HESI MED SURG A & B EXAM PRACTICE – LATEST 2022
MED SURG A
Which procedures are done for curative purposes (select all that apply)?
a.
... [Show More] Gastroscopy
b. Rhinoplasty
c. Tracheotomy
d. Hysterectomy
e. Herniorrhaphy
ANS
- d, e. Gastroscopy is for the purpose of diagnosis.
Rhinoplasty is done for a cosmetic improvement. A
tracheotomy is palliative
A patient is scheduled for a hemorrhoidectomy at an ambulatory day-surgery center. An advantage of performing
surgery at an ambulatory center is a decreased need for
a. laboratory tests and perioperative medications.
b. preoperative and postoperative teaching by the nurse.
c. psychologic support to alleviate fears of pain and discomfort.
d. preoperative nursing assessment related to possible risks and complications.
ANS
- a. Ambulatory surgery is usually less expensive and more
convenient, generally involving fewer laboratory tests,
fewer preoperative and postoperative medications, less
psychologic stress, and less susceptibility to hospitalacquired
infections. However, the nurse is still responsible
for assessing, supporting, and teaching the patient who
is undergoing surgery, regardless of where the surgery is
performed.
A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, "I just
want this over." What should the nurse do to promote a positive surgical outcome for the patient?
a. Ask the patient what her specific concerns are about the surgery.
b. Reassure the patient that the surgery will be over soon and she will be fine.
c. Redirect the patient's attention to the necessary preoperative preparations.
d. Tell the patient she should not be so anxious because she is having a common, safe surgery.
ANS
- a. Excessive anxiety and stress can affect surgical recovery
and the nurse's role in psychologically preparing the patient
for surgery is to assess for potential stressors that could
negatively affect surgery. Specific fears should be identified
and addressed by the nurse by listening and by explaining
planned postoperative care. Falsely reassuring the patient,
ignoring her behavior, and telling her not to be anxious are
not therapeutic.
Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the
nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (select
all that apply)?
a. Garlic
b. Fish oil
c. Valerian
d. Vitamin E
e. Astragalus
f. Ginkgo biloba
ANS
- a, b, d, f. Valerian may cause excess sedation. Astragalus
may increase blood pressure before and during surgery.
Priority Decision: When the nurse asks a preoperative patient about allergies, the patient reports a history of seasonal
environmental allergies and allergies to a variety of fruits. What should the nurse do next?
a. Note this information in the patient's record as hay fever and food allergies.
b. Place an allergy alert wristband that identifies the specific allergies on the patient.
c. Ask the patient to describe the nature and severity of any allergic responses experienced from these agents.
d. Notify the anesthesia care provider (ACP) because the patient may have an increased risk for allergies to
anesthetics.
ANS
- c. Risk factors for latex allergies include a history of
hay fever and allergies to foods such as avocados, kiwi,
bananas, potatoes, peaches, and apricots. When a patient
identifies such allergies, the patient should be further
questioned about exposure to latex and specific reactions
to allergens. A history of any allergic responsiveness
increases the risk for hypersensitivity reactions to drugs
used during anesthesia but the hay fever and fruit allergies
are specifically related to latex allergy. After identifying
the allergic reaction, the anesthesia care provider (ACP)
should be notified, the allergy alert wristband should be
applied, and the note in the record will include the allergies
and reactions as well as the nursing actions related to the
allergies.
During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need
for which preoperative diagnostic tests?
a. ECG and chest x-ray
b. Serum glucose and CBC
c. ABGs and coagulation tests
d. BUN, serum creatinine, and electrolytes
ANS
- d. BUN, serum creatinine, and electrolytes are used to
assess renal function and should be evaluated before
surgery. Other tests are often evaluated in the presence
of diabetes, bleeding tendencies, and respiratory or heart
disease.
During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory
function during or after surgery in a patient with which problem?
a. Obesity
b. Dehydration
c. Enlarged liver
d. Decreased peripheral pulses
ANS
- a. Obesity, as well as spinal, chest, and airway deformities,
may compromise respiratory function during and after
surgery. Dehydration may require preoperative fluid therapy
and an enlarged liver may indicate hepatic dysfunction that
will increase perioperative risk related to glucose control,
coagulation, and drug interactions. Weak peripheral pulses
may reflect circulatory problems that could affect healing.
What type of procedural information should be given to a patient in preparation for ambulatory surgery (select all
that apply)?
a. How pain will be controlled
b. Any fluid and food restrictions
c. Characteristics of monitoring equipment
d. What odors and sensations may be experienced
e. Technique and practice of coughing and deep breathing, if appropriate
ANS
- a, b, e. Procedural information includes what will or should
be done for surgical preparation, including what to bring and
what to wear to the surgery center, length and type of food
and fluid restrictions, physical preparation required, pain
control, need for coughing and deep breathing (if appropriate),
and procedures done before and during surgery (such as vital
signs, IV lines, and how anesthesia is administered). The other
options are sensory and process information (see Table 18-6).
The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the
form after the patient does so. By this action, what is the nurse doing?
a. Witnessing the patient's signature
b. Obtaining informed consent from the patient for the surgery
c. Verifying that the consent for surgery is truly voluntary and informed
d. Ensuring that the patient is mentally competent to sign the consent form
ANS
- a. The health care provider is ultimately responsible for
obtaining informed consent. However, the nurse may be
responsible for obtaining and witnessing the patient's
signature on the consent form. The nurse may be a patient
advocate during the signing of the consent form, verifying
that consent is voluntary and that the patient understands
the implications of consent, but the primary legal action by
the nurse is witnessing the patient's signature.
When the nurse prepares to administer a preoperative medication to a patient, the patient tells the nurse that she
really does not understand what the surgeon plans to do.
a. What action should be taken by the nurse?
b. What criterion of informed consent has not been met in this situation?
ANS
- a. The nurse should notify the health care provider because
the patient needs further explanation of the planned surgery.
b. Sufficient comprehension
A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast
tray with clear liquids on the morning of surgery. What response does the nurse expect when the anesthesia care
provider is notified?
a. Surgery will be done as scheduled.
b. Surgery will be rescheduled for the following day.
c. Surgery will be postponed for 8 hours after the fluid intake.
d. A nasogastric tube will be inserted to remove the fluids from the stomach.
ANS
- a. The preoperative fasting recommendations of the
American Society of Anesthesiology indicate that clear
liquids may be taken up to 2 hours before surgery for
healthy patients undergoing elective procedures. There is
evidence that longer fasting is not necessary.
What is the rationale for using preoperative checklists on the day of surgery?
a. The patient is correctly identified.
b. All preoperative orders and procedures have been carried out and records are complete.
c. Patients' families have been informed as to where they can accompany and wait for patients.
d. Preoperative medications are the last procedure before the patient is transported to the operating room.
ANS
- b. Preoperative checklists are a tool used to ensure that
the many preparations and precautions performed before
surgery have been completed and documented. Patient
identification, instructions to the family, and administration
of preoperative medications are often documented on the
checklist, which ensures that no details are omitted.
A common reason that a nurse may need extra time when preparing older adults for surgery is their
a. ineffective coping.
b. limited adaptation to stress.
c. diminished vision and hearing.
d. need to include caregivers in activities.
ANS
- c. One of the major reasons that older adults need increased
time preoperatively is the presence of impaired vision and
hearing that slows understanding of preoperative instructions
and preparation for surgery. Thought processes and cognitive
abilities may also be impaired in some older adults. The older
adult's decreased adaptation to stress because of physiologic
changes may increase surgical risks and overwhelming
surgery-related losses may result in ineffective coping
that is not directly related to time needed for preoperative
preparation. The involvement of caregivers in preoperative
activities may be appropriate for patients of all ages.
The nurse is reviewing the laboratory results for a preoperative patient. Which test result should be brought to the
attention of the surgeon immediately?
a. Serum K+ of 3.8 mEq/L
b. Hemoglobin of 15 g/dL
c. Blood glucose of 100 mg/dL
d. White blood cell (WBC) count of 18,500/μL
ANS
- d. This finding may indicate an infection. The surgeon
will probably postpone the surgery until the cause of the
elevated WBC count has been found.
The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knee
arthroscopy. What actions should the nurse take at this time (select all that apply)?
a. Ensure that the patient has voided.
b. Verify that the informed consent is signed.
c. Complete preoperative nursing documentation.
d. Verify that the right knee is marked with indelible marker.
e. Ensure that the H&P, diagnostic reports, and vital signs are on the chart.
ANS
- a, b, c, d, e. All of these are actions that are needed to
ensure that the patient is ready for surgery. In addition, the
nurse should verify that the identification band and allergy
band (if applicable) are on; the patient is not wearing
any cosmetics; nail polish has been removed; valuables
have been removed and secured; and prosthetics, such as
eyeglasses, have been removed and secured.
What is the physical environment of a surgery suite primarily designed to promote?
a. Electrical safety
b. Medical and surgical asepsis
c. Comfort and privacy of the patient
d. Communication among the surgical team
ANS
- b. Although all of the factors listed are important to the
safety and well-being of the patient, the first consideration
in the physical environment of the surgical suite is
prevention of transmission of infection to the patient.
When transporting an inpatient to the surgical department, which area is a nurse from another area of the hospital
able to access?
a. Clean core
b. Holding area
c. Corridors of surgical suite
d. Unprepared operating room
ANS
- b. Persons in street clothes or attire other than surgical scrub
clothing can interact with personnel of the surgical suite in
unrestricted areas, such as the holding area, nursing station,
control desk, or locker rooms. Only authorized personnel
wearing surgical attire and hair covering are allowed in
semirestricted areas, such as corridors, and masks must be
worn in restricted areas, such as operating rooms and clean
core and scrub sink areas.
Which nursing actions are completed by the scrub nurse (select all that apply)?
a. Prepares instrument table
b. Documents intraoperative care
c. Remains in the sterile area of the OR
d. Checks mechanical and electrical equipment
e. Passes instruments to surgeon and assistants
f. Monitors blood and other fluid loss and urine output
ANS
- a, c, e. The circulating nurse documents intraoperative care,
checks mechanical and electrical equipment, and monitors
blood and other fluid loss and urine output.
What is the primary goal of the circulating nurse during preparation of the operating room, transferring and
positioning the patient, and assisting the anesthesia team?
a. Avoiding any type of injury to the patient
b. Maintaining a clean environment for the patient
c. Providing for patient comfort and sense of well-being
d. Preventing breaks in aseptic technique by the sterile members of the team
ANS
- a. The protection of the patient from injury in the operating
room environment is maintained by the circulating nurse
by ensuring functioning equipment, preventing falls and
injury during transport and transfer, monitoring asepsis, and
providing supportive care for the anesthetized patient.
Goals for patient safety in the OR include the Universal Protocol. What is included in this protocol?
a. All surgical centers of any type must submit reports on patient safety infractions to the accreditation agencies.
b. Members of the surgical team stop whatever they are doing to check that all sterile items have been prepared
properly.
c. Members of the surgical team pause right before surgery to meditate for 1 minute to decrease stress and
possible errors.
d. A surgical timeout
ANS
- d. The Universal Protocol supported by The Joint
Commission (TJC) is used to prevent wrong site, wrong
procedure, and wrong surgery in view of a high rate of these problems nationally. It involves pausing just before
the procedure starts to verify patient identity, surgical
site, and surgical procedure.
A break in sterile technique occurs during surgery when the scrub nurse touches
a. the mask with sterile gloved hands.
b. sterile gloved hands to the gown at chest level.
c. the drape at the incision site with sterile gloved hands.
d. the lower arm to the instruments on the instrument tray.
ANS
- a. The mask covering the face is not considered sterile and
if in contact with sterile gloved hands, it contaminates the
gloves. The gown at chest level and to 2 inches above the
elbows is considered sterile, as is the drape placed at the
surgical area.
During surgery, a patient has a nursing diagnosis of risk for perioperative positioning injury. What is a common risk
factor for this nursing diagnosis?
a. Skin lesions
b. Break in sterile technique
c. Musculoskeletal deformities
d. Electrical or mechanical equipment failure
ANS
- c. Musculoskeletal deformities can be a risk factor for
positioning injuries and require special padding and
support on the operating table. Skin lesions and break
in sterile technique are risk factors for infection and
electrical or mechanical equipment failure may lead to
other types of injury.
At the end of the surgical procedure, the perioperative nurse evaluates the patient's response to the nursing care
delivered during the perioperative period. What reflects a positive outcome related to the patient's physical status?
a. The patient's right to privacy is maintained.
b. The patient's care is consistent with the perioperative plan of care.
c. The patient receives consistent and comparable care regardless of the setting.
d. The patient's respiratory function is consistent with or improved from baseline levels established preoperatively.
ANS
- d. The Perioperative Nursing Data Set includes outcome
statements that reflect standards and recommended
practices of perioperative nursing. Outcomes related
to physiologic responses include those of physiologic
function, such as respiratory function; perioperative safety
includes the patient's freedom from any type of injury;
and behavioral responses include knowledge and actions
of the patient and family, including the consistency of the
patient's care with the perioperative plan and the patient's
right to privacy.
Which short-acting barbiturates are most commonly used for induction of general anesthesia (select all that apply)?
a. Nitrous oxide
b. Propofol (Diprivan)
c. Isoflurane (Florane)
d. Thiopental sodium (Pentothal)
e. Sodium methohexital (Brevital)
ANS
- d, e. Nitrous oxide is a weak gaseous anesthetic. Propofol
(Diprivan) is a nonbarbiturate hypnotic that has a rapid onset
and may be used for induction. Isoflurane (Forane) is a
volatile liquid inhalation agent.
Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the
patient will need early in the anesthesia recovery period?
a. Warm blankets
b. Analgesic medication
c. Observation for respiratory depression
d. Airway protection in anticipation of vomiting
ANS
- b. The volatile liquid inhalation agents have very little
residual analgesia and patients experience early onset of
pain when the agents are discontinued. These agents are
associated with a low incidence of nausea and vomiting.
Prolonged respiratory depression is not common because of
their rapid elimination. Hypothermia is not related to use of
these agents but they may precipitate malignant hyperthermia
in conjunction with neuromuscular blocking agents.
What is the primary advantage of the use of midazolam (Versed) as an adjunct to general anesthesia?
a. Amnestic effect
b. Analgesic effect
c. Prolonged action
d. Antiemetic effect
ANS
- a. Midazolam (Versed) is a rapid, short-acting, sedativehypnotic
benzodiazepine that is used to prevent recall of
events under anesthesia because of its amnestic properties
Identify the rationale for the use of each of the following drugs during surgery and one nursing implication indicated
in the care of the patient immediately postoperatively related to the drug.
MED SURG B
A nurse is providing teaching to a client who has a new prescription for psyllium. Which of the following information should the nurse include in the teaching?
ANS
- Drink 240 mL (8 oz) of water after administration
A nurse is caring for a client who has DKA. Which of the following findings should indicate to the nurse that the client's condition is improving?
ANS
- Glucose 272 mg/dL
A nurse is admitting a client who has active TB. Which of the following types of transmission precautions should the nurse initiate?
ANS
- Airborne
A nurse is providing teaching to a client who has asthma about the use of a metered-dose inhaler. The nurse should identify that which of the following client actions indicates an understanding of the teaching?
ANS
- Holding breath for 10 secs after inhaling
A nurse is assessing a client who is at risk for the development of pernicious anemia resulting from peptic ulcer disease. Which of the following images depicts a condition caused by pernicious anemia?
ANS
- image of a smooth red tongue
A nurse on a medsurg unit is reviewing the medical record of an older adult client who is receiving IV fluid therapy. Which of the following client information should indicate to the nurse that the client requires re-evaluation of the IV therapy prescription?
ANS
- BUN
A nurse is assessing a client following the completion of hemodialysis. Which of the following findings is the nurse's priority to report to the provider?
ANS
- Restlessness
A nurse is receiving report on a client who is postop following an open repair of Zenker's diverticulum. The nurse should anticipate the surgical incision to be in which of the following locations?
ANS
- A
A nurse is teaching a group of newly licensed nurses about pain management for older adult clients. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching?
ANS
- Ibuprofen can cause gastrointestinal bleeding in older adult clients
A nurse is planning a health promotional presentation for a group of African American clients at a community center. Which of the following disorders presents the greatest risk to this group?
ANS
- Hypertension
A nurse is preparing to administer phenytoin 600 mg PO daily to a client. The amount available is oral solution 125 mg/5mL. how many mL should the nurse administer?
ANS
- 24 mL
A nurse is checking the ECG rhythm strip for a client who has temporary pacemaker. The nurse notes a pacemaker artifact followed by a QRS complex. Which of the following actions should the nurse take?
ANS
- Document that depolarization has occurred
A nurse is providing discharge instructions to a client who has active TB. Which of the following information should the nurse include in the instructions?
ANS
- Sputum specimens are necessary every 2 to 4 weeks until there are 3 negative cultures
A nurse is providing preop teaching for a client who is scheduled for a mastectomy. Which of the following statements should the nurse make?
ANS
- I will refer you to community resources that can provide support
A nurse is assessing a client who is postop following a TURP and notes clots in the clients indwelling urinary catheter and a decrease in urinary output. Which of the following actions should the nurse take?
ANS
- Irrigate the indwelling urinary catheter
A nurse is assessing a client who has peripheral arterial disease. Which of the following findings should the nurse expect?
ANS
- Hair loss on the lower legs
A nurse is planning discharge teaching for a client who has an external fixation device for a fracture of the lower extremity. Which of the following instructions should the nurse include in the plan of care?
ANS
- Use crutches with rubber tips
A nurse is reviewing the lab results of a client who has aplastic anemia. Which of the following findings indicates a potential complication?
ANS
- WBC count 2,000/mm
A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect?
ANS
- constipation
A nurse is caring for a client who is receiving TPN and is NPO. When reviewing the chart, the nurse notes the following prescription: capillary blood glucose AC and HS. Which of the following acions should the nurse take?
ANS
- Contact the provider to clarify the prescription
A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain?
ANS
- Alternate application of heat and cold to the affected joints
A nurse is caring for a client who is 8 hr postop following a total hip arthroplasty. The client is unable to void on the bedpan. Which of the following actions should the nurse take first?
ANS
- Scan the bladder with a portable ultrasound [Show Less]