HESI - MEDICAL SURGICAL PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE WITH RATIONALES
A client is admitted to the hospital with a medical diagnosis of pneumococcal
pneumonia. The nurse knows that the prognosis for gram-negative pneumonias
(such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because:
A. They occur in the lower love alveoli which are more sensitive to infection
B. Gram-negative organisms are more resistant to antibiotic therapy
C. They occur in healthy young adults who have recently been debilitated by an
upper respiratory infection.
D. Gram-negative pneumonias usually affect infants and small children. --
CORRECT ANSWER--B. Gram-negative organisms are more resistant to
antibiotic therapy
The gram-negative organisms are resistant to drug therapy which makes
recovery very difficult. Gram-negative pneumonias affect all lobes of the lung.
The mean age for contracting this type of pneumonia is 50 years, and it usually
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,strikes debilitated persons such as alcoholics, diabetics, and those with chronic
lung diseases.
A client is placed on a mechanical ventilator following a cerebral hemorrhage,
and vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed.
What is the priority nursing diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles.
B. High risk for infection related to increased intracranial pressure.
C. Potential for injury related to impaired lung expansion.
D. Social isolation related to inability to communicate. --CORRECT
ANSWER--A. Impaired communication related to paralysis of skeletal muscles.
To increase the client's tolerance of endotracheal intubation and/or mechanical
ventilation, a skeletal-muscle relaxant, such as vecuronium, is usually
prescribed. Impaired communication is a serious outcome because the client
cannot communicate his/her needs due to intubation and diaphragmatic
paralysis caused by the drug. Although this client might also experience, it is
not a priority when compared to A. Infection is not related to increased
intracranial pressure. The mechanical ventilator provides consistent lung
expansion.
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, When preparing a client who has had a total laryngectomy for discharge, what
instruction is most important for the nurse to include in the discharge teaching?
A. Recommend that the client carry suction equipment at all times.
B. Instruct the client to have writing materials with him at all times.
C. Tell the client to carry a medic alert card stating that he is a total neck
breather.
D. Tell the client not to travel alone. --CORRECT ANSWER--C. Tell the client
to carry a medic alert card stating that he is a total neck breather.
It is imperative that total neck breathers carry a medic alert notice so that if they
have a cardiac arrest, mouth-to-neck breathing can be done. Mouth-to-mouth
resuscitation will not help them. They do not need to carry nor refrain from D.
There are many alternative means of communication for clients who have had a
laryngectomy; depending on B is probably the least effective.
The nurse would be correct in withholding a dose of digoxin in a client with
congestive heart failure without specific instruction from the healthcare
provider if the client's:
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QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE WITH RATIONALES
A client is admitted to the hospital with a medical diagnosis of pneumococcal
pneumonia. The nurse knows that the prognosis for gram-negative pneumonias
(such as E. coli, Klebsiella, Pseudomonas, and Proteus) is very poor because:
A. They occur in the lower love alveoli which are more sensitive to infection
B. Gram-negative organisms are more resistant to antibiotic therapy
C. They occur in healthy young adults who have recently been debilitated by an
upper respiratory infection.
D. Gram-negative pneumonias usually affect infants and small children. --
CORRECT ANSWER--B. Gram-negative organisms are more resistant to
antibiotic therapy
The gram-negative organisms are resistant to drug therapy which makes
recovery very difficult. Gram-negative pneumonias affect all lobes of the lung.
The mean age for contracting this type of pneumonia is 50 years, and it usually
Page | 1
,strikes debilitated persons such as alcoholics, diabetics, and those with chronic
lung diseases.
A client is placed on a mechanical ventilator following a cerebral hemorrhage,
and vecuronium bromide (Norcuron) 0.04 mg/kg q12 hours IV is prescribed.
What is the priority nursing diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles.
B. High risk for infection related to increased intracranial pressure.
C. Potential for injury related to impaired lung expansion.
D. Social isolation related to inability to communicate. --CORRECT
ANSWER--A. Impaired communication related to paralysis of skeletal muscles.
To increase the client's tolerance of endotracheal intubation and/or mechanical
ventilation, a skeletal-muscle relaxant, such as vecuronium, is usually
prescribed. Impaired communication is a serious outcome because the client
cannot communicate his/her needs due to intubation and diaphragmatic
paralysis caused by the drug. Although this client might also experience, it is
not a priority when compared to A. Infection is not related to increased
intracranial pressure. The mechanical ventilator provides consistent lung
expansion.
Page | 2
, When preparing a client who has had a total laryngectomy for discharge, what
instruction is most important for the nurse to include in the discharge teaching?
A. Recommend that the client carry suction equipment at all times.
B. Instruct the client to have writing materials with him at all times.
C. Tell the client to carry a medic alert card stating that he is a total neck
breather.
D. Tell the client not to travel alone. --CORRECT ANSWER--C. Tell the client
to carry a medic alert card stating that he is a total neck breather.
It is imperative that total neck breathers carry a medic alert notice so that if they
have a cardiac arrest, mouth-to-neck breathing can be done. Mouth-to-mouth
resuscitation will not help them. They do not need to carry nor refrain from D.
There are many alternative means of communication for clients who have had a
laryngectomy; depending on B is probably the least effective.
The nurse would be correct in withholding a dose of digoxin in a client with
congestive heart failure without specific instruction from the healthcare
provider if the client's:
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