HESI RN
Leadership and Management HESI
1. A nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram?
- A. Widened T wave
- B. Prominent U wave
- C. Prolonged QT interval
- D. Shortened ST segment
Correct answer: C
Rationale: In hypocalcemia, a decreased level of calcium can lead to a prolonged QT interval on the ECG due to its role in myocardial repolarization. A widened T wave (Choice A) is typically seen in hyperkalemia. A prominent U wave (Choice B) is associated with hypokalemia. A shortened ST segment (Choice D) is not a typical ECG finding in hypocalcemia.
2. The nurse is caring for a client with a history of congestive heart failure (CHF) who is receiving digoxin therapy. The client reports seeing halos around lights. Which action should the nurse take?
- A. Assess the client's digoxin level
- B. Increase the client's fluid intake
- C. Check the client's blood pressure
- D. Administer a dose of potassium
Correct answer: A
Rationale: Seeing halos around lights is a classic symptom of digoxin toxicity. The nurse should assess the client's digoxin level to determine if the dose needs to be adjusted or if the medication should be held. Increasing fluid intake or checking blood pressure would not directly address the symptom of halos around lights. Administering a dose of potassium is not indicated without knowing the digoxin level and could potentially worsen the toxicity.
3. Which of the following is a lipid that is a membrane component and a precursor to significant hormones?
- A. Nucleic acids
- B. Proteins
- C. Carbohydrates
- D. Steroids
Correct answer: D
Rationale: The correct answer is D, Steroids. Steroids are a type of lipid that function as essential components of cell membranes and serve as precursors for significant hormones like estrogen and testosterone. Nucleic acids (choice A) are not lipids but are molecules like DNA and RNA that store genetic information. Proteins (choice B) and carbohydrates (choice C) are biomolecules but are not lipids and do not serve as precursors for hormones or membrane components.
4. A client is admitted with deep vein thrombosis (DVT) and is receiving heparin therapy. What is the most important laboratory value to monitor during heparin therapy?
- A. Prothrombin time (PT)
- B. International normalized ratio (INR)
- C. Activated partial thromboplastin time (aPTT)
- D. Platelet count
Correct answer: C
Rationale: The activated partial thromboplastin time (aPTT) is the most important laboratory value to monitor during heparin therapy. It measures the intrinsic pathway of coagulation and is used to assess the effectiveness of heparin as an anticoagulant. Keeping the aPTT within the therapeutic range is crucial to prevent complications such as bleeding or clot formation. Prothrombin time (PT) and International normalized ratio (INR) are used to monitor warfarin therapy, not heparin. Platelet count is important to assess for thrombocytopenia, a potential side effect of heparin, but it is not the primary laboratory value to monitor the effectiveness of heparin therapy.
5. When assessing a client with a nursing diagnosis of fluid volume deficit, the nurse notes that the client's skin over the sternum 'tents' when gently pinched. Which action should the nurse implement?
- A. Confirm the finding by further assessing the client for jugular vein distention.
- B. Offer the client high-protein snacks between regularly scheduled mealtimes.
- C. Continue the planned nursing interventions to restore the client's fluid volume.
- D. Change the plan of care to include interventions for impaired skin integrity.
Correct answer: C
Rationale: When the nurse observes that the client's skin over the sternum 'tents' when gently pinched, it is a classic sign of fluid volume deficit. This finding indicates dehydration and the need to restore the client's fluid volume. Therefore, the appropriate action for the nurse is to continue the planned nursing interventions aimed at addressing the fluid deficit. Choice A is incorrect as jugular vein distention is associated with fluid overload, not deficit. Choice B is incorrect as offering high-protein snacks does not directly address the fluid volume deficit. Choice D is incorrect as the priority is to address the fluid deficit before addressing skin integrity issues.