HESI Med-Surg RN Custom Exam 2023 (Med Surg II Class)

TEST 1 Answer Section MULTIPLE CHOICE 1. ANS: C Signs of chronic arterial insufficiency include decreased hair growth in the legs and feet, absent or decreased pedal pulses, infection in the foot, poor wound healing, thickened nails, and a shiny appearance of the skin (C). Femoral pulses (A) should still be palpable in the diabetic with chronic arterial insufficiency. A positive Homan's sign is an indicator of deep vein thrombosis (B). (D) would probably not be affected significantly by chronic arterial insufficiency. 2. ANS: C 4 lbs / 2.2 = 1.8 kg. 1.8 x 15 = 27 mg (C). NOTE, the fact that the drug is diluted in 25 ml of D5W, is not relevant to the calculation requested. 3. ANS: C The client is exhibiting symptoms of magnesium sulfate toxicity--decreased reflexes (normal is +2), a low normal respiratory rate (normal is 12 to 20 breaths/min), a less than average urinary output (30 ml/hour is average), and a low magnesium sulfate level (normal is 4 to 8mg/dl). Based on these findings, the nurse should stop the infusion (C). (A) is contraindicated. (B) would not fully alleviate the magnesium sulfate toxicity symptoms. (D) (the antagonist for magnesium sulfate) would be indicated if the respiratory rate were less than 12 breaths/minute. 4. ANS: A This medication causes paralysis (A) following intravenous injection. Peak effects persist for 35 to 60 minutes. (B and C) would not be possible if the medication is effective. The Glasgow coma scale is used to evaluate the neurological status of the client and does not evaluate the effectiveness (D) of this medication. 5. ANS: B Frequent and/or large doses of acetaminophen can cause an increase in liver enzymes, indicating possible liver damage (B). If the client reported unusual bleeding, or an increase in aspirin usage, it would be important for the nurse to assess for increased bleeding and monitor (A and/or C). (D) is not affected by increases in acetaminophen doses. 6. ANS: C Ringing in the ears (tinnitus) (C) is an important sign of aspirin overdosage and should be reported immediately. Though a tepid sponge bath may lowe r the child's temperature, the prescription for aspirin should not be held (A). Aspirin should be taken with at least eight ounces of wate r to completely was h the tablet into the stomach and to help prevent GI discomfort (B). Yellow halos are associated with Digoxin toxicity, not aspirin (D). 7. ANS: D The classic picture of Cushing's syndrome in the adult is central-type obesity with thin extremities (D), along with a "buffalo hump" in the supraclavicular area, heavy trunk, and thin fragile skin. The symptoms described in (A) are clinical manifestations of hypothyroidism, and in (B) of hyperthyroidism. (C) may indicate a goiter or a tumor of the thyroid gland. 8. ANS: D A pulse oximeter reading of 90% indicates an arterial blood gas of less than 80 to 100 and should be assessed immediately (D). (A) is an expected finding. (B) is not an unusual finding. (C) is an expected finding for this client. 9. ANS: A Client behaviors indicating that the expected outcome of, "decreased venous congestion" has been met would include elevating the legs, increasing walking time, and an observable decrease in edema of the lower extremities (A). (B and C) would be appropriate for outcomes for, "Attains or maintains tissue integrity." (D) would be an appropriate outcome for, "Demonstrates an increase in arterial blood supply to extremities." 10. ANS: D Life-threatening complications such as hypovolemia and sepsis can occur following a paracentesis, and measurement of vital signs (D) will provide assessment data that will help detect the occurrence of such complications. (A) might be assessed to check for circulation in the lowe r extremities, but are not indicated for postparacentesis assessment. Reduction of (B) may occur as the result of decreased fluid in the peritoneal cavity, but is a desired outcome, not a complication, of this procedure. (C) is not affected by a paracentesis procedure.