HESI - Medical Surgical Practice Exam Questions And Correct Detailed Answers (Verified Answers) Already Graded A+

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HESI - Medical Surgical Practice Exam Questions And Correct Detailed Answers (Verified Answers) Already Graded A+

• The nurse would be correct in withholding a dose of digoxin in a client with

congestive heart failure without specific instruction from the healthcare provider if

the client's:

• serum digoxin level is 1.5
• blood pressure is 104/68
• serum potassium level is 3
• apical pulse is 68/min

Correct Answer: C. serum potassium level is 3

Explanation: Hypokalemia can precipitate digitalis toxicity in person receiving digoxin which will increase the change of dangerous dysrhythmias. The therapeutic range for digoxin is 0.8 to 2 ng/ml. A is within this range. B would not warrant the nurse withholding the digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min.

• The nurse is assessing a client's laboratory values following administration of

chemotherapy. Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome (TLS)?

• Serum PTT of 10 seconds
• Serum calcium of 5 mg/dl
• Oxygen saturation of 90%
• Hemoglobin of 10 g/dl

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Correct Answer: B. Serum calcium of 5 mg/dl.

Explanation: TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and

hyperphosphatemia.

• A client has undergone insertion of a permanent pacemaker. When developing a

discharge teaching plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which symptoms are most important to teach the client?

• Facial flushing
• Fever
• Pounding headache
• Feelings of dizziness

Correct Answer: D. Feelings of dizziness

Explanation: Feelings of dizziness may occur as the result of a decreased heart rate, leading to decreased cardiac output. A and C will not occur as the result of pacemaker failure. B may be an indication of infection postoperatively, but is not an indication of pacemaker failure.

• A client is placed on a mechanical ventilator following a cerebral hemorrhage, and

vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed. What is the priority nursing diagnosis for this client?

• Impaired communication related to paralysis of skeletal muscles.
• High risk for infection related to increased intracranial pressure.
• Potential for injury related to impaired lung expansion.
• Social isolation related to inability to communicate.

Correct Answer: A. Impaired communication related to paralysis of skeletal muscles.Explanation: To increase the client's tolerance of endotracheal intubation and/or mechanical ventilation, a skeletal-muscle relaxant, such as vecuronium, is usually prescribed. Impaired communication is a serious outcome because the client cannot communicate his/her needs due to intubation and diaphragmatic paralysis caused by the drug. Although this client might also experience, it is not a priority when compared to A.Infection is not related to increased intracranial pressure. The mechanical ventilator provides consistent lung expansion.

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• A client is admitted to the hospital with a medical diagnosis of pneumococcal

pneumonia. The nurse knows that the prognosis for gram-negative pneumonias (such

as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because:

• They occur in the lower love alveoli which are more sensitive to infection
• Gram-negative organisms are more resistant to antibiotic therapy
• They occur in healthy young adults who have recently been debilitated by an upper

respiratory infection.

• Gram-negative pneumonias usually affect infants and small children.

Correct Answer: B. Gram-negative organisms are more resistant to antibiotic therapy Explanation: The gram-negative organisms are resistant to drug therapy which makes recovery very difficult. Gram-negative pneumonias affect all lobes of the lung. The mean age for contracting this type of pneumonia is 50 years, and it usually strikes debilitated persons such as alcoholics, diabetics, and those with chronic lung diseases.

• A client is admitted to the hospital with a diagnosis of severe acute diverticulitis.

Which assessment finding should the nurse expect this client to exhibit?

• Lower left quadrant pain and a low-grade fever
• Severe pain at McBurney's point and nausea.
• Abdominal pain and intermittent tenesmus
• Exacerbations of severe diarrhea

Correct Answer: A. Lower left quadrant pain and a low-grade fever.

Explanation: Left lower quadrant pain occurs with diverticulitis because the sigmoid colon is the most common area for diverticula, and the inflammation of diverticula causes a low- grade fever.

• After the fourth dose of gentamicin sulfate (Garamycin) IV, the nurse plans to draw

blood samples to determine peak and trough levels. When are the best times to draw these samples?

• 15 minutes before and 15 minutes after the next dose
• One hour before and one hour after the next dose
• 5 minutes before and 30 minutes after the next dose

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• 30 minutes before and 30 minutes after the next dose

Correct Answer: C. 5 minutes before and 30 minutes after the next dose.

Explanation: Peak drug serum levels are achieved 30 minutes after IV administration of aminoglycosides. The best time to draw a trough is the closest time to the next administration. A, B, and D are not as good a time to draw the trough as C. B and D are not the best times to draw the peak of an aminoglycoside that has been administered IV.

• During CPR, when attempting to ventilate a client's lungs, the nurse notes that the

chest is not moving. What action should the nurse take first?

• Use a laryngoscope to check for a foreign body lodged in the esophagus.
• Reposition the head to validate that the head is in the proper position to open the airway.
• Turn the client to the side and administer three back blows.
• Perform a finger sweep of the mouth to remove any vomitus

Correct Answer: B. Reposition the head to validate that the head is in the proper position to open the airway.Explanation: The most frequent cause of inadequate aeration of the client's lungs during CPR is improper positioning of the head resulting in occlusion of the airway. A foreign body can occlude the airway, but this is not common unless choking preceded the cardiac emergency, and should not be the nurse's first action.

• A client with heart disease is on a continuous telemetry monitor and has developed

sinus bradycardia. In determining the possible cause of the bradycardia, the nurse assesses the client's medication record. Which medication is most likely the cause of the bradycardia?

• Propanolol (Inderal)
• Captopril (Capoten)
• Furosemide (Lasix)
• Dobutamine (Dobutrex)

Correct Answer: A. Propanolol (Inderal)

Explanation: Inderal is a beta adrenergic blocking agent, which causes decreased heart rate and decreased contractility. Neither B, an ACE inhibitor, nor C, a loop diuretic, causes