HESI Review Advanced Medical-Surgical Nursing (Miami Dade College): 100 Questions and Answers with Rationale. Includes Test-Taking Strategy, Level of Cognitive Ability, Client Needs, Integrated Process, Content Area and the Reference,. | Documents and Forms | Research Papers

HESI Review Advanced Medical-Surgical Nursing (Miami Dade College): 100 Questions and Answers with Rationale. Includes Test-Taking Strategy, Level of Cognitive Ability, Client Needs, Integrated Proces...

HESI Review Advanced Medical-Surgical Nursing (Miami Dade College): 100 Questions and Answers with Rationale. Includes Test-Taking Strategy, Level of Cognitive Ability, Client Needs, Integrated Proces... PLDZ-25
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A client who has undergone abdominal surgery calls the nurse and reports that she just felt “something give way” in the abdominal incision. The nurse checks the incision and notes the presence of wound dehiscence. The nurse immediately:

 

Contacts the physician Incorrect Documents the findings

Places the client in a supine position with the legs flat

 

Covers the abdominal wound with a sterile dressing moistened with sterile saline solution Correct

 

 

Level of Cognitive Ability: Applying Client Needs: Physiological Integrity

Integrated Process: Nursing Process/Implementation Content Area: Perioperative Care

Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., pp. 291, 292, 296). St. Louis: Saunders.

 

A client who just returned from the recovery room after a tonsillectomy and adenoidectomy is restless and her pulse rate is increased. As the nurse continues the assessment, the client begins to vomit a copious amount of bright-red blood. The immediate nursing action is to:

 

Notify the surgeon Correct Continue the assessment

Check the client’s blood pressure

 

Obtain a flashlight, gauze, and a curved hemostat

 

Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 657). St. Louis: Saunders.

A client who has just undergone surgery suddenly experiences chest pain, dyspnea, and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately sets about:

 

Preparing the client for a perfusion scan Attaching the client to a cardiac monitor

Administering oxygen by way of nasal cannula Correct

 

Ensuring that the intravenous (IV) line is patent

 

Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 680). St. Louis: Saunders.

. 4.ID: 383738703

A nurse is assessing a client who has a closed chest tube drainage system. The nurse notes constant bubbling in the water seal chamber. What actions should the nurse take? (Select all that apply).

 

Clamping the chest tube Changing the drainage system

Assessing the system for an external air leak Correct Reducing the degree of suction being applied

Documenting assessment findings, actions taken, and client response Correct

 

 

 

 

 

 

A nurse is helping a client with a closed chest tube drainage system get out of bed and into a chair. During the transfer, the chest tube is caught on the leg of the chair and dislodged from the insertion site. The immediate priority on the part of the nurse is:

 

Contacting the physician Reinserting the chest tube Transferring the client back to bed

 

Covering the insertion site with a sterile occlusive dressing Correct

A nurse performing nasopharyngeal suctioning and suddenly notes the presence of bloody secretions. The nurse would first:

 

Continue suctioning to remove the blood

 

Check the degree of suction being applied Correct Encourage the client to cough out the bloody secretions

Remove the suction catheter from the client’s nose and begin vigorous suctioning through the mouth

 

 

 

 

 

 

CLICK ON THE PRODUCT INFORMATION URL TO ACCESS MORE HESI REVIEW INFORMATION A client who has undergone abdominal surgery calls the nurse and reports that she just felt “something give way” in the abdominal incision. The nurse checks t
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