HESI RN
HESI Medical Surgical Exam
1. A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects?
- A. Hypercalcemia.
- B. Hypocalcemia.
- C. Hyperglycemia.
- D. Hypoglycemia.
Correct answer: A
Rationale: Corrected Question: A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects? Rationale: The correct answer is A, Hypercalcemia. Calcium acetate (PhosLo) is a medication used to lower phosphate levels in patients with chronic renal failure. It works by binding with dietary phosphate and preventing its absorption. However, this can lead to an excess of calcium in the blood, causing hypercalcemia. Therefore, the nurse should closely monitor the client for signs and symptoms of elevated calcium levels, such as nausea, vomiting, confusion, and muscle weakness. Choices B, C, and D are incorrect as calcium acetate does not typically cause hypocalcemia, hyperglycemia, or hypoglycemia.
2. A client with type 1 diabetes mellitus has influenza. The nurse should instruct the client to:
- A. Increase the frequency of self-monitoring (blood glucose testing).
- B. Reduce food intake to alleviate nausea.
- C. Discontinue the insulin dose if unable to eat.
- D. Take the normal dose of insulin.
Correct answer: A
Rationale: During illness, individuals with type 1 diabetes mellitus may experience increased insulin requirements due to factors such as stress and the release of counterregulatory hormones. Increasing the frequency of self-monitoring, as stated in choice A, is crucial to closely monitor and adjust insulin doses as needed. Choice B, reducing food intake to alleviate nausea, is incorrect as it may lead to hypoglycemia and does not address the increased insulin needs during illness. Choice C, discontinuing the insulin dose if unable to eat, is dangerous as it can result in uncontrolled hyperglycemia. Choice D, taking the normal dose of insulin, may not be sufficient during illness when insulin requirements are likely elevated.
3. If a client displays risk factors for coronary artery disease, such as smoking cigarettes, eating a diet high in saturated fat, or leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change the behavior. The nurse can best reinforce new adaptive behaviors by:
- A. Explaining how the risk factor behaviors lead to poor health.
- B. Withholding praise until the new behavior is well established.
- C. Rewarding the client whenever the acceptable behavior is performed.
- D. Instilling mild fear in the client to extinguish the behavior.
Correct answer: C
Rationale: The correct answer is C. A fundamental principle of behavior modification is that behavior that is rewarded is more likely to be continued. Therefore, rewarding the client whenever the acceptable behavior is performed is the best approach to reinforce new adaptive behaviors. Choice A is incorrect because simply explaining how the risk factor behaviors lead to poor health may not be as effective in promoting behavior change compared to positive reinforcement. Choice B is incorrect because withholding praise can hinder progress and motivation for the client. Choice D is incorrect because instilling fear is not a recommended method in behavior modification. It can lead to negative psychological effects and is not a sustainable approach to behavior change.
4. Which of the following is a priority intervention for a patient with suspected sepsis?
- A. Administering antibiotics.
- B. Administering IV fluids.
- C. Administering antipyretics.
- D. Monitoring blood cultures.
Correct answer: D
Rationale: Monitoring blood cultures is a crucial intervention in suspected sepsis because it helps identify the causative organism, which is essential for guiding appropriate antibiotic therapy. Administering antibiotics (Choice A) is important but should be guided by blood culture results. Administering IV fluids (Choice B) is also essential to support hemodynamic stability in sepsis. Administering antipyretics (Choice C) may help reduce fever but is not a priority compared to identifying the causative organism through blood cultures.
5. The client with peripheral artery disease has been prescribed clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client states which of the following?
- A. I should not be surprised if I bruise more easily or if my gums bleed a little when brushing my teeth.
- B. It is important to take this medicine with food to enhance its effectiveness and minimize stomach upset.
- C. I should stop taking Plavix if it makes me feel weak and dizzy.
- D. The doctor prescribed this medicine to make my platelets less likely to stick together and help prevent clots from forming.
Correct answer: C
Rationale: The correct answer is C. Weakness, dizziness, and headache are common adverse effects of Plavix and should be reported. It is essential to consult a physician before stopping Plavix as it plays a crucial role in preventing platelets from sticking together and forming clots. Choices A, B, and D are incorrect. Choice A is a common side effect of Plavix and does not indicate a need for further teaching. Choice B is incorrect because taking Plavix with or without food can affect its absorption and effectiveness. Choice D correctly explains the purpose of prescribing Plavix to prevent clot formation.
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