a nurse assesses clients on the medical surgical unit which clients are at risk for kidney problems select all that apply

HESI RN

HESI Medical Surgical Specialty Exam

1. Which clients are at risk for kidney problems? (Select all that apply.)

A. Clients taking synthetic creatine supplements
B. Clients taking metformin for diabetes mellitus
C. Clients taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for chronic back pain
D. Clients taking prenatal vitamins and using albuterol nebulizers

Correct answer: A

Rationale: Clients who take synthetic creatine supplements, metformin, and high-dose or long-term NSAIDs are at risk for kidney dysfunction. Synthetic creatine supplements can cause kidney damage, metformin may rarely cause lactic acidosis leading to renal impairment, and high-dose NSAIDs can lead to acute kidney injury. Prenatal vitamins and albuterol nebulizers are not known to significantly impact kidney function, thus do not pose a risk for kidney problems.

2. What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?

A. Ask the patient if she might be pregnant.
B. Reassure the patient that this is a normal side effect.
C. Report a possible superinfection to the provider.
D. Suspect that the patient is having a hematologic reaction.

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.

3. A 57-year-old male client is scheduled to have a stress-thallium test the following morning and is NPO after midnight. At 0130, he is agitated because he cannot eat and is demanding food. Which response is best for the nurse to provide to this client?

A. I'm sorry sir, you have a prescription for nothing by mouth from midnight tonight.
B. I will let you have one cracker, but that is all you can have for the rest of tonight.
C. What did the healthcare provider tell you about the test you are having tomorrow?
D. The test you are having tomorrow requires that you have nothing by mouth tonight.

Correct answer: D

Rationale: Being direct and explaining to the client that the test requires him to be NPO, is the most therapeutic statement because the nurse is responding to the client's question and providing him the reason why.

4. The nurse is providing discharge teaching for a patient who will receive oral levofloxacin (Levaquin) to treat pneumonia. The patient takes an oral hypoglycemic medication and uses over-the-counter (OTC) antacids to treat occasional heartburn. The patient reports frequent arthritis pain and takes acetaminophen when needed. Which statement by the nurse is correct when teaching this patient?

A. You may take antacids with levofloxacin to decrease gastrointestinal upset.
B. You may take nonsteroidal anti-inflammatory medications (NSAIDs) for arthritis pain.
C. You should monitor your serum glucose more closely while taking levofloxacin.
D. You should take levofloxacin on an empty stomach to improve absorption.

Correct answer: C

Rationale: Levofloxacin may increase the effects of oral hypoglycemic medications, so patients taking these should be advised to monitor their serum glucose levels closely.

5. A client has undergone insertion of a permanent pacemaker. When developing a discharge teaching plan, the nurse writes a goal of, 'The client will verbalize symptoms of pacemaker failure.' Which symptoms are most important to teach the client?

A. Facial flushing.
B. Fever.
C. Pounding headache.
D. Feelings of dizziness.

Correct answer: D

Rationale: The correct answer is 'D: Feelings of dizziness.' Feelings of dizziness may occur as a result of a decreased heart rate, leading to decreased cardiac output, which can be an indication of pacemaker failure. Teaching the client to recognize symptoms of decreased cardiac output, like dizziness, is crucial for early detection of pacemaker malfunction. Choices A, B, and C are less specific to pacemaker failure and are not commonly associated with this condition. Facial flushing, fever, and pounding headache are not typical signs of pacemaker failure and are not directly related to cardiac output, making them less relevant for teaching the client about pacemaker failure.