Review HESI RN Medical surgical exam

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HESI RN Medical surgical exam

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Total Questions : 54

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Question 1:

A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

A. Osmolarity B. Platelets C. Albumin D. Glucose

Answer and Explanation

Choice A:

Osmolarity is a measure of the concentration of solutes in the blood. While it can be important in certain contexts, it is not the primary concern when monitoring a client with Addison's disease who is on hydrocortisone therapy.

Choice B:

Platelets are a component of blood involved in clotting. Monitoring platelet count is important in certain conditions, but it is not the primary focus for a client with Addison's disease on hydrocortisone therapy.

Choice C:

Albumin is a protein in the blood that helps maintain osmotic pressure and transport substances. While it is important to monitor albumin levels in some conditions, it is not the primary concern for a client with Addison's disease on hydrocortisone therapy.

Choice D:

Glucose levels are crucial to monitor in clients with Addison's disease on hydrocortisone therapy. Hydrocortisone can affect glucose metabolism, potentially leading to hyperglycemia. Monitoring glucose levels helps ensure that the client's blood sugar remains within a safe range and allows for timely intervention if necessary.

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Question 2:

A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

A. Replace dietary table salt with salt substitutes. B. Encourage active range of motion to limit stiffness. C. Take prescribed pain medication after exercising joints. D. Avoid the consumption of wine, beer, and coffee.

Answer and Explanation

Choice A:

Replacing dietary table salt with salt substitutes is not specifically related to managing gout. Gout is caused by the accumulation of uric acid crystals in the joints, leading to inflammation and pain. The primary dietary factor influencing gout is purine intake, not sodium. While reducing sodium intake is generally beneficial for overall cardiovascular health, it does not directly impact uric acid levels or the management of gout. Therefore, recommending salt substitutes does not address the underlying cause or prevention of gout attacks. Moreover, some salt substitutes contain potassium chloride, which can have its own health implications, particularly for individuals with kidney issues.

Choice B:

Encouraging active range of motion to limit stiffness is important for maintaining joint function in many conditions, but during an acute gout attack, the primary focus should be on reducing inflammation and pain. Gout attacks cause severe pain and swelling, particularly in the affected joint, and encouraging active movement during an acute phase can exacerbate the pain and inflammation. It is more appropriate to rest the affected joint and manage pain and inflammation with medications and other supportive measures. Once the acute phase has resolved, gradual reintroduction of movement and exercise can help maintain joint function and prevent long-term stiffness.

Choice C:

Taking prescribed pain medication after exercising joints is not appropriate advice for managing gout. Pain medication, such as NSAIDs (nonsteroidal anti-inflammatory drugs), should be taken as prescribed by the healthcare provider to effectively manage pain and inflammation. It is crucial to follow the prescribed regimen for pain management, regardless of exercise or activity. Furthermore, during an acute gout attack, it is advisable to avoid activities that may aggravate the affected joint. Pain management should be proactive, and medications should be taken at regular intervals to maintain pain relief rather than in response to specific activities like exercise.

Choice D:

Avoiding the consumption of wine, beer, and coffee is crucial for managing gout. Alcohol, particularly beer and wine, contains high levels of purines, which can increase uric acid production and exacerbate gout symptoms. Alcohol also promotes dehydration, which can lead to higher uric acid concentrations in the blood. Both of these factors can trigger gout attacks. Coffee has mixed effects on gout; while some studies suggest that moderate coffee consumption may not significantly impact uric acid levels, it is generally advised to be cautious with its intake. Educating the client to avoid or limit these beverages can help prevent future gout attacks and manage symptoms more effectively. Dietary modifications are a key component of gout management, and avoiding high-purine foods and beverages is essential in reducing the frequency and severity of gout attacks.

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Question 3:

During a routine eye examination, an older client reports decreased peripheral vision and is found to have elevated intraocular pressures. Ophthalmic drops are prescribed for primary open-angle glaucoma (POAG). Which intervention(s) should the nurse include in this client's plan of care? Select all that apply.

A. Review written and verbal instructions for a reduced sodium diet. B. Teach strategies for aseptic administration of the eye drops. C. Describe how the use of the eye drops will help improve peripheral vision. D. Teach to apply pressure over the inner eye corner after eye drops. E. Explain the need to continue eye drops for the rest of their life.

Answer and Explanation

Choice A:

Reviewing written and verbal instructions for a reduced sodium diet is not directly related to the management of primary open-angle glaucoma (POAG). While a healthy diet can contribute to overall well-being, dietary sodium does not have a significant impact on intraocular pressure or glaucoma management. Therefore, this intervention does not directly address the client's primary condition of POAG.

Choice B:

Teaching strategies for aseptic administration of the eye drops is a critical intervention for clients with POAG. Proper administration of ophthalmic drops is essential to avoid contamination and infection. Aseptic techniques include washing hands before administering the drops, avoiding touching the dropper tip to any surface (including the eye), and ensuring that the dropper cap is replaced tightly after use. These measures help maintain the sterility of the medication and prevent complications such as eye infections, which can exacerbate the client's condition.

Choice C:

Describing how the use of the eye drops will help improve peripheral vision is not entirely accurate in the context of POAG. The primary goal of ophthalmic drops for POAG is to lower intraocular pressure and prevent further damage to the optic nerve, thereby preserving the remaining vision. These drops do not typically improve peripheral vision that has already been lost. Educating the client with accurate information about the purpose and benefits of the drops helps set realistic expectations and encourages adherence to the treatment regimen.

Choice D:

Teaching the client to apply pressure over the inner eye corner (punctal occlusion) after administering eye drops is an important intervention. Punctal occlusion helps prevent the medication from draining into the tear duct and being absorbed systemically. This technique increases the contact time of the medication with the eye, enhancing its effectiveness and reducing potential systemic side effects. Clients should be instructed to gently press the inner corner of the eye for a few minutes after instilling the drops to ensure maximum benefit.

Choice E:

Explaining the need to continue eye drops for the rest of their life is essential for clients with POAG. Glaucoma is a chronic condition that requires lifelong management to control intraocular pressure and prevent progression of the disease. Discontinuing the medication can lead to elevated intraocular pressures and irreversible vision loss. Clients should understand the importance of adherence to their prescribed treatment regimen and the lifelong commitment to managing their condition to preserve their vision and quality of life.

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Question 4:

A client with oral cancer is receiving radiotherapy (RT) prior to surgery. Which intervention should the nurse teach the client to implement in managing mucositis related to RT?

A. Place chin down and tilt head for dyspahgia during meals. B. Normal saline mouth rinses as swish and spit after meals and bedtime. C. Eat high caloric meals to prevent weight loss. D. Use a commercial mouthwash for xerostomia.

Answer and Explanation

Choice A:

Placing the chin down and tilting the head for dysphagia (difficulty swallowing) during meals is not directly related to managing mucositis. While it may help with swallowing difficulties, it does not address the inflammation and pain caused by mucositis.

Choice B:

Normal saline mouth rinses as swish and spit after meals and bedtime is an effective intervention for managing mucositis. Rinsing with saline helps to keep the mouth clean, reduce bacterial load, and soothe inflamed tissues. It can also help to remove food particles and debris, reducing the risk of infection and promoting healing. Saline rinses are gentle and do not contain irritating ingredients, making them ideal for sensitive oral tissues affected by mucositis.

Choice C:

Eating high caloric meals to prevent weight loss is important for overall nutrition, especially for clients undergoing cancer treatment. However, it does not specifically address the management of mucositis. High caloric meals alone will not alleviate the pain, inflammation, and ulceration associated with mucositis. Clients with mucositis often have difficulty eating due to pain, so focusing on soothing and healing the oral tissues is a priority before addressing caloric intake.

Choice D:

Using a commercial mouthwash for xerostomia (dry mouth) is not recommended for managing mucositis. Many commercial mouthwashes contain alcohol and other harsh ingredients that can further irritate the already inflamed mucous membranes. It is better to use a gentle and soothing rinse, such as saline, to manage mucositis symptoms and promote healing of the oral tissues.

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Question 5:

The nurse obtains a fingerstick blood glucose level using a bedside glucose meter from a client with a prescribed sliding scale insulin protocol. The meter indicates 56 mg/dL (3.12 mmol/L). At this time, which intervention should the nurse implement first?
Reference Range: Glucose 74 to 106 mg/dL (4.1 to 5.9 mmol/L)

A. Prepare the prescribed dose of rapid-acting insulin from the sliding scale instructions. B. Give the client six ounces of non-diet carbonated soda and instruct the client to drink it entirely. C. Collect a blood specimen by venipuncture to send to the laboratory for serum glucose analysis. D. Document the glucose reading in the electronic medical record (EMR).

Answer and Explanation

Choice A:

Preparing the prescribed dose of rapid-acting insulin from the sliding scale instructions is not appropriate when the client's blood glucose level is low (56 mg/dL). Administering insulin at this point could further lower the blood glucose level, potentially leading to severe hypoglycemia. The priority is to raise the client's blood glucose level to a safe range.

Choice B:

Giving the client six ounces of non-diet carbonated soda and instructing the client to drink it entirely is the correct first intervention. The client’s blood glucose level is significantly below the normal reference range (hypoglycemia). Administering a fast-acting carbohydrate, such as non-diet soda, helps to quickly increase the blood glucose level to a safer range. This intervention addresses the immediate need to correct the hypoglycemia and prevent potential complications such as confusion, seizures, or loss of consciousness.

Choice C:

Collecting a blood specimen by venipuncture to send to the laboratory for serum glucose analysis is not the first intervention to implement. While laboratory confirmation of blood glucose levels can be important, the immediate priority is to treat the hypoglycemia. Delaying treatment to collect a laboratory specimen could result in worsening of the client's condition. Immediate administration of a fast-acting carbohydrate should be prioritized.

Choice D:

Documenting the glucose reading in the electronic medical record (EMR) is important but not the first priority. While accurate documentation is necessary for ongoing care, the immediate intervention should focus on treating the hypoglycemia. Once the client's blood glucose level has been stabilized, the nurse can then document the reading and subsequent interventions in the EMR.

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Question 6:

The nurse is assessing a client who is one day postoperative parathyroidectomy and finds that the client is experiencing stridor. After notifying the healthcare provider (HCP), the nurse should prepare for which procedure?

A. Central line insertion. B. Nasogastric tube (NGT) insertion. C. Tracheostomy placement. D. Pacemaker placement.

Answer and Explanation

Choice A:

Central line insertion is not the appropriate intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates airway obstruction, which requires immediate airway management, not central venous access.

Choice B:

Nasogastric tube (NGT) insertion is not the correct intervention for stridor. NGT insertion is typically used for gastrointestinal decompression or feeding, not for managing airway obstruction.

Choice C:

Tracheostomy placement is the correct intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates a potential airway obstruction, which can be life-threatening. A tracheostomy provides a secure airway and ensures adequate ventilation.

Choice D:

Pacemaker placement is not relevant to managing stridor. Pacemakers are used for cardiac rhythm management and do not address airway obstruction.

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Question 7:

A client with diabetes mellitus is admitted with an upper respiratory infection. Which changes in blood glucose management should the nurse tell the client to expect?

A. Increased oral fluid intake B. Restriction of caloric intake C. Higher doses of insulin D. Fewer fingerstick glucose checks

Answer and Explanation

Choice A:

Increased oral fluid intake is a general recommendation for clients with an infection to prevent dehydration and help thin respiratory secretions. While staying hydrated is important, it is not a specific change in blood glucose management for a client with diabetes and an upper respiratory infection.

Choice B:

Restriction of caloric intake is not appropriate advice for a client with diabetes and an infection. During illness, the body’s metabolic needs increase, and caloric intake should be adjusted to meet these needs. Restricting calories can lead to inadequate nutrition and further complications.

Choice C:

Higher doses of insulin are often needed for clients with diabetes who are experiencing an infection. Infections can cause increased stress on the body, leading to elevated blood glucose levels. The body’s inflammatory response and the release of stress hormones can result in insulin resistance and higher blood sugar levels. Therefore, it is common for healthcare providers to adjust insulin doses upward to manage these changes and maintain glycemic control during periods of illness.

Choice D:

Fewer fingerstick glucose checks are not recommended. In fact, during illness, it is crucial for clients with diabetes to monitor their blood glucose levels more frequently. Close monitoring helps to detect hyperglycemia or hypoglycemia and allows for timely adjustments in insulin or other diabetes medications. Frequent glucose checks are essential for managing blood sugar levels effectively during illness.

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Question 8:

The nurse is caring for a client with a history of type 2 diabetes mellitus (DM) and hypertension who arrived at the clinic for a scheduled visit. Which finding should the nurse recognize as a possible complication?
Reference Range: Creatinine 0.5 to 1.1 mg/dL (44 to 97 umol/L) Glycosylated hemoglobin (HbA1c) Good diabetic control: less than 7% White Blood Cell 5,000 to 10,000/mm3 (5 to 10 x 10^9/L) Fasting Blood Glucose 74 to 106 mg/dL (4.1 to 5.9 mmol/L)

A. Fasting serum glucose 140 mg/dL (7.77 mmol/L). B. Glycosylated hemoglobin (A1c) 6.9%. C. Serum creatinine 1.6 mg/dL (141.44 umol/L). D. White blood cell (WBC) 11,000/mm3 (11 x 10^9/L).

Answer and Explanation

Choice A:

A fasting serum glucose level of 140 mg/dL (7.77 mmol/L) indicates hyperglycemia, which is elevated but not an immediate life-threatening complication. It suggests poor blood glucose control but does not directly indicate a complication specific to type 2 diabetes and hypertension. This value should prompt further evaluation and adjustments in diabetes management, but it is not as critical as other potential findings.

Choice B:

A glycosylated hemoglobin (A1c) level of 6.9% is within the range of good diabetic control. While it indicates the client has been managing their blood glucose levels relatively well over the past few months, it does not suggest a current complication. This value is used to assess long-term glucose control rather than acute issues.

Choice C:

A serum creatinine level of 1.6 mg/dL (141.44 umol/L) is elevated and indicates impaired kidney function. Clients with type 2 diabetes mellitus and hypertension are at increased risk for kidney disease, known as diabetic nephropathy or hypertensive nephropathy. Elevated creatinine levels suggest that the kidneys are not filtering waste products effectively, which is a significant complication that requires immediate attention and intervention.

Choice D:

A white blood cell (WBC) count of 11,000/mm3 (11 x 10^9/L) is slightly elevated and may suggest an infection or inflammation. However, it is not a specific complication related to type 2 diabetes mellitus and hypertension. Elevated WBC counts warrant further investigation to identify any underlying infection or inflammatory process, but it is not as directly related to diabetic or hypertensive complications as elevated serum creatinine.

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Question 9:

After teaching a client newly diagnosed with cholecystitis about recommended diet changes, the nurse evaluates the client's learning. Which food choices eliminated by the client indicate to the nurse that teaching has been successful?

A. Whole milk and dairy servings of ice cream. B. Citrus fruit and melon with a salt substitute. C. Pasta with herbal butter and no meat sauce. D. Canned vegetables with additional table salt.

Answer and Explanation

Choice A:

Eliminating whole milk and dairy servings of ice cream is an appropriate choice for a client with cholecystitis. These foods are high in fat, and a low-fat diet is recommended for managing cholecystitis. High-fat foods can stimulate the gallbladder to contract, which can exacerbate symptoms and cause pain. By removing these high-fat items from their diet, the client is following the recommended dietary guidelines for managing cholecystitis.

Choice B:

Eliminating citrus fruit and melon with a salt substitute does not specifically address the dietary recommendations for cholecystitis. While citrus fruits and melon are generally healthy choices, they are not high in fat and do not need to be eliminated from the diet. Additionally, using a salt substitute does not have a significant impact on cholecystitis management.

Choice C:

Eliminating pasta with herbal butter and no meat sauce is not necessary for managing cholecystitis. Pasta itself is not high in fat, and using herbal butter instead of regular butter can be a lower-fat option. As long as the pasta dish is prepared with low-fat ingredients, it can be part of a cholecystitis-friendly diet.

Choice D:

Eliminating canned vegetables with additional table salt does not specifically address the dietary recommendations for cholecystitis. While it is generally a good idea to limit sodium intake for overall health, this recommendation is more relevant for managing conditions like hypertension. The focus for cholecystitis management should be on reducing dietary fat rather than sodium.

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Question 10:

A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

A. Confirmation of the autoimmune disease process. B. Representative of a decline in the client's condition. C. Indication of the onset of joint degeneration. D. Evidence of spread of the disease to the kidneys.

Answer and Explanation

Choice A:

An elevated serum rheumatoid factor is most commonly associated with rheumatoid arthritis, an autoimmune disease. This finding supports the diagnosis and indicates the presence of autoantibodies that attack the body's own tissues. The rheumatoid factor is used as one of the diagnostic criteria for rheumatoid arthritis and confirms the autoimmune nature of the disease. It does not indicate disease severity or progression but rather the presence of the disease.

Choice B:

An elevated serum rheumatoid factor is not necessarily representative of a decline in the client's condition. While high levels of rheumatoid factor can be present in individuals with active disease, they do not directly correlate with disease activity or progression. The presence of rheumatoid factor alone does not provide information about the current state or severity of the client's condition.

Choice C:

An elevated serum rheumatoid factor does not indicate the onset of joint degeneration. Rheumatoid factor is an antibody that indicates the presence of an autoimmune response but does not directly cause joint damage. Joint degeneration in rheumatoid arthritis results from the chronic inflammation and immune response within the joints, leading to tissue damage over time. Rheumatoid factor is a marker of the disease but not a direct indicator of joint damage.

Choice D:

An elevated serum rheumatoid factor is not evidence of the spread of the disease to the kidneys. Rheumatoid arthritis primarily affects the joints and can also have systemic manifestations, but the presence of rheumatoid factor is not indicative of kidney involvement. Kidney involvement in rheumatoid arthritis is relatively rare and would typically require additional diagnostic tests and clinical evaluation to determine.

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Total Questions : 54

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HESI RN Medical surgical exam

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