HESI RN
HESI Medical Surgical Practice Quiz
1. A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first?
- A. Contact the provider and recommend discontinuing the metformin.
- B. Keep the client NPO for at least 6 hours prior to the examination.
- C. Check the client’s capillary artery blood glucose and administer prescribed insulin.
- D. Administer intravenous fluids to dilute and increase the excretion of dye.
Correct answer: A
Rationale: Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The client’s health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the client’s blood glucose, and administering intravenous fluids should be part of the client’s plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.
2. A client is returning home after arthroscopy of the shoulder. The nurse should tell the client:
- A. To resume full activity the next day
- B. Not to eat or drink anything until the next morning
- C. To keep the shoulder completely immobilized for the rest of the day
- D. To report to the physician the development of fever or redness and heat at the site
Correct answer: D
Rationale: After arthroscopy, it is important for the client to report any signs of infection, such as the development of fever or redness and heat at the site, to the physician promptly. Options A, B, and C are incorrect. The client should not resume full activity the next day as rest and limited movement are usually recommended post-arthroscopy. It is not necessary to withhold food or fluids until the next morning; the client may resume the usual diet immediately unless otherwise instructed. While immobilization may be recommended for a period, keeping the shoulder completely immobilized for the rest of the day is not typically necessary post-arthroscopy.
3. A client is recovering after a nephrostomy tube was placed 6 hours ago. The nurse notes drainage in the tube has decreased from 40 mL/hr to 12 mL over the last hour. Which action should the nurse take?
- A. Document the finding in the client’s record.
- B. Evaluate the tube as working in the hand-off report.
- C. Clamp the tube in preparation for removing it.
- D. Assess the client’s abdomen and vital signs.
Correct answer: D
Rationale: The correct action for the nurse to take in this situation is to assess the client’s abdomen and vital signs. The nephrostomy tube should have a consistent amount of drainage, and a decrease may indicate obstruction. Before notifying the provider, the nurse must assess the client for pain, distention, and changes in vital signs. This assessment is crucial to gather essential information to report accurately. Documenting the finding without further assessment may delay necessary intervention. Evaluating the tube as working in the hand-off report or clamping the tube prematurely are not appropriate actions and could lead to complications if there is an obstruction.
4. A nurse reviews the laboratory findings of a client with a urinary tract infection. The laboratory report notes a “shift to the left†in the client’s white blood cell count. Which action should the nurse take?
- A. Request that the laboratory perform a differential analysis on the white blood cells.
- B. Notify the provider and start an intravenous line for parenteral antibiotics.
- C. Collaborate with the unlicensed assistive personnel (UAP) to strain the client’s urine for renal calculi.
- D. Assess the client for a potential allergic reaction and anaphylactic shock.
Correct answer: B
Rationale: A “shift to the left†in a white blood cell count indicates an increase in band cells, which is typically associated with urosepsis. In this scenario, the nurse should notify the provider and initiate IV antibiotics as a left shift is often seen in severe infections like urosepsis. Requesting a differential analysis on white blood cells would not be the immediate action needed in response to a left shift. Collaborating to strain urine for renal calculi is unrelated to the situation of a left shift in white blood cells due to urosepsis. Assessing for allergic reactions and anaphylactic shock is not the priority as a left shift is not indicative of an allergic response; it is associated with an increase in band cells, not eosinophils.
5. A client with histoplasmosis has the following arterial blood gas (ABG) results: pH 7.30, PCO2 58 mm Hg, PO2 75 mm Hg, HCO3 27 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct answer: A
Rationale: The client's ABG results show a low pH (acidosis) and an elevated PCO2, indicating respiratory acidosis. In respiratory acidosis, there is inadequate excretion of CO2, leading to increased PCO2 levels and a decrease in pH. Therefore, the correct answer is 'Metabolic acidosis'. Choices B, C, and D are incorrect. Metabolic alkalosis is characterized by elevated pH and bicarbonate levels. Respiratory acidosis involves low pH and high PCO2 levels, as seen in this case. Respiratory alkalosis is associated with high pH and low PCO2 levels.
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