HESI RN
HESI Medical Surgical Test Bank
1. A client with acute kidney injury (AKI) weighing 50kg and having a potassium level of 6.7mEq/L (6.7mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first?
- A. Calcium acetate, one tablet by mouth
- B. Sodium polystyrene sulfonate, 15 grams by mouth
- C. Epoetin Alfa, recombinant, 2,500 units subcutaneously
- D. Sevelamer, one tablet by mouth
Correct answer: B
Rationale: In a client with acute kidney injury (AKI) and hyperkalemia, the priority intervention is to lower the potassium level swiftly. Sodium polystyrene sulfonate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, reducing the overall potassium levels. Calcium acetate, epoetin alfa, and sevelamer are not indicated for the immediate reduction of potassium levels in hyperkalemia. Calcium acetate is used to control phosphate levels, epoetin alfa is a medication to treat anemia by stimulating red blood cell production, and sevelamer is a phosphate binder used in chronic kidney disease to reduce phosphate levels.
2. The client who experiences angina has been advised to follow a low-cholesterol diet. Which of the following meals would be best?
- A. Hamburger, salad, and milkshake.
- B. Baked liver, green beans, and coffee.
- C. Spaghetti with tomato sauce, salad, and coffee.
- D. Fried chicken, green beans, and skim milk.
Correct answer: C
Rationale: The best meal option for a client with angina following a low-cholesterol diet is spaghetti with tomato sauce, salad, and coffee. This meal is lower in cholesterol content compared to the other options provided. Hamburger with salad and milkshake, baked liver with green beans and coffee, and fried chicken with green beans and skim milk are higher in cholesterol and may not be suitable for an individual with angina who needs to adhere to a low-cholesterol diet.
3. The nurse is collecting information from a client with chronic pancreatitis who reports persistent gnawing abdominal pain. To help the client manage the pain, which assessment data is most important for the nurse to obtain?
- A. Presence and activity of bowel sounds
- B. Color and consistency of feces
- C. Eating patterns and dietary intake
- D. Level and amount of physical activity
Correct answer: C
Rationale: In chronic pancreatitis, managing abdominal pain is crucial, and assessing the client's eating patterns and dietary intake is essential. Dietary modifications can help alleviate symptoms and reduce the workload on the pancreas. Choices A, B, and D are not directly related to pain management in chronic pancreatitis. Bowel sounds, fecal characteristics, and physical activity may provide important information in other conditions but are not the priority in this scenario.
4. A client with functional urinary incontinence is being taught by a nurse. Which statement should the nurse include in this client’s teaching?
- A. Clean around your catheter daily with soap and water.
- B. Wash the vaginal weights with a 10% bleach solution after each use.
- C. Informing about available operations to repair your bladder.
- D. Buy slacks with elastic waistbands that are easy to pull down.
Correct answer: D
Rationale: Functional urinary incontinence is not related to bladder issues but rather to difficulties with ambulation or accessing the toilet. The goal is to help the client manage clothing independently. Elastic waistband slacks that are easy to pull down facilitate timely access to the toilet. Choices A and B are unrelated and not applicable to functional urinary incontinence. Choice C is incorrect as surgeries to repair the bladder are not indicated for functional urinary incontinence.
5. To assess the quality of an adult client's pain, what approach should the nurse use?
- A. Observe body language and movement.
- B. Ask the client to describe the pain.
- C. Identify effective pain relief measures.
- D. Provide a numeric pain scale.
Correct answer: B
Rationale: The correct answer is to ask the client to describe the pain. This approach allows the nurse to gather subjective information directly from the client, such as the quality, intensity, location, and factors that aggravate or alleviate the pain. Observing body language and movement (Choice A) can provide additional cues but may not fully capture the client's pain experience. Identifying effective pain relief measures (Choice C) and providing a numeric pain scale (Choice D) are important aspects of pain management but do not directly assess the quality of the client's pain.
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