HESI Med Surg 1 Questions And
Answers
Ao43-year-
oldohomeless,omalnourishedofemaleoclientowithoaohistoryoofoalcoholismoisotransferredotooth
eoICU.oSheoisoplacedoonotelemetry,oandotheorhythmostriposhownoisoobtained.oTheonurseop
alpatesoaoheartorateoofo160obeats/min,oandotheoclient'sobloodopressureoiso90/54ommoHg.oB
asedoonotheseofindings,owhichoIVomedicationoshouldotheonurseoadminister?
oA.
Amiodaroneo(Cordarone)
oB.
Magnesiumosulfate
oC.
Lidocaineo(Xylocaine)
oD.
Procainamideo(Pronestyl)o-oCORRECTooANSWER-B.
Magnesiumosulfate
Rationale:
Becauseotheoclientohasochronicoalcoholism,osheoisolikelyotoohaveohypomagnesemia.o(B)ois
otheorecommendedodrugoforotorsadesodeopointes,owhichoisoaoformoofopolymorphicoventricu
larotachycardiao(VT)ousuallyoassociatedowithoaoprolongedoQTointervalothatooccursowithohy
pomagnesemia.o(AoandoD)oincreaseotheoQTointerval,owhichocanocauseotheotorsadesotoowo
rsen.o(C)oisotheoantiarrhythmicoofochoiceoinomostocasesoofodrug-
inducedomonomorphicoVT,onototorsades.
Ao62-year-
oldowomanowhoolivesoaloneotrippedoonoaorugoinoherohomeoandofracturedoherohip.oWhichopr
edisposingofactoromostolikelyocontributedotootheofractureoinotheoproximaloendoofoherofemur
?
A.
Failingoeyesightoresultingoinoanounsafeoenvironment
o
B.
o
Renaloosteodystrophyoresultingofromochronicokidneyodiseaseo(CKD)
o
C.
o
Osteoporosisoresultingofromodecliningohormoneolevels
o
o D.
,Cerebralovesselochangesocausingotransientoischemicoattackso-oCORRECTooANSWER-C.
Osteoporosisoresultingofromodecliningohormoneolevels
Theomostocommonocauseoofoaofracturedohipoinoolderowomenoisoosteoporosis,oresultingofro
moreducedocalciumoinotheobonesoasoaoresultoofohormonalochangesoinotheoperimenopausal
oyearso(C).o(A)omayooromayonotohaveocontributedotootheoaccident,obutoeyeochangesowereo
notoinvolvedoinopromotingotheohipofracture.o(B)oisonotoaocommonoconditionoofoolderopeople
obutoisoassociatedowithoCKD.oAlthougho(D)omayoresultoinotransientoischemicoattackso(TIAs
)oorostroke,oitowillonotoresultoinofragilityoofotheobones,oasodoesoosteoporosis.
Ao74-year-
oldomaleoclientoisoadmittedotootheointensiveocareounito(ICU)owithoaodiagnosisooforespiratory
ofailureosecondaryotoopneumonia.oCurrently,oheoisoventilator-
dependent,owithosettingsoofotidalovolumeo(VT)oofo750omLoandoanointermittentomandatoryov
entilationo(IMV)orateoofo10obreaths/min.oArterialobloodogaso(ABG)oresultsoareoasofollows:op
H,o7.48;oPaco2,o30ommoHg;oPao2,o64ommoHg;oHCO3,o25omEq/L;oandoFio2,o0.80.oWhichoi
nterventionoshouldotheonurseoimplementofirst?
A.
IncreaseotheoventilatoroVTotoo850omL.
o
B.
o
DecreaseotheoventilatoroIMVotooaorateoofo8obreaths/min.
o
C.
o
ReduceotheoFio2otoo0.70oandoredrawoABGs.
o
D.
o
Addo5ocmopositiveoend-expiratoryopressureo(PEEP).o-oCORRECTooANSWER-D.
Addo5ocmopositiveoend-expiratoryopressureo(PEEP).
Rationale:
AddingoPEEPo(D)ohelpsoimproveooxygenationowhileoreducingoFio2otooaolessotoxicolevel.o(
A,oB,oandoC)owillonotoresultoinoimprovedooxygenationoandocouldocauseofurtherocomplicatio
nsoforothisoclient,owhooisoexperiencingorespiratoryofailure.
Ao77-year-
oldofemaleoclientoisoadmittedotootheohospitalowithoconfusionoandoanorexiaoofoseveralodays'o
duration.oSheohasosymptomsoofonauseaoandovomitingoandoisocurrentlyocomplainingoofoaoh
eadache.oTheoclient'sopulseorateoiso43obeats/min.oTheonurseoisomostoconcernedoaboutothe
oclient'sohistoryorelatedotoowhichomedication?
A.
Warfarino(Coumadin)
o
o B.
, Ibuprofeno(Motrin)
o
C.
o
Nitroglycerino(Nitrostat)
o
D.
o
Digoxino(Lanoxin)o-oCORRECTooANSWER-D.
Digoxino(Lanolin)
Ratioanle:
Olderopersonsoareoparticularlyosusceptibleotootheobuildupoofocardiacoglycosides,osuchoaso
digoxino(Lanoxin)oorodigitoxino(medicationsoderivedofromodigitalis)o(D),otooaotoxicoleveloinot
heirosystems.oToxicityocanocauseoanorexia,onausea,ovomiting,odiarrhea,oheadache,oandof
atigue.o(A,oB,oandoC)oareounlikelyotooresultoinotheosymptomsodescribed.
Aocentralovenousocatheterohasobeenoinsertedoviaoaojugularovein,oandoaoradiographohasoco
nfirmedoplacementoofotheocatheter.oAoprescriptionohasobeenoreceivedoforoaomedicationoST
AT,obutoIVofluidsohaveonotoyetobeenostarted.oWhichoactionoshouldotheonurseotakeopriorotooa
dministeringotheoprescribedomedication?
A.
Assessoforosignsoofojugularovenousodistention.
o
B.
o
Obtainotheoneededointravenousosolution.
o
C.
o
Flushotheolineowithoheparinizedosolution.
o
D.
o
Flushotheolineowithonormalosaline.o-oCORRECTooANSWER-D.
Flushotheolineowithonormalosaline.
Rationale:
MedicationocanobeoadministeredoviaoaocentralolineowithoutoadditionaloIVofluids.oTheolineosh
ouldofirstobeoflushedowithoaonormalosalineosolutiono(D)otooensureopatency.oInsufficientoevid
enceoexistsoonotheoeffectivenessoofoflushingocathetersowithoheparino(C).o(A)owillonotoaffecto
theodecisionotooadministerotheomedicationoandoisonotoaopriority.oAdministrationoofotheomedi
cationoSTAToisoofogreateropriorityothano(B).
Aoclientodiagnosedowithoanginaopectorisocomplainsoofochestopainowhileoambulatingoinotheo
hallway.oWhichoactionoshouldotheonurseoimplementofirst?
A.
Supportotheoclientotooaosittingoposition.
B.
Answers
Ao43-year-
oldohomeless,omalnourishedofemaleoclientowithoaohistoryoofoalcoholismoisotransferredotooth
eoICU.oSheoisoplacedoonotelemetry,oandotheorhythmostriposhownoisoobtained.oTheonurseop
alpatesoaoheartorateoofo160obeats/min,oandotheoclient'sobloodopressureoiso90/54ommoHg.oB
asedoonotheseofindings,owhichoIVomedicationoshouldotheonurseoadminister?
oA.
Amiodaroneo(Cordarone)
oB.
Magnesiumosulfate
oC.
Lidocaineo(Xylocaine)
oD.
Procainamideo(Pronestyl)o-oCORRECTooANSWER-B.
Magnesiumosulfate
Rationale:
Becauseotheoclientohasochronicoalcoholism,osheoisolikelyotoohaveohypomagnesemia.o(B)ois
otheorecommendedodrugoforotorsadesodeopointes,owhichoisoaoformoofopolymorphicoventricu
larotachycardiao(VT)ousuallyoassociatedowithoaoprolongedoQTointervalothatooccursowithohy
pomagnesemia.o(AoandoD)oincreaseotheoQTointerval,owhichocanocauseotheotorsadesotoowo
rsen.o(C)oisotheoantiarrhythmicoofochoiceoinomostocasesoofodrug-
inducedomonomorphicoVT,onototorsades.
Ao62-year-
oldowomanowhoolivesoaloneotrippedoonoaorugoinoherohomeoandofracturedoherohip.oWhichopr
edisposingofactoromostolikelyocontributedotootheofractureoinotheoproximaloendoofoherofemur
?
A.
Failingoeyesightoresultingoinoanounsafeoenvironment
o
B.
o
Renaloosteodystrophyoresultingofromochronicokidneyodiseaseo(CKD)
o
C.
o
Osteoporosisoresultingofromodecliningohormoneolevels
o
o D.
,Cerebralovesselochangesocausingotransientoischemicoattackso-oCORRECTooANSWER-C.
Osteoporosisoresultingofromodecliningohormoneolevels
Theomostocommonocauseoofoaofracturedohipoinoolderowomenoisoosteoporosis,oresultingofro
moreducedocalciumoinotheobonesoasoaoresultoofohormonalochangesoinotheoperimenopausal
oyearso(C).o(A)omayooromayonotohaveocontributedotootheoaccident,obutoeyeochangesowereo
notoinvolvedoinopromotingotheohipofracture.o(B)oisonotoaocommonoconditionoofoolderopeople
obutoisoassociatedowithoCKD.oAlthougho(D)omayoresultoinotransientoischemicoattackso(TIAs
)oorostroke,oitowillonotoresultoinofragilityoofotheobones,oasodoesoosteoporosis.
Ao74-year-
oldomaleoclientoisoadmittedotootheointensiveocareounito(ICU)owithoaodiagnosisooforespiratory
ofailureosecondaryotoopneumonia.oCurrently,oheoisoventilator-
dependent,owithosettingsoofotidalovolumeo(VT)oofo750omLoandoanointermittentomandatoryov
entilationo(IMV)orateoofo10obreaths/min.oArterialobloodogaso(ABG)oresultsoareoasofollows:op
H,o7.48;oPaco2,o30ommoHg;oPao2,o64ommoHg;oHCO3,o25omEq/L;oandoFio2,o0.80.oWhichoi
nterventionoshouldotheonurseoimplementofirst?
A.
IncreaseotheoventilatoroVTotoo850omL.
o
B.
o
DecreaseotheoventilatoroIMVotooaorateoofo8obreaths/min.
o
C.
o
ReduceotheoFio2otoo0.70oandoredrawoABGs.
o
D.
o
Addo5ocmopositiveoend-expiratoryopressureo(PEEP).o-oCORRECTooANSWER-D.
Addo5ocmopositiveoend-expiratoryopressureo(PEEP).
Rationale:
AddingoPEEPo(D)ohelpsoimproveooxygenationowhileoreducingoFio2otooaolessotoxicolevel.o(
A,oB,oandoC)owillonotoresultoinoimprovedooxygenationoandocouldocauseofurtherocomplicatio
nsoforothisoclient,owhooisoexperiencingorespiratoryofailure.
Ao77-year-
oldofemaleoclientoisoadmittedotootheohospitalowithoconfusionoandoanorexiaoofoseveralodays'o
duration.oSheohasosymptomsoofonauseaoandovomitingoandoisocurrentlyocomplainingoofoaoh
eadache.oTheoclient'sopulseorateoiso43obeats/min.oTheonurseoisomostoconcernedoaboutothe
oclient'sohistoryorelatedotoowhichomedication?
A.
Warfarino(Coumadin)
o
o B.
, Ibuprofeno(Motrin)
o
C.
o
Nitroglycerino(Nitrostat)
o
D.
o
Digoxino(Lanoxin)o-oCORRECTooANSWER-D.
Digoxino(Lanolin)
Ratioanle:
Olderopersonsoareoparticularlyosusceptibleotootheobuildupoofocardiacoglycosides,osuchoaso
digoxino(Lanoxin)oorodigitoxino(medicationsoderivedofromodigitalis)o(D),otooaotoxicoleveloinot
heirosystems.oToxicityocanocauseoanorexia,onausea,ovomiting,odiarrhea,oheadache,oandof
atigue.o(A,oB,oandoC)oareounlikelyotooresultoinotheosymptomsodescribed.
Aocentralovenousocatheterohasobeenoinsertedoviaoaojugularovein,oandoaoradiographohasoco
nfirmedoplacementoofotheocatheter.oAoprescriptionohasobeenoreceivedoforoaomedicationoST
AT,obutoIVofluidsohaveonotoyetobeenostarted.oWhichoactionoshouldotheonurseotakeopriorotooa
dministeringotheoprescribedomedication?
A.
Assessoforosignsoofojugularovenousodistention.
o
B.
o
Obtainotheoneededointravenousosolution.
o
C.
o
Flushotheolineowithoheparinizedosolution.
o
D.
o
Flushotheolineowithonormalosaline.o-oCORRECTooANSWER-D.
Flushotheolineowithonormalosaline.
Rationale:
MedicationocanobeoadministeredoviaoaocentralolineowithoutoadditionaloIVofluids.oTheolineosh
ouldofirstobeoflushedowithoaonormalosalineosolutiono(D)otooensureopatency.oInsufficientoevid
enceoexistsoonotheoeffectivenessoofoflushingocathetersowithoheparino(C).o(A)owillonotoaffecto
theodecisionotooadministerotheomedicationoandoisonotoaopriority.oAdministrationoofotheomedi
cationoSTAToisoofogreateropriorityothano(B).
Aoclientodiagnosedowithoanginaopectorisocomplainsoofochestopainowhileoambulatingoinotheo
hallway.oWhichoactionoshouldotheonurseoimplementofirst?
A.
Supportotheoclientotooaosittingoposition.
B.
