HESI RN
HESI Medical Surgical Practice Quiz
1. A nurse cares for a client with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for an intravenous urography. Which action should the nurse take first?
- A. Contact the provider and recommend discontinuing the metformin.
- B. Keep the client NPO for at least 6 hours prior to the examination.
- C. Check the client’s capillary artery blood glucose and administer prescribed insulin.
- D. Administer intravenous fluids to dilute and increase the excretion of dye.
Correct answer: A
Rationale: Metformin can cause lactic acidosis and renal impairment as the result of an interaction with the dye. This drug must be discontinued for 48 hours before the procedure and not started again after the procedure until urine output is well established. The client’s health care provider needs to provide alternative therapy for the client until the metformin can be resumed. Keeping the client NPO, checking the client’s blood glucose, and administering intravenous fluids should be part of the client’s plan of care, but are not the priority, as the examination should not occur while the client is still taking metformin.
2. The occupational health nurse is completing a yearly self-evaluation. Which activity should the nurse document as an example of proficient performance criteria in professionalism?
- A. contributes money to a professional society or organization
- B. maintains chairmanship of the hospital nursing council
- C. documents the nursing process in care management
- D. develops policy initiatives that impact occupational health and safety
Correct answer: D
Rationale: The correct answer is D because developing policy initiatives that impact occupational health and safety demonstrates leadership and proficiency in contributing to the field. Choices A, B, and C do not directly relate to professionalism criteria in the context of occupational health nursing. Contributing money to a professional society, maintaining chairmanship of a nursing council, or documenting the nursing process, while important, do not specifically highlight the nurse's impact on occupational health and safety through policy development.
3. A female patient who is allergic to penicillin will begin taking an antibiotic to treat a lower respiratory tract infection. The patient tells the nurse that she almost always develops a vaginal yeast infection when she takes antibiotics and that she will take fluconazole (Diflucan) with the antibiotic being prescribed. Which macrolide should the nurse question for this patient?
- A. Azithromycin (Zithromax)
- B. Clarithromycin (Biaxin)
- C. Erythromycin (E-Mycin)
- D. Fidaxomicin (Dificid)
Correct answer: C
Rationale: The nurse should question the prescription of erythromycin for this patient. When erythromycin is given concurrently with fluconazole, erythromycin blood concentration and the risk of sudden cardiac death increase. Therefore, it is not recommended to use erythromycin in combination with fluconazole for this patient. Azithromycin, clarithromycin, and fidaxomicin are alternative macrolide antibiotics that can be considered for this patient without the same risk of interactions when used with fluconazole.
4. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
- A. Discuss what the treatment regimen means to him.
- B. Refer the client to a mental health nurse practitioner.
- C. Reschedule the appointments to another date and time.
- D. Discuss the option of peritoneal dialysis.
Correct answer: A
Rationale: The best initial action for the nurse in this scenario is to have a discussion with the client about what the treatment regimen means to him. It is important to assess the client's anxiety, coping styles, and acceptance of the required treatment for CKD. The client may be in denial of the diagnosis or may have concerns that need to be addressed. While rescheduling hemodialysis appointments could be helpful, referring the client to a mental health nurse practitioner or discussing peritoneal dialysis are not the most appropriate first steps. Understanding the client's perspective and concerns is crucial before exploring other interventions.
5. A male client with impaired renal function who takes ibuprofen daily for chronic arthritis is showing signs of gastrointestinal (GI) bleeding. After administering IV fluids and a blood transfusion, his blood pressure is 100/70 mm Hg, and his renal output is 20 ml/hour. Which intervention should the nurse include in his care plan?
- A. Maintain the client NPO during the diuresis phase.
- B. Evaluate daily serial renal laboratory studies for progressive elevations.
- C. Observe the urine character for sedimentation and cloudy appearance.
- D. Monitor for the onset of polyuria greater than 150 ml/hour.
Correct answer: B
Rationale: In this scenario, the correct intervention for the nurse to include in the care plan is to evaluate daily serial renal laboratory studies for progressive elevations. This is crucial in monitoring renal function and detecting any worsening renal impairment. Option A is not directly related to managing renal function in this case. Option C focuses more on urinary characteristics rather than renal function monitoring. Option D addresses polyuria, which is an excessive urine output, but it does not specifically address the need for evaluating renal laboratory studies for progressive elevations.