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

Correct Answer: Immobilize the extremity, elevate the arm, and apply ice wrapped in cloth to the site

For brown recluse spider bites, initial management includes immobilization, elevation of the affected extremity to reduce edema, and application of a wrapped ice pack to slow venom activity and limit the expanding necrotic zone. Cold application is appropriate — unlike black widow bites, which require warm compresses for muscle spasm relief. Option a is incorrect because heat application to a brown recluse bite accelerates the local enzymatic activity of the dermonecrotic venom and increases the rate and extent of tissue necrosis. Warm compresses are specifically contraindicated for loxoscelism. Option b is incorrect because no commercially approved antivenom for brown recluse spider bites is available in the United States. Treatment is supportive, focusing on wound care, pain management, and monitoring for systemic effects such as hemolysis. Option c is incorrect because incision and drainage does not remove venom from tissue already penetrated by the bite and risks introducing infect

Correct Answer: I should wear tight polyester clothing over the rash to protect the blisters

Tight synthetic clothing worn directly over herpes zoster lesions causes friction, irritates blistered skin, traps heat and moisture, and worsens pain. The client should be instructed to wear loose, soft, natural-fiber clothing that minimizes contact with the vesicular lesions. Option a is incorrect because Option a is incorrect as a teaching gap — cool, wet compresses are appropriate and comforting for herpes zoster and do not indicate a misunderstanding. This statement demonstrates correct self-care behavior. Option c is incorrect because Option c is incorrect as a teaching gap — initiating antiviral therapy within seventy-two hours of rash onset is the correct therapeutic window for reducing zoster severity and duration. This statement demonstrates the client understands the time-sensitive nature of treatment. Option d is incorrect because Option d is incorrect as a teaching gap — avoiding contact with varicella-naive individuals is the correct precaution because herpes zoster can t

Correct Answer: Immediately discontinue the trimethoprim-sulfamethoxazole

The absolute first priority in Stevens-Johnson syndrome is immediate removal of the causative drug. Continued exposure to the triggering agent allows the immune-mediated epidermal detachment to progress. Stopping the offending medication is the single most critical intervention and cannot be delayed for any other treatment. Option b is incorrect because wound care, while essential in SJS management, is not the first priority. Applying topical agents to blistered skin before removing the causative drug leaves the immunological trigger in place and permits ongoing epidermal destruction. Option c is incorrect because the role of corticosteroids in Stevens-Johnson syndrome is controversial and their use is not universally recommended. More critically, administering steroids before stopping the causative drug does not halt the immune-mediated trigger and may mask ongoing progression. Option d is incorrect because protective isolation supports infection risk reduction in a client with disrup

Correct Answer: Two forms of contraception are required and monthly pregnancy tests are mandatory

iPLEDGE requires two simultaneous forms of effective contraception during isotretinoin therapy and monthly negative pregnancy tests regardless of contraceptive method. Isotretinoin is one of the most potent human teratogens, and no single contraceptive method is considered sufficient protection against an exposure with catastrophic fetal consequences. Option a is incorrect because oral contraceptives alone are explicitly considered insufficient protection under iPLEDGE. A second form of contraception — such as barrier method — must be used simultaneously. Single-method contraception carries a failure rate that is unacceptable given the drug's teratogenicity. Option b is incorrect because monthly pregnancy tests are mandatory for all females of childbearing potential in the iPLEDGE program, regardless of contraceptive method or reported sexual activity. No exemptions exist; the tests are a non-negotiable program requirement. Option d is incorrect because isotretinoin is absolutely

Correct Answer: Calcipotriene typically requires one to three weeks for visible improvement and results are still expected

Calcipotriene, a vitamin D analogue, requires one to three weeks of consistent daily use before visible clinical improvement appears. At two and a half weeks the client is at the expected onset window. Continued consistent use should be encouraged, and the client can expect to see results very soon. Option a is incorrect because calcipotriene does not produce results within three to five days. The drug modulates keratinocyte proliferation through vitamin D nuclear receptor pathways, a mechanism requiring sustained exposure over days to weeks before plaque morphology changes are visible. Option b is incorrect because two and a half weeks is within the expected therapeutic onset range for calcipotriene. Labeling the medication ineffective before the full one-to-three-week window has elapsed would result in premature discontinuation of a potentially effective treatment. Option c is incorrect because while some clients may take longer to respond, the standard expected onset for calcipotrie

Correct Answer: Wear sunscreen or protective clothing whenever exposed to sunlight during treatment

Tacrolimus carries a warning about increased ultraviolet radiation sensitivity and a theoretical risk of skin malignancy with prolonged sun exposure. Clients must apply broad-spectrum sunscreen and wear protective clothing to minimize UV exposure during and after tacrolimus treatment. Option a is incorrect because tacrolimus should be applied in a thin layer rather than massaged aggressively. The drug's mechanism does not require occlusion or vigorous rubbing; excessive application wastes medication and may increase systemic absorption through already-inflamed skin. Option b is incorrect because tacrolimus is contraindicated on infected skin. As a calcineurin inhibitor, it suppresses local immune responses necessary for clearing bacterial, viral, or fungal infections. All infections must be treated and resolved before applying tacrolimus. Option d is incorrect because occlusive dressings are explicitly contraindicated with tacrolimus. Occlusion dramatically increases systemic abso

Correct Answer: Constricting bands cause ischemic tissue necrosis; aspirin worsens venom-induced coagulopathy

Constricting bands interrupt arterial blood flow, causing limb ischemia and concentrating venom in devascularized tissue. Many snake venoms, including pit viper venom, induce coagulopathy, and aspirin's antiplatelet effect dramatically worsens this hemorrhagic complication. Both are contraindicated in snakebite first aid. Option a is incorrect because band placement location is irrelevant — constricting bands are contraindicated entirely in snakebite management, not just when placed at the wrong level. The analgesic comparison misses the critical point: aspirin is contraindicated because of its antiplatelet effect on venom-induced coagulopathy. Option b is incorrect because the harm from a constricting band is arterial ischemia, not simply venous congestion. And while opioid analgesia may be appropriate, the problem with aspirin is not analgesic efficacy but its platelet-inhibiting mechanism that worsens coagulopathy — requiring antiplatelet-free analgesics. Option c is incorrect

Correct Answer: Clients taking thiazide diuretics should use PABA-free sunscreen to avoid cross-reactive hypersensitivity

Hydrochlorothiazide causes photosensitivity and belongs to the sulfonamide class. PABA-containing sunscreens have been associated with hypersensitivity reactions in clients taking sulfonamide-related drugs. Switching to a broad-spectrum PABA-free sunscreen avoids this cross-reactive sensitivity while still providing photoprotection. Option b is incorrect because topical sunscreen applied to skin does not reach the gastrointestinal tract and cannot affect oral drug absorption. Transdermal PABA absorption is negligible, and no pharmacokinetic mechanism supports the claim that sunscreen affects hydrochlorothiazide bioavailability. Option c is incorrect because thiazide diuretics do not alter the metabolic processing of topically applied PABA or change its photoprotective capability on the skin surface. No evidence supports a pharmacokinetic interaction in which hydrochlorothiazide changes sunscreen efficacy. Option d is incorrect because dismissing the thiazide-PABA interaction leads the

Correct Answer: Moisture-retentive dressing such as a hydrocolloid or transparent film

A stage II pressure injury with a clean, pink-red wound bed benefits from a moisture-retentive dressing such as a hydrocolloid. Moist wound healing provides the optimal environment for epithelial cell migration, accelerating closure of the partial-thickness injury without disrupting fragile new tissue. Option a is incorrect because dry gauze disrupts newly forming epithelial cells when it adheres to the wound bed and is removed. Twice-daily changes with dry gauze repeatedly traumatize the surface of a healing wound and do not maintain the moist environment evidence-based wound care requires. Option c is incorrect because wet-to-dry packing is a mechanical debridement technique designed for wounds with necrotic tissue that requires removal. Applying it to a clean stage II wound with a viable pink wound bed would debride healthy epithelial cells and delay rather than support healing. Option d is incorrect because allowing a wound bed to dry promotes hard eschar formation that blocks epit

Correct Answer: Two forms of effective contraception are required during therapy and for three years after stopping

Acitretin is a Category X teratogen, and two simultaneous forms of effective contraception must be used throughout therapy and for three years after the last dose. Acitretin converts to etretinate — a long-persisting teratogen with a half-life of 120 days stored in adipose tissue — extending reproductive risk far beyond the drug's own half-life. Option a is incorrect because acitretin is absolutely contraindicated at any gestational age. It is a Category X drug producing severe craniofacial, cardiac, and central nervous system malformations; no trimester is safe, and discovering pregnancy while taking it does not permit continued use. Option b is incorrect because a single oral contraceptive is explicitly insufficient under acitretin prescribing requirements. The drug's catastrophic teratogenicity requires two simultaneous contraceptive methods; oral contraception alone carries a failure rate unacceptable for this degree of fetal risk. Option c is incorrect because thirty day