HESI RN
HESI RN Medical Surgical Practice Exam
1. A nurse is assessing the status of a client with diabetes mellitus. The nurse concludes that the client is exhibiting adequate diabetic control if the serum level of glycosylated hemoglobin A1C (HbA1C) is less than:
- A. 7%
- B. 9%
- C. 10%
- D. 15%
Correct answer: A
Rationale: The correct answer is A: 7%. Glycosylated hemoglobin A1C (HbA1C) level of 7.0% or less is considered indicative of adequate diabetic control. This level reflects good long-term blood sugar management. Choices B, C, and D are incorrect because an HbA1C level above 7% indicates poor diabetic control and an increased risk of complications associated with diabetes, such as cardiovascular disease, neuropathy, and retinopathy.
2. When obtaining the health history of a client suspected of having bladder cancer, which question should the nurse ask to determine the client's risk factors?
- A. Do you smoke cigarettes?
- B. Do you consume alcohol?
- C. Do you use recreational drugs?
- D. Do you take any prescription drugs?
Correct answer: A
Rationale: The correct answer is A: 'Do you smoke cigarettes?' Smoking is a major risk factor for bladder cancer. Cigarette smoke contains harmful chemicals that can accumulate in the urine and damage the lining of the bladder, increasing the risk of developing cancer. Alcohol use, recreational drug use, and most prescription drugs are not directly linked to an increased risk of bladder cancer. It is important for the nurse to assess smoking history as a significant risk factor in determining the client's risk for bladder cancer.
3. A client is being taught about self-catheterization in the home setting. Which statements should the nurse include in this client’s teaching? (Select all that apply.)
- A. Wash your hands before and after self-catheterization.
- B. Use lubricant on the tip of the catheter before insertion.
- C. A & B
- D. Self-catheterize at least twice a day or every 12 hours.
Correct answer: C
Rationale: In teaching a client about self-catheterization, it is essential to emphasize proper hand hygiene before and after the procedure to prevent infections. Using lubricant on the catheter helps with insertion and reduces discomfort. Therefore, statements A and B are correct and should be included in the client's teaching. Option D is incorrect because self-catheterization frequency should be individualized based on the client's needs, and a specific time frame like every 12 hours may not be suitable for everyone. Choosing a smaller lumen catheter is preferred over a larger one. Self-catheterization should not be limited to a specific time frame but should be based on the individual's needs and voiding patterns. Therefore, option C is the correct choice as it includes the two essential statements for teaching self-catheterization in the home setting.
4. A serum phenytoin determination is prescribed for a client with a seizure disorder who is taking phenytoin (Dilantin). Which result indicates that the prescribed dose of phenytoin is therapeutic?
- A. 3 mcg/mL
- B. 8 mcg/mL
- C. 16 mcg/mL
- D. 28 mcg/mL
Correct answer: C
Rationale: The correct answer is 16 mcg/mL (Choice C). The therapeutic serum phenytoin range is typically 10 to 20 mcg/mL. A level below this range may lead to continued seizure activity, indicating subtherapeutic levels. Choices A, B, and D are below the therapeutic range and would not be considered therapeutic for a client with a seizure disorder on phenytoin therapy.
5. The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient’s extremities. The nurse will perform which action?
- A. Hold the dose and notify the provider.
- B. Request an order for a blood glucose level.
- C. Request an order for a BUN and creatinine level.
- D. Request an order for diphenhydramine (Benadryl).
Correct answer: A
Rationale: When a patient on TMP-SMX presents with a petechial rash, it can be indicative of a severe adverse reaction such as thrombocytopenia or a hypersensitivity reaction. The appropriate action for the nurse to take in this situation is to hold the dose of TMP-SMX and notify the healthcare provider immediately. This is crucial to prevent further administration of a medication that may be causing a serious adverse effect. Requesting a blood glucose level (Choice B) is not relevant in this scenario as the patient's presentation is suggestive of a skin-related issue rather than a glucose-related problem. Similarly, requesting a BUN and creatinine level (Choice C) would not address the immediate concern of a petechial rash and its association with TMP-SMX. Requesting an order for diphenhydramine (Choice D) may help manage itching or mild allergic reactions but is not the priority when a petechial rash is observed, as it may indicate a more severe reaction requiring immediate intervention.
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