BSN 266 HESI Med Surg Practice Exam Version 1 (2023/ 2024 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale

BSN 266 HESI Med Surg Practice Exam

(2023/ 2024 Update) Questions and Verified

Answers with Rationales|100% Correct|

Grade A- Nightingale

Q: The client admitted with peripheral vascular disease (PVD) asks the nurse why

her legs hurt when she walks. The nurse bases a response on the knowledge that the

main characteristic of PVD is:

1. Decreased blood flow.

2. Increased blood flow.

3. Slow blood flow.

4. Thrombus formation.

Answer:

1

Decreased blood flow is a common characteristic of all PVD. When the

demand for oxygen to the working muscles becomes greater than the supply, pain is the

outcome. Slow blood flow throughout the circulatory system may suggest pump failure.

Thrombus formation can result from stasis or damage to the intima of the vessels.

Q: The nurse is planning care for a client who is diagnosed with peripheral vascular

disease (PVD) and has a history of heart failure. The nurse should develop a plan of

care that is based on the fact that the client may have a low tolerance for exercise

related to:

1. Decreased blood flow.

2. Increased blood flow.

3. Decreased pain.

4. Increased blood viscosity.

Answer:

1

A client with PVD and heart failure will experience decreased blood flow. In

this situation, low exercise tolerance (oxygen demand becomes greater than the oxygen

supply) may be related to less blood being ejected from the left ventricle into the

systemic circulation. Decreased blood supply to the tissues results in pain. Increased

blood viscosity may be a component, but it is of much less importance than the disease

processes.

Q: When assessing the lower extremities of a client with peripheral vascular

disease (PVD), the nurse notes bilateral ankle edema. The edema is related to:

1. Competent venous valves.

2. Decreased blood volume.

3. Increase in muscular activity.

4. Increased venous pressure.

Answer:

4

In PVD, decreased blood flow can result in increased venous pressure. The

increase in venous pressure results in an increase in capillary hydrostatic pressure,

which causes a net filtration of fluid out of the capillaries into the interstitial space,

resulting in edema. Valves often become incompetent with PVD. Blood volume is not

decreased in this condition. Decreased muscular action would contribute to the

formation of edema in the lower extremities.

Q: The nurse is obtaining the pulse of a client who has had a femoral-popliteal

bypass surgery 6 hours ago. (See below) Which assessment provides the most accurate

information about the client's postoperative status?

1. radial pulse

2. femoral pulse

3. apical pulse

4. dorsalis pedis pulse

Answer:

4

The presence of a strong dorsalis pedis pulse indicates that there is circulation to

the extremity distal to the surgery indicating that the graft between the femoral and

popliteal artery is allowing blood to circulate effectively. Answer 1 shows the nurse

obtaining the radial pulse; answer 2 shows the femoral pulse, which is proximal to the

surgery site and will not indicate circulation distal to the surgery site. Answer 3 shows

the nurse obtaining an apical pulse.

Q: The nurse is teaching a client about risk factors associated with atherosclerosis

and how to reduce the risk. Which of the following is a risk factor that the client is not

able to modify?

1. Diabetes.

2. Age.

3. Exercise level.

4. Dietary preferences

Answer:

2

Age is a nonmodifiable risk factor for atherosclerosis. The nurse instructs the

client to manage modifiable risk factors such as comorbid diseases (eg, diabetes),

activity level, and diet. Controlling serum blood glucose levels, engaging in regular

aerobic activity, and choosing a diet low in saturated fats can reduce the risk of

developing atherosclerosis.

Q: The nurse is assessing the lower extremities of the client with peripheral

vascular disease (PVD). During the assessment, the nurse should expect to find which of

the following clinical manifestations of PVD? Select all that apply.

1. Hairy legs.

2. Mottled skin.

3. Pink skin.

4. Coolness.

5. Moist skin.

Answer:

2,4

Reduction of blood flow to a specific area results in decreased oxygen and

nutrients. As a result, the skin may appear mottled. The skin will also be cool to the

touch. Loss of hair and dry skin are other signs that the nurse may observe in a client

with PVD of the lower extremities.

Q: The nurse is unable to palpate the client's left pedal pulses. Which of the

following actions should the nurse take next?

1. Auscultate the pulses with a stethoscope.

2. Call the physician.

3. Use a Doppler ultrasound device.

4. Inspect the lower left extremity

Answer:

3

When pedal pulses are not palpable, the nurse should obtain a Doppler

ultrasound device. Auscultation is not likely to be helpful if the pulse isn't palpable.

Inspection of the lower extremity can be done simultaneously when palpating, but the

nurse should first try to locate a pulse by Doppler. Calling the physician may be

necessary if there is a change in the client's condition.

Q: Which of the following lipid abnormalities is a risk factor for the development

of atherosclerosis and peripheral vascular disease?

1. Low concentration of triglycerides.

2. High levels of high-density lipid (HDL) cholesterol.

3. High levels of low-density lipid (LDL) cholesterol.

4. Low levels of LDL cholesterol.

Answer:

3

An increased LDL cholesterol concentration has been documented as a risk

factor for the development of atherosclerosis. LDL cholesterol is not broken down in

the liver but is deposited into the intima of the blood vessels. Low triglyceride levels

are desirable. High HDL and low LDL levels are beneficial and are known to be

protective for the cardiovascular system.

Q: When assessing an individual with peripheral vascular disease, which clinical

manifestation would indicate complete arterial obstruction in the lower left leg?

1. Aching pain in the left calf.

2. Burning pain in the left calf.

3. Numbness and tingling in the left leg.

4. Coldness of the left foot and ankle

Answer:

4

Coldness in the left foot and ankle is consistent with complete arterial

obstruction. Other expected findings would include paralysis and pallor. Aching pain, a

burning sensation, or numbness and tingling are earlier signs of tissue hypoxia and

ischemia and are commonly associated with incomplete obstruction.