HESI RN
HESI Leadership and Management
1. An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:
- A. Gives small continuous doses of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.
- B. Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.
- C. Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.
- D. Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.
Correct answer: A
Rationale: The correct answer is A. An external insulin pump delivers small continuous doses of regular insulin subcutaneously throughout the day to meet the basal insulin needs. The client can also self-administer a bolus dose with an additional dosage from the pump before each meal to cover the mealtime insulin needs. Option B is incorrect as insulin pumps do not typically release programmed doses of insulin into the bloodstream at specific intervals; instead, they infuse insulin subcutaneously. Option C is incorrect as insulin pumps are not surgically attached to the pancreas; they are worn externally. Option D is incorrect as NPH insulin is not commonly used in insulin pumps, and the pumps do not continuously infuse insulin directly into the bloodstream but rather subcutaneously.
2. The healthcare provider is preparing to administer methylergonovine maleate (Methergine) to a postpartum client. Based on what assessment finding should the healthcare provider withhold the drug?
- A. Respiratory rate of 22 breaths/min
- B. A large amount of lochia rubra
- C. Blood pressure 149/90
- D. Positive Homan’s sign
Correct answer: C
Rationale: A blood pressure of 149/90 is an indication to withhold Methergine due to its potential to further increase blood pressure. Methergine is a medication that can cause vasoconstriction, leading to elevated blood pressure. In this case, administering Methergine could exacerbate the elevated blood pressure, posing a risk to the patient. Therefore, it is crucial to withhold the medication in the presence of hypertension to prevent adverse effects. The other options are not directly related to the administration of Methergine. A respiratory rate of 22 breaths/min is within the normal range. A large amount of lochia rubra may indicate normal postpartum bleeding. A positive Homan’s sign is associated with deep vein thrombosis, which is not a contraindication for administering Methergine.
3. The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?
- A. Give small amounts of baby food with each feeding.
- B. Thicken formula with cereal for each feeding.
- C. Dilute the child's formula with equal parts of water.
- D. Offer 10% dextrose in water between most feedings.
Correct answer: B
Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.
4. The client with congestive heart failure (CHF) is receiving discharge instructions. Which statement by the client indicates a need for further teaching?
- A. I will weigh myself daily and report a weight gain of more than 2 pounds in 24 hours.
- B. I will take my diuretic medication in the morning.
- C. I will call my healthcare provider if I experience increased shortness of breath.
- D. I will drink at least 3 liters of fluid each day.
Correct answer: D
Rationale: The correct answer is D. Drinking at least 3 liters of fluid each day may be contraindicated for a client with CHF due to the risk of fluid overload. This can exacerbate heart failure symptoms and lead to complications. Options A, B, and C are all appropriate statements that demonstrate understanding of managing CHF and seeking appropriate medical attention when needed.
5. A client who had a gestational trophoblastic disease (GTD) evacuated 2 days ago is being... What intervention is most important for the nurse to implement?
- A. Teach the client about the use of a home pregnancy test.
- B. Schedule weekly home visits to draw hCG values.
- C. Schedule a 5-week follow-up with the healthcare provider.
- D. Begin chemotherapy administration during the first home visit.
Correct answer: B
Rationale: The most important intervention for the nurse to implement is to schedule weekly home visits to draw hCG values. Monitoring hCG levels is crucial in detecting potential complications like choriocarcinoma following GTD evacuation. Teaching about home pregnancy tests (Choice A) may not be as immediate and critical as monitoring hCG levels. A 5-week follow-up appointment (Choice C) may be too delayed for close monitoring. Initiating chemotherapy (Choice D) without appropriate hCG monitoring and evaluation is not recommended as the first-line intervention.