HESI MED SURG EXAM| 2VERSIONS NEWEST
QUESTIONS AND ANSWERS LATEST UPDATE ACTUAL
EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS
(VERIFIED) RATED A+| PDF
1. The arterial blood gas (ABG) readings that indicate compensated respiratory
acidosis are a PaCO2 of
A. 30 mm Hg and bicarbonate level of 24 mEq/L.
B. 30 mm Hg and bicarbonate level of 30 mEq/L.
C. 50 mm Hg and bicarbonate level of 20 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L. If compensation is present,
carbon dioxide and bicarbonate are abnormal (or nearly so) in opposite directions
(e.g., one is acidotic and the other alkalotic).
2. A patient admitted to the emergency department with tension
pneumothorax and mediastinal shift following an automobile crash is most
likely to exhibit A. bradycardia.
B. severe hypotension.
C. mediastinal flutter.
D. a sucking chest wound.
B. severe hypotension. Mediastinal shift may cause compression of the lung in the
direction of the shift and compression, traction, torsion, or kinking of the great
vessels. Blood return to the heart is dangerously impaired and causes a
subsequent decrease in cardiac output and blood pressure. Tachycardia is a
clinical manifestation of tension pneumothorax. An uncovered opened
pneumothorax is associated with a sucking chest wound and mediastinal flutter.
3. In preparing the preoperative teaching plan for a patient who is to undergo a
total laryngectomy, a nurse should give highest priority to the
A. tracheostomy being in place for 2 to 3 days.
B. patient's not being able to speak normally again.
,C. insertion of a gastrostomy feeding tube during surgery.
D. patient's not being able to perform deep-breathing exercises.
B. patient's not being able to speak normally again. Patients who have a total
laryngectomy have a permanent tracheostomy and will need to learn how to
speak using alternative methods, such as an artificial larynx. The tracheostomy
will be permanent to allow normal breathing patterns and air exchange. After
surgery, the patient's nutrition is supplemented with enteral feedings, and when
the patient can swallow secretions, oral feedings can begin. Deep-breathing
exercises should be performed with the patient at least every 2 hours to prevent
further pulmonary complications.
4. After a posterior nasal pack is inserted by a physician, the patient is very
anxious and states, "I don't feel like I'm breathing right." The immediate
intervention the nurse should initiate is to
A. monitor ABGs.
B. reassure the patient that this is normal discomfort.
C. cut the pack strings and pull the packing out with a hemostat.
D. direct a flashlight into the patient's mouth and inspect the oral cavity.
D. direct a flashlight into the patient's mouth and inspect the oral cavity. The
nurse should inspect the oral cavity for the presence of blood, soft palate
necrosis, and proper placement of the posterior plug. If the posterior plug is
visible, the physician should be notified for readjustment of the packing.
Reassurance, cutting the strings, and ABGs are not top priority interventions. The
nurse needs further data before intervening.
5. A nurse is performing assessment for a patient diagnosed with chronic
obstructive pulmonary disease (COPD). Which of the following findings should
the nurse expect to observe?
A. Nonproductive cough
B. Prolonged inspiration
C. Vesicular breath sounds
D. Increased anterior-posterior chest diameter
D. Increased anterior-posterior chest diameter An increased anterior-posterior
diameter is a compensatory mechanism experienced by patients with COPD and is
caused by air-trapping. Patients with COPD have a productive cough, often
,expectorating copious amounts of sputum. Because of air-trapping, patients with
COPD experience a prolonged expiration because the rate of gas on exhalation
takes longer to escape. Chest auscultation for patients with COPD often reveals
wheezing, crackles, and other adventitious breath sounds.
6. A nurse is working on a respiratory care unit where many of the patients are
affected by asthma. Which of the following actions by the nurse would most
likely increase respiratory difficulty for the patients?
A. Wearing perfume to work
B. Encouraging patients to ambulate daily C. Allowing the patients to eat green
leafy vegetables
D. Withholding antibiotic therapy until cultures are obtained
A. Wearing perfume to work People with asthma should avoid extrinsic allergens
and irritants (e.g., dust, pollen, smoke, certain foods, colognes and perfumes,
certain types of medications) because their airways become inflamed, producing
shortness of breath, chest tightness, and wheezing. Many green leafy vegetables
are rich in vitamins, minerals, and proteins, which incorporate healthy lifestyle
patterns into the patients' daily living routines. Routine exercise is a part of a
prudent lifestyle, and for patients with asthma the physical and psychosocial
effects of ambulation can incorporate feelings of well-being, strength, and
enhancement of physical endurance. Antibiotic therapy is always initiated after
cultures are obtained so that the sensitivity to the organism can be readily
identified.
7. The most appropriate position to assist a patient with chronic obstructive
pulmonary disease (COPD) who is having difficulty breathing would be a
A. high Fowler's position without a pillow behind the head.
B. semi-Fowler's position with a single pillow behind the head.
C. right side-lying position with the head of the bed at 45 degrees' elevation.
D. sitting upright and forward position with arms supported on an over-the-bed
table.
D. sitting upright and forward position with arms supported on an over-the-bed
table.Sitting upright and leaning forward with arms supported on an over-the-bed
table would be of most help to this patient, because it allows for expansion of the
thoracic cage in all four directions (front, back, and two sides).
, 8. A person complains of fatigue and malaise and has a slight temperature
elevation for 2 days before symptoms of influenza (fever, chest congestion, and
productive cough) become noticeable. During the time immediately before the
illness is diagnosed, the patient
A. could avoid contracting the disease if treatment is begun with antibiotics.
B. is unable to spread the disease because it is still in the incubation period. C. is
in the prodromal stage and is highly contagious and able to spread the disease.
D. has a nosocomial infection, which affects approximately two million
individuals a year.
C. is in the prodromal stage and is highly contagious and able to spread the
disease. The prodromal stage is a short period of time (hours to several days)
immediately preceding the onset of an illness during which the patient is very
contagious. Antibiotics are not effective against viral illnesses. The incubation
period is the time from entry of the organism to the onset of symptoms and, in
some viral illnesses, may be contagious. Nosocomial infections are those acquired
in a hospital, and this scenario does not suggest the source of the infection.
9. In older adults, infection after exposure to respiratory illness is most likely to
A. result in similar rates of infection as in the younger adult.
B. be easily prevented with the use of antibiotics after being exposed.
C. result in serious lower respiratory infection related to weakened respiratory
muscles and fewer cilia.
D. be less serious because the older adult has less contact with younger children
who are most likely to carry serious infections.
C. result in serious lower respiratory infection related to weakened respiratory
muscles and fewer cilia. Changes in the older adult respiratory system make older
adults more susceptible to infections that can be very serious and life threatening.
Use of antibiotics to "prevent" lung infections is not recommended and is
ineffective for viral infections.
10. If a nurse is caring for an 80-year-old patient with a temperature of 100.4° F,
crackles at the right lung base, pain with deep inspiration, and dyspnea, which
of the following orders is the nurse's priority? A. Sputum specimen for culture
and sensitivity
B. Codeine 15 mg orally every 6 hours as needed
QUESTIONS AND ANSWERS LATEST UPDATE ACTUAL
EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS
(VERIFIED) RATED A+| PDF
1. The arterial blood gas (ABG) readings that indicate compensated respiratory
acidosis are a PaCO2 of
A. 30 mm Hg and bicarbonate level of 24 mEq/L.
B. 30 mm Hg and bicarbonate level of 30 mEq/L.
C. 50 mm Hg and bicarbonate level of 20 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L. If compensation is present,
carbon dioxide and bicarbonate are abnormal (or nearly so) in opposite directions
(e.g., one is acidotic and the other alkalotic).
2. A patient admitted to the emergency department with tension
pneumothorax and mediastinal shift following an automobile crash is most
likely to exhibit A. bradycardia.
B. severe hypotension.
C. mediastinal flutter.
D. a sucking chest wound.
B. severe hypotension. Mediastinal shift may cause compression of the lung in the
direction of the shift and compression, traction, torsion, or kinking of the great
vessels. Blood return to the heart is dangerously impaired and causes a
subsequent decrease in cardiac output and blood pressure. Tachycardia is a
clinical manifestation of tension pneumothorax. An uncovered opened
pneumothorax is associated with a sucking chest wound and mediastinal flutter.
3. In preparing the preoperative teaching plan for a patient who is to undergo a
total laryngectomy, a nurse should give highest priority to the
A. tracheostomy being in place for 2 to 3 days.
B. patient's not being able to speak normally again.
,C. insertion of a gastrostomy feeding tube during surgery.
D. patient's not being able to perform deep-breathing exercises.
B. patient's not being able to speak normally again. Patients who have a total
laryngectomy have a permanent tracheostomy and will need to learn how to
speak using alternative methods, such as an artificial larynx. The tracheostomy
will be permanent to allow normal breathing patterns and air exchange. After
surgery, the patient's nutrition is supplemented with enteral feedings, and when
the patient can swallow secretions, oral feedings can begin. Deep-breathing
exercises should be performed with the patient at least every 2 hours to prevent
further pulmonary complications.
4. After a posterior nasal pack is inserted by a physician, the patient is very
anxious and states, "I don't feel like I'm breathing right." The immediate
intervention the nurse should initiate is to
A. monitor ABGs.
B. reassure the patient that this is normal discomfort.
C. cut the pack strings and pull the packing out with a hemostat.
D. direct a flashlight into the patient's mouth and inspect the oral cavity.
D. direct a flashlight into the patient's mouth and inspect the oral cavity. The
nurse should inspect the oral cavity for the presence of blood, soft palate
necrosis, and proper placement of the posterior plug. If the posterior plug is
visible, the physician should be notified for readjustment of the packing.
Reassurance, cutting the strings, and ABGs are not top priority interventions. The
nurse needs further data before intervening.
5. A nurse is performing assessment for a patient diagnosed with chronic
obstructive pulmonary disease (COPD). Which of the following findings should
the nurse expect to observe?
A. Nonproductive cough
B. Prolonged inspiration
C. Vesicular breath sounds
D. Increased anterior-posterior chest diameter
D. Increased anterior-posterior chest diameter An increased anterior-posterior
diameter is a compensatory mechanism experienced by patients with COPD and is
caused by air-trapping. Patients with COPD have a productive cough, often
,expectorating copious amounts of sputum. Because of air-trapping, patients with
COPD experience a prolonged expiration because the rate of gas on exhalation
takes longer to escape. Chest auscultation for patients with COPD often reveals
wheezing, crackles, and other adventitious breath sounds.
6. A nurse is working on a respiratory care unit where many of the patients are
affected by asthma. Which of the following actions by the nurse would most
likely increase respiratory difficulty for the patients?
A. Wearing perfume to work
B. Encouraging patients to ambulate daily C. Allowing the patients to eat green
leafy vegetables
D. Withholding antibiotic therapy until cultures are obtained
A. Wearing perfume to work People with asthma should avoid extrinsic allergens
and irritants (e.g., dust, pollen, smoke, certain foods, colognes and perfumes,
certain types of medications) because their airways become inflamed, producing
shortness of breath, chest tightness, and wheezing. Many green leafy vegetables
are rich in vitamins, minerals, and proteins, which incorporate healthy lifestyle
patterns into the patients' daily living routines. Routine exercise is a part of a
prudent lifestyle, and for patients with asthma the physical and psychosocial
effects of ambulation can incorporate feelings of well-being, strength, and
enhancement of physical endurance. Antibiotic therapy is always initiated after
cultures are obtained so that the sensitivity to the organism can be readily
identified.
7. The most appropriate position to assist a patient with chronic obstructive
pulmonary disease (COPD) who is having difficulty breathing would be a
A. high Fowler's position without a pillow behind the head.
B. semi-Fowler's position with a single pillow behind the head.
C. right side-lying position with the head of the bed at 45 degrees' elevation.
D. sitting upright and forward position with arms supported on an over-the-bed
table.
D. sitting upright and forward position with arms supported on an over-the-bed
table.Sitting upright and leaning forward with arms supported on an over-the-bed
table would be of most help to this patient, because it allows for expansion of the
thoracic cage in all four directions (front, back, and two sides).
, 8. A person complains of fatigue and malaise and has a slight temperature
elevation for 2 days before symptoms of influenza (fever, chest congestion, and
productive cough) become noticeable. During the time immediately before the
illness is diagnosed, the patient
A. could avoid contracting the disease if treatment is begun with antibiotics.
B. is unable to spread the disease because it is still in the incubation period. C. is
in the prodromal stage and is highly contagious and able to spread the disease.
D. has a nosocomial infection, which affects approximately two million
individuals a year.
C. is in the prodromal stage and is highly contagious and able to spread the
disease. The prodromal stage is a short period of time (hours to several days)
immediately preceding the onset of an illness during which the patient is very
contagious. Antibiotics are not effective against viral illnesses. The incubation
period is the time from entry of the organism to the onset of symptoms and, in
some viral illnesses, may be contagious. Nosocomial infections are those acquired
in a hospital, and this scenario does not suggest the source of the infection.
9. In older adults, infection after exposure to respiratory illness is most likely to
A. result in similar rates of infection as in the younger adult.
B. be easily prevented with the use of antibiotics after being exposed.
C. result in serious lower respiratory infection related to weakened respiratory
muscles and fewer cilia.
D. be less serious because the older adult has less contact with younger children
who are most likely to carry serious infections.
C. result in serious lower respiratory infection related to weakened respiratory
muscles and fewer cilia. Changes in the older adult respiratory system make older
adults more susceptible to infections that can be very serious and life threatening.
Use of antibiotics to "prevent" lung infections is not recommended and is
ineffective for viral infections.
10. If a nurse is caring for an 80-year-old patient with a temperature of 100.4° F,
crackles at the right lung base, pain with deep inspiration, and dyspnea, which
of the following orders is the nurse's priority? A. Sputum specimen for culture
and sensitivity
B. Codeine 15 mg orally every 6 hours as needed
