HESI RN
Leadership HESI
1. The nurse is caring for a client with hyperaldosteronism. Which of the following laboratory results would the nurse expect?
- A. Hypokalemia
- B. Hypernatremia
- C. Hyperkalemia
- D. Hypocalcemia
Correct answer: A
Rationale: In hyperaldosteronism, there is an excess of aldosterone production, leading to increased sodium retention and potassium excretion by the kidneys. This results in hypokalemia (low potassium levels). Therefore, the correct answer is hypokalemia (Choice A). Hypernatremia (Choice B) is an incorrect choice as hyperaldosteronism primarily affects potassium and not sodium levels. Hyperkalemia (Choice C) is also incorrect because hyperaldosteronism causes potassium excretion, leading to low levels. Hypocalcemia (Choice D) is not typically associated with hyperaldosteronism; instead, it is more related to conditions affecting calcium regulation.
2. A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent claudication. The nurse determines this medication is effective when the client reports which of the following?
- A. I am having fewer aches and pains.
- B. I do not have headaches anymore.
- C. I am able to walk further without leg pain.
- D. My toes are turning grayish black in color.
Correct answer: C
Rationale: The correct answer is C. Cilostazol improves blood flow to the muscles, which helps alleviate symptoms of intermittent claudication. An improvement in walking distance without leg pain indicates the effectiveness of the medication. Choices A and B are not directly related to the expected outcome of Cilostazol therapy for intermittent claudication. Choice D is concerning for a potential adverse effect and should be reported to the healthcare provider immediately.
3. Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication?
- A. Tinnitus
- B. Diarrhea
- C. Constipation
- D. Decreased respirations
Correct answer: A
Rationale: The correct answer is A: Tinnitus. Salicylic acid can lead to systemic toxicity, known as salicylism, which may manifest with symptoms like tinnitus, dizziness, hyperventilation, and mental disturbances. Tinnitus is a common early sign of salicylism and should be monitored closely by the nurse to prevent further complications.
4. After observing a mother giving her 11-month-old ferrous sulfate followed by two ounces of orange juice, what should the nurse do next?
- A. Suggest placing the iron drops in the orange juice and feed the infant.
- B. Advise the mother to follow the iron drops with formula instead of orange juice.
- C. Instruct the mother to feed the infant nothing in the next 30 minutes after the iron.
- D. Give positive feedback about the way she administered the sulfate.
Correct answer: D
Rationale: Providing positive feedback is essential in reinforcing correct behaviors. By praising the mother for properly administering the ferrous sulfate to her 11-month-old, the nurse can encourage her to continue following the correct procedure. This positive reinforcement can boost the mother's confidence and adherence to the recommended administration method, ultimately benefiting the infant's health.
5. At what age are women likely to enter menopause?
- A. 35 - 40 years
- B. 40 - 45 years
- C. 45 - 50 years
- D. 25 - 30 years
Correct answer: C
Rationale: Women generally enter menopause between the ages of 45 - 50 years. During this stage, women experience a decline in estrogen production, leading to the cessation of menstrual cycles. Choices A, B, and D are incorrect as they do not fall within the typical age range for menopause onset. Menopause typically occurs later in life, around the age of 45 to 50 years, although individual variations exist.