Med Surg HESI Exit Exam .

Science Medicine Nursing Med Surg HESI Exit Exam . 1. While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth on the client's legs. What additional assessment provides further data to support this finding? a. Palpate for the presence of femoral pulses bilaterally. b. Assess for the presence of a positive Homan's sign. c. Observe the appearance of the skin on the client's legs. d. Watch the client's posture and balance during ambulation - Answer-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. The healthcare provider prescribes 15 mg/kg of Streptomycin for an infant weighing 4 pounds. The drug is diluted in 25 ml of D5W to run over 8 hours. How much Streptomycin will the infant receive? a. 9 mg. b. 18 mg. c. 27 mg. d. 36 mg - Answer-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 In assessing a client with preeclampsia who is receiving magnesium sulfate, the nurse determines that her deep tendon reflexes are 1+; respiratory rate is 12 breaths/minute; urinary output is 90 ml in 4 hours; magnesium sulfate level is 9 mg/dl. Based on these findings, what intervention should the nurse implement? a. Continue the magnesium sulfate infusion as prescribed. b. Decrease the magnesium sulfate infusion by one-half. c. Stop the magnesium sulfate infusion immediately. d. Administer calcium gluconate immediately. - Answer-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. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective? a. The client's expremities are paralyzed. b. The peripheral nerve stimulator causes twitching. c. The client clinches fist upon command. d. The client's Glagow Coma Scale score is 14 - Answer-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. An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report? a. Look at last quarter's hemoglobin and hematocrit, expecting an increase today due to dehydration.