HESI MS HESI Medical and Surgical Exam - Set 4 - Part 3

Correct Answer: Water promotes renal filtration to flush excess isotope from the bladder before scanning to reduce image artifact.

After isotope injection, the drug circulates and a portion accumulates in the bladder through renal excretion. Bladder radiotracer creates dense artifact on pelvic bone images that can obscure findings. Drinking water and voiding before scanning clears the bladder of excess isotope, producing cleaner images of the pelvic and lumbar skeleton. Option a is incorrect because the radiation dose from the injected radioisotope is fixed by the amount administered and does not change based on how much water the client drinks afterward. Blood dilution of the isotope after injection has no effect on the emitted radiation or the absorbed dose. Option b is incorrect because the bone scan isotope concentrates in areas of increased osteoblast activity driven by metabolic bone dynamics, not by blood flow changes induced by hydration. Drinking water does not alter the pharmacokinetic distribution of the radiopharmaceutical in bone tissue. Option c is incorrect because allergic reactions to bone scan is

Correct Answer: Adjusting the boot disturbs the pulling force and countertraction balance, canceling the therapeutic effect and allowing muscle spasms to worsen.

Buck's traction exerts a calibrated straight pull through a system of weights and pulleys, with the client's body weight providing countertraction. Any change to the boot's position alters the direction and magnitude of the pulling force, disrupting the mechanical therapeutic intent, allowing muscle spasms to return, and potentially worsening fracture alignment. Option b is incorrect because self-adjusting the boot changes the traction mechanics without nursing knowledge of what was altered and why. Even if the client reports the adjustment afterward, the therapeutic force balance may be compromised during the interval, and some adjustments cannot simply be reversed by reporting. Option c is incorrect because Buck's traction provides specific preoperative benefits — muscle spasm reduction and fracture immobilization — that cannot be replicated by simply removing the device for comfort. Discontinuing traction without a provider order risks increased pain and fracture

Correct Answer: Reduce activity during inflammation flares, pursue weight reduction to decrease joint load, and switch to low-impact exercise such as swimming.

In osteoarthritis, excess weight multiplies compressive forces on knee cartilage; even modest weight loss produces measurable pain reduction. Exercise must be curtailed during active inflammation to prevent cartilage breakdown, and low-impact activities such as swimming or cycling maintain fitness without the high joint loading of long-distance walking on pavement. Option a is incorrect because increasing walking distance beyond the client's current pain threshold intensifies articular cartilage stress and accelerates the degenerative process. Weight loss is appropriate, but achieving it by pushing through significant daily pain is counterproductive and harmful. Option b is incorrect because inclines increase knee compressive and shear forces with each step. Adding elevation to a walk that already causes severe pain by the second mile would worsen symptoms and articular damage rather than improving either fitness or joint health. Option d is incorrect because complete inactivity a

Correct Answer: Both crossing the legs and pulling the knee toward the chest are prohibited because they create positions that can dislocate the prosthesis.

After total hip arthroplasty, three movements are specifically prohibited to prevent prosthetic dislocation: hip flexion beyond 90 degrees, hip adduction across the midline, and internal rotation. Crossing the legs produces adduction and rotation; pulling the knee to the chest creates extreme flexion. Both actions must be strictly avoided in the early postoperative period. Option a is incorrect because crossing the legs after hip arthroplasty creates adduction and internal rotation, which are two of the three prohibited movements. Telling the family that it is acceptable while only flagging the knee-to-chest movement gives a dangerously incomplete set of precautions. Option b is incorrect because unrestricted range-of-motion exercises performed by family members who are not trained in safe postoperative positioning can displace the new prosthesis. Early mobilization occurs under physical therapy supervision within defined safe ranges, not through unguided family-performed stretches. Op

Correct Answer: Minimize sitting time as it increases intradiscal pressure; sleep on the side with knees and hips flexed and a pillow between the legs; avoid lifting objects above elbow height.

Sitting substantially increases intradiscal pressure at the L4-L5 level and must be minimized in early lumbar disk surgery recovery. Side-lying with hips and knees flexed and a pillow between the legs maintains lumbar alignment and reduces surgical site tension. Lifting above elbow height creates spinal flexion forces that can disrupt the repair. Option a is incorrect because prolonged sitting is specifically contraindicated after lumbar disk surgery. Eight hours at a computer within one week places repeated compressive loading on the operated disk level and can cause hardware failure or reherniation during the critical early healing phase. Option c is incorrect because laminectomy removes part of the vertebral arch but does not restore full structural stability or eliminate healing requirements. Unrestricted return to all activities ignores the weeks needed for the surgical site, bone, and surrounding soft tissue to heal adequately. Option d is incorrect because three weeks of complet

Correct Answer: Contact the provider before administering colchicine, because the drug requires caution in clients with renal impairment.

Colchicine is used with caution in clients with renal or hepatic impairment because reduced clearance prolongs the drug's half-life and increases plasma concentrations, raising the risk of serious toxicity including bone marrow suppression and neuromuscular toxicity. The nurse must consult the provider before giving the first dose. Option b is incorrect because renal function significantly affects colchicine elimination. In stage 3 CKD with a creatinine clearance of only 32 mL per minute, normal dosing produces drug accumulation that can reach toxic concentrations. Disregarding this interaction is a medication safety error. Option c is incorrect because doubling a dose in a client with impaired renal clearance would dramatically increase the risk of toxicity. Dose adjustments in renal impairment involve reducing the dose or extending the dosing interval, not compensating with more drug. Option d is incorrect because allopurinol, which increases urinary uric acid excretion, depends

Correct Answer: Raise the head of the bed and unkink the catheter tubing immediately to relieve bladder distension.

The clinical picture is autonomic dysreflexia triggered by bladder distension from kinked catheter tubing. Raising the head of the bed immediately uses gravity to lower blood pressure, and unkinning the tubing eliminates the noxious stimulus that is sustaining the sympathetic outburst. Both actions are performed simultaneously without delay. Option a is incorrect because analgesics and delayed reassessment allow a blood pressure of 194 mm Hg to persist while the stimulus driving it continues uncorrected. The noxious stimulus must be removed first; managing pain without removing the cause is ineffective and potentially dangerous. Option b is incorrect because laying the client flat in autonomic dysreflexia eliminates the gravity-assisted pressure reduction from the upright head position, causing the blood pressure to rise further. The head must be elevated, not lowered. Option c is incorrect because calling rapid response and immediately administering antihypertensives bypasses the firs

Correct Answer: Facial swelling, foamy urine, or a significant decrease in daily urine output.

Rising creatinine with significant proteinuria and red cell casts confirms active lupus nephritis. Facial edema from protein loss below oncotic threshold, foamy urine from protein excretion, and oliguria from declining GFR are urgent signs that the nephritis is worsening toward renal failure and require immediate provider contact. Option a is incorrect because joint pain and morning stiffness describe the musculoskeletal activity of SLE, not the progression of glomerulonephritis. While these symptoms are monitored as part of disease management, they are not warning signs of the renal deterioration that poses the greatest long-term threat in this client. Option b is incorrect because the malar butterfly rash is a dermatological SLE manifestation that does not correlate reliably with renal function. Changes in the facial rash pattern may reflect overall disease activity but are not specific indicators of nephritis progression. Option d is incorrect because photosensitivity is a well-know

Correct Answer: Recognize this as baclofen withdrawal from an empty pump and notify the provider immediately for emergent refill.

Abrupt intrathecal baclofen withdrawal from an empty pump is a life-threatening emergency producing severe rebound spasticity, fever, confusion, hypotension, rhabdomyolysis, and potential respiratory failure. Immediate provider notification and emergent pump refill are required. Without intervention, this syndrome progresses to multi-organ failure and death. Option a is incorrect because oral baclofen cannot replicate the cerebrospinal fluid concentrations achieved through intrathecal delivery; the CNS levels are fundamentally different. Waiting another week for a scheduled refill allows a pharmacological withdrawal crisis to progress to fatal severity. Option c is incorrect because fever, hypotension, and confusion are not expected consequences of a missed refill appointment — they are signs of a withdrawal emergency. Restarting the pump at a lower dose without urgent provider evaluation and addressing the withdrawal manifestations would be clinically negligent. Option d is incorrect

Correct Answer: Phenelzine, a monoamine oxidase inhibitor, combined with carbidopa-levodopa can produce a severe hypertensive crisis; the nurse must withhold phenelzine and contact the provider immediately.

Phenelzine is an MAOI that blocks catecholamine breakdown. Combined with carbidopa-levodopa, which floods the system with dopamine precursor, the result is a dangerous accumulation of catecholamines producing severe hypertensive crisis. The nurse must withhold the phenelzine and reach the provider before any dose is administered. Option a is incorrect because drowsiness is not the primary or most dangerous interaction. Holding the established carbidopa-levodopa while contacting the provider would deprive the Parkinson's client of essential therapy without basis, worsening motor symptoms unnecessarily while the real danger — hypertensive crisis — is not addressed. Option b is incorrect because the harm from combining an MAOI with levodopa is pharmacodynamic, not pharmacokinetic. The problem is not one of absorption timing but of concurrent catecholamine excess. Separating doses by four hours does not eliminate the MAOI-induced accumulation of dopamine that produces the hypertensive