HESI MED SURG III FINAL EXAM 2023 STUDY BUNDLE PACK SOLUTION (Verified Answers)

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HESI Med Surg III Exam Questions and Answers 2023
(Verified Answers)

1. List four common symptoms of pneumonia the nurse might note on physical examination: – Tachypnea, shallow respirations with use of accessory muscles- abrupt onset of fever with shaking and chills (not reliable in older adults)

• productive cough with pleuritic pain
• rapid, bounding pulse

1. State four nursing interventions for assisting the client to cough productively: – deep breathing q2 hours (may use incentive spirometer)

• use humidity to loosen secretions (may be used with O2)
• suctioning the airway if necessary, also helps with coughing
• chest physiotherapy
  -increase fluids to 3L/day

1. What symptoms of pneumonia might the nurse expect to see in an older
   client?: – confusion

• lethargy/malaise
• anorexia
• rapid respiratory rate
• tachycardia

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4. How does the nurse prevent hypoxia when suctioning?: oxygenate with 100%O2 for 1-2 minutes before and after suctioning
5. During mechanical ventilation, what are three major nursing interventions?-: – verify that the alarms are on

• maintain settings, and check often to ensure that they are specifically set as
  prescribed by the HCP
• verify functioning of ventilator at least q4 hours
  -keep airway clear by coughing and suctioning

4. When examining a client with emphysema, what physical findings is the
   nurse most likely to see?: – bronchospasm and dyspnea

• change in breathing pattern
• over inflation of lungs… barrel chest
• generalized cyanosis
• either dry or productive cough
• higher CO2 than average
• low O2, usually between 90-92%
• decreased breath sounds
• coarse crackles in lungs that tend to disappear after coughing
• orthopnea
• poor nutrition, weight loss
• activity intolerance
  -anxiety from not being able to breath

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7. What is the most common risk factor associated with lung cancer?: cigarettesmoking/marijuana
8. describe why preop care is important for a pt going for a laryngectomy: –
   involve family and client in manipulation of trach equipment before surgery

• plan acceptable communication methods
• refer to speech pathologist
• discuss rehab program

7. List 5 nursing interventions after chest tube insertion.: – keep all tubing
   loosely coiled below chest level, ensure connections are tight and taped

• keep water seal and suction control at appropriate levels
• monitor fluid drainage and mark times of measurement and the fluid level
• observe for bubbling in water seal chamber
• monitor clients clinical status
• check position of chest drainage system
• encourage client to deep breath periodically
• do not empty collection chamber container of chest tube, replace whole unit whenfull
• do not strip or milk chest tubes
• chest tubes are not clamped, if drainage system breaks, place distal end of tube
  in sterile water as an emergency water seal
• maintain dry occlusive dressing
  

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HESI Med Surg III Study Guide Questions and Answers
2023 (Verified Answers)

1. How much of our body weight consists of fluid?: 60%
2. What affects Body fluids?: age, percent of body fat, gender
3. Intracellular fluid: in the cell
4. Extracellular Fluid: out of the cell
5. What is Extracellular fluid made up of?: Intravascular
   Interstitial
   Transcellula

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6. What are the active chemicals used in electrolyte basics?: Cations (+) and
   Anions (-)
7. What are major Cations?: potassium
   sodium
   calcium
   magnesium
   hydrogen
8. What are major Anions?: phosphate
   chloride
   Bicarbonate
9. When someone gets a lab test drawn to see their electrolyte status what isit usually drawn on?
   a-ICF
   b- creatinine
   c- BUN
   d- ECF: d- ECF

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10. How do Solutes Move?: diffusion and active transport
11. what is diffusion?: solutes move from higher to lower concentration
12. what is active transport?: solutes move from low to high concentrations with
    assistance from something like the sodium-potassium pump
    (this requires energy)
13. How does fluid move?: Osmosis
    Capillary filtration
14. How does Osmosis work?: movement of fluid from a lower solute concentration to an area of high solute concentration
15. How does Capillary Filtration work?: site of exchange is at capillaries
16. what is third spacing?: volume in capillary space goes into tissue
17. When would Capillary Filtration occur?: people with HTN, urinary retention,
    liver failure, edema
18. Osmolarity: concentration of particle/solutes per LITER of solution
19. Osmolality: concentration of particles/solutes per KILOGRAM
20. Tonicity: osmolality of a solution in relation to normal plasma

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21. How is Fluid Balance Regulated?: Kidneys
    Thirst Mechanism
    Anti-Diuretic Hormone
    Renin- Angiotensin Aldosterone System
    Natriuritc Peptide
22. How do Kidneys help with regulation?: filters 170 liters of plasma a day
    excrete 1.5 liters of urine a day
    regulates ECF
    regulates electrolyte and acid-base balances
    excretes toxic waste products
23. How does the Thirst Mechanism work?: this is a sign of dehydration
24. Purpose of ADH: stops diuresis and urination
    causes kidneys to retain volume and water
    urinary output decreased
    reduce serum osmolality
    more volume less solute
25. Renin Angiotensin Aldosterone System: -helps to urinate
    -renin is released when there is a decrease renal perfusion
    -activated angiotensin 1 which is a vasoconstrictor
    
27. Hesi Med Surg III Final Exam 2023 Study Exam

1. A 79 year old patient has been admitted with BPH. What is most
   appropri- ate to include in the nursing plan of care
   a. Limit fluid intake to no more than 1000 ml/day
   b. Leave a light on in the bathroom during the night
   c. Ask the patient to use a urinal so that urine can be measured
   d. Pad the patients bed to accommodate overflow incontinence✔✔ B
   The patient’s age and diagnosis indicate a likelihood of nocturia, so
   leaving the light on in the bathroom is appropriate. Fluids should be
   encouraged because dehydration is more common in older patients.
   The information in the question does not indicate that measurement of
   the patient’s output is necessary or that the patient has overflow
   incontinence.
2. A female patient with a suspected UTI is to provide a clean catch
   urine specimen for culture and sensitivity testing. To obtain the
   specimen, the nurse will
   a. Have the patient empty the bladder completely, then obtain the next
   urine specimen that the patient is able to void
   b.Teach the patient to clean the urethral area, void a small amount into
   the toilet, and then void into a sterile specimen cup
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c. Insert a short sterile mini catheter attached to a collecting container into
the urethra and bladder to obtain the specimen
d. Clean the area around the meatus with a povidine-iodine (betadine)
swab and then have the patient void into a sterile container✔✔ B
This answer describes the technique for obtaining a clean-catch
specimen. The answer beginning, “insert a short, small, ‘mini’ catheter
attached to a collecting container” describes a technique that would
result in a sterile specimen, but a health care provider’s order for a
catheterized specimen would be required. Using Betadine before
obtaining the specimen is not necessary, and might result in
suppressing the growth of some bacteria. The technique described in
the answer beginning “have the patient empty the bladder
completely” would not result in a sterile specimen.

3. Which statement made by a patient who had a cystoscopy the
   previous day should be reported immediately to the HCP?
   a. My urine looks pink
   b. My IV site is bruised
   c. My sleep was restless
   d. My temperature is 101✔✔ D
   The patient’s elevated temperature may indicate a bladder
   infection, a possible complication of cystoscopy. The health care
   provider should be notified so that
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5. antibiotic therapy can be started. Pink-tinged urine is expected after a
6. cystoscopy. The insomnia and bruising should be discussed further
7. with the patient but do not indicate a need to notify the health care
8. provider.

4. To determine possible causes, the nurse will ask a patient admitted
   with acute glomerulonephritis about
   a. Recent bladder infection
   b. History of kidney stones
   c. Recent sore throat and fever
   d. History of high blood pres✔✔ B
   Acute glomerulonephritis frequently occurs after a streptococcal
   infection such as strep throat. It is not caused by kidney stones,
   hypertension, or urinary tract infection (UTI).
5. The nurse will anticipate teaching a patient with nephrotic syndrome
   who develops flank pain about treatment with
   a. Antibiotics
   b. Antifungals
   c. Anticoagulants
   d. Antihypertensive✔✔ C
   Flank pain in a patient with nephrotic syndrome suggests a renal vein
   thrombosis, and anticoagulation is needed. Antibiotics are used to
   treat a patient with flank pain caused by pyelonephritis. Fungal
   pyelonephritis is uncommon and is treated with antifungals.
   Antihypertensives are used if the patient has high blood pressure
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6. The nurse will plan to teach a 27 year old woman who smokes two
   packs a day about the risk for
   a. Kidney stones
   b. Bladder cancer
   c. Bladder infection
   d. Interstitial cystitis✔✔ B
   Cigarette smoking is a risk factor for bladder cancer. The patient’s
   risk for devel- oping interstitial cystitis, urinary tract infection (UTI),
   or kidney stones will not be reduced by quitting smoking.
7. Following rectal surgery, a patient voids about 50 mL of urine every 30-
   60 minutes for the first 4 hours. Which nursing intervention is most
   appropriate?
   a. Monitor the patients intake and output overnight
   b. Have the patient drink small amounts of fluid frequently
   c. Use an ultrasound scanner to check the postvoid residual volume
   d. Reassure the patient that this is normal after anesthesia for rectal surgery✔✔ C
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HESI Med Surg III Review

1. increasing temperature has what effect on the body’s metabolism?
   what can fever cause✔✔ increasing temp increases the body’s demand
   for nutri- ents and oxygen…
   fever can cause dehydration r/t excessive fluid loss d/t diaphoresis
   2.why is hydration important w/ PNA✔✔ thins out mucus trapped in
   bronchi- oles/alveoli–facilitates expectoration
   replacement of fluid lost by lungs through evaporation
   3.early s/s of cerebral hypoxia✔✔ irritability and restlessness
   4.preventing PNA: flu shot/pneumovax
   vaccine avoid sick people, indoor
   pollutants, no smoking adequate
   nutrition/fluids
   if comatose–elevate HOB when before and after feeding, turn pt
   frequently
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5. As COPD worsens, what happens to a patient’s O2/CO2 levels in
   their blood and what is the condition that results?
   is this more of a problem for emphysema or chronic bronchitis✔✔ as
   COPD worsens, hypoxemia and hypercapnia result–leading to
   respiratory acidosis
   emphysema leads more toward hypercapnia bc the alveoli are effected
   6.what bed position facilitates productive cough✔✔ semi-fowler or highfowler
   7.Emphysema vs. Chronic Bronchitis: CB: airway problem (chronically
   in- flamed)—chronic sputum production, increased bronchial wall
   thickness–obstruc- tion of airflow, chronic hypoxemia, cor pulmonale
   (s/s RSHF)
   —>blue bloater, cyanosis, RSHF—JVD, crackles/expiratory wheezes
   Emphysema–alveoli problem–air trapping, compensatory
   hyperventilation–barrel chest
   –>pink puffer–pursed lip breathers, diminished breath sounds
   8.tx for COPD: mucolytics
   bronchodilators (SABA/LABA–theophylline, albuterol,
   ipratropium) anti-inflammatory drugs (fluticasone)
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7. tripod position, pursed-lip breathing, diaphragmatic breathing
8. low FIO2 to prevent CO2
9. retention monitor for s/s of
10. fluid overload
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2023 HESI Med Surg III Final Exam

1. Diagnostic testing has revealed that a patient’s hepatocellular
   carcinoma (HCC) is limited to one lobe. The nurse should anticipate that
   this patient’s plan of care will focus on what intervention?
   a) Lobectomy
   b) Liver transplantation
   c) Cryosurgery
   d) Laser hyperthermia✔✔ a) Lobectomy
2. The nurse and physician are viewing a brain scan, which indicates
   bleed- ing at the point of impact to the skull and edema on the opposite
   side. The client is sleeping but can be aroused. The client has no memory
   of accident. The nurse provides all details to the next shift and is most
   accurate to report which type of injury?
   a) Coup injury
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b) Contusion
c) Contrecoup injury
d) Head injury✔✔ c) Contrecoup injury

3. A client has undergone enucleation. What complication of
   enucleation should be addressed by the nurse?
   a) Hemorrhage
   b) Pneumonia
   c) Hypotension
   d) Nausea and vomiting✔✔ a) Hemorrhage
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4. When caring for a client who is post intracranial surgery what is the
   most important parameter to monitor?
   a) Signs of infection
   b) Intake and output
   c) Nutritional status
   d) Body temperature✔✔ d) Body temperature
5. A client is diagnosed with keratitis. What advice should the nurse give
   this client?
   a) Use dark glasses.
   b) Frequently wash the face and hair.
   c) Use warm soaks frequently.
   d) Massage the surrounding area.✔✔ a) Use dark glasses.
6. A client is diagnosed with blepharitis. What symptoms should a
   nurse monitor in this client?
   a) Patchy flakes clinging to the eyelashes
   b) Redness
   c) A red pustule in the internal tissue of the eyelid
   d) A halo around the pupil✔✔ a) Patchy flakes clinging to the eyelashes
7. While cleaning gutters, a client reports getting debris in the eyes. On
   inspection, no obvious foreign object is noted. Which of the following
   diag- nostic evaluation techniques would be most beneficial for this
   client?
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a) Administer fluorescein dye.
b) Obtain an x-ray for orbital fractures.
c) Assess intraocular movements.
d) Assess with tonometer.✔✔ a) Administer fluorescein dye.

8. The nurse is caring for a client who is scheduled for surgery to relieve
   pressure on a compressed nerve. The compression does not involve the
   spinal cord. What kind of spinal nerve root compression does the nurse
   know this is?
   a) Extramedullary
   b) Intramedullary
   c) Spinal
   d) Peripheral✔✔ a) Extramedullary
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