HESI Medical Surgical Exam

HESI Medical Surgical Exam Related

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A client with chronic obstructive pulmonary disease (COPD) presented with shortness of breath. Oxygen therapy was started at 2 liters/minute via nasal cannula. The arterial blood gases (ABGs) after treatment were pH 7.36, PaO2 62, PaCO2 59, and HCO3. Which statement describes the most likely cause of the simultaneous increase in both the PaO2 and the PaCO2?

  • A. The hypercapnia resulted from the rapid respirations.
  • B. The hypoxic drive was reduced by the oxygen therapy.
  • C. The client had a pneumothorax which restricted ventilation.
  • D. The client had a pulmonary embolism that reduced perfusion.
Correct Answer: B

Rationale: In patients with COPD, oxygen therapy can reduce the hypoxic drive, which is the primary stimulus for breathing in these individuals. By providing supplemental oxygen, the hypoxic drive is diminished, resulting in decreased respiratory effort. As a consequence, the PaO2 may increase due to the supplemental oxygen, but this can lead to a decrease in the respiratory drive and subsequent retention of carbon dioxide, causing an increase in PaCO2 levels. Option A is incorrect because rapid respirations would typically lower PaCO2 levels. Option C is incorrect as a pneumothorax would lead to impaired gas exchange and decreased PaO2 levels without necessarily affecting PaCO2 levels. Option D is incorrect as a pulmonary embolism would typically result in ventilation-perfusion mismatch and decreased PaO2 levels without directly impacting PaCO2 levels.

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The client is preparing a morning dose of insulin, which includes 10 units of regular and 22 units of NPH. The nurse is verifying the client's preparation accuracy. What should the syringe read for the correct dose?

  • A. 22 units.
  • B. 10 units.
  • C. 32 units.
  • D. 42 units.
Correct Answer: C

Rationale: The correct answer is 32 units. To determine the correct dose, the nurse needs to add the 10 units of regular insulin to the 22 units of NPH, resulting in a total of 32 units. Therefore, the syringe should read 32 units. Choices A, B, and D are incorrect because they do not reflect the accurate total dose required for the morning insulin administration.

The client with chronic renal failure is receiving peritoneal dialysis. Which of the following is the most important action for the nurse to take?

  • A. Administer the prescribed antibiotics.
  • B. Monitor for signs of infection.
  • C. Encourage the client to increase fluid intake.
  • D. Monitor the client's weight daily.
Correct Answer: B

Rationale: Monitoring for signs of infection is crucial in clients undergoing peritoneal dialysis. Peritonitis is a severe complication associated with peritoneal dialysis, making it essential to promptly identify any signs of infection, such as abdominal pain, cloudy dialysate, fever, and an elevated white blood cell count. Administering antibiotics without proper assessment can lead to antibiotic resistance and should not be the initial action. Encouraging increased fluid intake may not be appropriate without assessing the client's fluid status. Monitoring weight alone does not address the immediate risk of peritonitis in a client undergoing peritoneal dialysis.

Prior to administering tissue plasminogen activator (t-PA), the nurse should assess the client for which of the following contraindications to administering the drug?

  • A. Age over 60 years.
  • B. History of cerebral hemorrhage.
  • C. History of heart failure.
  • D. Cigarette smoking.
Correct Answer: B

Rationale: The correct answer is B: History of cerebral hemorrhage. A history of cerebral hemorrhage is a contraindication to t-PA administration because of the increased risk of bleeding. Choices A, C, and D are incorrect. Age over 60 years is not a contraindication for t-PA administration. While older age may pose some risks, it is not an absolute contraindication. History of heart failure is not a direct contraindication to t-PA administration. Cigarette smoking, while a risk factor for cardiovascular disease, is not a specific contraindication for t-PA administration.

A client with chronic renal failure is prescribed a low-protein diet. The nurse should explain to the client that the purpose of this diet is to:

  • A. Prevent fluid overload.
  • B. Reduce the workload on the kidneys.
  • C. Prevent dehydration.
  • D. Maintain electrolyte balance.
Correct Answer: B

Rationale: The correct answer is B: 'Reduce the workload on the kidneys.' A low-protein diet is prescribed for clients with chronic renal failure to decrease the production of urea and other nitrogenous wastes, which can accumulate in the body when the kidneys are not functioning properly. This reduction in protein intake helps to lessen the burden on the kidneys, as they may have difficulty in filtering and excreting waste products. Choice A is incorrect because fluid overload is more related to restrictions in fluid intake rather than protein intake. Choice C is incorrect as a low-protein diet does not directly prevent dehydration. Choice D is incorrect because while electrolyte balance is essential in renal failure, the primary purpose of a low-protein diet is to reduce the workload on the kidneys by limiting the production of waste products.

When giving a report about a client who had a gastrectomy from the intensive care unit to the post-surgical unit nurse, what is the most effective way to assure essential information is reported?

  • A. Give the report face-to-face with both nurses in a quiet room.
  • B. Audiotape the report for future reference and documentation.
  • C. Use a printed checklist with information individualized for the client.
  • D. Document essential transfer information in the client's electronic health record.
Correct Answer: C

Rationale: Using a printed checklist with individualized information is the most effective way to ensure that all key details about the client who had a gastrectomy are covered during the report. This method helps in structuring the information systematically, reducing the risk of missing important details. Face-to-face communication in a quiet room (Choice A) is important for effective communication but may not guarantee the coverage of all essential information. Audiotaping the report (Choice B) may not be practical for immediate reference or interaction. Documenting in the electronic health record (Choice D) is essential but may not facilitate a comprehensive real-time exchange of information between the nurses.

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