HESI RN
HESI RN Nursing Leadership and Management Exam 5
1. A client with Addison's disease is being educated on managing the condition. Which of the following statements indicates a need for further teaching?
- A. I should carry an emergency kit with hydrocortisone at all times.
- B. I need to increase my sodium intake during hot weather.
- C. I can skip my medication if I feel well.
- D. I should avoid stress as much as possible.
Correct answer: C
Rationale: The correct answer is C. Clients with Addison's disease should not skip their medication, even if they feel well, as consistent medication is necessary to manage the condition. Choice A is correct as carrying an emergency kit with hydrocortisone is essential for managing potential adrenal crises. Choice B is correct as increasing sodium intake during hot weather helps prevent electrolyte imbalances. Choice D is correct as stress can trigger adrenal crisis in individuals with Addison's disease, so stress management is crucial.
2. The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which assessment finding is most concerning?
- A. Increased fatigue
- B. Headache
- C. Elevated blood pressure
- D. Low urine output
Correct answer: C
Rationale: In a client with chronic kidney disease (CKD) receiving erythropoietin therapy, an elevated blood pressure is the most concerning assessment finding. This finding can indicate worsening hypertension, which requires prompt intervention to prevent complications such as cardiovascular events or further kidney damage. Increased fatigue (Choice A) is a common symptom in CKD and can be expected with the condition itself or the treatment. Headache (Choice B) can also occur but is less specific to CKD or its treatment. Low urine output (Choice D) is a concern in CKD but may not be directly related to erythropoietin therapy.
3. A healthcare professional is reading the chest x-ray report of a client who has just been intubated. The report states that the tip of the endotracheal tube lies 1 cm above the carina. The healthcare professional interprets that the tube is positioned above:
- A. The first tracheal cartilaginous ring
- B. The point where the larynx connects to the trachea
- C. The bifurcation of the right and left main stem bronchi
- D. The area connecting the oropharynx to the laryngopharynx
Correct answer: C
Rationale: The carina is a cartilaginous ridge that separates the openings of the two main stem (right and left) bronchi. If an endotracheal tube is inserted past the carina, the tube will enter the right main stem bronchus due to the natural curvature of the airway. This positioning is dangerous as only the right lung will be ventilated. It can be identified as only the right lung will have breath sounds and rise and fall with ventilation. Choices A, B, and D are incorrect as they do not relate to the specific anatomical landmark mentioned in the scenario.
4. A client with a history of chronic kidney disease is receiving erythropoietin therapy. Which finding indicates that the therapy is effective?
- A. Hemoglobin of 12 g/dL.
- B. Reticulocyte count of 1%.
- C. Blood pressure of 130/80 mm Hg.
- D. Serum ferritin level of 100 ng/mL.
Correct answer: A
Rationale: The correct answer is A. A hemoglobin level of 12 g/dL is an indicator of effective erythropoietin therapy as it shows an increase in red blood cell production. Reticulocyte count (choice B) reflects the bone marrow's response to anemia but does not directly confirm the effectiveness of erythropoietin therapy. Blood pressure (choice C) and serum ferritin level (choice D) are not specific indicators of the effectiveness of erythropoietin therapy for chronic kidney disease.
5. The healthcare provider is preparing to administer magnesium sulfate to a laboring client whose blood pressure has increased from 110/60 mmHg to 140/90 mmHg. Which action is the highest priority?
- A. Provide a quiet environment with subdued lighting.
- B. Have calcium gluconate immediately available.
- C. Assess deep tendon reflexes (DTRs) every 4 hours.
- D. Insert a Foley catheter with a urimeter to monitor hourly output.
Correct answer: B
Rationale: Having calcium gluconate readily available is crucial when administering magnesium sulfate, as it serves as the antidote in case of magnesium toxicity. Magnesium sulfate can lead to respiratory depression and cardiac arrest in cases of overdose or toxicity, making the prompt availability of calcium gluconate essential for immediate administration to counteract these effects. Providing a quiet environment with subdued lighting may be beneficial for the client's comfort but is not the highest priority in this situation. Assessing deep tendon reflexes every 4 hours is important when administering magnesium sulfate, but it is not the highest priority compared to having calcium gluconate available. Inserting a Foley catheter with a urimeter to monitor hourly output is not the highest priority when preparing to administer magnesium sulfate in this scenario.