HESI RN
HESI Medical Surgical Practice Exam
1. In a patient with chronic kidney disease, which of the following is a common electrolyte imbalance?
- A. Hyperkalemia.
- B. Hypokalemia.
- C. Hypernatremia.
- D. Hyponatremia.
Correct answer: A
Rationale: Hyperkalemia is a common electrolyte imbalance in chronic kidney disease. In chronic kidney disease, the kidneys' reduced function leads to the decreased excretion of potassium, resulting in elevated serum potassium levels. This can be dangerous as hyperkalemia can lead to life-threatening arrhythmias. Hypokalemia (Choice B) is less common in chronic kidney disease as the impaired kidneys tend to retain potassium. Hypernatremia (Choice C) is more commonly seen in conditions such as dehydration, not primarily in chronic kidney disease. Hyponatremia (Choice D) is also possible in chronic kidney disease but is less common compared to hyperkalemia.
2. A client in acute renal failure has a serum potassium of 7.5 mEq/L. Based on this finding, the nurse should anticipate implementing which action?
- A. Administer an IV of normal saline rapidly and NPH insulin subcutaneously.
- B. Administer a retention enema of Kayexalate.
- C. Add 40 mEq of KCL (potassium chloride) to the present IV solution.
- D. Administer a lidocaine bolus IV push.
Correct answer: B
Rationale: In acute renal failure with a high serum potassium level, the priority intervention is to lower potassium levels to prevent complications like cardiac arrhythmias. Administering a retention enema of Kayexalate is the correct action as it helps lower high potassium levels by exchanging sodium for potassium in the intestines. Options A, C, and D are incorrect. Administering normal saline rapidly and NPH insulin or adding more potassium to the IV solution can further increase potassium levels, worsening the condition. Lidocaine is not indicated for treating hyperkalemia.
3. When turning an immobile bedridden client without assistance, which action best ensures client safety?
- A. Securely grasp the client's arm and leg.
- B. Put bed rails up on the side of bed opposite from the nurse.
- C. Correctly position and use a turn sheet.
- D. Lower the head of the client's bed slowly.
Correct answer: B
Rationale: The correct answer is to put bed rails up on the side of the bed opposite from the nurse. This action is essential to prevent the client from falling out of bed during the turning process. Since the nurse can only stand on one side of the bed, having the bed rails up on the opposite side provides an additional safety measure. Securing the client's arm and leg or lowering the head of the bed would not prevent the client from falling and may pose a risk of injury. Using a turn sheet correctly can be helpful, but ensuring the bed rails are up is a more direct safety measure in this situation.
4. In Primary Health care, the concept of accessibility requires that:
- A. Patients should be required to accept one service in order to gain access to another type of service.
- B. A referral network, including transportation, to higher-level facilities should be coupled to PHC services.
- C. Patients' access to services should be contingent on social or cultural backgrounds, age, and marital status.
- D. Patients' access to services should be based on one's educational status.
Correct answer: B
Rationale: In Primary Health care, accessibility entails having a referral network and transportation system in place to link patients to higher-level facilities when needed. Choice A is incorrect because patients should not be required to accept one service to access another. Choice C is incorrect as access to services should not be contingent on social or cultural backgrounds, age, or marital status. Choice D is also incorrect because educational status should not determine patients' access to healthcare services.
5. After checking the fingerstick glucose at 1630, what action should be implemented?
- A. Notify the healthcare provider.
- B. Administer 8 units of insulin aspart SubQ.
- C. Give an IV bolus of Dextrose 50% 50 ml.
- D. Perform quality control on the glucometer.
Correct answer: B
Rationale: Administering insulin aspart (rapid-acting insulin) is the appropriate action to manage the elevated glucose level of 1630. Choice A, notifying the healthcare provider, is not the immediate action needed for this glucose level. Choice C, giving an IV bolus of Dextrose 50%, would exacerbate hyperglycemia instead of treating it. Choice D, performing quality control on the glucometer, is not relevant to the management of the patient's glucose level at this time.