HESI RN Medical Surgical Practice Exam

HESI RN Medical Surgical Practice Exam Related

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To evaluate the positive effect of furosemide (Lasix) 40 mg/day in a client with chronic kidney disease (CKD), what is the best action for the nurse to take?

  • A. Obtain daily weights of the client.
  • B. Auscultate heart and breath sounds.
  • C. Palpate the client's abdomen.
  • D. Assess the client's diet history.
Correct Answer: A

Rationale: The correct answer is A. Furosemide (Lasix) is a loop diuretic used to manage fluid overload and hypertension in clients with CKD. Monitoring daily weights is crucial as weight changes reflect fluid status. Each kilogram of weight change approximately corresponds to 1 liter of fluid retention or loss, making it essential for evaluating the medication's effectiveness. Auscultating heart and breath sounds is more relevant for heart failure cases with fluid retention, not specifically for assessing the effect of furosemide in CKD. Palpating the abdomen is not a direct indicator of furosemide's effectiveness; instead, assessing for edema would be appropriate. While assessing the client's diet history is important to monitor electrolyte balance due to potassium loss with furosemide, it does not directly evaluate the medication's efficacy.

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A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention?

  • A. A 29-year-old client after a difficult vaginal delivery - Habit training
  • B. A 58-year-old postmenopausal client who is not taking estrogen therapy - Electrical stimulation
  • C. A 64-year-old female with Alzheimer's-type senile dementia - Bladder training
  • D. A 77-year-old female who has difficulty ambulating - Exercise therapy
Correct Answer: B

Rationale: The correct pairing is a 58-year-old postmenopausal client who is not taking estrogen therapy with electrical stimulation. Electrical stimulation is used for clients with stress incontinence related to menopause and low estrogen levels. Exercise therapy improves pelvic wall strength and is not specifically for ambulation issues. Habit training is more effective for cognitively impaired clients, like those with Alzheimer's-type senile dementia. Bladder training requires the client to be alert, aware, and able to resist the urge to urinate, which may not be suitable for clients with cognitive impairments.

A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the healthcare provider? (Select all that apply.)

  • A. Foul-smelling drainage
  • B. Bloody drainage at site
  • C. A & B
  • D. All of the above
Correct Answer: C

Rationale: After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if there is foul-smelling drainage, bloody drainage at the site, or both. Foul-smelling drainage can indicate infection, while bloody drainage may suggest bleeding. Clear drainage is generally normal after a nephrostomy. A headache would not typically be directly related to nephrostomy complications. Therefore, options A and B are correct choices for urgent notification, making option C the correct answer.

A client's urinalysis results show a urine osmolality of 1200 mOsm/L. What action should the nurse take?

  • A. Encourage the client to drink more fluids.
  • B. Contact the provider and recommend a low-sodium diet.
  • C. Prepare to administer an intravenous diuretic.
  • D. Obtain a suction device and implement seizure precautions.
Correct Answer: A

Rationale: The correct action for the nurse to take when the client has a urine osmolality of 1200 mOsm/L, indicating dehydration, is to encourage the client to drink more fluids. Dehydration can lead to elevated urine osmolality, and increasing fluid intake can help rehydrate the client. A low-sodium diet is not the priority in this scenario as it would not directly address the dehydration indicated by the high urine osmolality. Administering an intravenous diuretic would further concentrate the urine, exacerbating the dehydration. Obtaining a suction device and implementing seizure precautions are not indicated based on the client's urine osmolality results and would not address the underlying issue of dehydration.

A client presents with a urine specific gravity of 1.018. What action should the nurse take?

  • A. Evaluate the client's intake and output for the past 24 hours.
  • B. Document the finding in the chart and continue to monitor.
  • C. Obtain a specimen for a urine culture and sensitivity.
  • D. Encourage the client to drink more fluids, especially water.
Correct Answer: B

Rationale: A urine specific gravity of 1.018 falls within the normal range, indicating adequate hydration. Therefore, the appropriate action is to document this finding in the client's chart and continue monitoring. There is no need to evaluate intake and output, as the specific gravity is normal. Obtaining a urine culture and sensitivity or encouraging increased fluid intake is unnecessary in this situation.

After a lumbar puncture, into which position does the nurse assist the client?

  • A. Flat
  • B. Semi-Fowler
  • C. Side-lying with the head of the bed elevated
  • D. Sitting up in a recliner with the feet elevated
Correct Answer: A

Rationale: After a lumbar puncture, the client should be positioned flat. This position helps prevent post-procedure spinal headaches and cerebrospinal fluid leakage. Keeping the client flat for up to 12 hours is crucial in minimizing these risks. Choices B, C, and D are incorrect because elevating the head of the bed or sitting up can increase the risk of complications by altering the pressure in the spinal canal, potentially leading to headaches and fluid leakage.

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