HESI RN
HESI Medical Surgical Exam
1. A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects?
- A. Hypercalcemia.
- B. Hypocalcemia.
- C. Hyperglycemia.
- D. Hypoglycemia.
Correct answer: A
Rationale: Corrected Question: A client with chronic renal failure is receiving calcium acetate (PhosLo). The nurse should monitor the client for which of the following side effects? Rationale: The correct answer is A, Hypercalcemia. Calcium acetate (PhosLo) is a medication used to lower phosphate levels in patients with chronic renal failure. It works by binding with dietary phosphate and preventing its absorption. However, this can lead to an excess of calcium in the blood, causing hypercalcemia. Therefore, the nurse should closely monitor the client for signs and symptoms of elevated calcium levels, such as nausea, vomiting, confusion, and muscle weakness. Choices B, C, and D are incorrect as calcium acetate does not typically cause hypocalcemia, hyperglycemia, or hypoglycemia.
2. A female client on a psychiatric unit is sweating profusely while vigorously doing push-ups and then running the length of the corridor several times before crashing into furniture in the sitting room. Picking herself up, she begins to verbally attack other clients. What intervention is most appropriate for the RN to use to manage the client’s behavior?
- A. Assist the client to a safe area to avoid injury.
- B. Establish clear and firm limits with the client.
- C. Offer medication to help calm the client down.
- D. Speak with the client in a calm, non-threatening manner.
Correct answer: A
Rationale: Assisting the client to a safe area is the most appropriate intervention in this scenario. This action helps prevent injury to the client and others while allowing for de-escalation in a controlled environment. While establishing clear and firm limits (Choice B) may be necessary in some situations, the immediate priority here is safety. Offering medication (Choice C) should not be the first response unless the situation escalates further and poses a risk to the client or others. Speaking with the client in a calm, non-threatening manner (Choice D) may not be effective when the client is in an agitated state and engaging in risky behavior.
3. Which one of the following is not a stage in the ovarian cycle of the menstrual cycle?
- A. Recruitment of Graafian follicle
- B. Selection of dominant follicle
- C. Luteal phase
- D. Formation of corpus luteum
Correct answer: A
Rationale: The correct answer is A. The recruitment of the Graafian follicle is indeed a stage in the ovarian cycle. During the ovarian cycle, the primary follicles are recruited to develop further, leading to the formation of the Graafian follicle. The selection of the dominant follicle, luteal phase, and formation of the corpus luteum are other essential stages in the ovarian cycle. Therefore, option A is not correct as it is a crucial phase in the process of ovulation and fertilization.
4. The nurse is administering intravenous fluids to a dehydrated patient. On the second day of care, the patient's weight has increased by 2.25 pounds. The nurse would expect that the patient's fluid intake has
- A. equaled urine output.
- B. exceeded urine output by 1 L.
- C. exceeded urine output by 2.5 L.
- D. exceeded urine output by 3 L.
Correct answer: B
Rationale: A weight gain of 1 kg, or approximately 2.2 to 2.5 lb, is generally equivalent to 1 liter (L) of fluid retained by the body. In this case, the patient's weight gain of 2.25 pounds suggests an excess fluid retention of approximately 1 liter, indicating that the patient's fluid intake has exceeded urine output by 1 liter. Choices C and D are incorrect as they overestimate the fluid excess based on the patient's weight gain. Choice A is incorrect as it implies an exact balance between fluid intake and urine output, which is not reflected in the given weight increase.
5. Why is it important to involve both men and women in many aspects of the RH program?
- A. Promote responsible and caring attitudes and behavior for the benefit of all
- B. Prevent abuse of pregnant women
- C. Minimize sexually transmitted diseases
- D. Promote love and care among couples
Correct answer: A
Rationale: Involving both men and women in the RH program is crucial to promote responsible and caring attitudes and behavior for the benefit of all. This inclusive approach ensures that diverse perspectives are considered, leading to better outcomes and fostering a sense of shared responsibility. While preventing abuse of pregnant women is important, it is just one aspect of the broader goal of promoting overall well-being. Similarly, minimizing sexually transmitted diseases is crucial but not the sole reason for involving both genders. Promoting love and care among couples is desirable, but the primary focus should be on fostering responsible and caring attitudes for the benefit of all individuals involved in reproductive health programs.