MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
A nurse is reinforcing teaching with a
client who has HIV and is being dis-
charged to home. Which of the following
instructions should the nurse include in
the teaching?
A. Take temperature once a day. A.
B. Wash the armpits and genitals with a
gentle cleanser daily.
C. Change the litter boxes while wearing
gloves.
D. Wash dishes in warm water.
A nurse is caring for a client who is post-
operative following a tracheostomy, and
has copious and tenacious secretions.
Which of the following is an acceptable
method for the nurse to use to thin this
client's secretions?
A. Provide humidified oxygen.
A.
B. Perform chest physiotherapy prior to
suctioning.
C. Prelubricate the suction catheter tip
with sterile saline when suctioning the
airway.
D. Hyperventilate the client with 100%
oxygen before suctioning the airway..
Following admission, a client with a vas-
cular occlusion of the right lower extrem-
ity calls the nurse and reports difficulty
sleeping because of cold feet. Which of
the following nursing actions should the
nurse take to promote the client's com-
B.
fort?
A. Rub the client's feet briskly for several
minutes.
B. Obtain a pair of slipper socks for the
client.
C. Increase the client's oral fluid intake.
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
D. Place a moist heating pad under the
client's feet.
A nurse is caring for a client is who is 4
hr postoperative following a transurethral
resection of the prostate (TURP). Which
of the following is the priority finding for
the nurse report to the provider? C.
A. Emesis of 100 mL
B. Oral temperature of 37.5° C (99.5° F)
C. Thick, red-colored urine
D. Pain level of 4 on a 0 to 10 rating scale
A nurse is caring for a client who has
a temperature of 39.7° C (103.5° F)
and has a prescription for a hypothermia
blanket. The nurse should monitor the
client for which of the following adverse
A.
effects of the hypothermia blanket?
A. Shivering
B. Infection
C. Burns
D. Hypervolemia
A nurse is reinforcing teaching about ex-
ercise with a client who has type 1 di-
abetes mellitus. Which of the following
statements by the client indicates an un-
derstanding of the teaching?
A. "I will carry a complex carbohydrate
snack with me when I exercise." D.
B. "I should exercise first thing in the
morning before eating breakfast."
C. "I should avoid injecting insulin into my
thigh if I am going to go running."
D. "I will not exercise if my urine is posi-
tive for ketones."
A nurse notes a small section of bowel
protruding from the abdominal incision of
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
a client who
is postoperative. After calling for assis-
tance, which of the following actions
should the nurse take first?
A. Cover the client's wound with a moist,
sterile dressing. A.
B. Have the client lie supine with knees
flexed.
C. Check the client's vital signs.
D. Inform the client about the need to
return to surgery.
A nurse is collecting data from a client
who has alcohol use disorder and is ex-
periencing metabolic acidosis. Which of
the following manifestations should the
nurse expect? B.
A. Cool, clammy skin.
B. Hyperventilation
C. Increased blood pressure
D. Bradycardia
A nurse is reinforcing discharge teaching
with a client following a cataract extrac-
tion. Which of the following should the
nurse include in the teaching?
A. Avoid bending at the waist.
A.
B. Remove the eye shield at bedtime.
C. Limit the use of laxatives if constipat-
ed.
D. Seeing flashes of light is an expected
finding following extraction.
A nurse is caring for a client who has
heart failure and has been taking digoxin
0.25 mg daily. The client refuses break-
fast and reports nausea. Which of the C
following actions should the nurse take
first?
1) Suggest that the client rests before
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
eating the meal.
2) Request a dietary consult.
3) Check the client's vital signs.
4) Request an order for an antiemetic.
A nurse is caring for a client who is 3
days postoperative following a cholecys-
tectomy. The nurse suspects the client's
wound is infected because the drainage
from the dressing is yellow and thick.
Which of the following findings should
D.
the nurse report as the type of drainage
found?
1) Sanguineous
2) Serous
3) Serosanguineous
4) Purulent
A nurse is reinforcing discharge teaching
to a client following arthroscopic surgery.
To prevent postoperative complications
which of the following actions should be
reinforced during the teaching?
1) Administer an opioid analgesic to the
client 30 min prior to initiating CPM exer-
cises.
A.
2) Place the client's affected leg into the
CPM machine with the machine in the
flexed position.
3) Place the client into a high Fowler's
position when initiating the CPM exercis-
es.
4) Align the joints of the CPM machine
with the knee gatch in the client's bed.
A nurse is collecting data from a client
who has emphysema. Which of the fol-
lowing findings should the nurse expect? A, B, C, D
(Select all that apply.)
1) Dyspnea
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
A nurse is reinforcing teaching with a
client who has HIV and is being dis-
charged to home. Which of the following
instructions should the nurse include in
the teaching?
A. Take temperature once a day. A.
B. Wash the armpits and genitals with a
gentle cleanser daily.
C. Change the litter boxes while wearing
gloves.
D. Wash dishes in warm water.
A nurse is caring for a client who is post-
operative following a tracheostomy, and
has copious and tenacious secretions.
Which of the following is an acceptable
method for the nurse to use to thin this
client's secretions?
A. Provide humidified oxygen.
A.
B. Perform chest physiotherapy prior to
suctioning.
C. Prelubricate the suction catheter tip
with sterile saline when suctioning the
airway.
D. Hyperventilate the client with 100%
oxygen before suctioning the airway..
Following admission, a client with a vas-
cular occlusion of the right lower extrem-
ity calls the nurse and reports difficulty
sleeping because of cold feet. Which of
the following nursing actions should the
nurse take to promote the client's com-
B.
fort?
A. Rub the client's feet briskly for several
minutes.
B. Obtain a pair of slipper socks for the
client.
C. Increase the client's oral fluid intake.
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
D. Place a moist heating pad under the
client's feet.
A nurse is caring for a client is who is 4
hr postoperative following a transurethral
resection of the prostate (TURP). Which
of the following is the priority finding for
the nurse report to the provider? C.
A. Emesis of 100 mL
B. Oral temperature of 37.5° C (99.5° F)
C. Thick, red-colored urine
D. Pain level of 4 on a 0 to 10 rating scale
A nurse is caring for a client who has
a temperature of 39.7° C (103.5° F)
and has a prescription for a hypothermia
blanket. The nurse should monitor the
client for which of the following adverse
A.
effects of the hypothermia blanket?
A. Shivering
B. Infection
C. Burns
D. Hypervolemia
A nurse is reinforcing teaching about ex-
ercise with a client who has type 1 di-
abetes mellitus. Which of the following
statements by the client indicates an un-
derstanding of the teaching?
A. "I will carry a complex carbohydrate
snack with me when I exercise." D.
B. "I should exercise first thing in the
morning before eating breakfast."
C. "I should avoid injecting insulin into my
thigh if I am going to go running."
D. "I will not exercise if my urine is posi-
tive for ketones."
A nurse notes a small section of bowel
protruding from the abdominal incision of
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
a client who
is postoperative. After calling for assis-
tance, which of the following actions
should the nurse take first?
A. Cover the client's wound with a moist,
sterile dressing. A.
B. Have the client lie supine with knees
flexed.
C. Check the client's vital signs.
D. Inform the client about the need to
return to surgery.
A nurse is collecting data from a client
who has alcohol use disorder and is ex-
periencing metabolic acidosis. Which of
the following manifestations should the
nurse expect? B.
A. Cool, clammy skin.
B. Hyperventilation
C. Increased blood pressure
D. Bradycardia
A nurse is reinforcing discharge teaching
with a client following a cataract extrac-
tion. Which of the following should the
nurse include in the teaching?
A. Avoid bending at the waist.
A.
B. Remove the eye shield at bedtime.
C. Limit the use of laxatives if constipat-
ed.
D. Seeing flashes of light is an expected
finding following extraction.
A nurse is caring for a client who has
heart failure and has been taking digoxin
0.25 mg daily. The client refuses break-
fast and reports nausea. Which of the C
following actions should the nurse take
first?
1) Suggest that the client rests before
, MED-SURG II HESI TEST BANK 2024-2025 ACTUAL EXAM 150 QUESTIO
AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED A
SWERS) |AGRADE
Study online at https://quizlet.com/_g6v8mi
eating the meal.
2) Request a dietary consult.
3) Check the client's vital signs.
4) Request an order for an antiemetic.
A nurse is caring for a client who is 3
days postoperative following a cholecys-
tectomy. The nurse suspects the client's
wound is infected because the drainage
from the dressing is yellow and thick.
Which of the following findings should
D.
the nurse report as the type of drainage
found?
1) Sanguineous
2) Serous
3) Serosanguineous
4) Purulent
A nurse is reinforcing discharge teaching
to a client following arthroscopic surgery.
To prevent postoperative complications
which of the following actions should be
reinforced during the teaching?
1) Administer an opioid analgesic to the
client 30 min prior to initiating CPM exer-
cises.
A.
2) Place the client's affected leg into the
CPM machine with the machine in the
flexed position.
3) Place the client into a high Fowler's
position when initiating the CPM exercis-
es.
4) Align the joints of the CPM machine
with the knee gatch in the client's bed.
A nurse is collecting data from a client
who has emphysema. Which of the fol-
lowing findings should the nurse expect? A, B, C, D
(Select all that apply.)
1) Dyspnea
