HESI RN
HESI Medical Surgical Practice Exam Quizlet
1. What is the most important content for the nurse to include in discharge teaching for a 51-year-old truck driver who smokes two packs of cigarettes a day, is 30 pounds overweight, and has been diagnosed with a gastric ulcer?
- A. Information about smoking cessation.
- B. Diet instructions for a low-residue diet.
- C. Instructions on a weight-loss program.
- D. The importance of increasing milk in the diet.
Correct answer: A
Rationale: The correct answer is A: Information about smoking cessation. Smoking is a significant risk factor for ulcer formation. It is crucial for the nurse to include smoking cessation information in the discharge teaching to help manage the gastric ulcer and prevent further complications. Choices B, C, and D are less relevant in this scenario. While diet modifications may be beneficial, addressing smoking cessation takes precedence due to its direct correlation with ulcer development.
2. Which of the following lipid abnormalities is a risk factor for the development of atherosclerosis and peripheral vascular disease?
- A. Low concentration of triglycerides.
- B. High levels of high-density lipoprotein (HDL) cholesterol.
- C. High levels of low-density lipoprotein (LDL) cholesterol.
- D. Low levels of LDL cholesterol.
Correct answer: C
Rationale: The correct answer is C: High levels of low-density lipoprotein (LDL) cholesterol. High levels of LDL cholesterol contribute to the development of atherosclerosis and peripheral vascular disease by being deposited in the blood vessel walls, leading to the formation of plaques that can obstruct blood flow. Choice A is incorrect as a low concentration of triglycerides is not typically associated with an increased risk of atherosclerosis or PVD. Choice B is incorrect as high levels of high-density lipoprotein (HDL) cholesterol are actually considered protective against atherosclerosis as it helps remove cholesterol from arteries. Choice D is incorrect as low levels of LDL cholesterol are not typically considered a risk factor for atherosclerosis or PVD.
3. A client is recovering from a closed percutaneous kidney biopsy and reports increased pain from 3 to 10 on a scale of 0 to 10. Which action should the nurse take first?
- A. Reposition the client on the operative side.
- B. Administer the prescribed opioid analgesic.
- C. Assess the pulse rate and blood pressure.
- D. Examine the color of the client’s urine.
Correct answer: C
Rationale: An abrupt increase in pain following a percutaneous kidney biopsy may indicate internal hemorrhage. Assessing the client's pulse rate and blood pressure is crucial as changes in vital signs can be indicative of hemorrhage. This assessment is essential in determining the client's hemodynamic status and the need for immediate intervention. Repositioning the client, administering pain medication, or checking urine color are not the priority actions in this situation and may delay necessary interventions for potential hemorrhage.
4. A client is starting urinary bladder training. Which statement should the nurse include in this client’s teaching?
- A. Use the toilet when you first feel the urge, rather than at specific intervals.
- B. Try to consciously hold your urine until the scheduled toileting time.
- C. Initially try to use the toilet at least every half hour for the first 24 hours.
- D. The toileting interval can be increased once you have been continent for a week.
Correct answer: B
Rationale: In urinary bladder training, the client should be taught to try to consciously hold their urine until the scheduled toileting time. This helps in training the bladder to hold urine for longer periods. Option A is incorrect because the goal is to consciously hold urine, not void immediately. Option C is incorrect as toileting at least every half hour may not promote bladder training. Option D is incorrect as increasing the toileting interval should be based on the client's comfort and progress, not just after being continent for a week.
5. When preparing a client who has had a total laryngectomy for discharge, what instruction is most important for the nurse to include in the discharge teaching?
- A. Recommend that the client carry suction equipment at all times.
- B. Instruct the client to have writing materials with them at all times.
- C. Tell the client to carry a medic alert card stating that they are a total neck breather.
- D. Tell the client not to travel alone.
Correct answer: C
Rationale: The most crucial instruction for a client who has had a total laryngectomy is to carry a medic alert card stating that they are a total neck breather. This is important because if they experience a cardiac arrest, mouth-to-neck breathing may be required. Choice A about carrying suction equipment is not the most critical as the client may not always need it. Choice B is not as essential as having a medic alert card. Choice D is not directly related to the client's safety due to their laryngectomy.
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