HESI RN
Evolve HESI Medical Surgical Practice Exam
1. A client has a long history of hypertension. Which category of medication would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?
- A. Antibiotic
- B. Histamine blocker
- C. Bronchodilator
- D. Angiotensin-converting enzyme (ACE) inhibitor
Correct answer: D
Rationale: The correct answer is D, Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By blocking this conversion, ACE inhibitors promote vasodilation and improve perfusion to the kidneys. Additionally, ACE inhibitors block the breakdown of bradykinin and prostaglandin, further contributing to vasodilation. They also lead to increased renin and decreased aldosterone levels. These effects help in reducing blood pressure and protecting the kidneys in clients with hypertension. Antibiotics are used to fight infections, histamine blockers reduce inflammation, and bronchodilators widen the bronchi, none of which address the underlying processes involved in slowing the progression of chronic kidney disease (CKD) in hypertensive clients.
2. Complete abortion is characterized by:
- A. Os closed.
- B. Firm contracted uterus.
- C. Heavy bleeding.
- D. Heavy cramping.
Correct answer: A
Rationale: Complete abortion is characterized by a firm contracted uterus with a closed os. This closure of the os indicates that the products of conception have been completely expelled from the uterus. Choices B, C, and D are incorrect because a firm contracted uterus with a closed os is the hallmark sign of a complete abortion, not heavy bleeding, heavy cramping, or any other features.
3. The healthcare provider is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the healthcare provider specifically note as a result of the massive cell destruction that occurred from the chemotherapy?
- A. Anemia
- B. Decreased platelets
- C. Increased uric acid level
- D. Decreased leukocyte count
Correct answer: C
Rationale: Following chemotherapy for leukemias and lymphomas, hyperuricemia is common due to the massive cell kill. Chemotherapy leads to the rapid destruction of cancer cells, releasing large amounts of nucleic acids, which are broken down into uric acid. Monitoring and managing uric acid levels are crucial to prevent complications such as renal damage and gout.
4. The client with chronic renal failure asks why a low-protein diet is necessary. Which of the following is the best response by the nurse?
- A. It reduces the workload on your kidneys.
- B. It helps prevent the buildup of waste products.
- C. It helps maintain electrolyte balance in your body.
- D. It helps prevent dehydration.
Correct answer: B
Rationale: A low-protein diet is necessary for clients with chronic renal failure to help prevent the buildup of waste products, such as urea, in the body. Choice A is incorrect as the primary reason for a low-protein diet is to manage waste product accumulation rather than reducing the workload on the kidneys. Choice C is incorrect as electrolyte balance is typically managed through dietary restrictions beyond protein intake. Choice D is incorrect as preventing dehydration is not the primary purpose of a low-protein diet in chronic renal failure.
5. One hour after giving birth to an 8-pound infant, a client's lochia rubra has increased from small to large, and her fundus is boggy despite massage. The client's pulse is 84 beats/minute, and blood pressure is 156/96. The healthcare provider prescribes Methergine 0.2 mg IM × 1. What action should the healthcare provider take immediately?
- A. Give the medication as prescribed and monitor for efficacy.
- B. Encourage the client to breastfeed rather than bottle-feed.
- C. Have the client empty her bladder and massage the fundus.
- D. Call the healthcare provider to question the prescription.
Correct answer: D
Rationale: The correct action for the healthcare provider to take immediately is to call the healthcare provider to question the prescription. Methergine is contraindicated in clients with hypertension due to its potential to elevate blood pressure further. In this scenario, the client's blood pressure is already elevated at 156/96, making it unsafe to administer Methergine. The LPN/LVN should advocate for the client's safety by questioning the prescription to prevent potential harm.