HESI MS HESI Medical and Surgical Exam - Set 3 - Part 2

Correct Answer: Secondary intention: the wound will granulate closed from the base outward

Secondary intention healing is used for contaminated wounds such as a ruptured appendix site. The wound is left open to granulate from the base upward, preventing abscess formation from sealing bacteria inside. Wet-to-dry dressings mechanically debride the wound bed with each change. Option a is incorrect because primary intention describes immediate closure of clean, uncontaminated wounds with sutures or staples. A contaminated field from a ruptured appendix is intentionally left open to prevent sealing in bacteria, which is the opposite of primary closure. Option b is incorrect because tertiary intention involves initial open wound management followed by planned surgical closure after three to five days once contamination is controlled. Wet-to-dry dressings for gradual granulation describe secondary intention, not the delayed primary closure of tertiary intention. Option d is incorrect because accelerated intention is not a recognized wound healing classification. Wound healing is ca

Correct Answer: Follow a high-fiber diet with adequate hydration when symptom-free

During remission, a high-fiber diet softens stool, decreases colonic intraluminal pressure, and reduces the risk of diverticula becoming inflamed. Adequate hydration ensures the fiber forms a soft, bulky stool rather than a hard, pressure-generating mass. Option a is incorrect because a permanent low-fiber diet increases colonic pressure during defecation and promotes the formation of new diverticula. Long-term low-fiber intake is a known risk factor for diverticular disease progression rather than a protective measure. Option b is incorrect because current evidence no longer supports eliminating seeds, nuts, and raw produce from the diet of clients with diverticular disease. Raw fruits and vegetables supply the dietary fiber that reduces the colonic pressure underlying diverticulitis recurrence. Option c is incorrect because a high-protein, low-carbohydrate diet does not address the elevated colonic pressure that underlies diverticular disease. Reducing carbohydrates does not reduce c

Correct Answer: Increase soluble fiber intake gradually and consume at least two liters of water daily

Soluble fiber such as psyllium absorbs water to form a gel that softens stool and regulates intestinal transit in IBS-C. Adequate hydration — at least two liters daily — prevents fiber from compacting and allows its stool-normalizing effect to work consistently. Option a is incorrect because carbonated beverages introduce gas into the gastrointestinal tract, worsening the bloating and cramping that commonly accompany IBS. Gas-producing drinks are widely identified as symptom triggers rather than therapeutic recommendations. Option b is incorrect because restricting fluid intake worsens constipation by reducing stool water content. Adequate hydration is a foundational recommendation for IBS-C; telling a client to limit fluids would directly oppose the mechanism by which soluble fiber normalizes stool. Option d is incorrect because high-fat diets trigger exaggerated gastrocolic reflexes in IBS clients, potentially causing cramping and unpredictable bowel changes. Fat does not lubricate t

Correct Answer: Prothrombin time and platelet count

Liver biopsy punctures a highly vascular organ, carrying significant hemorrhage risk. Prothrombin time and platelet count assess coagulation status before the procedure; abnormal values must be corrected to minimize the risk of uncontrolled post-procedural bleeding. Option b is incorrect because electrolyte levels reflect fluid balance rather than coagulation capacity. Although relevant to overall hepatic disease assessment, sodium and potassium values do not determine whether the client can safely tolerate a bleeding-risk procedure. Option c is incorrect because the white cell differential identifies infection or immune dysfunction rather than bleeding risk. Elevated counts may reflect hepatic inflammation, but they do not guide pre-procedure clearance the way coagulation studies do for a percutaneous liver biopsy. Option d is incorrect because albumin and bilirubin reflect synthetic function and jaundice severity over time. These values are important for overall liver disease staging

Correct Answer: Right side-lying with a firm pillow or rolled blanket pressed against the biopsy site

After liver biopsy, the client is positioned on the right side with a firm support pressed against the puncture site. This applies direct compression over the biopsy entry point and uses the weight of the liver against the abdominal wall to tamponade bleeding at the puncture site. Option a is incorrect because semi-Fowler with elevated arms does not apply any compression to the right-sided liver puncture. This position is used for respiratory support and provides no mechanical tamponade effect for post-biopsy hemorrhage prevention. Option b is incorrect because left lateral positioning moves the liver away from the wound rather than using body weight to compress it. Post-liver biopsy positioning must place the right side down to apply tamponade pressure directly over the puncture site. Option d is incorrect because Trendelenburg increases intra-abdominal pressure by tilting the head down and does not apply localized compression to the biopsy site. Increased pressure in this position co

Correct Answer: Hold aspirin for three to seven days before the procedure

Aspirin irreversibly inhibits platelet aggregation and significantly increases hemorrhage risk during polypectomy. Holding aspirin three to seven days before the procedure allows sufficient new platelet production to restore hemostatic function before the tissue is cut. Option a is incorrect because continuing aspirin through the procedure day maintains full platelet inhibition during polypectomy. Uninterrupted antiplatelet therapy substantially increases the risk of immediate and delayed post-polypectomy hemorrhage. Option b is incorrect because a single day without aspirin is insufficient to restore platelet function. Aspirin's irreversible binding to platelets means its hemostatic effect persists for the entire platelet lifespan of seven to ten days; meaningful recovery requires at least three days off the drug. Option c is incorrect because doubling aspirin after polypectomy would dramatically increase post-procedural bleeding risk by maximally inhibiting the platelets needed

Correct Answer: Elevate the head of the bed six inches and avoid eating within three hours of bedtime

Elevating the head of the bed uses gravity to keep gastric contents below the lower esophageal sphincter. Avoiding food for three hours before sleep reduces gastric volume and acid load available to reflux during the supine period, addressing both mechanical and chemical reflux triggers. Option a is incorrect because lying flat eliminates the gravitational barrier against reflux. Supine positioning allows gastric contents to reach the lower esophageal sphincter without any gravitational resistance, directly worsening nighttime reflux in a client with a hiatal hernia. Option c is incorrect because antacid use immediately before lying down provides only brief neutralization and does not prevent subsequent acid secretion throughout the night. Head elevation and meal timing modifications address the underlying mechanism rather than just buffering existing acid. Option d is incorrect because eating a bedtime snack — regardless of its composition — increases gastric volume and acid secretion

Correct Answer: Client produces two to three soft or loose stools per day with improved orientation

The therapeutic endpoint for lactulose in hepatic encephalopathy is two to three soft or loose stools per day. This frequency indicates adequate colonic acidification trapping ammonia for excretion. Improved orientation confirms that circulating ammonia levels are falling as the treatment takes effect. Option a is incorrect because one formed, firm stool per day indicates insufficient lactulose effect. The colonic environment has not been adequately acidified, ammonia may continue accumulating, and the goal of multiple soft stools to clear ammonia-containing fecal material has not been met. Option b is incorrect because lactulose does not affect renal tubular function or urine production. Its mechanism is entirely colonic; monitoring urine output is not an endpoint for lactulose therapy and reflects a different organ system entirely. Option d is incorrect because abdominal girth reduction reflects resolution of ascitic fluid, which is managed with sodium restriction and diuretics. Lact

Correct Answer: Confirm that blood cultures were drawn before giving the antibiotic

Cultures must be obtained before the first antibiotic dose because antibiotics rapidly suppress or kill the causative organism, rendering cultures falsely negative within minutes of exposure. The nurse confirms cultures were already collected this morning before administering the prescribed dose. Option b is incorrect because delaying antibiotics in active cellulitis risks bacteremia and septic progression. The clinical solution is not to withhold treatment but to confirm cultures precede the first dose; empirical antibiotic therapy is appropriately started while sensitivities are pending. Option c is incorrect because drawing cultures after the first antibiotic dose dramatically reduces culture yield. The organism may be suppressed within minutes of antibiotic exposure, eliminating the ability to identify the causative pathogen and determine appropriate sensitivity-guided therapy. Option d is incorrect because reviewing prior laboratory results does not replace confirming that today&#

Correct Answer: Alcohol converts acitretin to etretinate, a long-persisting teratogen stored in fat tissue

Alcohol metabolically converts acitretin to etretinate, which has a half-life of approximately 120 days compared to acitretin's two to three days. Etretinate is highly embryotoxic, accumulates in adipose tissue, and extends the period of reproductive risk from two years to potentially three years or longer after stopping the drug. Option a is incorrect because the primary danger of alcohol with acitretin is metabolic conversion, not a pharmacokinetic elevation in plasma concentration. Increased plasma levels are not the mechanism — the creation of a long-persisting teratogen is the specific and catastrophic concern. Option b is incorrect because enzyme competition reducing drug efficacy is not the established pharmacological interaction between alcohol and acitretin. The interaction produces a new compound — etretinate — rather than changing acitretin's concentration through competitive inhibition. Option c is incorrect because while both acitretin and alcohol are individuall

Correct Answer: Telangiectasia caused by corticosteroid-induced dermal atrophy

Prolonged topical corticosteroid use on the thin skin of the face causes dermal atrophy, breaking down connective tissue supporting superficial capillaries and producing visible telangiectasia. This is a well-recognized adverse effect of extended high-potency steroid application to thin-skinned areas. Option a is incorrect because topical corticosteroids inhibit melanocyte activity and more commonly produce hypopigmentation rather than hyperpigmentation. Increased pigmentation from melanocyte stimulation is not an expected adverse effect of steroid cream application. Option c is incorrect because contact dermatitis from the vehicle base would present with erythema, vesicles, and pruritus characteristic of an allergic reaction. The thin, dilated thread-like vessels described are a distinct adverse effect of the steroid component itself, not the carrier ingredients. Option d is incorrect because steroid-induced perioral or periorificial dermatitis and rosacea-like eruptions present with

Correct Answer: Basal cell carcinoma of the nodular subtype

A pearly or translucent waxy nodule with a rolled, raised border and visible telangiectasia on the nose is the classic morphological description of nodular basal cell carcinoma — the most common skin cancer in light-skinned adults. It is slow-growing and locally invasive with rare metastatic potential. Option a is incorrect because actinic keratosis presents as rough, scaly, erythematous patches on sun-damaged skin. It is a flat, precancerous lesion with a scaly texture rather than a raised, pearly nodule with a rolled translucent border. Option b is incorrect because melanoma in its early phase presents as an asymmetric, multicolored flat or slightly raised lesion with irregular borders. The ABCDE criteria of melanoma do not include a pearly, dome-shaped nodule with a rolled translucent edge. Option d is incorrect because squamous cell carcinoma appears as a firm, indurated, erythematous nodule that may ulcerate or form a central keratotic plug. It lacks the pearly translucent quality

Correct Answer: The Koebner phenomenon

The Koebner phenomenon describes the appearance of new psoriatic plaques at sites of skin injury such as cuts, burns, or surgical incisions. Clients should be instructed to avoid scratching and protect skin from trauma to reduce the triggering of new plaque formation. Option b is incorrect because Auspitz sign refers to pinpoint bleeding that occurs when a psoriatic scale is removed, revealing dilated dermal capillary loops. While relevant to psoriasis assessment, Auspitz sign describes a finding upon scale removal, not new lesion formation at injury sites. Option c is incorrect because Nikolsky sign is elicited by applying lateral shear pressure to the skin and observing epidermal separation, indicating failure of intercellular adhesion. It is associated with pemphigus vulgaris and Stevens-Johnson syndrome, not with psoriasis pathophysiology. Option d is incorrect because Darier sign is specific to mastocytosis and describes the urticaria and flare response produced by stroking a mast

Correct Answer: Verify that blood cultures were drawn before administering the vancomycin

The nurse must confirm cultures were obtained before the first antibiotic dose because vancomycin rapidly suppresses MRSA growth, rendering blood cultures falsely negative within minutes. If cultures have not been drawn, they must be collected before the first dose to preserve diagnostic accuracy. Option a is incorrect because collecting cultures after the first vancomycin dose would yield falsely negative or misleading results due to antibiotic suppression of the organism. Once antibiotics are started, microbiological culture yield is significantly compromised. Option b is incorrect because withholding IV vancomycin pending sensitivity results in active MRSA cellulitis risks septic progression. Empirical vancomycin therapy is appropriate and evidence-based for suspected MRSA; therapy is adjusted once sensitivities are reported. Option c is incorrect because topical mupirocin does not penetrate tissue sufficiently to treat invasive MRSA cellulitis and is inappropriate as a substitute o

Correct Answer: Remove the stinger by scraping horizontally with a flat edge such as a credit card

Removing the stinger immediately by scraping horizontally with a flat object such as a credit card prevents continued venom injection from the still-attached venom sac. Pinching or squeezing the stinger compresses the sac and injects additional venom; a scraping motion avoids this. Option a is incorrect because epinephrine is indicated for systemic anaphylaxis with airway involvement or hemodynamic compromise. A localized one-centimeter welt with no systemic symptoms does not meet the threshold for epinephrine, and prophylactic administration introduces unnecessary cardiovascular risk. Option b is incorrect because tourniquets are contraindicated for all insect stings. Applying a constricting band does not limit venom absorption and causes limb ischemia; current evidence does not support tourniquet use for any common envenomation. Option d is incorrect because prolonged ice water immersion risks cold injury to tissue that would not occur with the recommended brief covered-ice-pack appl

Correct Answer: Epinephrine 0.3 mg intramuscular into the lateral thigh

Anaphylaxis requires immediate intramuscular epinephrine as the only first-line life-saving treatment. Epinephrine reverses bronchoconstriction, reduces upper airway mucosal edema, and restores vascular tone. The lateral thigh provides rapid, reliable absorption even through clothing. Option b is incorrect because diphenhydramine addresses histamine-mediated symptoms but has a slow onset that cannot reverse the life-threatening bronchospasm and angioedema of anaphylaxis within the critical window. Antihistamines are adjunct therapy after epinephrine, never first-line. Option c is incorrect because corticosteroids have a two-to-four-hour onset of action and cannot reverse the acute physiological crisis of anaphylaxis. Methylprednisolone is used as secondary adjunct therapy to reduce biphasic reactions, not to treat the immediate emergency. Option d is incorrect because albuterol alone treats bronchospasm but cannot address cardiovascular collapse, angioedema, or the vasodilatory compone

Correct Answer: Notify the provider because this WBC level suggests silver sulfadiazine-induced leukopenia

Silver sulfadiazine can cause leukopenia as a significant adverse effect. A WBC of 2,600 per microliter falls below the normal range of 4,500 to 11,000. The provider must be notified promptly because this finding typically warrants discontinuing silver sulfadiazine and switching to an alternative topical agent. Option a is incorrect because a week-long delay in acting on a WBC of 2,600 in an already immunocompromised burn patient is unsafe. Leukopenia from silver sulfadiazine requires prompt provider notification rather than watchful waiting with a repeat check in seven days. Option b is incorrect because increasing dressing frequency increases total silver sulfadiazine exposure over time and could worsen the leukopenia. The appropriate response is to notify the provider about the adverse effect, not to modify application technique. Option d is incorrect because droplet precautions are designed to protect against respiratory pathogen transmission, not to address leukopenia. If protecti

Correct Answer: Avoid all alcohol because methotrexate causes severe and potentially irreversible hepatotoxicity

Methotrexate is directly hepatotoxic, and combining it with alcohol dramatically multiplies the risk of severe hepatic fibrosis and cirrhosis. Clients must completely abstain from alcohol for the full duration of methotrexate therapy, as even moderate intake can produce irreversible liver damage. Option a is incorrect because while methotrexate produces photosensitivity requiring sun protection, sunburn is not a fatal consequence of this medication. Hepatotoxicity causing liver failure and myelosuppression causing sepsis are the adverse effects requiring the most critical pre-treatment counseling. Option b is incorrect because folic acid supplementation reduces gastrointestinal side effects and mouth sores — uncomfortable but not life-threatening. While important for quality of life, this instruction does not address the life-threatening hepatic toxicity that requires complete alcohol abstinence. Option c is incorrect because while methotrexate is teratogenic and contraception is essen

Correct Answer: Contact precautions with gloves and gown for all care involving the lesions

Localized herpes zoster requires contact precautions because varicella zoster virus is transmitted through direct contact with vesicular lesion fluid. Gloves and gown protect staff and visitors, and varicella-susceptible individuals must not enter the room until all lesions have crusted. Option b is incorrect because droplet precautions address pathogens spread through large respiratory droplets such as influenza or meningococcal disease. Herpes zoster transmission from localized lesions occurs through direct contact with lesion fluid, not through respiratory droplet spread. Option c is incorrect because airborne precautions in a negative-pressure room are required only for disseminated herpes zoster, which occurs in severely immunocompromised clients. Localized zoster confined to a dermatome requires contact precautions, not airborne isolation. Option d is incorrect because herpes zoster is contagious to varicella-naive or immunocompromised persons who can develop primary chickenpox f

Correct Answer: Immerse the foot in water maintained at 40 to 42 degrees Celsius

The evidence-based rewarming method for frostbite is immersion in water maintained at 40 to 42 degrees Celsius for fifteen to thirty minutes. This controlled moist heat gradually restores circulation without the burn risk and temperature unpredictability of dry heat sources. Option a is incorrect because rubbing or massaging frostbitten tissue causes mechanical trauma to cells that contain ice crystals, resulting in further cellular destruction. The tissue must be handled gently — no friction, no massage — during or after rewarming. Option b is incorrect because dry heat sources including heating pads and blankets do not maintain a reliably safe temperature and can cause thermal burns in tissue that lacks pain sensation due to cold-induced nerve damage. Moist immersion at a controlled 40 to 42 degrees Celsius is the standard. Option d is incorrect because a radiant heating vent produces uncontrolled, often excessive temperatures well above the safe rewarming range. The client cannot fe