HESI RN
RN Medical/Surgical NGN HESI 2023
1. A client with elevated levels of antidiuretic hormone (ADH) triggers the release of this hormone due to which disorder?
- A. Pneumonia
- B. Dehydration
- C. Renal failure
- D. Edema
Correct answer: B
Rationale: Antidiuretic hormone (ADH) increases tubular permeability to water, causing more water absorption into the capillaries. ADH is released in response to a rising extracellular fluid osmolarity, such as in dehydration. Pneumonia, renal failure, and edema do not typically lead to the release of ADH. Pneumonia is an inflammatory lung condition, renal failure affects kidney function, and edema is the accumulation of excess fluid in the tissues, none of which directly stimulate the release of ADH.
2. A client has undergone renal angiography via the right femoral artery. The nurse determines that the client is experiencing a complication of the procedure upon noting:
- A. Urine output of 40 mL/hr
- B. Blood pressure of 118/76 mm Hg
- C. Respiratory rate of 18 breaths/min
- D. Pallor and coolness of the right leg
Correct answer: D
Rationale: Pallor and coolness of the right leg indicate a potential vascular complication following renal angiography, such as hemorrhage, thrombosis, or embolism. These signs suggest impaired circulation in the affected limb. Urine output, blood pressure, and respiratory rate are not typically associated with complications of renal angiography. Complications of this procedure mainly involve allergic reactions to the dye, dye-induced renal damage, and various vascular issues.
3. The client has been receiving peritoneal dialysis. The nurse should assess the client for which of the following complications that is most likely to occur?
- A. Electrolyte imbalance
- B. Peritonitis
- C. Infection
- D. Hyperglycemia
Correct answer: B
Rationale: Peritonitis is the most likely complication to occur in clients receiving peritoneal dialysis due to the risk of infection. Peritonitis is a serious inflammation of the peritoneum lining the abdominal cavity, commonly caused by infection. While electrolyte imbalance and hyperglycemia are possible complications in some cases, peritonitis poses a more immediate and severe threat to the client's health. Infection is a general term that can encompass peritonitis but is not as specific as directly identifying peritonitis as the primary concern in this scenario.
4. During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not moving. What action should the nurse take first?
- A. Use a laryngoscope to check for a foreign body lodged in the airway.
- B. Reposition the head to ensure that the airway is properly opened.
- C. Turn the client to the side and administer three back blows.
- D. Perform a finger sweep of the mouth to clear any obstructions.
Correct answer: B
Rationale: The most common reason for inadequate lung aeration during CPR is the incorrect positioning of the head, leading to airway obstruction. Therefore, the initial action should be to reposition the head to open the airway properly and attempt to ventilate again. Using a laryngoscope to check for foreign bodies in the airway (Choice A) is not the first step and could delay crucial interventions. Turning the client to the side and administering back blows (Choice C) is not indicated in this scenario as the focus is on ventilating the lungs. Performing a finger sweep of the mouth (Choice D) is not recommended as it may push obstructions further into the airway during CPR.
5. What is the most common symptom of gastroesophageal reflux disease (GERD)?
- A. Heartburn.
- B. Nausea.
- C. Abdominal pain.
- D. Vomiting.
Correct answer: A
Rationale: The correct answer is A: Heartburn. Heartburn is the most common symptom of GERD as it occurs due to the reflux of stomach acid into the esophagus. This leads to a burning sensation in the chest that can worsen after eating, lying down, or bending over. Choice B, Nausea, is not typically the most common symptom of GERD, although it can occur in some cases. Choice C, Abdominal pain, is not a primary symptom of GERD and is more commonly associated with other gastrointestinal conditions. Choice D, Vomiting, is also not the most common symptom of GERD, although it can occur in severe cases or as a result of complications.
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