HESI RN
HESI Leadership and Management
1. A healthcare professional is reading a physician's progress notes in the client's record and reads that the physician has documented 'insensible fluid loss of approximately 800 mL daily.' The healthcare professional understands that this type of fluid loss can occur through:
- A. The skin
- B. Urinary output
- C. Wound drainage
- D. The gastrointestinal tract
Correct answer: A
Rationale: Insensible fluid loss refers to the fluid lost from the body that is not easily measured, such as through sweating and respiration. The skin is a major contributor to insensible fluid loss due to evaporation of water through the skin. Choice B, urinary output, represents measurable fluid loss through urine excretion. Choice C, wound drainage, is a measurable form of fluid loss that occurs externally from a wound. Choice D, the gastrointestinal tract, primarily involves fluid loss through feces and is also a measurable form of output. Therefore, the correct answer is 'A: The skin,' as it is the main route for insensible fluid loss.
2. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
- A. 2 to 5 g of a simple carbohydrate.
- B. 10 to 15 g of a simple carbohydrate.
- C. 18 to 20 g of a simple carbohydrate.
- D. 25 to 30 g of a simple carbohydrate.
Correct answer: B
Rationale: The correct answer is B: 10 to 15 g of a simple carbohydrate. In the treatment of hypoglycemia, it is important to administer a specific amount of simple carbohydrates to raise blood glucose levels effectively without causing hyperglycemia. 10 to 15 g of simple carbohydrates, such as glucose tablets, fruit juice, or regular soft drinks, is recommended to rapidly increase blood sugar levels in clients experiencing hypoglycemia. Choices A, C, and D are incorrect as they either provide too little or too much glucose, which may not effectively treat the hypoglycemic episode or may lead to rebound hyperglycemia.
3. How often should rotation sites for insulin injection be separated from one another?
- A. Every third day.
- B. Every week.
- C. Every 2-3 weeks.
- D. Every 2-4 weeks.
Correct answer: C
Rationale: Insulin injection sites should be rotated every 2-3 weeks to prevent lipodystrophy and ensure proper insulin absorption. Option A ('Every third day') is too frequent and does not allow enough time for the previous site to heal properly. Option B ('Every week') might not provide adequate time for the tissue to recover. Option D ('Every 2-4 weeks') could potentially lead to overuse of a single injection site, increasing the risk of lipodystrophy and inconsistent insulin absorption. Therefore, the recommended interval of every 2-3 weeks is optimal for insulin injection site rotation.
4. A client with DM asks a nurse why it is necessary to rotate injection sites when using an insulin pen. The nurse's best response would be:
- A. To prevent scar tissue from forming under the skin.
- B. To make the injections less painful.
- C. To help the insulin absorb better.
- D. To keep the skin looking healthy.
Correct answer: C
Rationale: The correct answer is C: "To help the insulin absorb better." Rotating injection sites is important as it helps to ensure better insulin absorption and reduces the risk of developing lipodystrophy. Option A is incorrect as rotating sites primarily aims to optimize insulin absorption, not prevent scar tissue. Option B is inaccurate because rotating injection sites does not necessarily make the injections less painful. Option D is incorrect as the primary reason for rotating injection sites is not related to the aesthetics of the skin but rather to enhance insulin absorption and prevent complications.
5. A client with Addison's disease is experiencing an Addisonian crisis. The nurse should expect to administer which of the following medication?
- A. Insulin
- B. Hydrocortisone
- C. Levothyroxine
- D. Methimazole
Correct answer: B
Rationale: During an Addisonian crisis, the adrenal glands are not producing enough cortisol, leading to a life-threatening situation. Hydrocortisone, a glucocorticoid, is the medication of choice in managing an Addisonian crisis. It helps replace deficient cortisol levels, stabilize blood pressure, and prevent further complications. Insulin (Choice A) is not indicated in Addison's disease unless specifically needed for diabetes management. Levothyroxine (Choice C) is used in hypothyroidism, not in Addison's disease. Methimazole (Choice D) is used to manage hyperthyroidism, which is not related to Addison's disease or its crisis.
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