HESI RN
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1. A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:
- A. 2-4 hours after administration
- B. 6-14 hours after administration
- C. 16-18 hours after administration
- D. 18-24 hours after administration
Correct answer: B
Rationale: The correct answer is B: 6-14 hours after administration. NPH insulin has an onset of action within 1-2 hours, a peak action at 6-14 hours, and a duration of action of 16-24 hours. The peak action period, which is when the risk of hypoglycemia is highest, falls between 6-14 hours after administration. Choices A, C, and D are incorrect because they do not align with the typical action profile of NPH insulin.
2. In a male client with a history of hypertension diagnosed with primary hyperaldosteronism, the hypertension is caused by excessive hormone secretion from which of the following glands?
- A. Adrenal cortex
- B. Pancreas
- C. Adrenal medulla
- D. Parathyroid
Correct answer: A
Rationale: Primary hyperaldosteronism is characterized by excessive secretion of aldosterone from the adrenal cortex. Aldosterone, a hormone produced by the adrenal cortex, plays a crucial role in regulating blood pressure by promoting sodium and water retention in the kidneys. The adrenal medulla secretes catecholamines like epinephrine and norepinephrine, which are involved in the 'fight or flight' response, not in regulating blood pressure. The pancreas secretes insulin and glucagon, hormones involved in blood sugar regulation, not blood pressure. The parathyroid glands regulate calcium levels in the blood, not blood pressure.
3. The healthcare provider is monitoring a client with Cushing's syndrome. Which of the following findings should be reported to the healthcare provider immediately?
- A. Hyperglycemia
- B. Hypertension
- C. Low-grade fever
- D. Weight gain
Correct answer: C
Rationale: In a client with Cushing's syndrome, a low-grade fever should be reported immediately as it may indicate an infection. Clients with Cushing's syndrome are immunosuppressed, making them more susceptible to infections. Hyperglycemia and hypertension are common findings in Cushing's syndrome and are managed as part of the condition. Weight gain is also a common symptom in Cushing's syndrome and may not require immediate reporting unless it is sudden and severe.
4. A client with hypothyroidism is at risk for which of the following complications?
- A. Thyroid storm
- B. Myxedema coma
- C. Cushing's syndrome
- D. Diabetic ketoacidosis
Correct answer: B
Rationale: Myxedema coma is a severe, life-threatening complication that can occur in individuals with untreated or inadequately treated hypothyroidism. It is characterized by extreme hypothyroidism leading to decreased mental status, hypothermia, bradycardia, and respiratory depression. Thyroid storm (Choice A) is a severe complication of hyperthyroidism, not hypothyroidism. Cushing's syndrome (Choice C) results from prolonged exposure to high levels of cortisol, not related to hypothyroidism. Diabetic ketoacidosis (Choice D) is a complication of uncontrolled diabetes, not directly associated with hypothyroidism.
5. Which of the following actions could be considered a breach of patient confidentiality?
- A. Discussing patient information with other healthcare providers in a private setting.
- B. Sharing patient information with family members without the patient's consent.
- C. Discussing patient information in public areas where others may overhear.
- D. Sharing patient information in a private, secure setting with other healthcare providers involved in the patient's care.
Correct answer: C
Rationale: Discussing patient information in public areas where others may overhear is considered a breach of patient confidentiality because it compromises the privacy and confidentiality of the patient's health information. Choices A and D are not breaches of confidentiality as discussing patient information with other healthcare providers in a private setting or in a private, secure setting with those involved in the patient's care is appropriate. Choice B is also incorrect as sharing patient information with family members without the patient's consent could potentially be a breach of privacy but is not the best answer in this context.
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