HESI Medical Surgical Assignment Exam

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The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action?

  • A. Administer the medication as ordered.
  • B. Encourage the patient to drink more fluids.
  • C. Hold the medication and request an order for serum BUN and creatinine.
  • D. Request an order for serum electrolytes and administer the medication.
Correct Answer: C

Rationale: The correct action is to hold the medication and request an order for serum BUN and creatinine. Thiazide diuretics, such as hydrochlorothiazide, are contraindicated in renal failure. In this case, the patient has oliguria, which is a reduced urine output, indicating potential renal insufficiency. Before administering the diuretic, it is crucial to evaluate the patient's renal function through serum BUN and creatinine levels. Encouraging the patient to drink more fluids (Choice B) may not address the underlying issue of renal function. Administering the medication as ordered (Choice A) without assessing renal function can be harmful. Requesting serum electrolytes and administering the medication (Choice D) overlooks the need for a specific evaluation of renal function in this scenario.

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The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patient's admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?

  • A. Administer the digoxin and monitor the patient's electrocardiogram closely.
  • B. Hold the digoxin dose and notify the provider of the patient's lab values.
  • C. Request an order for an intravenous bolus of potassium.
  • D. Request an order for oral potassium supplements.
Correct Answer: B

Rationale: In the scenario presented, the patient has a low serum potassium level, which can predispose the patient to digoxin toxicity. It is essential for the nurse to hold the digoxin dose and promptly notify the healthcare provider of the abnormal lab values. Option A is incorrect because administering digoxin without addressing the low potassium level can potentiate toxicity. Option C is inappropriate as potassium should not be given as an IV bolus, especially in the case of hypokalemia. Option D is incorrect because oral potassium supplements may not be sufficient for rapidly correcting severe hypokalemia in an acute care setting.

A client has an elevated blood urea nitrogen (BUN)/creatinine ratio. Which action should the nurse take first?

  • A. Assess the client's dietary habits.
  • B. Inquire about the client's use of nonsteroidal anti-inflammatory drugs (NSAIDs).
  • C. Hold the client's metformin (Glucophage).
  • D. Contact the health care provider immediately.
Correct Answer: A

Rationale: An elevated blood urea nitrogen (BUN)/creatinine ratio can indicate various conditions such as dehydration, urinary obstruction, catabolism, or a high-protein diet. The initial action the nurse should take is to assess the client's dietary habits to determine if the elevated ratio is related to diet. Inquiring about the use of NSAIDs is important as they can impact kidney function, but dietary causes should be ruled out first. Holding metformin or contacting the health care provider without assessing the dietary habits would be premature actions as they may not address the underlying cause of the elevated BUN/creatinine ratio.

A healthcare professional reviews the allergy list of a client scheduled for an intravenous urography. Which client allergy should prompt urgent contact with the healthcare provider?

  • A. Seafood
  • B. Penicillin
  • C. Bee stings
  • D. Red food dye
Correct Answer: A

Rationale: Clients with seafood allergies should alert healthcare professionals to urgently contact the healthcare provider before an intravenous urography. The standard dyes used in this procedure can trigger severe allergic reactions in individuals with seafood allergies. Penicillin, bee stings, and red food dye allergies do not pose a direct threat during intravenous urography, making them less critical for immediate intervention.

Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infections?

  • A. Sulfonamides are bactericidal.
  • B. Sulfonamides are synthetic compounds.
  • C. Sulfonamides have antifungal and antiviral properties.
  • D. Sulfonamides increase bacterial synthesis of folic acid.
Correct Answer: B

Rationale: The characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infections is that sulfonamides are synthetic compounds, not derived from biologic substances. Choice A is incorrect because sulfonamides are bacteriostatic, not bactericidal. Choice C is incorrect because sulfonamides do not have antifungal and antiviral properties. Choice D is incorrect because sulfonamides act by inhibiting bacterial synthesis of folic acid, not increasing it.

The provider has ordered Kayexalate and sorbitol to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?

  • A. Sodium 125 mEq/L and potassium 2.5 mEq/L
  • B. Sodium 150 mEq/L and potassium 3.6 mEq/L
  • C. Sodium 135 mEq/L and potassium 6.9 mEq/L
  • D. Sodium 148 mEq/L and potassium 5.5 mEq/L
Correct Answer: C

Rationale: Severe hyperkalemia, with a potassium level of 6.9 mEq/L, requires aggressive treatment with Kayexalate and sorbitol to increase the body's excretion of potassium. The normal range for serum potassium is 3.5 to 5.5 mEq/L, so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation. Therefore, option C (Sodium 135 mEq/L and potassium 6.9 mEq/L) is the correct choice as it indicates severe hyperkalemia warranting the administration of Kayexalate and sorbitol. Options A, B, and D have either potassium levels within normal limits, which would not necessitate this aggressive treatment, or potassium levels that are lower than what would typically prompt the need for Kayexalate and sorbitol.

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