HESI RN
HESI RN Nursing Leadership and Management Exam 6
1. A client with type 1 DM is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should prioritize which action?
- A. Administering intravenous fluids.
- B. Administering oral glucose.
- C. Administering a fever-reducing medication.
- D. Administering oxygen therapy.
Correct answer: A
Rationale: Administering intravenous fluids is the priority in treating DKA for several reasons. DKA is characterized by severe dehydration and electrolyte imbalances due to hyperglycemia. IV fluids help to correct dehydration, restore electrolyte balance, and decrease blood glucose levels. Administering oral glucose (Choice B) would be contraindicated in DKA as the primary issue is high blood glucose levels. Administering a fever-reducing medication (Choice C) is not the priority in managing DKA. Administering oxygen therapy (Choice D) may be necessary in some cases, but correcting dehydration and electrolyte imbalances take precedence in the management of DKA.
2. Albert refuses his bedtime snack. This should alert the healthcare provider to assess for:
- A. Elevated serum bicarbonate and decreased blood pH.
- B. Signs of hypoglycemia earlier than expected.
- C. Symptoms of hyperglycemia due to NPH insulin peak time.
- D. Presence of sugar in the urine.
Correct answer: B
Rationale: When a patient like Albert refuses his bedtime snack, it can lead to hypoglycemia, especially if they are on medication such as insulin. Hypoglycemia can occur earlier than expected due to the lack of carbohydrate intake before bedtime. This situation warrants the healthcare provider to monitor for signs and symptoms of hypoglycemia. Choice A is incorrect because the given scenario is more indicative of hypoglycemia than metabolic alkalosis. Choice C is incorrect as NPH insulin peak time is not directly related to skipping a bedtime snack. Choice D is incorrect as sugar in the urine typically indicates hyperglycemia, not hypoglycemia.
3. The nurse is caring for a client with a history of adrenal insufficiency. The nurse should monitor for which of the following signs of an Addisonian crisis?
- A. Hypertension
- B. Hyperglycemia
- C. Severe hypotension
- D. Tachycardia
Correct answer: C
Rationale: In an Addisonian crisis, there is a lack of adrenal hormones leading to severe hypotension. Hypertension (choice A) is not a typical sign of Addisonian crisis but can occur in conditions like pheochromocytoma. Hyperglycemia (choice B) is not a characteristic sign of an Addisonian crisis. Tachycardia (choice D) may occur as a compensatory mechanism in response to hypotension, but severe bradycardia is more common in an Addisonian crisis.
4. The client with type 2 DM is being taught about the importance of foot care. Which instruction should be included?
- A. Soak your feet in hot water every night.
- B. Walk barefoot whenever possible.
- C. Use a heating pad to warm your feet.
- D. Wear comfortable shoes that allow air circulation.
Correct answer: D
Rationale: The correct instruction for the client with type 2 DM regarding foot care is to wear comfortable shoes that allow air circulation. This helps prevent foot injuries and infections, which are common complications in clients with diabetes. Choice A is incorrect as soaking feet in hot water can lead to burns and skin damage. Choice B is incorrect because walking barefoot increases the risk of injury and infection. Choice C is incorrect as using a heating pad can also potentially lead to burns and skin damage.
5. A client with DM is scheduled to have surgery. The nurse should plan to:
- A. Give the client a regular diet as ordered.
- B. Hold the client's insulin on the morning of surgery.
- C. Monitor the client's blood glucose level closely during the perioperative period.
- D. Have the client stop taking insulin 48 hours before surgery.
Correct answer: C
Rationale: The correct answer is to monitor the client's blood glucose level closely during the perioperative period. This is essential to ensure that the client's blood glucose levels remain within the target range and to prevent complications such as hypo- or hyperglycemia. Choices A, B, and D are incorrect because giving a regular diet as ordered, holding insulin on the morning of surgery, or stopping insulin 48 hours before surgery can lead to uncontrolled blood glucose levels, posing risks to the client's safety during the surgical procedure.
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