HESI RN
HESI Medical Surgical Specialty Exam
1. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?
- A. Administer the drug and observe closely for hypersensitivity reactions.
- B. Ask the provider whether a cephalosporin from a different generation may be used.
- C. Contact the provider to report drug hypersensitivity.
- D. Notify the provider and suggest an oral cephalosporin.
Correct answer: A
Rationale: When a patient has a history of a rash with amoxicillin, a beta-lactam antibiotic like ceftriaxone should be administered cautiously due to a possible cross-reactivity. The nurse should still administer the drug but closely monitor the patient for any signs of hypersensitivity reactions. Asking for a different generation of cephalosporin or suggesting an oral form does not address the potential cross-reactivity issue. Contacting the provider to report drug hypersensitivity would delay care when the patient needs immediate treatment.
2. A client was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should a nurse expect to find?
- A. Blood urea nitrogen (BUN) of 52 mg/dL
- B. Creatinine of 2.3 mg/dL
- C. BUN of 10 mg/dL
- D. BUN/creatinine ratio of 8:1
Correct answer: A
Rationale: In cardiogenic shock, decreased renal perfusion leads to an elevated BUN. Choice A is correct. Creatinine remains normal in cardiogenic shock as it signifies kidney damage, which has not occurred in this case. A low BUN indicates overhydration, malnutrition, or liver damage, which are not typically seen in cardiogenic shock. A low BUN/creatinine ratio is associated with fluid volume excess or acute renal tubular acidosis, not specifically indicative of cardiogenic shock.
3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mg/dL. What question should the nurse ask first when taking this client’s history?
- A. Have you been taking any aspirin, ibuprofen, or naproxen recently?
- B. Do you have anyone in your family with renal failure?
- C. Have you had a diet that is low in protein recently?
- D. Has a relative had a kidney transplant lately?
Correct answer: A
Rationale: The correct question to ask the client first is about their recent intake of nephrotoxic medications like aspirin, ibuprofen, or naproxen. Elevated serum creatinine and BUN levels indicate possible renal issues, making it crucial to assess potential causes such as medication-induced nephrotoxicity. Inquiring about family history of renal failure or recent kidney transplants would not provide immediate insights into the client's current renal condition. While a diet low in protein could influence BUN levels, it is important to address medication history first due to the acute presentation in the emergency department.
4. What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?
- A. Ask the patient if she might be pregnant.
- B. Reassure the patient that this is a normal side effect.
- C. Report a possible superinfection to the provider.
- D. Suspect that the patient is having a hematologic reaction.
Correct answer: C
Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.
5. The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?
- A. Digitalis
- B. Hydrochlorothiazide
- C. Hydrocortisone
- D. Vitamin D
Correct answer: A
Rationale: Calcium gluconate is administered to treat hyperkalemia by reducing myocardial irritability. When given to a patient taking digitalis, it can lead to digitalis toxicity. Digitalis and calcium gluconate both affect cardiac function, and their concomitant use can potentiate adverse effects. Hydrochlorothiazide, Hydrocortisone, and Vitamin D may impact potassium levels, but they do not interact with calcium gluconate in a way that would cause concern for toxicity.
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