Medical-Surgical HESI Practice
A client is admitted to the medical intensive care unit with a diagnosis of myocardial infarction.
The client's history indicates the infarction occurred ten hours ago. Which laboratory test result
would the nurse expect this client to exhibit?
A. Elevated LDH
B. Elevated serum amylase
C. Elevated CK-MB
D. Elevated hematocrit - ANS C. Elevated CK-MB
Rationale:
The cardiac isoenzyme CK-MB (C) is the one of the cardiac markers to indicate myocardial
damage in the presence of MI symptoms and after a positive troponin. The troponin levels will
elevate within 2-3 hours indicating myocardial ischemia, followed by the CK-MB cardiac markers
within 6-9 hours, peaking within 12 to 20 hours after myocardial infarction (MI).
A client has a staging procedure for cancer of the breast and ask the nurse which type of breast
cancer has the poorest prognosis. Which information should the nurse offer the client?
A. Stage II
B. Invasive infiltrating ductal carcinoma
C. T1N0M0
D. Inflammatory with peau d'orange - ANS D. Inflammatory with peau d'orange
Rationale:
Inflammatory breast cancer onset is very rapid and a very rare form of breast cancer and is
considered the most aggressive form of breast malignancies. It is often mistaken for a breast
infection because it has a thickened appearance like an orange peel (peau d'orange), causing
the breast to become swollen and tender.
A middle-aged male client with diabetes continues to eat an abundance of foods that are high in
sugar and fat. According to the Health Belief Model, which event is most likely to increase the
client's willingness to become compliant with the prescribed diet?
A. He visits his diabetic brother who just had surgery to amputate an infected foot
B. He is provided with the most current information about the dangers of untreated diabetes
C. He comments on the community service announcements about preventing complications
associated with diabetes
D. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet -
ANS A. He visits his diabetic brother who just had surgery to amputate an infected foot
Rationale:
The loss of a limb due to diabetes by a family member should be the strongest event or "cue to
action" and is most likely to increase the client's perceived seriousness of the disease.
, A client is admitted for further testing to confirm sarcoidosis. Which diagnostic test provides
definitive information that the nurse should report to the healthcare provider?
A. Lung tissue biopsy
B. Positive blood cultures
C. Magnetic resonance imaging (MRI)
D. Computerized tomography (CT) of the thorax - ANS A. Lung tissue biopsy
Rationale:
Sarcoidosis is an inflammatory condition that is characterized by the formation of widespread
granulomatous lesions involving a pulmonary primary site. Although chest radiography identifies
sarcoidosis, lung tissue biopsy obtained by bronchoscopy or bronchoalveolar lavage provides
definitive confirmation.
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action
should the nurse implement?
A. Position the head of the bed (HOB) flat
B. Withhold intravenous fluids
C. Administer a bolus of IV fluids
D. Give an antihypertensive medication - ANS D. Give an antihypertensive medication
Rationale:
Most ischemic strokes occur during sleep when baseline blood pressure declines or blood
viscosity increases due to minimal fluid intake. Completed strokes usually produce neurologic
deficits within an hour, and the client's current elevated blood pressure requires antihypertensive
medication.
An elderly client is admitted with a diagnosis of bacterial pneumonia. The nurse's assessment of
the client will most likely reveal which sign/symptom?
A. Leukocytosis and febrile
B. Polycythemia and crackles
C. Pharyngitis and sputum production
D. Confusion and tachycardia - ANS D. Confusion and tachycardia
Rationale:
The onset of pneumonia in the elderly may be signaled by general deterioration, confusion,
increased heart rate or increased respiratory rate due to the decreased oxygen- carbon dioxide
exchange at the alveoli, known as the V-Q mismatch.
The nurse is working with a 71-year-old obese client with bilateral osteoarthritis (OA) of the hips.
What recommendation should the nurse make that is most beneficial in protecting the client's
joints?
A. Increase the amount of calcium intake in the diet
B. Apply alternating heat and cold therapies
A client is admitted to the medical intensive care unit with a diagnosis of myocardial infarction.
The client's history indicates the infarction occurred ten hours ago. Which laboratory test result
would the nurse expect this client to exhibit?
A. Elevated LDH
B. Elevated serum amylase
C. Elevated CK-MB
D. Elevated hematocrit - ANS C. Elevated CK-MB
Rationale:
The cardiac isoenzyme CK-MB (C) is the one of the cardiac markers to indicate myocardial
damage in the presence of MI symptoms and after a positive troponin. The troponin levels will
elevate within 2-3 hours indicating myocardial ischemia, followed by the CK-MB cardiac markers
within 6-9 hours, peaking within 12 to 20 hours after myocardial infarction (MI).
A client has a staging procedure for cancer of the breast and ask the nurse which type of breast
cancer has the poorest prognosis. Which information should the nurse offer the client?
A. Stage II
B. Invasive infiltrating ductal carcinoma
C. T1N0M0
D. Inflammatory with peau d'orange - ANS D. Inflammatory with peau d'orange
Rationale:
Inflammatory breast cancer onset is very rapid and a very rare form of breast cancer and is
considered the most aggressive form of breast malignancies. It is often mistaken for a breast
infection because it has a thickened appearance like an orange peel (peau d'orange), causing
the breast to become swollen and tender.
A middle-aged male client with diabetes continues to eat an abundance of foods that are high in
sugar and fat. According to the Health Belief Model, which event is most likely to increase the
client's willingness to become compliant with the prescribed diet?
A. He visits his diabetic brother who just had surgery to amputate an infected foot
B. He is provided with the most current information about the dangers of untreated diabetes
C. He comments on the community service announcements about preventing complications
associated with diabetes
D. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet -
ANS A. He visits his diabetic brother who just had surgery to amputate an infected foot
Rationale:
The loss of a limb due to diabetes by a family member should be the strongest event or "cue to
action" and is most likely to increase the client's perceived seriousness of the disease.
, A client is admitted for further testing to confirm sarcoidosis. Which diagnostic test provides
definitive information that the nurse should report to the healthcare provider?
A. Lung tissue biopsy
B. Positive blood cultures
C. Magnetic resonance imaging (MRI)
D. Computerized tomography (CT) of the thorax - ANS A. Lung tissue biopsy
Rationale:
Sarcoidosis is an inflammatory condition that is characterized by the formation of widespread
granulomatous lesions involving a pulmonary primary site. Although chest radiography identifies
sarcoidosis, lung tissue biopsy obtained by bronchoscopy or bronchoalveolar lavage provides
definitive confirmation.
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action
should the nurse implement?
A. Position the head of the bed (HOB) flat
B. Withhold intravenous fluids
C. Administer a bolus of IV fluids
D. Give an antihypertensive medication - ANS D. Give an antihypertensive medication
Rationale:
Most ischemic strokes occur during sleep when baseline blood pressure declines or blood
viscosity increases due to minimal fluid intake. Completed strokes usually produce neurologic
deficits within an hour, and the client's current elevated blood pressure requires antihypertensive
medication.
An elderly client is admitted with a diagnosis of bacterial pneumonia. The nurse's assessment of
the client will most likely reveal which sign/symptom?
A. Leukocytosis and febrile
B. Polycythemia and crackles
C. Pharyngitis and sputum production
D. Confusion and tachycardia - ANS D. Confusion and tachycardia
Rationale:
The onset of pneumonia in the elderly may be signaled by general deterioration, confusion,
increased heart rate or increased respiratory rate due to the decreased oxygen- carbon dioxide
exchange at the alveoli, known as the V-Q mismatch.
The nurse is working with a 71-year-old obese client with bilateral osteoarthritis (OA) of the hips.
What recommendation should the nurse make that is most beneficial in protecting the client's
joints?
A. Increase the amount of calcium intake in the diet
B. Apply alternating heat and cold therapies
