HESI RN
HESI Medical Surgical Practice Exam
1. A client receiving warfarin (Coumadin) therapy should have which of the following laboratory results reviewed to evaluate the effectiveness of the therapy?
- A. Complete blood count (CBC).
- B. Prothrombin time (PT).
- C. International normalized ratio (INR).
- D. Partial thromboplastin time (PTT).
Correct answer: C
Rationale: The correct answer is C: International normalized ratio (INR). The INR is the most appropriate laboratory result to review when evaluating the effectiveness of warfarin (Coumadin) therapy. Warfarin is an anticoagulant medication, and the INR helps determine if the dosage is within a therapeutic range to prevent clotting or bleeding complications. Choice A, a Complete Blood Count (CBC), provides information about the cellular components of blood but does not directly assess the anticoagulant effects of warfarin. Choice B, Prothrombin time (PT), measures the time it takes for blood to clot but is not as specific for monitoring warfarin therapy as the INR. Choice D, Partial Thromboplastin Time (PTT), evaluates the intrinsic pathway of coagulation and is not the primary test used to monitor warfarin therapy.
2. A school nurse is organizing a vaccination clinic for middle school students. Which vaccine is most important for the nurse to include?
- A. hepatitis B
- B. tetanus, diphtheria, and pertussis (Tdap)
- C. varicella
- D. measles, mumps, and rubella (MMR)
Correct answer: B
Rationale: The most important vaccine for the school nurse to include in the vaccination clinic for middle school students is the tetanus, diphtheria, and pertussis (Tdap) vaccine. Tdap is recommended for preteens as part of the routine vaccination schedule to protect against these serious diseases. Hepatitis B, varicella, and MMR vaccines are also important but for this specific age group, Tdap takes precedence to ensure protection against tetanus, diphtheria, and pertussis.
3. A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most important for the nurse to teach this client?
- A. Avoid high carbohydrate foods.
- B. Decrease intake of fat-soluble vitamins.
- C. Decrease caloric intake.
- D. Restrict salt and fluid intake.
Correct answer: D
Rationale: The correct answer is to restrict salt and fluid intake. In clients with cirrhosis presenting with pedal edema and ascites, excessive fluid retention occurs, necessitating the restriction of salt and fluid to alleviate these symptoms. Choice A, avoiding high carbohydrate foods, is not the priority in this situation. Decreasing intake of fat-soluble vitamins (Choice B) is not specifically indicated for managing edema and ascites in cirrhosis. While maintaining an appropriate caloric intake is important, decreasing caloric intake (Choice C) is not the primary focus when addressing fluid retention in cirrhosis.
4. When teaching parents of a 5-year-old child with sickle cell anemia about pain management, what information should be included?
- A. Apply cold compresses to painful areas.
- B. Encourage the child to rest as much as possible.
- C. Administer prescribed pain medication at the first sign of pain.
- D. Offer a high-protein diet to help with pain management.
Correct answer: C
Rationale: Administering prescribed pain medication at the first sign of pain is crucial in managing sickle cell anemia-related pain effectively. Prompt administration helps prevent the pain from escalating and becoming severe, enhancing the child's comfort and quality of life. Cold compresses, rest, and diet modifications may play supportive roles but are not as directly impactful in addressing acute pain episodes associated with sickle cell anemia. Therefore, while comforting measures like cold compresses and rest are helpful, they should not replace the importance of timely administration of prescribed pain medication. Additionally, offering a high-protein diet, although important for overall health, is not directly linked to managing acute pain in sickle cell anemia.
5. In which step of cellular respiration is the most adenosine triphosphate (ATP) created?
- A. Electron transport chain
- B. Glycolysis
- C. Citric acid cycle (the Krebs cycle)
- D. All of these produce equal amounts of ATP
Correct answer: A
Rationale: The electron transport chain is the step in cellular respiration that generates the most ATP. During this step, up to 34 ATP molecules can be produced from a single glucose molecule. Choice B, Glycolysis, produces a smaller amount of ATP (2 ATP molecules per glucose), and choice C, Citric acid cycle, produces some ATP but not as much as the electron transport chain. Choice D is incorrect because different steps of cellular respiration produce varying amounts of ATP, with the electron transport chain being the most efficient in ATP generation.