HESI - Medical Surgical
Nursing test-Exam TEST
BANK FOR MEDICAL
SURGICAL NURSING 11TH
EDITION IGNATAVICIUS
DONNA D. IGNATAVICIUS
ACTUAL UPDATED 2024
300+ QUESTIONS AND
ANSWERS WITH RATIONALES
100% QUARANTEED TO PASS
The nurse is assessing a group of clients.
Which clients are at greater risk for
hypothermia or frostbite? (select all that
apply)
a. an older woman with hypertension
b. a young man with a body mass index of
42
c. a young many who has just consumed six
martinis
d. an older man who smokes a pack of
cigarettes a day
e. a young woman who is anorexic
f. a young woman who is diabetic -
ANSWER-C, D, E, F
Rationale.
clients with poor nutrition, fatigue, and
multiple chronic illnesses are at greater risk
for hypothermia. Clients who smoke,
consume alcohol, or have impaired
peripheral circulation have a higher
incidence of frostbite.
The nurse is caring for four clients. Which
client assessment is the most indicative of
having pain?
A) Client stating that he is "anxious"
B) Heart rate of 105 beats/min and
restlessness
C) Blood pressure 150/70 mm Hg and
sleeping
D) Postoperative client with a neck incision -
ANSWER-B
Rationale.
At times clients are unable to verbalize that
they are in pain but there are indicators
that the client may have acute pain such as
increased heart rate, increased blood
pressure, increased respirations, sweating,
restlessness, and overall distress. All the
other distractors could indicate clients who
have the potential for being in pain, but
restlessness with tachycardia is the most
indicative.
When describing patient education
approaches, the nurse educator would
explain that informal teaching is an
approach that
a. follows formalized plans
b. has standardized content
c. often occurs one-to-one
d. addresses group needs - ANSWER-C.
Rationale.
Informal teaching is individualized one on
one teaching which represents the majority
of patient education done by nurses that
occurs when an intervention is explained or
a question is answered. Group needs are
often the focus of formal patient education
courses or classes. Informal teaching does
not necessarily follow a specific formalized
plan. It may be planned with specific
content, but it is individualized responses to
patient needs. Formal teaching involves the
use of a curriculum/course plan with
standardized content.
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