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Exam (elaborations)

BSN HESI 266 MED SURG EXAM / BSN 266 HESI MED SURG LATEST ACTUAL EXAM

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BSN HESI 266 MED SURG EXAM / BSN 266 HESI MED SURG LATEST ACTUAL EXAM

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Written in
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BSN HESI 266 MED SURG EXAM / BSN 266 HESI MED SURG
LATEST ACTUAL EXAM
Client is recovering from a transurethral prostatectomy. Which activity should be
limited until after the first postoperative visit with the healthcare provider? -
ANSWER: Drink 3L

A client with stage IV bone cancer is admitted to the hospital for a 1-10 scale. Which
intervention should the nurse implement? - ANSWER: Administer opioid and non-
opioid medications simultaneously

A client experiences an AOB incompatibility reaction after multiple blood
transfusions. Which finding should the nurse report immediately to the health care
provider?

a. low back pain and hypotension

b. rhinitis and nasal stuffiness

c. delayed painful rash with urticarial

d. arthritic joint changes and chronic pain - ANSWER: a. low back pain and
hypotension

ANSWER: (A) LOW BACK PAIN AND HYPOTENSTION

When conducting discharge teaching for a client
diagnosed with diverticulosis, which diet instruction should the nurse include?

a. Have small frequent meals and sit up for at least two hours after meals.

b. Eat a bland diet and avoid spicy foods.

c. Eat a high fiber diet and increase fluid intake.

d. Eat a soft diet with increased intake of milk and milk products - ANSWER: c. Eat a
high fiber diet and increase fluid intake.

ANSWER (C) EAT A HIGH-FIBER DIET AND INCREASE FLUID INTAKE

The nurse observes an increased number of blood clots in the drainage tubing of a
client with continuous bladder irrigation following a transurethral resection of the
prostate (TURP). What is the best initial nursing action?

a. Provide additional oral fluid intake

,b. Measure the client's intake and output.

c. Increase the flow of the bladder
irrigation

d. Administer a PRN dose of an antispasmodic agent - ANSWER: c. Increase the flow
of the bladder
irrigation


ANSWER (C) Increase the flow of the bladder irrigation

A client wit lung cancer who wears a subcutaneous morphine sulfate patch for pain
is short of breath and difficult to arouse. When performing a head
-to-toe assessment, the nurse discovers four analgesic patches on - ANSWER:
Remove all morphine patches

Coming down the basement steps, a client is brought to the emergency room X-
ray ... cast, which assessment finding warrants immediate
Intervention by the nurse? - ANSWER: Right foot pale with sluggish capillary refill

An overweight, young adult who was
recently Check finger stick glucose diagnosed with type 2 diabetes mellitus is
admitted for a hernia repair. He tells the nurse that he is feeling very weak and
jittery.

Which actions should the nurse implement?
(Select all that apply.)

a. Check finger stick
glucose

b. Assess skin temperature
and moisture

c. Measure pulse and blood
pressure - ANSWER: a. Check finger stick
glucose

b. Assess skin temperature
and moisture

c. Measure pulse and blood
pressure

ANSWER: (CAM)

, A client who underwent cardiac stent placement four days ago arrives to the
emergency department reporting a sudden onset of chest pressure and
shortness of breath. Which action should the nurse take next?

a. Listen for extra heart sounds, murmurs, and r
hythm with the bell of
the stethoscope.

b. Evaluate upper and lower extremities for perfusion, pulse volume,
and pitting edema.

c. Verify troponin level assessments are scheduled every 3-6 hours for a series of
three.

d. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
. - ANSWER: d. Obtain a 12-lead electrocardiogram and begin continuous cardiac
monitoring

While completing a health assessment for a client with migraine headaches, the
nurse assesses bilateral weakness in the clients hand grips. The client reports joint
pain and trouble twisting a door knob due to weaknesses. Which action should the
nurses take in response to these figures?

a. Implement fall precautions to reduce the clients risk of injury.

b. Explain that relief of the migraine pain will reduce related symptoms.

c. Gather additional assessment data about the pain and weakness.

d. Consult with the occupational therapist for a functional assessment - ANSWER: c.
Gather additional assessment data about the pain and weakness.

The nurse is caring for a client diagnosed with psoriasis vulgaris who is receiving
psoralen and ultraviolet A light (PUVA) treatment.
Which assessment finding indicates that the client has been overexposed to the
treatment?

a. Thick skin plaques topped by silvery white scales

b. Tenderness upon palpation and generalized erythema

c. Brown, rough, greasy, wart-like papules on the face

d. Requires sunglasses because sunlight hurts eyes - ANSWER: b. Tenderness upon
palpation and generalized erythema
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