HESI MED SURG / MED SURG 55 QUESTIONS RN V1 (MOST ANSWER(S))

154 HESI MED SURG / MED SURG 55 QUESTIONS RN V1 (MOST ANSWER(S)) A 55-year-old patient is preparing to start an exercise program. The health care provider wants 60% of maximum target heart rate. Calculate the heart rate that the nurse will add to the care plan as the target heart rate. Record answer as a whole number. maximum heart rate ANS: 99 Teach patients to calculate their maximum heart rate by subtracting their current age in years from 220 and then obtaining their target heart rate by taking 60% to 90% of the maximum, depending on their health care provider’s recommendation. 220 − 55 = 165 × 0.6 = 99. 1. A nurse is teaching a patient about medications. Which statement from the patient indicates teaching is effective? a. “My parenteral medication must be taken with food.” b. “I will rotate the sites in my left leg when I give my insulin.” c. “Once I start feeling better, I will stop taking my antibiotic.” “If I am 30 minutes late taking my medication, I should skip that d. dose.” ANS: B For daily insulin, rotate site within anatomical area. Rotating injections within the same body part (instrasite rotation) provides greater consistency in absorption of medication. Parenteral medication absorption is not affected by the timing of meals. Taking a medication 30 minutes late is within the 60-minute window of the time medications should be taken. Medications are usually 154 stopped based on the provider’s orders except in extenuating circumstances. With some medications, such as antibiotics, it is crucial that the full course of medication is taken to avoid relapse of infection. 2. A nurse is preparing to administer an injection to a patient. Which statement made by the patient is an indication for the nurse to use the Z-track method? a. “I am allergic to many medications.” b. “I’m really afraid that a big needle will hurt.” c. “The last shot like that turned my skin colors.” d. “My legs are too obese for the needle to go through.” ANS: C The Z-track is indicated when the medication being administered has the potential to irritate sensitive tissues. It is recommended that, when administering IM injections, the Z-track method be used to minimize local skin irritation by sealing the medication in muscle tissue. The Z-track method is not meant to reduce discomfort from the procedure. If a patient is allergic to a medication, it should not be administered. If a patient has additional subcutaneous tissue to go through, a needle of a different size may be selected. 3. A 2-year-old child is ordered to have eardrops daily. Which action will the nurse take? a. Pull the auricle down and back to straighten the ear canal. b. Pull the auricle upward and outward to straighten the ear canal. c. Sit the child up for 2 to 3 minutes after instilling drops in ear canal. d. Sit the child up to insert the cotton ball into the innermost ear canal. ANS: A Children up to 3 years of age should have the auricle pulled down and back, children 3 years of age to adults should have the auricle pulled upward and outward. Solution should be instilled 1 cm (1/2 in) above the opening of the ear canal. The patient should remain in the side-lying position 2 to 3 minutes. If a 154 cotton ball is needed, place it into the outermost part of the ear canal. 4. A patient has an order to receive 0.3 mL of U-500 insulin. Which syringe will the nurse obtain to administer the medication? a. 3-mL syringe b. U-100 syringe c. Needleless syringe d. Tuberculin syringe ANS: D Because there is no syringe currently designed to prepare U-500 insulin, many medication errors result with this kind of insulin. To prevent errors, ensure that the order for U-500 specifies units and volume (e.g., 150 units, 0.3 mL of U-500 insulin), and use tuberculin syringes to draw up the doses. A 3 mL and U-100 can result in inaccurate dosing. A needleless syringe will not be acceptable in this situation. 5. A patient has an order to receive 12.5 mg of hydrochlorothiazide. The nurse has on hand a 25 mg tablet of hydrochlorothiazide. How many tablet(s) will the nurse administer? a. 1/2 tablet b. 1 tablet c. 1 1/2 tablets d. 2 tablets ANS: A 1/2 tablet will be given. The nurse is careful to perform nursing calculations to ensure proper medication administration. The dose ordered is 12.5. The dose on hand is 25. 12.5/25 = 1/2 tablet. 6. The patient is to receive phenytoin (Dilantin) at 0900. When will be the ideal time for the nurse to schedule a trough level? a. 0800 154 b. 0830 c. 0900 d. 0930 ANS: B 5 Trough levels are generally drawn 30 minutes before the drug is administered. If the medication is administered at 0900, the trough should be drawn at 0830. 7. A patient is receiving vancomycin. Which function is the priority for the nurses to assess? a. Vision b. Hearing c. Heart tones d. Bowel sounds ANS: B A side effect of vancomycin is ototoxicity—hearing. It does not affect vision, heart tones, or bowel sounds. 8. A health care provider orders lorazepam (Ativan) 1 mg orally 2 times a day. The dose available is 0.5 mg per tablet. How many tablet(s) will the nurse administer for each dose? a.1 b.2 c.3 d.4 ANS: B The nurse will give 2 tablets. It will take 2 tablets (0.5) to equal 1 mg OR ordered dose (1) over dose on hand (0.5). 1/0.5 = 2 tablets. 9. The nurse is preparing to administer an injection into the deltoid muscle of an adult patient. Which needle size and length will the nurse choose? a. 18 gauge × 1 1/2 inch 6 b. 23 gauge × 1/2 inch c. 25 gauge × 1 inch d. 27 gauge × 5/8 inch ANS: C For an intramuscular injection into an adult deltoid muscle, a 25-gauge, 1-inch needle is recommended. An 18- gauge needle is too big. While a 23-gauge needle can be used, a 1/2-inch needle is too small. A 27-gauge, 5/8 -inch needle is used for intradermal. 10. When the nurse administers an IM corticosteroid injection, the nurse aspirates. What is the rationale for the nurse aspirating? a. Prevent the patient from choking. b. Increase the force of the injection. c. Ensure proper placement of the needle. d. Reduce the discomfort of the injection. ANS: C The purpose of aspiration is to ensure that the needle is in the muscle and not in the vascular system. Blood return upon aspiration indicates improper placement, and the injection should not be given. While a patient can aspirate fluid and food into the lungs, this is not related to the reason for why a nurse pulls back the syringe plunger after inserting the needle (aspirates) before injecting the medication. Reducing discomfort and prolonging absorption time are not reasons for aspirating medications. 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