HESI MS HESI Medical and Surgical Exam - Set 1 - Part 2

Correct Answer: Ventricular tachycardia with pulse requiring antidysrhythmic therapy

Ventricular tachycardia is characterized by no P waves, wide and bizarre QRS complexes, a rate of 140 to 250 beats per minute, and a regular rhythm. The client here is alert with palpitations, indicating pulsed VT requiring immediate antidysrhythmic intervention per provider order. Option a is incorrect because sinus tachycardia has identifiable P waves before each QRS complex, and the QRS width is normal at under 0.10 seconds. The absent P waves and wide bizarre QRS complexes in the strip described exclude sinus tachycardia. Option b is incorrect because atrial fibrillation shows an irregularly irregular ventricular response with no organized P waves but with narrow QRS complexes in the absence of aberrant conduction. A completely regular rate of 162 with wide QRS and no P waves does not fit the AF pattern. Option c is incorrect because ventricular fibrillation produces completely chaotic electrical activity with no identifiable QRS complexes and no measurable rate. The rhythm describ

Correct Answer: Development of a new regurgitant leak through the treated valve

After balloon valvuloplasty, the nurse specifically monitors for signs of a regurgitant valve — changes in cardiac rhythm, heart sounds, and cardiac output — because balloon inflation can tear the valve leaflets, converting stenosis to regurgitation. This is a procedure-specific complication distinct from general cardiac catheterization risks. Option b is incorrect because contrast dye allergy reactions are a standard post-catheterization concern for any contrast-enhanced procedure. Monitoring for allergic response is not unique to valvuloplasty and does not reflect the structural valve consequence that is specific to this procedure. Option c is incorrect because groin hematoma is a universal complication of any femoral access cardiovascular procedure. It does not distinguish the valvuloplasty-specific risk, which targets the valve structure rather than the vascular access site. Option d is incorrect because contrast-related fluid considerations apply to any invasive procedure using io

Correct Answer: Activate the rapid response team and prepare for emergency surgery

Sudden severe tearing abdominal pain with radiation to the back and flank combined with hemodynamic collapse — BP of 68/42 and heart rate of 134 — in a client with known aortic aneurysm indicates rupture. Activating the rapid response team and preparing for emergency surgical intervention is the immediate life-saving priority. Option a is incorrect because documenting a focused assessment before summoning emergency help wastes critical time in a potentially fatal rupture. The hemodynamic signs of shock identify the emergency, and no further assessment data are needed before activating the emergency response. Option b is incorrect because administering an antihypertensive to a client with a systolic BP of 68 mm Hg would further lower an already dangerously low pressure and could cause cardiovascular collapse. Antihypertensives protect against aneurysm strain in hemodynamically stable clients, not during active rupture with shock. Option d is incorrect because Trendelenburg positioning i

Correct Answer: Rises within 3 hours and remains elevated for up to 7 to 10 days after injury

Troponin I is highly cardiac-specific and rises within 3 hours of myocardial cell injury. It persists elevated for up to 7 to 10 days, providing a long diagnostic window for clients who present late. Normal troponin I is less than 0.35 ng/mL, so any elevation indicates myocardial cell damage. Option a is incorrect because the described rapid rise and 24-hour clearance characterizes myoglobin, which rises within 2 hours but declines after 7 hours. Myoglobin's short window and lack of cardiac specificity make it less useful for late-presenting clients or for confirming infarction definitively. Option b is incorrect because the 6-hour rise and 48-to-72-hour normalization describes CK-MB isoenzyme kinetics, not troponin I. CK-MB peaks at 18 hours and returns to normal within 48 to 72 hours, whereas troponin I persists much longer. Option c is incorrect because cardiac troponin I is specifically derived from cardiac muscle and has minimal expression in skeletal muscle. This cardiac spe

Correct Answer: Digoxin toxicity is present, potentiated by hypokalemia from the loop diuretic

This constellation — anorexia, nausea, yellow halos around lights, bradycardia at 46, and hypokalemia at 3.0 mEq/L — represents digoxin toxicity potentiated by furosemide-induced hypokalemia. Saunders specifies that hypokalemia markedly increases digoxin toxicity risk, and all four findings are hallmarks of this drug interaction. Option b is incorrect because spironolactone is a potassium-retaining diuretic that would cause hyperkalemia. This client has hypokalemia at 3.0 mEq/L, which is the opposite of what spironolactone produces. The bradycardia here is from digoxin toxicity, not from a potassium-elevating diuretic effect. Option c is incorrect because hypertensive retinopathy causes progressive visual blurring or vision loss, not the characteristic yellow halo phenomenon. Yellow vision with halos is a documented hallmark of digoxin toxicity and appears alongside the gastrointestinal and cardiac rhythm findings listed in this scenario. Option d is incorrect because isolated hypokale

Correct Answer: Direct heat sources including warm water soaks must be avoided due to burn risk

Saunders specifies that clients with peripheral arterial disease must never apply direct heat to the lower limbs, including warm water soaks. Decreased peripheral sensation from chronic ischemia prevents reliable temperature detection, creating burn risk even from seemingly mild heat sources. Option a is incorrect because encouraging warm water soaks contradicts the PAD safety guideline. Decreased sensation in ischemic limbs prevents reliable temperature detection, and even mildly hot water can cause a burn before the client recognizes it as dangerous. Vasodilation does not outweigh the thermal injury risk. Option b is incorrect because neither warm nor cool soaks are generally recommended as routine foot care for PAD clients. More importantly, the critical teaching point is the absolute prohibition on direct heat, not a comparison between water temperatures. Option d is incorrect because no temperature check is reliable enough to protect a client whose peripheral sensation is already

Correct Answer: Warmth, redness, and edema after arterial bypass are expected signs of restored blood flow

After arterial bypass surgery, warmth, redness, and edema in the revascularized extremity are expected findings of restored blood flow to previously ischemic tissue. Saunders identifies these as normal postoperative outcomes of arterial revascularization rather than signs of infection or thrombosis. Option a is incorrect because postoperative wound infection would present with localized incision-line redness, purulent drainage, fever, and elevated white cell count. The diffuse warmth, redness, and swelling distributed throughout the limb after arterial revascularization reflects reperfusion, not infection. Option b is incorrect because early postoperative DVT would typically manifest as calf or thigh tenderness, localized warmth, and unilateral swelling without the limb-wide redness associated with arterial reperfusion. A palpable pedal pulse further supports arterial success rather than venous obstruction. Option c is incorrect because a palpable pedal pulse after femoropopliteal bypa

Correct Answer: Metformin, because contrast dye can cause renal impairment leading to lactic acidosis

Metformin is withheld 24 hours before cardiac catheterization and for 48 hours after because iodinated contrast medium can impair renal function. If the kidneys are compromised, metformin accumulates in the blood, creating risk of potentially fatal lactic acidosis. Renal function must be assessed before the medication is restarted. Option a is incorrect because glipizide may be held on the morning of the procedure due to NPO status and hypoglycemia concern, but there is no established indication to withhold it 24 hours before and 48 hours after based on a specific contrast-drug interaction. Option c is incorrect because repaglinide has no documented interaction with iodinated contrast that requires the extended pre- and post-procedure withholding period. The unique concern about metformin and lactic acidosis in the context of contrast-induced nephropathy is specific to the biguanide class. Option d is incorrect because pioglitazone is associated with fluid retention as an adverse effec

Correct Answer: Heparin-induced thrombocytopenia with thrombosis requiring heparin discontinuation

Heparin-induced thrombocytopenia with thrombosis (HITT) presents 5 to 10 days into heparin therapy with a significant platelet count drop and paradoxical new thrombosis despite therapeutic heparin. The simultaneous thrombocytopenia and new DVT while on heparin is the defining pattern of HITT, requiring immediate discontinuation of all heparin products and switching to an alternative anticoagulant. Option b is incorrect because DIC causes simultaneous microvascular thrombosis and systemic hemorrhage with laboratory findings of elevated D-dimer, low fibrinogen, and prolonged clotting times. The isolated new focal DVT without bleeding in the heparin context points to HITT rather than the widespread consumptive coagulopathy of DIC. Option c is incorrect because post-surgical platelet consumption is typically mild, resolves within days, and does not produce new thrombosis. A drop from 230,000 to 62,000 over 6 days concurrent with new clot formation is not the expected trajectory of surgical

Correct Answer: Administer prescribed IV antihypertensive medication and monitor BP every 5 minutes

Hypertensive crisis with systolic above 180 mm Hg and diastolic above 120 mm Hg and end-organ symptoms requires immediate IV antihypertensive therapy. Saunders specifies monitoring blood pressure every 5 minutes during IV administration to guide titration and prevent overcorrection. The brain, heart, and kidneys are at risk from ongoing extreme pressure. Option a is incorrect because oral antihypertensives act too slowly for a hypertensive crisis with active neurological symptoms. A 30-minute wait allows ongoing cerebral and renal damage. IV medications provide the rapid, titratable response needed when organ damage is occurring. Option b is incorrect because the Trendelenburg position increases venous return and would elevate an already dangerous blood pressure. This position is used for hypotensive states. In hypertensive crisis, the head of the bed should be elevated at 45 degrees, not lowered. Option d is incorrect because a detailed headache history and full neurological assessmen

Correct Answer: Particulate respirator, gown, and gloves for this contact situation

Saunders specifies that the nurse wears an individually fitted particulate respirator when caring for a client with active TB and a gown when clothing may become contaminated, as during a bed bath. Standard precaution gloves are also required. This combination protects the nurse's airway, clothing, and skin. Option a is incorrect because a surgical mask does not filter airborne particles small enough to carry Mycobacterium tuberculosis. TB is transmitted via airborne droplet nuclei, which require a fitted particulate respirator to prevent inhalation. A surgical mask provides droplet protection only, which is insufficient for airborne pathogens. Option b is incorrect because a face shield with gown but without a particulate respirator leaves the most critical protection gap — the airway. A face shield protects the mucous membranes of the face but does not filter the fine airborne droplet nuclei carrying Mycobacterium tuberculosis, which require a fitted particulate respirator. Opti

Correct Answer: Sit upright and lean forward with your elbows on your knees or a table

The tripod position — sitting upright and leaning forward with elbows resting on the knees or an overbed table — fixes the shoulder girdle, allowing accessory respiratory muscles to assist ventilation more effectively. Saunders identifies this and similar forward-leaning postures as the recommended positions for managing dyspnea in emphysema. Option b is incorrect because side-lying does not fix the shoulder girdle or allow accessory muscles to function at full mechanical advantage. The tripod position's therapeutic value lies in bracing the upper extremities against a surface, which cannot be achieved in a lateral recumbent position. Option c is incorrect because sitting upright with hands on thighs does not fix the shoulder girdle, which is the key mechanism by which the tripod position allows accessory muscles to assist ventilation. The hands must be braced against a surface to create the leverage needed for the pectoral and scalene muscles to function. Option d is incorrect be

Correct Answer: Silent breath sounds in active respiratory distress indicate near-total airflow obstruction

Wheezing requires airflow through narrowed airways. When obstruction becomes so severe that virtually no air moves, wheezing disappears — but this is not improvement. Saunders identifies silent breath sounds during an acute asthma attack as a life-threatening sign associated with impending respiratory failure and status asthmaticus. Option a is incorrect because effective bronchodilator treatment would increase airflow, producing audible sounds and improving saturation. Disappearing wheezing paired with worsening saturation and increased respiratory effort indicates obstruction has worsened to the point of near-airlessness, not that the treatment worked. Option b is incorrect because hyperventilation increases minute ventilation and would raise rather than decrease oxygen saturation. The declining saturation combined with visible respiratory distress confirms genuine gas exchange failure, not an artifact of breathing pattern. Option d is incorrect because pneumothorax would cause absen

Correct Answer: Three consecutive negative sputum cultures must be obtained before returning to work

Saunders states the client may return to former employment when three consecutive sputum cultures are negative. This microbiological standard confirms that active bacterial shedding has ceased and the client is no longer infectious to coworkers and community contacts. Option a is incorrect because 2 to 3 weeks of therapy marks the point at which transmission risk is greatly reduced, not the point at which the client is declared noninfectious and cleared to return to work. Microbiological confirmation through sputum cultures is required before work clearance. Option b is incorrect because chest x-ray findings do not confirm the absence of active bacterial shedding. Radiographic changes may persist even after the client is microbiologically noninfectious, and chest imaging is not the standard criterion used to determine when a TB client may return to the workplace. Option c is incorrect because a single negative sputum culture does not meet the Saunders criterion for return to work. Vari

Correct Answer: Elevate the head of the bed and prepare to administer supplemental oxygen

After notifying the rapid response team, Saunders priority nursing actions for suspected pulmonary embolism include reassuring the client, elevating the head of the bed, and preparing to administer oxygen. Head-of-bed elevation reduces respiratory work, and supplemental oxygen addresses the hypoxia from impaired gas exchange across the embolized vessels. Option b is incorrect because obtaining and transmitting an ECG to a cardiologist is a secondary diagnostic action. While ECG findings in PE may show right heart strain patterns, the immediate nursing priority is positioning and oxygenation rather than remote diagnostic communication. Option c is incorrect because sequential compression devices prevent new DVT formation and are not an acute response to an active pulmonary embolism. The immediate priority is supporting the client's oxygenation and circulation, not further DVT prophylaxis. Option d is incorrect because chest tube insertion is the treatment for pneumothorax or hemoth

Correct Answer: Notify the provider immediately and prepare for possible ventilatory support

This ABG shows respiratory acidosis with CO2 retention (PaCO2 74) and decreasing level of consciousness, indicating CO2 narcosis in a COPD client. Saunders specifies that mechanical ventilation should be prepared when supplemental oxygen cannot maintain acceptable PaO2 and PaCO2 levels. The provider must be notified immediately for this deteriorating situation. Option a is incorrect because increasing oxygen to high flow in a COPD client with chronic CO2 retention suppresses the hypoxic respiratory drive, potentially reducing the drive to breathe and worsening CO2 accumulation. Low-flow oxygen titrated to ABG values is the standard for COPD management. Option b is incorrect because withdrawing all oxygen would cause dangerous hypoxia in a client with an already compromised PaO2. The hypoxic drive concept does not justify creating acute hypoxic danger. Oxygen must be titrated carefully, not removed entirely. Option d is incorrect because a drowsy, minimally responsive client cannot safe

Correct Answer: It increases airway pressure during exhalation, keeping small airways open longer

Pursed-lip breathing creates back-pressure during exhalation that prevents premature small airway collapse in COPD, where loss of elastic recoil allows airways to close early. This technique promotes maximal carbon dioxide expiration, reduces air trapping, and is specified by Saunders as a key breathing technique that increases airway pressure and keeps passages open. Option a is incorrect because pursed-lip breathing acts mechanically on the airways during exhalation rather than through a cardiovascular mechanism. Any secondary reduction in heart rate during improved breathing reflects better gas exchange, not a direct cardiac effect of the technique itself. Option b is incorrect because pursed-lip breathing is applied during the expiratory phase, not during inhalation. The technique does not slow inspiratory airflow. Its benefit is entirely in the exhalation phase by prolonging it and maintaining positive pressure in the airways. Option c is incorrect because pursed-lip breathing doe

Correct Answer: Document the finding as an expected post-biopsy outcome and continue monitoring

After bronchoscopy with biopsy, blood-streaked sputum is an expected finding for several hours because of tissue trauma from the procedure. Saunders confirms this is a normal post-biopsy occurrence requiring monitoring rather than emergency escalation. Frank hemorrhage, hemodynamic changes, or significant bleeding would warrant provider notification. Option a is incorrect because blood-streaked sputum in the first hours after airway tissue biopsy is a predictable procedural consequence, not a sign of active hemorrhage requiring emergency notification. Frank blood with increasing volume or hemodynamic instability would change the clinical priority. Option c is incorrect because mild blood streaking in the recovery period from bronchoscopy does not indicate a bleeding source requiring re-examination. Emergency bronchoscopy is a major procedure reserved for significant uncontrolled bleeding, not for the normal tissue seepage following a biopsy. Option d is incorrect because blood-streaked

Correct Answer: Wear a surgical mask throughout the entire transport

Saunders specifies that when a client with active TB must leave the isolation room for a procedure or test, the client should wear a surgical mask during transport. The mask contains the client's exhaled droplet nuclei and prevents TB-containing air from entering the corridor and potentially reaching other vulnerable patients. Option a is incorrect because the fitted particulate respirator is the protective equipment worn by healthcare workers to protect themselves from inhaling the client's droplet nuclei. The client wears a surgical mask to contain the exhaled organisms, not the filtration respirator designed for the wearer's inhalation protection. Option b is incorrect because covering the mouth with a hand provides completely inadequate containment of airborne droplet nuclei, which are extremely small and remain suspended in air. Handwashing removes contact contaminants; it does nothing to contain the fine infectious aerosols produced by breathing and speaking. Optio

Correct Answer: Computed tomography pulmonary angiography with contrast dye injection

Computed tomography pulmonary angiography is described by Saunders as the preferred diagnostic test for pulmonary embolism. It directly visualizes the pulmonary arteries and detects filling defects from emboli using contrast dye. The V/Q scan is used only when contrast is contraindicated, such as with allergy or severe renal insufficiency. Option b is incorrect because the V/Q scan is not the gold standard for all clients. It is reserved for situations where CTPA cannot be performed safely due to contrast allergy or inadequate renal function. When CTPA is available and the client can receive contrast, it is the preferred method. Option c is incorrect because traditional catheter-based pulmonary angiography is an older, invasive approach that has largely been replaced by CTPA in current clinical practice. While technically definitive, its procedural risk and resource requirements make it a second-line option rather than the preferred diagnostic method. Option d is incorrect because ABG