HESI RN
HESI Medical Surgical Specialty Exam
1. A client who has just undergone a skin biopsy is listening to discharge instructions from the nurse. The nurse determines that the client has misunderstood the directions if the client indicates that as part of aftercare he plans to:
- A. Use the antibiotic ointment as prescribed
- B. Return in 7 days to have the sutures removed
- C. Apply cool compresses to the site twice a day for 20 minutes
- D. Call the physician if excessive drainage from the wound occurs
Correct answer: C
Rationale: The correct answer is C. Applying cool compresses to the site twice a day for 20 minutes is not a recommended aftercare practice for a skin biopsy. After a skin biopsy, it is important to keep the dressing dry and in place for a minimum of 8 hours. Choice A is correct as using the antibiotic ointment as prescribed is a common post-biopsy instruction to prevent infection. Choice B is also correct as returning in 7 days to have the sutures removed is part of the typical follow-up care after a skin biopsy. Choice D is correct as it is important to call the physician if excessive drainage from the wound occurs to prevent complications.
2. A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 L/min. The nurse responds that this would be harmful because it could:
- A. Be drying to nasal passages
- B. Decrease the client’s oxygen-based respiratory drive
- C. Increase the risk of pneumonia due to drier air passages
- D. Decrease the client’s carbon dioxide–based respiratory drive
Correct answer: B
Rationale: Increasing the oxygen flow rate beyond 2 L/min for a client with COPD can decrease the client's oxygen-based respiratory drive. In clients with COPD, the natural respiratory drive is based on the level of oxygen instead of carbon dioxide, as seen in healthy individuals. Increasing the oxygen level independently can suppress the drive to breathe, leading to respiratory failure. Choices A, C, and D are incorrect because drying of nasal passages, increased risk of pneumonia due to drier air passages, and decreasing the carbon dioxide-based respiratory drive are not the primary concerns associated with increasing the oxygen flow rate in a client with COPD.
3. The patient is being educated on taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?
- A. I may need additional sodium and calcium while taking this medication.
- B. I should consume plenty of fruits and vegetables while taking this drug.
- C. I should be cautious when getting up from a bed or chair while on this medication.
- D. I will take the medication in the morning to reduce certain side effects.
Correct answer: A
Rationale: The correct answer is A because patients do not require extra sodium or calcium while taking hydrochlorothiazide, a thiazide diuretic. This medication actually promotes the excretion of sodium and water. Choices B, C, and D are correct statements regarding the use of hydrochlorothiazide. Patients are encouraged to have a diet rich in fruits and vegetables, be careful with position changes due to potential orthostatic hypotension, and take the medication in the morning to reduce the need for frequent urination during nighttime.
4. What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?
- A. Ask the patient if she might be pregnant.
- B. Reassure the patient that this is a normal side effect.
- C. Report a possible superinfection to the provider.
- D. Suspect that the patient is having a hematologic reaction.
Correct answer: C
Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.
5. A client who is postmenopausal and has had two episodes of bacterial urethritis in the last 6 months asks, “I never have urinary tract infections. Why is this happening now?†How should the nurse respond?
- A. Your immune system becomes less effective as you age.
- B. Low estrogen levels can make the tissue more susceptible to infection.
- C. You should be more careful with your personal hygiene in this area.
- D. It is likely that you have an untreated sexually transmitted disease.
Correct answer: B
Rationale: Low estrogen levels in postmenopausal women decrease moisture and secretions in the perineal area, causing tissue changes that predispose them to infection, including urethritis. This is a common reason for urethritis in postmenopausal women. While immune function does decrease with aging and sexually transmitted diseases can cause urethritis, the most likely reason in this case is the low estrogen levels. Personal hygiene practices are usually not a significant factor in the development of urethritis.
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