HESI RN Med Surg Exam 3

Extract:

Question 1 of 5

A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable to eat or drink without becoming nauseated and vomiting. Which finding should the nurse report to the healthcare provider?

Correct Answer: Yellow sclera is a sign of jaundice, indicating a significant buildup of bilirubin due to a blocked bile duct, requiring immediate attention.

Rationale:

Question 2 of 5

The nurse is teaching the client about incentive spirometry in the preoperative unit. Which statement regarding incentive spirometry should the nurse include with preoperative teaching?

A. Failure to keep your lungs working may result in pneumonia after surgery which could, in turn, result in death. B. Incentive spirometry is conducted routinely after surgery and will be demonstrated when you return from surgery. C. You will use the incentive spirometer for the first postoperative day until deep breathing and coughing can be done comfortably. D. Deep breathing exercises are encouraged to maintain lung capacity and to strengthen respiratory muscles, which will help prevent complications. G. D

Correct Answer: This statement explains the purpose and benefits of deep breathing exercises, providing a clear rationale for the intervention.

Rationale:

Question 3 of 5

During a home visit, the nurse should evaluate the effectiveness of a client's treatment for chronic obstructive pulmonary disease (COPD) by assessing for which primary symptom?

A. Tachycardia. B. Edem of the ankles. C. Dyspnea. D. Unilateral diminished breath sounds. G. C

Correct Answer: Dyspnea is the primary symptom of COPD, and its reduction indicates effective treatment.

Rationale:

Question 4 of 5

After placing a client who is having a seizure in the side-lying position, which intervention should the nurse implement?

A. Apply soft restraints to all extremities. B. Remove objects that could cause injury. C. Place pillows around the client's head. D. Administer oxygen per nasal cannula. G. B

Correct Answer: Removing objects that could cause injury ensures a safe environment during a seizure.

Rationale:

Question 5 of 5

During the evening shift, a client with Alzheimer's disease becomes agitated, restless, and repeatedly attempts to leave the room unattended. Which intervention should the nurse implement?

A. Take a walk with the client. B. Sit the client in a recliner. C. Administer a sleeping medication. D. Move the client to a locked unit. G. A

Correct Answer: Taking a walk with the client helps reduce agitation and restlessness through physical activity and supervision.

Rationale:

HESI RN Med Surg Exam 3 | Nurselytic

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HESI RN

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