HESI Medical Surgical Exam

HESI Medical Surgical Exam Related

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A client who has developed acute kidney injury (AKI) due to an aminoglycoside antibiotic has moved from the oliguric phase to the diuretic phase of AKI. Which parameters are most important for the nurse to plan to carefully monitor?

  • A. Side effects of total parenteral nutrition (TPN) and Intralipids.
  • B. Uremic irritation of mucous membranes and skin surfaces.
  • C. Elevated creatinine and blood urea nitrogen (BUN).
  • D. Hypovolemia and electrocardiographic (ECG) changes.
Correct Answer: D

Rationale: During the diuretic phase of acute kidney injury (AKI), monitoring for hypovolemia and electrocardiographic (ECG) changes is crucial. Hypovolemia can occur due to the increased urine output in this phase, potentially leading to dehydration and electrolyte imbalances. Electrolyte imbalances can result in ECG changes, such as arrhythmias, which can be life-threatening. Therefore, careful monitoring of fluid status and ECG findings helps in preventing complications. Choices A, B, and C are not the most crucial parameters to monitor during the diuretic phase of AKI. Side effects of total parenteral nutrition (TPN) and Intralipids, uremic irritation of mucous membranes and skin surfaces, and elevated creatinine and blood urea nitrogen (BUN) are important considerations in other phases of AKI or in other conditions, but they are not the primary focus during the diuretic phase when hypovolemia and ECG changes take precedence.

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The home health nurse provides teaching about insulin self-injection to a client who was recently diagnosed with diabetes mellitus. When the client begins to perform a return demonstration of an insulin injection into the abdomen, which instruction should the nurse provide?

  • A. Select a different injection site
  • B. Continue with the insulin injection
  • C. Keep the skin flat rather than bunched
  • D. Lie down flat for better skin exposure
Correct Answer: B

Rationale: Choosing to continue with the insulin injection is the correct instruction in this scenario because it allows the client to demonstrate proper technique and reinforces their learning. Selecting a different injection site (choice A) is not necessary if the client is injecting into the abdomen as it is a suitable site. Keeping the skin flat rather than bunched (choice C) is a good practice but is not the priority in this situation where the client is demonstrating the injection technique. Lying down flat for better skin exposure (choice D) is not required and may not be practical for the client during routine self-injections.

A client with diabetes mellitus who is taking NPH insulin (Humulin N) in the evening is most likely to become hypoglycemic shortly after midnight because this insulin peaks in 6 to 8 hours. What intervention should the nurse recommend to help prevent hypoglycemia while the client is sleeping?

  • A. Eat a bedtime snack.
  • B. Avoid physical activity.
  • C. Take half the usual dose of insulin.
  • D. Discontinue insulin until the next meal.
Correct Answer: A

Rationale: Eating a bedtime snack is the most appropriate intervention to prevent hypoglycemia during the night when NPH insulin peaks. This snack helps maintain blood glucose levels and counteracts the risk of hypoglycemia. Avoiding physical activity is not recommended as it can further lower blood sugar levels. Taking half the usual dose of insulin can lead to inadequate control of blood sugar levels. Discontinuing insulin until the next meal can result in uncontrolled hyperglycemia, especially during the peak action of NPH insulin.

When giving a report about a client who had a gastrectomy from the intensive care unit to the post-surgical unit nurse, what is the most effective way to assure essential information is reported?

  • A. Give the report face-to-face with both nurses in a quiet room.
  • B. Audiotape the report for future reference and documentation.
  • C. Use a printed checklist with information individualized for the client.
  • D. Document essential transfer information in the client's electronic health record.
Correct Answer: C

Rationale: Using a printed checklist with individualized information is the most effective way to ensure that all key details about the client who had a gastrectomy are covered during the report. This method helps in structuring the information systematically, reducing the risk of missing important details. Face-to-face communication in a quiet room (Choice A) is important for effective communication but may not guarantee the coverage of all essential information. Audiotaping the report (Choice B) may not be practical for immediate reference or interaction. Documenting in the electronic health record (Choice D) is essential but may not facilitate a comprehensive real-time exchange of information between the nurses.

A client with chronic renal failure is prescribed a low-protein diet. The nurse should explain to the client that the purpose of this diet is to:

  • A. Prevent fluid overload.
  • B. Reduce the workload on the kidneys.
  • C. Prevent dehydration.
  • D. Maintain electrolyte balance.
Correct Answer: B

Rationale: The correct answer is B: 'Reduce the workload on the kidneys.' A low-protein diet is prescribed for clients with chronic renal failure to decrease the production of urea and other nitrogenous wastes, which can accumulate in the body when the kidneys are not functioning properly. This reduction in protein intake helps to lessen the burden on the kidneys, as they may have difficulty in filtering and excreting waste products. Choice A is incorrect because fluid overload is more related to restrictions in fluid intake rather than protein intake. Choice C is incorrect as a low-protein diet does not directly prevent dehydration. Choice D is incorrect because while electrolyte balance is essential in renal failure, the primary purpose of a low-protein diet is to reduce the workload on the kidneys by limiting the production of waste products.

The nurse is providing discharge instructions to a client who is receiving prednisone 5 mg PO daily for a rash due to contact with poison ivy. Which symptoms should the nurse tell the client to report to the healthcare provider?

  • A. Rapid weight gain
  • B. Abdominal striae
  • C. Moon faces
  • D. Gastric irritation
Correct Answer: A

Rationale: Rapid weight gain can indicate fluid retention, which is a serious side effect of prednisone and should be reported.

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