HESI RN
HESI Medical Surgical Practice Exam
1. In a patient with deep vein thrombosis (DVT), which of the following symptoms would be expected?
- A. Chest pain.
- B. Shortness of breath.
- C. Coughing up blood.
- D. Cyanosis.
Correct answer: B
Rationale: Shortness of breath is a common symptom of deep vein thrombosis (DVT) due to the risk of a pulmonary embolism. DVT occurs when a blood clot forms in a deep vein, usually in the legs. If a portion of the clot breaks loose and travels to the lungs, it can cause a pulmonary embolism, leading to symptoms like shortness of breath. Chest pain is more commonly associated with conditions like a heart attack or pulmonary embolism itself. Coughing up blood is a symptom more indicative of conditions such as pulmonary embolism or lung cancer. Cyanosis, which is a bluish discoloration of the skin or mucous membranes due to poor oxygenation, can be seen in severe cases of pulmonary embolism but is not a typical symptom of DVT.
2. The nurse is collecting information from a client with chronic pancreatitis who reports persistent gnawing abdominal pain. To help the client manage the pain, which assessment data is most important for the nurse to obtain?
- A. Presence and activity of bowel sounds
- B. Color and consistency of feces
- C. Eating patterns and dietary intake
- D. Level and amount of physical activity
Correct answer: C
Rationale: In chronic pancreatitis, managing abdominal pain is crucial, and assessing the client's eating patterns and dietary intake is essential. Dietary modifications can help alleviate symptoms and reduce the workload on the pancreas. Choices A, B, and D are not directly related to pain management in chronic pancreatitis. Bowel sounds, fecal characteristics, and physical activity may provide important information in other conditions but are not the priority in this scenario.
3. A client has just regained bowel sounds after undergoing surgery. The physician has prescribed a clear liquid diet for the client. Which of the following items should the nurse ensure is available in the client’s room before allowing the client to drink?
- A. Straw
- B. Napkin
- C. Oxygen saturation monitor
- D. Suction equipment
Correct answer: D
Rationale: After surgery, when a client has just regained bowel sounds and is prescribed a clear liquid diet, the nurse needs to consider the possibility of impaired swallow reflexes due to anesthesia effects, leading to an increased risk of aspiration. Despite checking the gag and swallow reflexes before offering fluids, having suction equipment readily available in the client's room is essential to manage any potential aspiration risk. Therefore, the correct answer is suction equipment (choice D). Choices A, B, and C are incorrect because while a straw, napkin, and oxygen saturation monitor may be useful in other situations, they are not directly related to managing the risk of aspiration associated with offering fluids to a client post-surgery.
4. After teaching a client with renal cancer who is prescribed temsirolimus (Torisel), the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?
- A. I will take this medication with food and plenty of water.
- B. I shall keep my appointment at the infusion center each week.
- C. I’ll limit my intake of green leafy vegetables while on this medication.
- D. I must not take this medication if I have an infection or am feeling ill.
Correct answer: B
Rationale: The correct answer is B. Temsirolimus, also known as Torisel, is administered as a weekly intravenous infusion. This medication blocks protein needed for cell division, inhibiting cell cycle progression. It is not taken orally, so there is no need to take it with food or water. Keeping the weekly infusion center appointment is crucial for the client to receive the prescribed treatment effectively. Choice A is incorrect as temsirolimus is not taken with food or water. Choice C is incorrect because there is no need to limit the intake of green leafy vegetables while on this medication. Choice D is incorrect as having an infection or feeling ill does not prohibit the use of temsirolimus.
5. The nurse is caring for a client with chronic renal failure who is on a low-potassium diet. Which of the following foods should the client avoid?
- A. Bananas
- B. Potatoes
- C. Rice
- D. Apples
Correct answer: A
Rationale: Bananas are high in potassium content, which can lead to hyperkalemia in clients with chronic renal failure who are on a low-potassium diet. Therefore, it is crucial for these clients to avoid bananas. Potatoes, rice, and apples are lower in potassium compared to bananas and are generally considered safe for consumption in clients with chronic renal failure on a low-potassium diet.
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