HESI MS HESI Medical and Surgical Exam - Set 3 - Part 1

Correct Answer: Peppermint, chocolate, and fried foods

Peppermint and chocolate relax the lower esophageal sphincter, and fried high-fat foods delay gastric emptying and increase reflux episodes. Together these are the primary dietary triggers the GERD client must eliminate. Option b is incorrect because brown rice and steamed vegetables are bland, low-fat foods that do not affect lower esophageal sphincter tone. These foods are well tolerated by most clients with GERD and are not triggers. Option c is incorrect because chamomile tea is a mild, non-caffeinated herbal beverage that does not relax the lower esophageal sphincter. Unlike coffee and regular tea, chamomile has no identified role in GERD pathophysiology. Option d is incorrect because lean protein sources and whole-grain bread have low fat content and do not delay gastric emptying or reduce sphincter tone. These foods are appropriate components of a GERD-friendly diet.

Correct Answer: Murphy sign

Murphy sign is positive when right upper quadrant palpation during inspiration causes pain severe enough to stop the breath. It indicates cholecystitis, as the inflamed gallbladder descends onto the examiner's fingers during inhalation. Option a is incorrect because rebound tenderness is elicited by pressing deeply into the abdomen and quickly releasing, causing pain on release. It indicates peritoneal irritation and is assessed differently from the inspiratory maneuver described. Option b is incorrect because Cullen sign refers to periumbilical ecchymosis caused by retroperitoneal hemorrhage, visible in severe pancreatitis. It is a visual finding, not a response to palpation during inspiration. Option d is incorrect because McBurney point tenderness describes localized pain two-thirds from the umbilicus to the right anterior superior iliac spine, the hallmark assessment for appendicitis — a different organ in a different quadrant.

Correct Answer: Arrange transportation home before the procedure appointment

EGD requires moderate sedation, which renders the client unable to drive safely for several hours after the procedure. Confirming a responsible adult driver is arranged before discharge is the highest priority safety instruction the nurse must reinforce the evening before. Option a is incorrect because clothing comfort is a minor convenience with no patient safety consequence. Advising loose clothing does not prevent harm; lacking transportation after sedation does. Option c is incorrect because taking medications with a full glass of water violates the NPO restriction required for safe EGD sedation. However, NPO instructions are typically given at scheduling — transportation planning is the gap most likely missed on the evening before discharge. Option d is incorrect because eating breakfast on the morning of the procedure directly violates NPO requirements and would cause cancellation or aspiration risk. The nurse must explicitly contradict this misconception, but transportation — th

Correct Answer: Early dumping syndrome

Early dumping syndrome occurs within fifteen to thirty minutes of eating after gastrectomy. Rapid gastric emptying of hyperosmolar contents draws fluid into the intestinal lumen from the vascular space, producing the vasomotor symptoms of flushing, dizziness, and cramping. Option b is incorrect because anastomotic stricture causes progressive dysphagia or difficulty with food passing, not episodic vasomotor symptoms tied to meal timing. Stricture symptoms present as obstruction rather than postprandial flushing and cramping. Option c is incorrect because afferent loop syndrome is caused by kinking or obstruction of the afferent limb after Billroth II procedures, producing postprandial epigastric pain relieved by bilious vomiting — a different clinical pattern from the vasomotor symptoms described. Option d is incorrect because alkaline reflux gastritis produces persistent epigastric burning and nausea from bile entering the gastric remnant. It lacks the characteristic vasomotor flushin

Correct Answer: It protects the stomach lining from NSAID-induced damage

Misoprostol is a synthetic prostaglandin E1 analogue that replaces the prostaglandins NSAIDs suppress. It stimulates mucus and bicarbonate secretion and reduces acid output, providing cytoprotection against NSAID-induced gastric ulceration. Option a is incorrect because misoprostol does not neutralize acid. Acid neutralization is the mechanism of antacids such as calcium carbonate or magnesium hydroxide; misoprostol works through prostaglandin receptor–mediated mucosal defense enhancement. Option b is incorrect because misoprostol does not treat diarrhea — it frequently causes diarrhea as one of its most common adverse effects. Adding it to prevent ibuprofen-related diarrhea would be pharmacologically counterproductive. Option d is incorrect because misoprostol can slow gastric emptying and does not have a prokinetic mechanism. Metoclopramide is the agent used to accelerate gastric emptying and reduce nausea; these are different drugs with distinct mechanisms.

Correct Answer: It acidifies the colon to trap ammonia as ammonium ion for fecal excretion

Lactulose is converted by colonic bacteria to lactic and acetic acids, lowering colonic pH. This acidic environment converts ammonia to ammonium ion, which cannot be absorbed across the gut wall and is excreted in stool, reducing the systemic ammonia driving hepatic encephalopathy. Option a is incorrect because lactulose has no sedating or neurological properties. The confusion of hepatic encephalopathy results from circulating ammonia, not from intestinal nerve activity, and lactulose cannot act on the brain by this mechanism. Option b is incorrect because lactulose works in the colon to trap ammonia, not by drawing fluid from the brain. Cerebral edema is managed with hyperosmotic agents such as mannitol; lactulose does not cross the blood-brain barrier. Option c is incorrect because lactulose acts entirely within the gastrointestinal tract by altering colonic pH. It has no effect on glomerular filtration rate or renal handling of nitrogenous waste; ammonia is expelled through the col

Correct Answer: Two to three soft or loose stools are produced daily

The therapeutic endpoint for lactulose in hepatic encephalopathy is two to three soft or loose stools per day. This stool frequency indicates adequate colonic acidification and ammonia trapping, which correlates with declining serum ammonia and improved neurological status. Option a is incorrect because urine output is not an endpoint for lactulose effectiveness. Lactulose works in the colon to excrete ammonia in stool; its mechanism has no relationship to renal tubular function or urine production volume. Option c is incorrect because lactulose does not affect serum sodium. Hyponatremia in cirrhosis is managed with fluid restriction and sodium monitoring; it is not corrected by the colonic acidification mechanism through which lactulose reduces ammonia. Option d is incorrect because abdominal girth reduction reflects resolution of ascites, which is managed with diuretics and sodium restriction. Lactulose targets encephalopathy through ammonia excretion and does not reduce ascitic flui

Correct Answer: Administer IV fluids and monitor intake and output every hour

Twelve bloody stools with tachycardia indicate significant fluid and blood loss with early hemodynamic compromise. IV fluid resuscitation with hourly intake and output monitoring restores circulating volume and prevents progression to hypovolemic shock, the immediate life threat. Option b is incorrect because extraintestinal manifestations of ulcerative colitis are clinically important but do not represent an immediate life threat. Hemodynamic stabilization in a tachycardic, high-stool-output client must precede comprehensive integumentary assessment. Option c is incorrect because ambulation stimulates peristalsis and would increase an already dangerously elevated stool frequency. This intervention is contraindicated in severe acute colitis and could accelerate fluid, electrolyte, and blood loss. Option d is incorrect because ostomy education is premature during active hemodynamic compromise. Surgical planning and colostomy teaching are appropriate only after the client is stabilized a

Correct Answer: Establish large-bore IV access and prepare for volume replacement

Variceal hemorrhage causes rapid massive blood loss. Large-bore IV access enables immediate fluid and blood product resuscitation to prevent circulatory collapse, which is the life-saving first priority in an actively bleeding client with hemodynamic compromise. Option a is incorrect because nasogastric tube insertion in a client with esophageal varices risks direct mechanical rupture of additional varices, worsening the hemorrhage. Airway protection and IV access precede diagnostic tube placement in this emergency. Option b is incorrect because placing an actively vomiting client supine with legs elevated greatly increases aspiration of blood and gastric contents. While Trendelenburg is used in some shock states, airway protection from massive hematemesis takes precedence over this positioning. Option d is incorrect because propranolol is prescribed prophylactically to reduce portal pressure and prevent initial variceal bleeding. During active massive hemorrhage, beta-blocker administ

Correct Answer: HBsAg positive beyond six months indicates chronic infection or a carrier state

HBsAg persisting beyond six months after initial infection means the virus has not been cleared. The client has developed chronic hepatitis B or become a carrier, requiring ongoing surveillance for liver damage and assessment for antiviral therapy. Option a is incorrect because resolved hepatitis B is marked by HBsAg disappearing and anti-HBs antibody appearing. A persistently positive HBsAg indicates continued presence of the viral surface antigen and ongoing viral activity. Option b is incorrect because vaccination produces anti-HBs antibody, not HBsAg. The surface antigen is a structural viral protein; its presence signals active infection or carrier state, not the immune protection that vaccination confers. Option c is incorrect because a result consistent at six-month repeat testing reflects a true clinical pattern, not laboratory error. Attributing the finding to error would delay appropriate counseling, monitoring, and treatment decision-making.

Correct Answer: Position the client supine and initiate prescribed IV albumin infusion

Post-paracentesis circulatory dysfunction with hypotension requires immediate supine positioning to improve venous return combined with IV albumin infusion, which is prescribed after large-volume paracentesis to expand intravascular volume and prevent continued hemodynamic deterioration. Option b is incorrect because the hypotension reflects intravascular fluid redistribution after ascitic drainage, not a procedural complication requiring surgical intervention. This is a predictable physiological response managed medically with positioning and albumin, not a return to the procedure suite. Option c is incorrect because post-paracentesis hypotension results from vascular fluid shifts, not from hemorrhage at the puncture site. The puncture site would require only a small dressing; the blood pressure drop demands immediate hemodynamic intervention. Option d is incorrect because oral fluid intake cannot adequately or rapidly replace the vascular deficit caused by large-volume ascitic draina

Correct Answer: Sitting upright with the knees flexed toward the chest

The knee-chest or fetal position reduces retroperitoneal tension by relieving stretch on the anterior abdominal wall. Leaning forward with knees drawn up frequently provides significant relief for clients with pancreatic inflammation, which is located in the retroperitoneum. Option a is incorrect because supine positioning with lumbar support does not reduce retroperitoneal pancreatic tension. The client is already flat and in pain; this position only adds a pillow to the same configuration that is currently providing no relief. Option c is incorrect because right lateral positioning does not address the retroperitoneal source of pancreatic pain and does not reduce abdominal wall stretch. Right lateral decubitus with a firm support is the post-liver biopsy position, not the comfort position for pancreatitis. Option d is incorrect because prone positioning with elevated arms stretches and increases intra-abdominal pressure, which would worsen rather than relieve the retroperitoneal pain

Correct Answer: I will wash my hands thoroughly with soap and water after every bowel movement

Hepatitis A spreads via the fecal-oral route. Thorough handwashing with soap and water after every bowel movement is the single most effective measure to interrupt transmission and prevent household members from ingesting the virus through contaminated surfaces or food. Option a is incorrect because hepatitis A can be transmitted to any household member through shared dishware contaminated with fecal virus. Adults are not less susceptible than children, and no family members should share utensils or dishes with the infected client. Option b is incorrect because the client is most contagious during the two weeks before jaundice appears and the week following. Jaundice resolution does not mark the end of infectivity; precautions must continue through the full infectious period as guided by the provider. Option d is incorrect because daily bathing reduces skin contamination but does not eliminate the fecal-oral transmission pathway. Handwashing after every bowel movement is the critical i

Correct Answer: Transition to a low-residue diet, then gradually increase fiber as tolerated

After clear liquids, the diet advances to low-residue foods to allow the healing colon to tolerate solid food with minimal stimulation, then fiber is gradually reintroduced as symptoms permit and continued long-term for prevention of future episodes. Option b is incorrect because colonoscopy is typically scheduled six to eight weeks after the acute episode resolves, not immediately upon symptom improvement. Dietary advancement is guided by clinical symptom resolution rather than waiting for procedural confirmation. Option c is incorrect because high-fat foods increase intestinal motility and do not coat the mucosa therapeutically. No evidence supports fat loading as a dietary transition strategy during diverticulitis recovery. Option d is incorrect because advancing directly from clear liquids to a high-fiber diet during the early recovery phase can re-aggravate colonic inflammation. High fiber is the long-term prevention strategy after full recovery, not the immediate next dietary ste

Correct Answer: Assess that the gag reflex has returned before allowing any oral intake

After EGD with topical pharyngeal anesthesia, the gag reflex is temporarily suppressed and oral intake must be withheld until it returns. The presence of a gag reflex confirms that protective airway reflexes are intact and aspiration risk has resolved. Option a is incorrect because procedure completion does not restore the gag reflex. Topical anesthesia applied to the pharynx during EGD continues to suppress protective reflexes for a period after the scope is removed, making early oral intake a direct aspiration hazard. Option b is incorrect because ice chips are a form of oral intake. They carry the same aspiration risk as water if the gag reflex has not returned. The safeness of any oral intake — solid, liquid, or semi-solid — depends on first confirming gag reflex presence. Option c is incorrect because throat soreness or its absence is not a reliable indicator of gag reflex return. A client can have significant throat discomfort from scope trauma while still having no protective ga

Correct Answer: Notify the surgeon immediately because the stoma color indicates compromised circulation

A purple-black stoma indicates ischemia or necrosis from inadequate arterial blood supply. A healthy stoma is beefy red and moist. Purple-black discoloration is a surgical emergency requiring immediate provider notification and likely stoma revision to prevent full necrosis. Option a is incorrect because purple-black discoloration in a stoma is never an expected finding, even immediately post-operative. Bruising appears around the stoma margins; the stoma mucosa itself should remain red and moist, and any dusky or dark color demands immediate action. Option c is incorrect because warm compresses cannot restore arterial blood flow to a stoma with compromised vasculature. Applying compresses to ischemic tissue wastes critical time that should be used to notify the surgeon for urgent assessment. Option d is incorrect because irrigating a potentially necrotic stoma with saline would not restore circulation and risks traumatizing already devitalized tissue. The cause of discoloration is vas

Correct Answer: Take sucralfate at least two hours before or after phenytoin on an empty stomach

Sucralfate forms a viscous protective gel in the stomach that binds to phenytoin and significantly reduces its absorption, risking subtherapeutic phenytoin levels and breakthrough seizures. Sucralfate must be given at least two hours apart from phenytoin and taken on an empty stomach. Option a is incorrect because taking sucralfate with food reduces its mucosal-coating effectiveness, and co-administering it with phenytoin causes the gel to bind and reduce phenytoin bioavailability. Both the timing and co-ingestion instruction are incorrect. Option b is incorrect because giving sucralfate simultaneously with phenytoin would allow the sucralfate gel to chelate phenytoin in the gastric environment, dramatically reducing phenytoin absorption and risking seizure recurrence in a client with a seizure disorder. Option d is incorrect because phenytoin dosing schedule is based on therapeutic pharmacokinetics, not a fixed bedtime requirement. The critical instruction is the two-hour separation b

Correct Answer: Check the pouching system for kinking, improper fit, or mechanical obstruction

Assessing the pouching system for kinking, improper flange seal, or internal obstruction is the first priority when an ileostomy produces no output. A pink moist stoma with stable vital signs suggests a mechanical rather than vascular or systemic cause — the most common and correctable problem. Option a is incorrect because seven consecutive hours of zero ileostomy output is not within normal variation. An ileostomy produces frequent, liquid output; prolonged absence requires investigation, not reassurance that it is expected. Option b is incorrect because ileostomies are not irrigated as a standard nursing intervention. Unlike sigmoid colostomies, ileostomies produce liquid output and irrigation is not a care measure — it risks fluid and electrolyte imbalance without addressing a mechanical obstruction. Option c is incorrect because applying a larger pouch addresses output management when output is occurring, not when it is absent. Changing the pouch size does nothing to identify or c

Correct Answer: Baked chicken breast with white rice

Baked chicken with white rice provides lean protein and a low-residue carbohydrate that minimizes intestinal stimulation during acute Crohn's inflammation. Low-fiber, easily digestible foods reduce the mechanical and inflammatory load on the inflamed bowel during a flare. Option b is incorrect because whole wheat toast and bran cereal contain insoluble fiber that speeds colonic transit and increases stool volume. High-fiber foods may be tolerated during Crohn's remission but are contraindicated during acute flares with six to eight liquid stools daily. Option c is incorrect because raw apple slices contribute pectin and insoluble fiber, while dried apricots are concentrated in fructose and sorbitol, both of which increase intestinal motility. Neither is appropriate for an acutely inflamed gut already producing high-volume diarrhea. Option d is incorrect because broccoli and cauliflower are gas-producing cruciferous vegetables with significant fiber content. These increase int

Correct Answer: Take prescribed stool softeners and maintain adequate fluid intake

Stool softeners prevent hard, traumatic stools from tearing the hemorrhoidectomy wound, and adequate fluid intake maintains stool moisture. This combination allows soft, atraumatic stools that pass without damaging the healing surgical site. Option a is incorrect because rectal suppositories require insertion into the anal canal, directly traumatizing the freshly sutured hemorrhoidectomy wound. Rectal insertion of any object is contraindicated during the post-operative healing period. Option c is incorrect because delaying bowel movements for five days would produce hard, impacted stool that causes far more wound trauma than regular soft passage. Prolonged stool holding creates a worse problem than daily soft defecation would. Option d is incorrect because the Valsalva maneuver dramatically increases intrarectal pressure, straining the surgical repair and risking wound dehiscence. It is strongly contraindicated after hemorrhoid surgery and would intensify rather than reduce wound traum