Evolve HESI Medical Surgical Practice Exam

Evolve HESI Medical Surgical Practice Exam Related

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The nurse is caring for a 70-kg patient who is receiving gentamicin (Garamycin) 85 mg 4 times daily. The patient reports experiencing ringing in the ears. The nurse will contact the provider to discuss

  • A. decreasing the dose to 50 mg QID.
  • B. giving the dose 3 times daily.
  • C. obtaining a serum drug level.
  • D. ordering a hearing test.
Correct Answer: C

Rationale: When a patient receiving gentamicin (Garamycin) reports experiencing ringing in the ears, it is crucial to consider the possibility of ototoxicity. Ototoxicity is a known adverse effect of aminoglycosides. The appropriate action for the nurse in this situation is to contact the provider to discuss obtaining a serum drug level. This is important to assess the drug concentration in the patient's blood, which can help determine if the ringing in the ears is related to the medication. Decreasing the dose or changing the dosing frequency without assessing the serum drug level may not address the underlying issue and could potentially lead to suboptimal treatment. Ordering a hearing test may be necessary at a later stage if the serum drug level indicates a concern. Therefore, option C, obtaining a serum drug level, is the most appropriate action to take in this scenario.

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A client who has received sodium bicarbonate in large amounts is at risk for metabolic alkalosis. For which of the following signs and symptoms does the nurse assess this client?

  • A. Disorientation and dyspnea
  • B. Drowsiness, headache, and tachypnea
  • C. Tachypnea, dizziness, and paresthesias
  • D. Dysrhythmias and decreased respiratory rate and depth
Correct Answer: D

Rationale: The correct answer is D. A client with metabolic alkalosis may present with dysrhythmias and a decreased respiratory rate and depth as the body tries to compensate by retaining carbon dioxide. Options A, B, and C do not typically correlate with the signs and symptoms of metabolic alkalosis. Disorientation, dyspnea, drowsiness, headache, tachypnea, dizziness, and paresthesias are not commonly associated with metabolic alkalosis. Therefore, they are incorrect choices.

A nurse plans care for an older adult client. Which interventions should the nurse include in this client's plan of care to promote kidney health? (Select all that apply.)

  • A. Ensure adequate fluid intake.
  • B. Leave the bathroom light on at night.
  • C. Encourage use of the toilet every 6 hours.
  • D. A & B
Correct Answer: D

Rationale: The correct interventions to promote kidney health in an older adult client include ensuring adequate fluid intake to maintain hydration and leaving the bathroom light on at night to promote safe ambulation. Adequate hydration supports kidney function and helps prevent urinary tract infections. Encouraging the use of the toilet every 6 hours is not specific to kidney health and may not be individualized to the client's needs. Providing thorough perineal care after each voiding is important for hygiene but not directly related to promoting kidney health. Assessing for urinary retention and urinary tract infections is crucial but falls under assessment rather than interventions for promoting kidney health specifically.

A client expresses difficulty voiding in public places. How should the nurse respond?

  • A. Offer to turn on the faucet in the bathroom to help stimulate urination.
  • B. Suggest a prescription for a diuretic to increase urine output.
  • C. Propose moving to a room with a private bathroom to enhance comfort.
  • D. Close the curtain to provide maximum privacy.
Correct Answer: D

Rationale: The nurse should prioritize the client's privacy when addressing issues related to voiding discomfort in public places. Closing the curtain in the current room would offer immediate privacy and support the client's needs. Turning on the faucet is not an evidence-based intervention for voiding difficulties. Prescribing a diuretic is not appropriate without further assessment. While moving to a room with a private bathroom might be ideal, it may not be immediately feasible, making ensuring privacy in the current setting the most appropriate action.

A nurse reviews a female client's laboratory results. Which result from the client's urinalysis should the nurse recognize as abnormal?

  • A. pH 5.6
  • B. Ketone bodies present
  • C. Specific gravity of 1.020
  • D. Clear and yellow color
Correct Answer: B

Rationale: The correct answer is B: Ketone bodies present. Ketone bodies in urine indicate abnormal metabolism, specifically the incomplete breakdown of fatty acids. Normally, there should be no ketones present in urine. Ketone bodies are produced when the body uses fat sources instead of glucose for cellular energy. A pH range between 4.6 and 8, a specific gravity between 1.005 and 1.030, and clear yellow color in urine are considered normal findings for a female client's urinalysis. Therefore, options A, C, and D are within normal ranges and not indicative of abnormal results in the urinalysis.

Upon arrival of a client transferred to the surgical unit, what should the nurse plan to do first?

  • A. Assess the patency of the airway
  • B. Check tubes and drains for patency
  • C. Check the dressing for bleeding
  • D. Assess the vital signs to compare them with preoperative measurements
Correct Answer: A

Rationale: The initial action for the nurse upon the arrival of a client to the surgical unit is to assess the patency of the airway. This step takes priority to ensure that the client has a clear airway for adequate breathing. Checking tubes and drains for patency, inspecting the dressing for bleeding, and assessing vital signs to compare with preoperative measurements are important subsequent steps in the assessment process. However, ensuring the airway is patent is the immediate priority to maintain the client's respiratory function and overall well-being.

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