HESI RN
Adult Health 1 HESI
1. Following a thyroidectomy, a patient complains of “a tingling feeling around my mouth.” Which assessment should the nurse complete immediately?
- A. Presence of the Chvostek’s sign
- B. Abnormal serum potassium level
- C. Decreased thyroid hormone level
- D. Bleeding on the patient’s dressing
Correct answer: A
Rationale: The correct assessment the nurse should complete immediately is checking for the presence of the Chvostek’s sign. The patient's complaint of tingling around the mouth is indicative of hypocalcemia, which can result from parathyroid injury/removal during thyroidectomy. The Chvostek’s sign is a clinical indication of hypocalcemia, where facial muscle twitching occurs when the facial nerve is tapped. Assessing serum potassium levels (choice B) is not the priority in this situation. While thyroid hormone levels (choice C) play a role in overall health, they do not directly relate to the patient’s current symptoms. Checking for bleeding on the dressing (choice D) is important but not the immediate priority when addressing potential hypocalcemia.
2. The healthcare provider is assessing the laboratory results for a client who is admitted with renal failure and osteodystrophy. Which findings are consistent with this client's clinical picture?
- A. Serum potassium of 4.0 mEq/L and total calcium of 9 mg/dL.
- B. White blood cell count of 15,000/mm3.
- C. Serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL.
- D. Hemoglobin of 12 g/dL and phosphorus of 2 mg/dL.
Correct answer: C
Rationale: In renal failure and osteodystrophy, there is an alteration in serum electrolyte balance. The correct answer is serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL. Renal failure is associated with hyperkalemia (elevated serum potassium) and hypocalcemia (low total calcium levels). Hyperphosphatemia is also commonly seen in renal failure. Choice A is incorrect as it describes normal levels of serum potassium and total calcium. Choice B is unrelated to the client's condition. Choice D is incorrect as it does not reflect the typical electrolyte imbalances seen in renal failure and osteodystrophy.
3. A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness?
- A. Lung sounds
- B. Blood pressure
- C. Blood ammonia level
- D. Serum potassium level
Correct answer: C
Rationale: In portosystemic encephalopathy, the liver's ability to detoxify ammonia is impaired, leading to elevated blood ammonia levels, which can cause neurological symptoms such as encephalopathy. Lactulose is given to reduce ammonia levels by promoting its excretion through the bowel. Therefore, assessing the blood ammonia level is crucial to determine the effectiveness of lactulose therapy in managing portosystemic encephalopathy.
4. A client is instructed to take levothyroxine (Synthroid). The medication should be taken:
- A. With food
- B. At lunchtime
- C. On an empty stomach
- D. At bedtime with a snack
Correct answer: C
Rationale: Levothyroxine should be taken on an empty stomach to enhance absorption. Taking it with food or at bedtime can interfere with its absorption, reducing its effectiveness. Therefore, it is essential for the client to take levothyroxine on an empty stomach to ensure optimal therapeutic outcomes.
5. A client with cirrhosis is admitted with hepatic encephalopathy. Which clinical finding is most concerning?
- A. Confusion and altered mental status
- B. Increased abdominal girth
- C. Yellowing of the skin
- D. Peripheral edema
Correct answer: A
Rationale: Confusion and altered mental status are the most concerning clinical findings in a client with hepatic encephalopathy. These symptoms indicate worsening liver function and potential neurological complications, requiring immediate medical attention. Increased abdominal girth may suggest ascites, yellowing of the skin can indicate jaundice, and peripheral edema may be related to fluid retention, but in the context of hepatic encephalopathy, confusion and altered mental status take precedence due to the risk of rapid deterioration and the need for prompt management.