HESI RN Medical Surgical Practice Exam

HESI RN Medical Surgical Practice Exam Related

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A client with stress incontinence is being taught about pelvic muscle exercises. Which statements should be included by the nurse? (Select all that apply.)

  • A. Starting and stopping the urine stream involves using pelvic muscles.
  • B. Tighten pelvic muscles for a slow count of 10 and then relax for a slow count of 10.
  • C. Pelvic muscle exercises can be performed in various positions: lying down, sitting up, and standing.
  • D. A & B
Correct Answer: D

Rationale: The correct statements to include when teaching a client with stress incontinence about pelvic muscle exercises are that starting and stopping the urine stream involve using pelvic muscles and that tightening pelvic muscles for a slow count of 10 and then relaxing for a slow count of 10 can help strengthen them. It is essential to highlight that pelvic muscle exercises can be performed in various positions, including lying down, sitting up, and standing. This variety in positions helps engage the muscles effectively. Performing these exercises 15 times in each position can aid in strengthening the pelvic floor muscles. Consistent exercise over several weeks typically leads to improved control over urine leakage. Choice C is incorrect because pelvic muscle exercises can be performed in different positions and are not limited to sitting upright with feet on the floor.

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A client admitted to the hospital with a diagnosis of acute pancreatitis has blood drawn for several serum laboratory tests. Which of the following serum amylase values, noted by the nurse reviewing the results, would be expected in this client at this time?

  • A. 48 units/L
  • B. 97 units/L
  • C. 150 units/L
  • D. 395 units/L
Correct Answer: D

Rationale: The correct answer is D: "395 units/L." The normal serum amylase range is 25 to 151 units/L. In acute pancreatitis, the amylase level is greatly increased, typically exceeding the upper limit of the normal range. Choices A, B, and C fall within the normal range of serum amylase levels and would not be expected in a client with acute pancreatitis.

When performing a health history on a patient who is to begin receiving a thiazide diuretic to treat heart failure, the nurse will be concerned about a history of which condition?

  • A. Asthma
  • B. Glaucoma
  • C. Gout
  • D. Hypertension
Correct Answer: C

Rationale: Thiazide diuretics block uric acid secretion, leading to elevated levels that can contribute to gout. Therefore, patients with a history of gout should take thiazide diuretics with caution. Asthma (Choice A), Glaucoma (Choice B), and Hypertension (Choice D) are not directly contraindicated with thiazide diuretics, making choices A, B, and D incorrect.

A CD4+ lymphocyte count is performed on a client infected with HIV. The results of the test indicate a CD4+ count of 450 cells/L. The nurse interprets this test result as indicating:

  • A. Improvement in the client
  • B. The need for antiretroviral therapy
  • C. The need to discontinue antiretroviral therapy
  • D. An effective response to the treatment for HIV
Correct Answer: B

Rationale: A CD4+ count of 450 cells/L is below the normal range (500-1600 cells/mcL), indicating a decline in immune function in the client. Antiretroviral therapy is recommended when the CD4+ count falls below 500 cells/mcL or below 25%, or when the client displays symptoms of HIV. Therefore, the interpretation of this test result suggests that the client requires antiretroviral therapy to manage the HIV infection. Choices A, C, and D are incorrect because a CD4+ count of 450 cells/L does not signify improvement, discontinuation of therapy, or an effective response to treatment for HIV.

A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?

  • A. Check the client's digoxin (Lanoxin) level.
  • B. Administer an anti-nausea medication.
  • C. Ask if the client can eat crackers.
  • D. Refer the client to a gastrointestinal specialist.
Correct Answer: A

Rationale: In a client with chronic kidney disease experiencing symptoms like nausea, vomiting, visual changes, and anorexia, it is crucial for the nurse to suspect digoxin (Lanoxin) toxicity. These symptoms are indicative of digoxin toxicity. Therefore, the best action for the nurse to take is to check the client's digoxin level. Administering anti-nausea medication, asking about eating crackers, and referring to a gastrointestinal specialist may help with symptom management but do not address the underlying cause of the symptoms, which is digoxin toxicity in this case.

A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide should the nurse question for this patient?

  • A. Azithromycin (Zithromax)
  • B. Clarithromycin (Biaxin)
  • C. Erythromycin (E-Mycin)
  • D. Fidaxomicin (Dificid)
Correct Answer: C

Rationale: The nurse should question the prescription of erythromycin for this patient. When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase. Therefore, it is not recommended to use erythromycin in combination with fluconazole for this patient. Azithromycin, clarithromycin, and fidaxomicin are alternative macrolide antibiotics that can be considered for this patient without the same risk of interactions when used with fluconazole.

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