HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Ulcerative Colitis - ANSWER Ulcerative colitis is a chronic ulcerative and inflammatory disease of the
mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods
of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea. The
inflammatory changes typically begin in the rectum and progress proximally through the colon
Crohn's Disease - ANSWER Crohn's disease is characterized by periods of remission and exacerbation. It
is a subacute and chronic inflammation of the GI tract wall that extends through all layers (i.e.,
transmural lesion). Although its characteristic histopathologic changes can occur anywhere in the GI
tract, it most commonly occurs in the distal ileum and the ascending colon. The onset of symptoms is
usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea
unrelieved by defecation
Crohn's Disease Diet - ANSWER Oral fluids and a low-residue, high-protein, high-calorie diet with
supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, reduce
inflammation, and control pain and diarrhea. Fluid and electrolyte imbalances from dehydration caused
by diarrhea are corrected by IV therapy as necessary if the patient is hospitalized or by oral fluids if the
patient is managed at home. Any foods that exacerbate diarrhea are avoided. Milk may contribute to
diarrhea in those with lactose intolerance. Cold foods and smoking are avoided because both increase
intestinal motility. Parenteral nutrition may be indicated.
Ulcerative Colitis-Goal - ANSWER The major goals for the patient include attainment of normal bowel
elimination patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit,
maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of
effective coping, absence of skin breakdown, increased knowledge about the disease process and self-
health management, and avoidance of complications.
Bariatric Surgery Post Op - ANSWER After surgery, the nurse assesses the patient for complications from
the bariatric surgery, such as hemorrhage, venous thromboembolism, bile reflux, dumping syndrome,
dysphagia, and bowel or gastric outlet obstruction.
Eat smaller but more frequent meals that contain protein and fiber; each meal size should not exceed 1
cup.
,HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).
Eat slowly and chew thoroughly
Assume a low Fowler position during mealtime and then remain in that position for 20-30 minutes after
mealtime—this delays stomach emptying and decreases the likelihood of dumping syndrome.
Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal and 30-60
minutes after mealtime.
Cholelithiasis- Jaundice - ANSWER Jaundice occurs in a few patients with gallbladder disease, usually
with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is
absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently
accompanied by marked pruritus (itching) of the skin.
Gallbladder Risk Factors - ANSWER The risk of developing such stones is increased in patients with
cirrhosis, hemolysis, and infections of the biliary tract.
Cholesterol stones account for most of the remaining 75% of cases of gallbladder disease in the United
States
Two to three times more women than men develop cholesterol stones and gallbladder disease
Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate
(Atromid-S); these medications are known to increase biliary cholesterol saturation. The incidence of
stone formation increases with age as a result of increased hepatic secretion of cholesterol and
decreased bile acid synthesis.
Peptic Ulcer Disease Complication - ANSWER Although vomiting is rare in an uncomplicated peptic ulcer,
it may be a symptom of a complication of an ulcer. It results from gastric outlet obstruction, caused by
either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the
inflamed mucous membrane adjacent to the ulcer.
Seizure Precautions - ANSWER Seizure precautions are maintained, including having available
functioning suction equipment with a suction catheter and oral airway. The bed is placed in a low
position with two to three side rails up and padded, if necessary, to prevent injury to the patient. The
patient may be drowsy and may wish to sleep after the seizure; they may not remember events leading
up to the seizure and for a short time thereafter.
, HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Rheumatoid Arthritis S/S - ANSWER The initial clinical manifestations of RA include symmetric joint pain
and morning joint stiffness lasting longer than 1 hour. Over the course of the disease, clinical
manifestations of RA vary, usually reflecting the stage and severity of the disease. Symmetric joint pain,
swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of the joints reveals
spongy or boggy tissue. Often, fluid can be aspirated from the inflamed joint. Characteristically, the
pattern of joint involvement begins in the small joints of the hands, wrists, and feet. In the early stages
of disease, even before the presentation of bony changes, limitation in function can occur when there is
active inflammation in the joints. Joints that are hot, swollen, and painful are not easily moved.
SLE Exacerbation - ANSWER The lesions often worsen during exacerbations (flares) of the systemic
disease and possibly are provoked by sunlight or artificial ultraviolet light. Oral ulcers, which may
accompany skin lesions, may involve the buccal mucosa or the hard palate, occur in crops, and are often
associated with exacerbations. Other cutaneous manifestations include splinter hemorrhages, alopecia,
and Raynaud's phenomenon
Pre-Op Lab - ANSWER Routine laboratory tests used to detect infection include the white blood count
(WBC) and the urinalysis. Surgery may be postponed in the presence of infection.
Ambulation Post-Op - ANSWER The patient should be taught that early and frequent ambulation
postoperatively, as tolerated, will help prevent complications.
Malignant Hyperthermia - ANSWER Malignant hyperthermia is a rare inherited muscle disorder that is
chemically induced by anesthetic agents
The initial symptoms of malignant hyperthermia are often cardiovascular, respiratory, and abnormal
musculoskeletal activity.
Tachycardia (heart rate greater than 150 bpm) may be an early sign.
Sympathetic nervous stimulation also leads to ventricular dysrhythmia, hypotension, decreased cardiac
output, oliguria, and, later, cardiac arrest.
Hypercapnia, an increase in carbon dioxide (CO2), may be an early respiratory sign.
With the abnormal transport of calcium, rigidity or tetanus-like movements occur, often in the jaw.
Generalized muscle rigidity is one of the earliest signs.
The rise in temperature is actually a late sign that develops rapidly; body temperature can increase 1°C
to 2°C (2°F to 4°F) every 5 minutes, and core body temperature can exceed 42°C (107°F)
Final with 93 complete solutions.
HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Ulcerative Colitis - ANSWER Ulcerative colitis is a chronic ulcerative and inflammatory disease of the
mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods
of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea. The
inflammatory changes typically begin in the rectum and progress proximally through the colon
Crohn's Disease - ANSWER Crohn's disease is characterized by periods of remission and exacerbation. It
is a subacute and chronic inflammation of the GI tract wall that extends through all layers (i.e.,
transmural lesion). Although its characteristic histopathologic changes can occur anywhere in the GI
tract, it most commonly occurs in the distal ileum and the ascending colon. The onset of symptoms is
usually insidious in Crohn's disease, with prominent right lower quadrant abdominal pain and diarrhea
unrelieved by defecation
Crohn's Disease Diet - ANSWER Oral fluids and a low-residue, high-protein, high-calorie diet with
supplemental vitamin therapy and iron replacement are prescribed to meet nutritional needs, reduce
inflammation, and control pain and diarrhea. Fluid and electrolyte imbalances from dehydration caused
by diarrhea are corrected by IV therapy as necessary if the patient is hospitalized or by oral fluids if the
patient is managed at home. Any foods that exacerbate diarrhea are avoided. Milk may contribute to
diarrhea in those with lactose intolerance. Cold foods and smoking are avoided because both increase
intestinal motility. Parenteral nutrition may be indicated.
Ulcerative Colitis-Goal - ANSWER The major goals for the patient include attainment of normal bowel
elimination patterns, relief of abdominal pain and cramping, prevention of fluid volume deficit,
maintenance of optimal nutrition and weight, avoidance of fatigue, reduction of anxiety, promotion of
effective coping, absence of skin breakdown, increased knowledge about the disease process and self-
health management, and avoidance of complications.
Bariatric Surgery Post Op - ANSWER After surgery, the nurse assesses the patient for complications from
the bariatric surgery, such as hemorrhage, venous thromboembolism, bile reflux, dumping syndrome,
dysphagia, and bowel or gastric outlet obstruction.
Eat smaller but more frequent meals that contain protein and fiber; each meal size should not exceed 1
cup.
,HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Eat only foods high in nutrients (e.g., peanut butter, cheese, chicken, fish, beans).
Eat slowly and chew thoroughly
Assume a low Fowler position during mealtime and then remain in that position for 20-30 minutes after
mealtime—this delays stomach emptying and decreases the likelihood of dumping syndrome.
Do not drink fluid with meals; instead, consume fluids up to 30 minutes before a meal and 30-60
minutes after mealtime.
Cholelithiasis- Jaundice - ANSWER Jaundice occurs in a few patients with gallbladder disease, usually
with obstruction of the common bile duct. The bile, which is no longer carried to the duodenum, is
absorbed by the blood and gives the skin and mucous membranes a yellow color. This is frequently
accompanied by marked pruritus (itching) of the skin.
Gallbladder Risk Factors - ANSWER The risk of developing such stones is increased in patients with
cirrhosis, hemolysis, and infections of the biliary tract.
Cholesterol stones account for most of the remaining 75% of cases of gallbladder disease in the United
States
Two to three times more women than men develop cholesterol stones and gallbladder disease
Stone formation is more frequent in people who use oral contraceptives, estrogens, or clofibrate
(Atromid-S); these medications are known to increase biliary cholesterol saturation. The incidence of
stone formation increases with age as a result of increased hepatic secretion of cholesterol and
decreased bile acid synthesis.
Peptic Ulcer Disease Complication - ANSWER Although vomiting is rare in an uncomplicated peptic ulcer,
it may be a symptom of a complication of an ulcer. It results from gastric outlet obstruction, caused by
either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the
inflamed mucous membrane adjacent to the ulcer.
Seizure Precautions - ANSWER Seizure precautions are maintained, including having available
functioning suction equipment with a suction catheter and oral airway. The bed is placed in a low
position with two to three side rails up and padded, if necessary, to prevent injury to the patient. The
patient may be drowsy and may wish to sleep after the seizure; they may not remember events leading
up to the seizure and for a short time thereafter.
, HESI NSG 123: Medical Surgical Nursing
Final with 93 complete solutions.
Rheumatoid Arthritis S/S - ANSWER The initial clinical manifestations of RA include symmetric joint pain
and morning joint stiffness lasting longer than 1 hour. Over the course of the disease, clinical
manifestations of RA vary, usually reflecting the stage and severity of the disease. Symmetric joint pain,
swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of the joints reveals
spongy or boggy tissue. Often, fluid can be aspirated from the inflamed joint. Characteristically, the
pattern of joint involvement begins in the small joints of the hands, wrists, and feet. In the early stages
of disease, even before the presentation of bony changes, limitation in function can occur when there is
active inflammation in the joints. Joints that are hot, swollen, and painful are not easily moved.
SLE Exacerbation - ANSWER The lesions often worsen during exacerbations (flares) of the systemic
disease and possibly are provoked by sunlight or artificial ultraviolet light. Oral ulcers, which may
accompany skin lesions, may involve the buccal mucosa or the hard palate, occur in crops, and are often
associated with exacerbations. Other cutaneous manifestations include splinter hemorrhages, alopecia,
and Raynaud's phenomenon
Pre-Op Lab - ANSWER Routine laboratory tests used to detect infection include the white blood count
(WBC) and the urinalysis. Surgery may be postponed in the presence of infection.
Ambulation Post-Op - ANSWER The patient should be taught that early and frequent ambulation
postoperatively, as tolerated, will help prevent complications.
Malignant Hyperthermia - ANSWER Malignant hyperthermia is a rare inherited muscle disorder that is
chemically induced by anesthetic agents
The initial symptoms of malignant hyperthermia are often cardiovascular, respiratory, and abnormal
musculoskeletal activity.
Tachycardia (heart rate greater than 150 bpm) may be an early sign.
Sympathetic nervous stimulation also leads to ventricular dysrhythmia, hypotension, decreased cardiac
output, oliguria, and, later, cardiac arrest.
Hypercapnia, an increase in carbon dioxide (CO2), may be an early respiratory sign.
With the abnormal transport of calcium, rigidity or tetanus-like movements occur, often in the jaw.
Generalized muscle rigidity is one of the earliest signs.
The rise in temperature is actually a late sign that develops rapidly; body temperature can increase 1°C
to 2°C (2°F to 4°F) every 5 minutes, and core body temperature can exceed 42°C (107°F)
