HESI Exit Practice Questions and Rationale (2)well
detailed answers/already graded A+
The nurse has completed giving discharge instructions to a client who has had a total joint
replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the
client understands the instructions if the client makes which statement?
1."Changes in the shape of the knee are expected." 2."Fever,
redness, and increased pain are expected."
3."All caregivers should be told about the metal implant." 4."Bleeding gums or
black stools may occur, but this is normal.": 3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of
the presence of the metal implant because certain tests and procedures will need to be avoided.
After total knee replacement, the client should report signs and symptoms of infection and any
changes in the shape of the knee. These could indicate developing complications. With a metal
implant, the client may be on anticoagulant therapy and should report adverse effects of this
therapy, including bleeding from a variety of sources, and the client will need antibiotic prophylaxis
for invasive procedures.
2. The nurse is caring for a client after the application of a plaster cast for a fractured left
radius. The nurse should suspect impairment with the neurovas- cular status of the client's
casted extremity if which findings are noted? Select all that apply.
98
,1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3. Client report of severe, deep, unrelenting pain
4. Client report of pain as nurse assesses finger movement
5. Client report of numbness and tingling sensation in the fingers: 3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent dam- age to nerve and
muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and muscle
damage may result in permanent contractures, deformity of the extremity, and functional
impairment. Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse indicate
adequate blood flow; swelling is expected after a fracture. Client report of severe, deep, unrelenting
pain; client report of numbness and tingling sensation; and client report of pain as the nurse
assesses finger movement are indicative of development of compartment syndrome.
3.A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which
are interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
98
,4.Muscle relaxers 5.Intermittent
traction: 2, 3, 4, 5
Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm
in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours
(depending on the health care provider's preference) after an injury. Application of ice to the spine of
a client could be uncomfortable and could result in feelings of being chilled.
4.The nurse is caring for a client who had surgery to repair a fractured
left-sided hip using a posterior approach. In implementing hip precautions, which action
should the nurse teach the client to avoid?
1. Crossing legs at the ankle
2. Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs
abducted from the midline: 1
Following surgery to repair a fractured hip using a posterior approach, client educa- tion should
include the following: avoiding crossing the legs at the ankle or the knee, using an elevated toilet
seat, placing a pillow between the legs while lying down for the first 6 weeks, keeping the legs
abducted from the midline, and keeping the hip in a neutral position at all times.
5.An older client is diagnosed with osteoporosis. The nurse teaches the client about self-
care measures, knowing that the client is most at risk for which problem as a result of this
disorder of the bones?
98
, 1.Anemia
2.Fractures
3.Infection
4.Muscle sprains: 2
The client is most at risk for fractures as a result of osteoporosis. Although other complications can
occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow disorders,
and muscle sprains are unrelated to osteoporo- sis.
6.A client with a new medication prescription for allopurinol asks the nurse, "I know this is
for gout, but how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production. 2.Allopurinol
reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Al- lopurinol
prevents influx of calcium ions during cell depolarization.: 1 Allopurinol is classified as an
antigout medication. It decreases uric acid production by inhibiting the xanthine oxidase enzyme,
and it reduces uric acid concentrations in both serum and urine. The other options are incorrect.
98
detailed answers/already graded A+
The nurse has completed giving discharge instructions to a client who has had a total joint
replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the
client understands the instructions if the client makes which statement?
1."Changes in the shape of the knee are expected." 2."Fever,
redness, and increased pain are expected."
3."All caregivers should be told about the metal implant." 4."Bleeding gums or
black stools may occur, but this is normal.": 3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of
the presence of the metal implant because certain tests and procedures will need to be avoided.
After total knee replacement, the client should report signs and symptoms of infection and any
changes in the shape of the knee. These could indicate developing complications. With a metal
implant, the client may be on anticoagulant therapy and should report adverse effects of this
therapy, including bleeding from a variety of sources, and the client will need antibiotic prophylaxis
for invasive procedures.
2. The nurse is caring for a client after the application of a plaster cast for a fractured left
radius. The nurse should suspect impairment with the neurovas- cular status of the client's
casted extremity if which findings are noted? Select all that apply.
98
,1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3. Client report of severe, deep, unrelenting pain
4. Client report of pain as nurse assesses finger movement
5. Client report of numbness and tingling sensation in the fingers: 3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent dam- age to nerve and
muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and muscle
damage may result in permanent contractures, deformity of the extremity, and functional
impairment. Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse indicate
adequate blood flow; swelling is expected after a fracture. Client report of severe, deep, unrelenting
pain; client report of numbness and tingling sensation; and client report of pain as the nurse
assesses finger movement are indicative of development of compartment syndrome.
3.A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which
are interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
98
,4.Muscle relaxers 5.Intermittent
traction: 2, 3, 4, 5
Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm
in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours
(depending on the health care provider's preference) after an injury. Application of ice to the spine of
a client could be uncomfortable and could result in feelings of being chilled.
4.The nurse is caring for a client who had surgery to repair a fractured
left-sided hip using a posterior approach. In implementing hip precautions, which action
should the nurse teach the client to avoid?
1. Crossing legs at the ankle
2. Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs
abducted from the midline: 1
Following surgery to repair a fractured hip using a posterior approach, client educa- tion should
include the following: avoiding crossing the legs at the ankle or the knee, using an elevated toilet
seat, placing a pillow between the legs while lying down for the first 6 weeks, keeping the legs
abducted from the midline, and keeping the hip in a neutral position at all times.
5.An older client is diagnosed with osteoporosis. The nurse teaches the client about self-
care measures, knowing that the client is most at risk for which problem as a result of this
disorder of the bones?
98
, 1.Anemia
2.Fractures
3.Infection
4.Muscle sprains: 2
The client is most at risk for fractures as a result of osteoporosis. Although other complications can
occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow disorders,
and muscle sprains are unrelated to osteoporo- sis.
6.A client with a new medication prescription for allopurinol asks the nurse, "I know this is
for gout, but how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production. 2.Allopurinol
reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Al- lopurinol
prevents influx of calcium ions during cell depolarization.: 1 Allopurinol is classified as an
antigout medication. It decreases uric acid production by inhibiting the xanthine oxidase enzyme,
and it reduces uric acid concentrations in both serum and urine. The other options are incorrect.
98
