HESI RN Medical Surgical Practice Exam

HESI RN Medical Surgical Practice Exam Related

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The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action?

  • A. Hold the dose and notify the provider.
  • B. Request an order for a blood glucose level.
  • C. Request an order for a BUN and creatinine level.
  • D. Request an order for diphenhydramine (Benadryl).
Correct Answer: A

Rationale: When a patient on TMP-SMX presents with a petechial rash, it can be indicative of a severe adverse reaction such as thrombocytopenia or a hypersensitivity reaction. The appropriate action for the nurse to take in this situation is to hold the dose of TMP-SMX and notify the healthcare provider immediately. This is crucial to prevent further administration of a medication that may be causing a serious adverse effect. Requesting a blood glucose level (Choice B) is not relevant in this scenario as the patient's presentation is suggestive of a skin-related issue rather than a glucose-related problem. Similarly, requesting a BUN and creatinine level (Choice C) would not address the immediate concern of a petechial rash and its association with TMP-SMX. Requesting an order for diphenhydramine (Choice D) may help manage itching or mild allergic reactions but is not the priority when a petechial rash is observed, as it may indicate a more severe reaction requiring immediate intervention.

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The client with diabetes mellitus is being taught how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)

  • A. I can continue to take an aspirin every 4 to 8 hours for my pain.
  • B. My weight should be maintained at a body mass index of 30.
  • C. Smoking should be stopped as soon as possible.
  • D. A & B
Correct Answer: D

Rationale: The correct answer is D. Both statements A and B indicate a lack of understanding of CKD prevention. Taking aspirin every 4 to 8 hours can lead to kidney damage, and maintaining a body mass index (BMI) of 30 is considered overweight, which can increase the risk of developing CKD. Statement C, on the other hand, correctly addresses smoking cessation, which is crucial in preventing CKD. Therefore, choices A and B are incorrect as they do not align with CKD prevention strategies, making option D the correct choice.

A nurse administers scopolamine as prescribed to a client in preparation for surgery. For which side effect of this medication does the nurse monitor the client?

  • A. Pupil constriction
  • B. Increased urine output
  • C. Complaints of dry mouth
  • D. Complaints of feeling sweaty
Correct Answer: D

Rationale: The correct answer is D: 'Complaints of feeling sweaty.' Scopolamine, an anticholinergic medication, commonly causes the side effect of decreased sweating, not increased urine output or pupil constriction. While dry mouth is a possible side effect, it is less likely than the altered sweating pattern. Therefore, the nurse should monitor the client for complaints of feeling sweaty due to the potential side effect of decreased sweating associated with scopolamine.

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.

After educating a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

  • A. I should drink at least 3 liters of fluid every day.
  • B. I will eliminate all dairy or sources of calcium from my diet.
  • C. Aspirin and aspirin-containing products can lead to stones.
  • D. The doctor can give me antibiotics at the first sign of a stone.
Correct Answer: A

Rationale: To prevent the formation of renal calculi, it is essential to maintain adequate hydration as dehydration can contribute to the precipitation of minerals leading to stone formation. Therefore, the correct statement indicating understanding of the teaching is choice A. Increasing fluid intake helps dilute urine and reduces the risk of stone formation. Eliminating all sources of calcium is not recommended as calcium is essential for various bodily functions and eliminating it can lead to other health issues. Aspirin and aspirin-containing products do not directly cause kidney stones. Antibiotics are not used to prevent or treat renal calculi, as they are not caused by bacterial infections.

When obtaining the health history of a client suspected of having bladder cancer, which question should the nurse ask to determine the client's risk factors?

  • A. Do you smoke cigarettes?
  • B. Do you consume alcohol?
  • C. Do you use recreational drugs?
  • D. Do you take any prescription drugs?
Correct Answer: A

Rationale: The correct answer is A: 'Do you smoke cigarettes?' Smoking is a major risk factor for bladder cancer. Cigarette smoke contains harmful chemicals that can accumulate in the urine and damage the lining of the bladder, increasing the risk of developing cancer. Alcohol use, recreational drug use, and most prescription drugs are not directly linked to an increased risk of bladder cancer. It is important for the nurse to assess smoking history as a significant risk factor in determining the client's risk for bladder cancer.

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