsonmwhomismhumanmimmunodeficiencymvirusm(HIV)mpositive.mWhichmsymptomsmconfir
mmtheirmsuspicions?
a.mHemhasmbegunmtomsleepm18moutmofm24mhours
b.mAmchangemhasmrecentlymoccurredminmhismhandwriting
c.mHemrefusesmtomseemanymofmhismfriendsmormtomreturnmtheirmphonemcalls
d.mHemexhibitsmangrymoutburstmwhenmthemsubjectmofmdyingmismapproachedm-
mCORRECTmANSWERmb.mAmchangemhasmrecentlymoccurredminmhismhandwriting
11.mAmhospitalizedmclientmwithmperipheralmarterialmdiseasem(PAD)misminstructedmregardingmlegmand
mfootmcare.mWhichmstatementmbymthemclientmindicatesmtomthemnursemthatmlearningmhasmoccurred?
a.m"WhenevermImammsittingminmamchairmImwillmkeepmmymlegsmupmtomreducemswelling"
b.m"Imcanmusemammirrormtomcheckmthembottomsmofmmymfeetmformanymsignsmofmbreakdown"
c.m"Imwillmtrymtomkeepmmovingmifmlegmpainmoccursmtomhelpmpromotemgoodmcirculation"
d.m"Imwillmusemmymswimmingmpoolmearlyminmthemdaymwhilemthemwatermismstillmverymcool"m-
mCORRECTmANSWERmb.m"Imcanmusemammirrormtomcheckmthembottomsmofmmymfeetmformanymsignsmofm
breakdown"
12.mWhilemcompletingmamhealthmassessmentmformamclientmwithmmigrainemheadaches,mthemnursemas
sessesmbilateralmweaknessminmthemclient'smhandmgrips.mThemclientmreportsmjointmpainmandmtroublem