the nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure when performing a health history on this patien
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HESI RN

HESI RN Medical Surgical Practice Exam

1. When performing a health history on a patient who is to begin receiving a thiazide diuretic to treat heart failure, the nurse will be concerned about a history of which condition?

Correct answer: C

Rationale: Thiazide diuretics block uric acid secretion, leading to elevated levels that can contribute to gout. Therefore, patients with a history of gout should take thiazide diuretics with caution. Asthma (Choice A), Glaucoma (Choice B), and Hypertension (Choice D) are not directly contraindicated with thiazide diuretics, making choices A, B, and D incorrect.

2. A serum phenytoin determination is prescribed for a client with a seizure disorder who is taking phenytoin (Dilantin). Which result indicates that the prescribed dose of phenytoin is therapeutic?

Correct answer: C

Rationale: The correct answer is 16 mcg/mL (Choice C). The therapeutic serum phenytoin range is typically 10 to 20 mcg/mL. A level below this range may lead to continued seizure activity, indicating subtherapeutic levels. Choices A, B, and D are below the therapeutic range and would not be considered therapeutic for a client with a seizure disorder on phenytoin therapy.

3. A client tells the clinic nurse about experiencing burning on urination, and assessment reveals that the client had sexual intercourse four days ago with a person who was casually met. Which action should the nurse implement?

Correct answer: B

Rationale: Obtaining a urethral drainage specimen for culture is crucial in diagnosing a potential sexually transmitted infection (STI) in this client. While assessing for perineal symptoms like itching, erythema, and excoriation (Choice C) may provide additional information, obtaining a culture is more definitive. Observing for a chancroid-like lesion (Choice A) is not as pertinent as obtaining a culture for a broader diagnostic approach. Identifying all sexual partners in the last four days (Choice D) is important for contact tracing but obtaining a specimen for culture takes priority in this scenario.

4. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?

Correct answer: B

Rationale: The correct answer is B because dialysis works by the movement of solutes from an area of higher concentration to an area of lower concentration, which is known as diffusion. The other statements are accurate: A correctly describes the movement of sodium during hemodialysis, C explains the removal of excess fluid by osmosis, and D highlights the purpose of the dialysate in removing toxins from the blood.

5. The healthcare provider is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information?

Correct answer: A

Rationale: The Cochrane Library provides systematic reviews of primary research in healthcare, making it a reliable resource for evidence-based practice. Choice B, a literature search in a database like CINAHL, may also be useful but does not guarantee the same level of systematic review and reliability as the Cochrane Library. Choice C, an online nursing textbook, may offer information but might not provide the most current or evidence-based practices. Choice D, the policy and procedure manual at the healthcare agency, is unlikely to offer the comprehensive evidence-based information needed for developing standards of care.

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