Combined Hesi Medical Surgical Test Bank Questions with Answers
A male client with sickle cell anemia, who has been hospitalized for another health problem, tells the nurse he has
had an erection for over 4 hours. What action should the nurse implement rst?
Notify the client’s healthcare provider.
Document the nding in the client record.
Prepare a warm enema solution for rectal instillation.
Obtain a large bore needle for aspiration of the corpora cavernosa.
Rationale
Priapism, a urologic emergency, is common during sickle cell crisis due to sickle cells clogging the
microcirculation in the penis, causing a reduction of blood ow and oxygenation to the penis, so the
healthcare provider should be rst noti ed immediately. The prescribed therapy may consist of noninvasive
measures such as applying ice to the penis, instilling a warm solution enema to increase out ow in the
corpora cavernosa and giving pain medications. If noninvasive measures do not work, then needle aspiration
of the corpora cavernosa is implemented by the healthcare provider.
The nurse completes visual inspection of a client’s abdomen. What technique should the nurse perform next in the
abdominal examination?
Percussion.
Auscultation.
Deep palpation. Light
palpation.
Rationale
Auscultation of the client’s abdomen is performed next because manual manipulation of the abdomen can
stimulate peristalsis and create inaccurate assessment of bowel sounds heard during auscultation.
Which intervention should the nurse implement that best con rms placement of an endotracheal tube (ETT)?