HESI MS HESI Medical and Surgical Exam - Set 5 - Part 3

Correct Answer: Asymmetry, irregular border, color variation, diameter over 6 mm, evolution

The ABCDE criteria — Asymmetry, Border irregularity, Color variation, Diameter greater than 6 millimeters, and Evolution or change over time — are the standard warning signs for malignant melanoma. Any lesion meeting one or more of these criteria warrants urgent dermatologic evaluation for biopsy and histological confirmation. Option b is incorrect because a smooth border, uniform color, and small diameter describe a benign mole or a low-risk lesion; concerning features are the opposite — irregularity, color variation, and larger size. Option c is incorrect because a firm pearlescent nodule with central ulceration and rolled edges is the classic presentation of basal cell carcinoma, not melanoma; basal cell carcinoma rarely metastasizes unlike melanoma. Option d is incorrect because a scaly, flat, bleeding patch describes squamous cell carcinoma in situ (Bowen's disease) or actinic keratosis rather than the pigmented, asymmetric, evolving lesion characteristic of melanoma.

Correct Answer: Spontaneous hemorrhage from severe thrombocytopenia

A platelet count below 50,000 per microliter indicates severe thrombocytopenia associated with prolonged bleeding after minor injury, and counts below 20,000 increase the risk of spontaneous hemorrhage. During this post-infusion nadir window, the nurse implements bleeding precautions — soft-bristle toothbrush, avoiding IM injections, monitoring for petechiae, guaiac testing stools — to prevent serious hemorrhage. Option a is incorrect because hypersensitivity reactions to gemcitabine occur during or immediately after infusion and manifest as flushing, urticaria, or bronchospasm, not as a delayed platelet-count-related complication. Option b is incorrect because peripheral neuropathy is caused by axonal or myelin damage from specific chemotherapy agents such as vincristine or cisplatin, not by platelet microthrombi; low platelets reduce clotting rather than promoting thrombosis. Option d is incorrect because tumor lysis syndrome is characterized by electrolyte disturbances — hyperkalemi

Correct Answer: A positive ANA is sensitive for SLE but is not specific, as it can be positive in other conditions

The ANA test is highly sensitive for SLE — most clients with lupus test positive — but it is not specific. ANA can be positive in rheumatoid arthritis, Sjogren's syndrome, scleroderma, drug-induced lupus, and even in healthy individuals. The anti-dsDNA antibody is far more specific for SLE and is used to confirm the diagnosis when ANA is positive. Option b is incorrect because a positive ANA alone does not confirm SLE; diagnosis requires meeting specific classification criteria including multiple clinical and laboratory findings; ANA positivity initiates the workup but does not end it. Option c is incorrect because ANA testing has a role in the initial diagnostic workup, not only in monitoring; it is one of the early tests ordered when SLE is clinically suspected based on symptoms. Option d is incorrect because a small percentage of clients with confirmed SLE test ANA-negative; a negative ANA reduces but does not eliminate the possibility of lupus when clinical features strongly s

Correct Answer: Discuss sperm banking before chemotherapy and radiation begin

ABVD chemotherapy and mediastinal radiation can cause permanent infertility by damaging testicular spermatogenesis and impair sperm quality during the treatment period. For a young male client who may want biological children, sperm banking before treatment begins is the only reliable way to preserve fertility. This conversation must happen before the first treatment cycle. Option a is incorrect because condom use addresses partner protection from potential chemotherapy-contaminated semen but does not preserve the client's future fertility; the critical intervention is banking sperm before treatment damages production. Option c is incorrect because fertility recovery after ABVD and radiation is not guaranteed; alkylating agents and radiation to nearby fields can cause permanent azoospermia, and advising the client to expect recovery may create false reassurance. Option d is incorrect because recommending adoption as the primary option before treatment and before assessing the clie

Correct Answer: Add household bleach to the toilet bowl before voiding and sit for 15 minutes before flushing

BCG is a live attenuated organism that can survive in urine. For six hours after intravesical BCG instillation, clients are instructed to add a small amount of household bleach to the toilet bowl before voiding, then allow the mixture to sit for at least 15 minutes before flushing to kill the organism and prevent environmental contamination with the live vaccine strain. Option b is incorrect because urine collection and return to the clinic is not the standard BCG home protocol; the bleach decontamination method allows safe home disposal without specialized specimen handling. Option c is incorrect because multiple flushes without bleach pre-treatment do not inactivate the live BCG organism; dilution by flushing is insufficient decontamination, and the bleach exposure time is required to chemically kill the attenuated bacteria. Option d is incorrect because disposing of BCG-containing urine in an outdoor environment spreads the live organism into uncontrolled settings, creating a public

Correct Answer: Doxorubicin-induced cardiomyopathy presenting years after treatment

Doxorubicin (Adriamycin), the 'A' in ABVD, causes dose-dependent cardiotoxicity through free radical damage to myocardial cells. This dilated cardiomyopathy is a well-recognized late effect that can manifest months to years after treatment completion, even when the client appeared to tolerate chemotherapy well. Survivors of Hodgkin's lymphoma require lifelong cardiac surveillance. Option a is incorrect because bleomycin causes pulmonary fibrosis rather than cardiac dysfunction; while pulmonary fibrosis can cause right heart strain over time, the echocardiographic finding of reduced ejection fraction is more directly explained by doxorubicin cardiotoxicity. Option b is incorrect because radiation esophagitis is an acute treatment complication, not a late effect presenting four years post-treatment, and it would cause odynophagia rather than reduced cardiac ejection fraction. Option d is incorrect because vinblastine causes peripheral neuropathy — sensory and motor nerve d

Correct Answer: Pneumocystis jirovecii pneumonia treated with trimethoprim-sulfamethoxazole

Pneumocystis jirovecii pneumonia (PJP) is the most common AIDS-defining opportunistic infection in clients with CD4 counts below 200 cells per microliter. The clinical picture of gradual-onset dyspnea, dry cough, low-grade fever, and bilateral interstitial infiltrates on chest x-ray is classic for PJP. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment and also used for prophylaxis in clients with CD4 below 200. Option b is incorrect because CMV pneumonitis typically causes more abrupt respiratory deterioration with bilateral pneumonitis in profoundly immunocompromised clients and is treated with ganciclovir, not TMP-SMX; the gradual clinical course here is more consistent with PJP. Option c is incorrect because Mycobacterium avium complex is a systemic infection in advanced AIDS that presents with fevers, night sweats, and diarrhea rather than the classic bilateral interstitial pneumonia pattern; it is not primarily a pulmonary infiltrative infection. Option d is inco

Correct Answer: Notify the provider immediately because bright red drainage indicates active bleeding

Bright red NG drainage on postoperative day two after gastrectomy indicates active arterial or venous hemorrhage at the anastomosis or resection site, which is abnormal at this stage. Expected drainage should be transitioning from dark red or coffee-ground material to greenish-yellow as healing progresses. Immediate provider notification is required for evaluation and possible return to the operating room. Option a is incorrect because irrigating the NG tube with saline introduces fluid that can obscure the quantity of bleeding and does not address the underlying hemorrhage; the priority is provider notification, not tube maintenance. Option b is incorrect because increasing suction pressure when active bleeding is suspected would accelerate blood loss from the surgical site rather than resolving the hemorrhage; suction pressure should not be increased independently. Option d is incorrect because bright red NG drainage on postoperative day two is never an expected finding and should ne

Correct Answer: Infusion-related reaction requiring immediate cessation of the rituximab infusion

Rituximab causes infusion-related reactions, particularly during the first infusion, characterized by fever, rigors, hypotension, and hypoxia appearing within minutes of starting the infusion. The priority action is stopping the infusion immediately to halt antigen-antibody complex formation. Supportive care — IV fluids, diphenhydramine, acetaminophen, and epinephrine if severe — follows. The infusion may be restarted at a slower rate after symptoms resolve. Option a is incorrect because tumor lysis syndrome develops over hours to days after chemotherapy begins and presents with electrolyte disturbances; the acute onset during rituximab infusion specifically points to an infusion-related reaction rather than metabolic crisis. Option c is incorrect because pulmonary embolism typically presents with pleuritic chest pain, sudden dyspnea, and tachycardia without the concurrent fever and rigors seen here; the timing during rituximab infusion is the distinguishing clinical clue. Option d is

Correct Answer: The waiting period allows the nurse to observe for and respond to anaphylaxis before the client leaves

Allergy immunotherapy injections introduce allergen extracts that can trigger a systemic anaphylactic reaction in sensitized individuals. Anaphylaxis typically develops within 20 to 30 minutes of injection. Requiring the client to remain in the clinic during this window ensures that trained staff and emergency equipment — including epinephrine — are immediately available if a severe reaction occurs. Option b is incorrect because the 30-minute post-injection observation period applies to every injection, not only the first injection from a new vial; sensitivity can change at any point in the treatment course and reactions occur unpredictably. Option c is incorrect because the opposite is true — anaphylaxis typically occurs within the first 20 to 30 minutes after injection while the client is still at the clinic, making the waiting period clinically essential rather than incidental. Option d is incorrect because the mandatory observation period is a clinical safety standard designed to a