HESI RN
HESI Medical Surgical Specialty Exam
1. A client with bladder cancer who underwent a complete cystectomy with ileal conduit is being assessed by a nurse. Which assessment finding should prompt the nurse to urgently contact the healthcare provider?
- A. The ileostomy is draining blood-tinged urine.
- B. There is serous sanguineous drainage on the surgical dressing.
- C. The ileostomy stoma appears pale and cyanotic.
- D. Oxygen saturations are 92% on room air.
Correct answer: C
Rationale: A pale or cyanotic appearance of the ileostomy stoma indicates compromised circulation, which can lead to necrosis if not promptly addressed. On the other hand, blood-tinged urine and serous sanguineous drainage are common following a complete cystectomy with ileal conduit. These findings do not typically indicate an urgent issue. An oxygen saturation of 92% on room air is slightly below the normal range but does not warrant urgent healthcare provider contact unless accompanied by significant respiratory distress or other concerning symptoms.
2. A client with a history of heart failure presents to the clinic with nausea, vomiting, yellow vision, and palpitations. Which finding is most important for the nurse to assess for this client?
- A. Assess distal pulses and signs of peripheral edema
- B. Determine the client's level of orientation and cognition
- C. Obtain a list of medications taken for cardiac history
- D. Ask the client about exposure to environmental heat
Correct answer: C
Rationale: The correct answer is to obtain a list of medications taken for cardiac history. The client's presentation is indicative of digitalis toxicity, commonly associated with medications like digoxin (Lanoxin) used in heart failure treatment. Understanding the client's medication history, particularly the use of digoxin, is crucial in confirming and managing digitalis toxicity. Assessing distal pulses and signs of peripheral edema (Choice A) may be relevant in heart failure but are not the priority in this case. Determining the client's level of orientation and cognition (Choice B) and asking about exposure to environmental heat (Choice D) are not directly related to the client's current symptoms and are less pertinent in this scenario.
3. The Punnett square shows that one parent carries the recessive gene for a cleft chin (c) while the other parent does not. What percentage of the parents' offspring is predicted to have a cleft chin?
- A. 25%
- B. 50%
- C. 0%
- D. 75%
Correct answer: C
Rationale: The correct answer is 0%. If one parent carries the recessive gene for a cleft chin while the other parent does not, none of the offspring will express the recessive phenotype. This is because in order for a child to have a cleft chin, they would need to inherit the recessive gene from both parents. Therefore, although the offspring could be carriers of the gene, none are predicted to have a cleft chin. Choices A, B, and D are incorrect because the presence of the recessive gene in one parent and its absence in the other would not result in any offspring showing the cleft chin trait.
4. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value is most concerning?
- A. Serum potassium of 5.5 mEq/L
- B. Serum creatinine of 1.5 mg/dl
- C. Serum creatinine of 2.5 mg/dl
- D. White blood cell count of 8,000/mm3
Correct answer: C
Rationale: A serum creatinine level of 2.5 mg/dl is the most concerning laboratory value in a client with chronic kidney disease scheduled for a renal biopsy. An elevated serum creatinine level indicates impaired kidney function, which is critical information before performing a renal biopsy. Option A (Serum potassium of 5.5 mEq/L) may be concerning for hyperkalemia but is not directly related to the renal biopsy procedure. Option B (Serum creatinine of 1.5 mg/dl) is within normal limits, suggesting relatively normal kidney function. Option D (White blood cell count of 8,000/mm3) is within the normal range and not directly related to the renal biopsy procedure or CKD management.
5. Which of the following is a key symptom of hypothyroidism?
- A. Weight loss.
- B. Heat intolerance.
- C. Cold intolerance.
- D. Increased appetite.
Correct answer: C
Rationale: Cold intolerance is a key symptom of hypothyroidism because a decreased metabolic rate leads to a reduced ability to regulate body temperature. Weight loss (Choice A) is more commonly associated with hyperthyroidism, where the metabolic rate is increased. Heat intolerance (Choice B) is also more indicative of hyperthyroidism, where excess thyroid hormone leads to an increased sensitivity to heat. Increased appetite (Choice D) is not typically seen in hypothyroidism; instead, individuals with hypothyroidism may experience weight gain due to the slowed metabolism.