HESI RN MEDICAL SURGICAL EXAM PACK QUESTIONS AND ANSWERS

HESI RN MEDICAL SURGICAL EXAM PACK QUESTIONS AND ANSWERS

1. An ER nurse is completing an assessment on a patient that is alert but struggles to answer questions. When she attempts to talk, she slurs her speech and
appears very frightened. What additional clinical manifestation does the nurse
expect to find if nacy's sysmptoms have
been caused by a brain attack (stroke)?
A. A carotid bruit
B. A hypotensive blood pressure
C. hyperreflexic deep tendon relexes.
D. Decreased bowel sounds
A) A carotid bruit.
Rationale: the carotid artery
(artery to the brain) is narrowed
in clients with a brain attack.
A bruit is an abnormal sound
heard on auscultation resulting
from interference with normal
blood flow. Usually the blood
pressure is hypertensive. Initially flaccid paralysis occurs,
resulting in hyporefkexic deep
tendon reflexes. Bowel sounds
are not indicative of a brain attack.
2. Which clinical manifestation further supports an assessment of a left-sided brain
attack?
A) Visual field deficit on the left side.
B) Spatial-perceptual deficits.
C) Paresthesia of the left side.
D) Global aphasia.
D) Global aphasia.
D) Global aphasia.
Rationale: Global aphasia
refers to difficulty speaking, listening, and understanding, as
well as difficulty reading and
writing. Symptoms vary from
person to person. Aphasia may
occur secondary to any brain
injury involving the left hemisphere. Visual field deficits,
spatial-perceptual deficits, and
paresthsia of the left side usually occur with right-sided brain
attack.
3. When preparing a patient for a noncontrast computed tomography (CT) scan
STAT, what nursing intervention should
the nurse implement?
A) Determine if the client has any allergies to iodine
B) Explain that the client will
not be able to move her head
throughout the CT scan.
Rationale: Because head motion will distort the images,
Nancy will have to remain still