HESI RN
HESI Medical Surgical Specialty Exam
1. After a urography, a client is instructed by a nurse. Which instruction should the nurse include in this client’s discharge teaching?
- A. Avoid direct contact with your urine for 24 hours until the dye clears.
- B. You may experience dribbling of urine for several weeks post-procedure.
- C. Drink at least 3 liters of fluids today to assist in dye elimination.
- D. Your skin may turn slightly yellow from the dye used in this procedure.
Correct answer: C
Rationale: It is important for the client to increase fluid intake to aid in the rapid elimination of the potentially nephrotoxic dye used in urography. This instruction will help prevent any adverse effects related to the dye. Choices A, B, and D are incorrect because the dye used in urography is not radioactive, so there is no need to avoid direct contact with urine, urine dribbling is not a common post-procedure occurrence, and the dye should not cause the client's skin to change color.
2. Why is lactated Ringer’s solution given to a patient experiencing vomiting and diarrhea?
- A. To increase interstitial and intracellular hydration
- B. To maintain plasma volume over time
- C. To pull water from the interstitial space into the extracellular fluid
- D. To replace water and electrolytes
Correct answer: D
Rationale: Lactated Ringer’s solution is an isotonic solution commonly used to replace water and electrolytes lost due to conditions like vomiting and diarrhea. It helps to restore fluid balance by replacing the lost volume and electrolytes. Option A is incorrect because hypotonic fluids, not lactated Ringer’s solution, increase interstitial and intracellular hydration. Option B is incorrect as colloidal solutions, not lactated Ringer’s solution, are used to maintain plasma volume over time. Option C is incorrect as hypertonic solutions, not lactated Ringer’s solution, pull water from the interstitial space into the extracellular fluid.
3. 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.
4. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?
- A. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.
- B. Continue the intravenous fluids as ordered and reassess the patient frequently.
- C. Notify the provider and discuss increasing the rate of fluids to 200 mL/hour.
- D. Stop the intravenous fluids and notify the provider of the assessment findings.
Correct answer: D
Rationale: The patient’s potassium level is within normal limits, but the decreased urine output indicates the patient should not receive additional IV potassium. Increasing potassium chloride to 40 mEq/L is not needed as the level is normal. Stopping the IV fluids is appropriate due to the decreased urine output, which suggests potential fluid overload. The nurse should notify the provider of the assessment findings for further management. Increasing the rate of fluids to 200 mL/hour is not recommended without addressing the decreased urine output first.
5. The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to
- A. acquired bacterial resistance.
- B. cross-resistance.
- C. inherent bacterial resistance.
- D. transferred resistance.
Correct answer: A
Rationale: The correct answer is A: acquired bacterial resistance. Acquired resistance happens when an organism has been exposed to the antibacterial drug, making it less effective over time. Cross-resistance (B) occurs when resistance to one drug leads to resistance to another. Inherent resistance (C) happens without prior exposure to the drug, meaning the bacteria are naturally resistant. Transferred resistance (D) involves the transfer of resistant genes from one organism to another, contributing to resistance development.
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