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

Correct Answer: Administer prescribed antibiotics, encourage fluids to 3 L daily, and promote coughing and repositioning

Saunders priority interventions for pneumonia include administering prescribed antibiotics for the causative organism, encouraging up to 3 liters of fluid daily to thin secretions, and promoting coughing, deep breathing, and frequent repositioning to mobilize and drain secretions from affected lung segments. Option a is incorrect because restricting fluids in pneumonia thickens secretions and worsens airway clearance, the opposite of the therapeutic goal. Ice packs are less effective than antipyretics for fever management and do not address the infectious process. Saunders recommends encouraging fluids, not restricting them. Option b is incorrect because nasotracheal suctioning every 2 hours is invasive and reserved for clients who cannot clear secretions independently. A client who can cough should be supported first with encouragement, positioning, and adequate hydration before escalating to mechanical airway clearance methods. Option c is incorrect because community-acquired pneumon

Correct Answer: Egg allergy due to the vaccine's egg-based preparation method

Saunders identifies egg allergy as a contraindication to the standard influenza vaccine because it is traditionally prepared in egg-based culture media. The vaccine contains egg protein that can trigger allergic reactions in sensitized individuals, requiring special precautions or alternative vaccine formulations. Option b is incorrect because age over 65 with chronic respiratory disease makes annual flu vaccination strongly recommended. Older adults with comorbidities face greater morbidity and mortality from influenza. These are priority populations for vaccination, not exclusion groups. Option c is incorrect because residents of long-term care facilities are a priority group for annual influenza vaccination, not an excluded population. Congregate living with shared air and vulnerable neighbors makes vaccination especially important, not contraindicated, for institutional residents. Option d is incorrect because diabetes mellitus is an indication for influenza vaccination rather than

Correct Answer: Positive result — HIV-positive clients have a positive threshold of 5 mm or more

HIV-positive clients are immunosuppressed, which blunts the immune response to tuberculin antigen, producing smaller reactions even with true exposure. Therefore, the positive threshold is lowered to 5 mm or more for HIV-infected persons. A 6 mm induration exceeds this threshold and is classified as a positive result requiring further evaluation. Option a is incorrect because the 10 mm threshold applies to different risk groups such as recent immigrants and institutional workers, not to immunocompromised clients. Using the wrong threshold for an HIV-positive client would miss positive results and delay identification and treatment of latent or active TB. Option b is incorrect because the result is fully interpretable using established criteria. A 6 mm induration in an HIV-positive client clearly exceeds the 5 mm threshold, making the result positive. Repeat testing is not required when the measurement unambiguously meets the classification standard. Option d is incorrect because TST in

Correct Answer: Respiratory rate increases to 30 breaths per minute with increasing dyspnea

A respiratory rate of 30 with increasing dyspnea after thoracentesis indicates a potentially life-threatening complication such as pneumothorax from inadvertent lung puncture or re-expansion pulmonary edema. Both conditions require immediate provider notification for urgent assessment and intervention. Option a is incorrect because mild soreness at the puncture site is an expected postprocedure finding from needle insertion through the intercostal space. Localized discomfort rated 3 out of 10 requires comfort measures and monitoring but does not indicate a complication requiring urgent escalation. Option b is incorrect because fatigue after thoracentesis is a normal response to the procedure, positioning, and underlying illness. Requesting rest is appropriate self-care behavior and does not indicate a complication in a client who has had 750 mL of fluid removed. Option c is incorrect because breath sounds that remain slightly decreased and unchanged from before the procedure reflect th

Correct Answer: Preventing alveolar collapse at end-expiration, recruiting collapsed units for gas exchange

PEEP maintains positive pressure at the end of expiration that prevents alveoli from collapsing between ventilator breaths. In ARDS, diffuse alveolar injury and surfactant loss cause widespread atelectasis. PEEP recruits and keeps open alveoli that would otherwise collapse, increasing the functional gas exchange surface area and improving oxygenation despite the underlying injury. Option a is incorrect because PEEP is an end-expiratory pressure setting that does not affect tidal volume. Tidal volume is set independently and reflects the volume of gas delivered per breath, while PEEP determines the baseline pressure maintained between breaths to prevent alveolar collapse. Option c is incorrect because high PEEP can actually increase pulmonary vascular resistance and impair right ventricular function by compressing alveolar capillaries. Reducing pulmonary artery pressure is not the mechanism by which PEEP improves oxygenation — it is actually an adverse hemodynamic effect to monitor. Opt

Correct Answer: Negative pressure in the isolation room is maintained only when the door stays shut

Active TB requires a negative-pressure isolation room. Negative pressure prevents contaminated air from flowing out of the room into the hallway when movement occurs. Saunders specifies that the door must remain tightly closed to maintain the negative pressure differential, which is the essential engineering control for airborne precautions. Option a is incorrect because contact precautions address transmission via direct skin-to-skin contact or contaminated surfaces, not airborne droplet nuclei. TB requires airborne precautions, not contact precautions, and the rationale for the closed door is the maintenance of negative pressure, not surface contamination prevention. Option b is incorrect because antibiotic resistance develops through inadequate or inconsistent drug therapy, not through environmental exposure in the hallway. Negative pressure in the room is an infection-prevention engineering control for protecting other patients, not a mechanism that influences bacterial drug suscep

Correct Answer: The albuterol inhaler is a rescue medication used during acute episodes to open airways

Short-acting beta-2 agonists such as albuterol are rescue medications that produce rapid bronchodilation during acute asthma episodes. They are not used on a daily scheduled basis; controller medications such as inhaled corticosteroids serve that role. Increasing reliance on albuterol signals worsening asthma control requiring medical reassessment. Option a is incorrect because albuterol is a short-acting rescue bronchodilator, not a controller medication. Long-acting bronchodilators or inhaled corticosteroids serve the daily controller role. Using a rescue inhaler daily indicates that the controller regimen needs reassessment rather than that the rescue inhaler has become a controller. Option b is incorrect because scheduled nightly albuterol use would indicate poorly controlled asthma requiring step-up therapy, not a recommended routine. Nocturnal symptoms are markers of severity that prompt the provider to intensify controller medications rather than establishing scheduled rescue us

Correct Answer: Prepare for intubation and mechanical ventilation with PEEP for respiratory failure

Severe flail chest with an SpO2 of 82% despite 8 L/min supplemental oxygen constitutes respiratory failure. Saunders specifies that severe flail chest associated with respiratory failure requires preparation for intubation and mechanical ventilation with PEEP to stabilize the chest wall internally through positive airway pressure and to correct gas exchange failure. Option b is incorrect because applying an occlusive dressing to stabilize the flail segment is an outdated approach that further restricts ventilation on the affected side without correcting the gas exchange failure. For severe hypoxia, airway management and ventilatory support take absolute priority over external chest wall stabilization. Option c is incorrect because positioning on the unaffected side and IV morphine may provide modest comfort and some splinting effect for mild flail chest, but they cannot reverse an SpO2 of 82%. The degree of gas exchange failure present requires mechanical ventilatory support, not posit

Correct Answer: Tension pneumothorax on the left requiring immediate needle decompression

Sudden high peak airway pressure, absent left chest rise, agitation, and oxygen desaturation in a PEEP-ventilated ARDS client suggest tension pneumothorax. PEEP can cause barotrauma in diseased lungs, allowing air to escape into the pleural space under increasing pressure. Saunders lists pneumothorax as a monitored complication after thoracentesis and in mechanical ventilation situations requiring immediate provider notification. Option a is incorrect because ventilator-associated pneumonia develops gradually over days with fever, purulent secretions, and progressive infiltrates rather than causing sudden acute deterioration with unilateral absent chest movement and a high-pressure alarm. Option b is incorrect because right mainstem intubation causes absent left-sided chest rise and could explain the unilateral findings. However, this complication typically occurs at intubation or with tube displacement, not as an acute onset event during ongoing stable ventilation in a PEEP-dependent

Correct Answer: Administer prescribed antibiotics, encourage 3 L of fluids daily, and promote coughing and repositioning

Saunders pneumonia management includes antibiotic therapy for the causative organism, encouraging up to 3 liters of fluid per day to thin secretions and prevent dehydration from fever, and promoting coughing, deep breathing, incentive spirometry, and frequent position changes to mobilize secretions. Together, these interventions address the infection and the airway clearance problem simultaneously. Option a is incorrect because restricting fluids thickens pulmonary secretions and worsens airway clearance, which is the opposite of the therapeutic goal. Saunders recommends up to 3 liters daily. Ice packs are less effective than antipyretics for fever, and complete activity restriction increases thrombosis and complications. Option c is incorrect because community-acquired pneumonia does not routinely require contact isolation; standard and potentially droplet precautions apply based on the organism. Bronchodilators are not primary therapy for bacterial pneumonia without concurrent reacti