HESI RN
HESI RN Medical Surgical Practice Exam
1. A nurse plans care for clients with urinary incontinence. Which client is correctly paired with the appropriate intervention?
- A. A 29-year-old client after a difficult vaginal delivery – Habit training
- B. A 58-year-old postmenopausal client who is not taking estrogen therapy – Electrical stimulation
- C. A 64-year-old female with Alzheimer’s-type senile dementia – Bladder training
- D. A 77-year-old female who has difficulty ambulating – Exercise therapy
Correct answer: B
Rationale: The correct pairing is a 58-year-old postmenopausal client who is not taking estrogen therapy with electrical stimulation. Electrical stimulation is used for clients with stress incontinence related to menopause and low estrogen levels. Exercise therapy improves pelvic wall strength and is not specifically for ambulation issues. Habit training is more effective for cognitively impaired clients, like those with Alzheimer's-type senile dementia. Bladder training requires the client to be alert, aware, and able to resist the urge to urinate, which may not be suitable for clients with cognitive impairments.
2. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide should the nurse question for this patient?
- A. Azithromycin (Zithromax)
- B. Clarithromycin (Biaxin)
- C. Erythromycin (E-Mycin)
- D. Fidaxomicin (Dificid)
Correct answer: C
Rationale: The nurse should question the prescription of erythromycin for this patient. When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase. Therefore, it is not recommended to use erythromycin in combination with fluconazole for this patient. Azithromycin, clarithromycin, and fidaxomicin are alternative macrolide antibiotics that can be considered for this patient without the same risk of interactions when used with fluconazole.
3. A patient has a serum potassium level of 2.7 mEq/L. The patient’s provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?
- A. As a single-dose 200 mEq oral tablet
- B. As an intravenous bolus over 15 to 20 minutes
- C. In an intravenous solution at a rate of 10 mEq/hour
- D. In an intravenous solution at a rate of 45 mEq/hour
Correct answer: C
Rationale: For a patient with severe hypokalemia with a serum potassium level of 2.7 mEq/L requiring 200 mEq of potassium replacement, the appropriate route of administration would be intravenous. Potassium chloride should be administered slowly to prevent adverse effects; therefore, the correct option is to administer the potassium in an intravenous solution at a rate of 10 mEq/hour. Choices A and B are incorrect because potassium should not be given as a single-dose oral tablet or as an intravenous bolus over a short period of time due to the risk of adverse effects. Choice D is also incorrect as the rate of 45 mEq/hour exceeds the recommended maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L, which is 10 mEq/hour.
4. A client is vomiting. For which acid-base imbalance does the nurse assess the client?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct answer: B
Rationale: In a client who is vomiting, the loss of gastric fluid containing hydrochloric acid can lead to metabolic alkalosis. Metabolic alkalosis is caused by the loss of acids such as hydrochloric acid from the body. Therefore, in this scenario, the nurse should assess the client for metabolic alkalosis. Choices A, C, and D are incorrect because vomiting does not typically lead to metabolic acidosis, respiratory acidosis, or respiratory alkalosis.
5. A nurse assesses a client who is recovering from a nephrostomy. Which assessment findings should alert the nurse to urgently contact the healthcare provider? (Select all that apply.)
- A. Foul-smelling drainage
- B. Bloody drainage at site
- C. A & B
- D. All of the above
Correct answer: C
Rationale: After a nephrostomy, the nurse should assess the client for complications and urgently notify the provider if there is foul-smelling drainage, bloody drainage at the site, or both. Foul-smelling drainage can indicate infection, while bloody drainage may suggest bleeding. Clear drainage is generally normal after a nephrostomy. A headache would not typically be directly related to nephrostomy complications. Therefore, options A and B are correct choices for urgent notification, making option C the correct answer.
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