HESI RN
HESI Medical Surgical Specialty Exam
1. The nurse is preparing to administer clarithromycin to a patient. When performing a medication history, the nurse learns that the patient takes warfarin to treat atrial fibrillation. The nurse will perform which action?
- A. Ask the provider if azithromycin may be used instead of clarithromycin.
- B. Obtain an order for continuous cardiovascular monitoring.
- C. Request an order for periodic serum warfarin levels.
- D. Withhold the clarithromycin and notify the provider.
Correct answer: C
Rationale: When a patient taking warfarin also needs to receive clarithromycin, it is essential to monitor periodic serum warfarin levels. Macrolides, including clarithromycin, can increase serum levels of drugs like warfarin. Monitoring serum drug levels helps ensure that the patient's warfarin dose can be adjusted, if necessary, to maintain therapeutic levels. Asking about using azithromycin instead is not the most appropriate action in this situation, as all macrolides can interact with warfarin. Continuous cardiovascular monitoring is not indicated solely based on the use of clarithromycin. Withholding the clarithromycin without proper assessment could delay necessary treatment and is not the best initial action.
2. A nurse is providing instructions to an adolescent who has a history of seizures and is taking an anticonvulsant medication. Which of the following statements indicates that the client understands the instructions?
- A. I will never be able to drive a car.
- B. My anticonvulsant medication will clear up my skin.
- C. I can't drink alcohol while I am taking my medication.
- D. If I forget my morning medication, I can take two pills at bedtime.
Correct answer: C
Rationale: The correct answer is C: 'I can't drink alcohol while I am taking my medication.' Alcohol can lower the seizure threshold and should be avoided by individuals taking anticonvulsants. Choice A is incorrect because it is an extreme statement and not necessary for someone taking anticonvulsants. Choice B is incorrect as anticonvulsant medications are not used to clear skin conditions. Choice D is incorrect because doubling up medication doses can be harmful and should not be done without healthcare provider approval.
3. The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid retraction, and a staring expression. These findings are consistent with which disorder?
- A. Graves' disease.
- B. Cushing's syndrome.
- C. Addison's disease.
- D. Hypothyroidism.
Correct answer: A
Rationale: The correct answer is A, Graves' disease. The symptoms described in the client are classic manifestations of hyperthyroidism, which is commonly caused by Graves' disease, an autoimmune condition affecting the thyroid. Weight loss, racing heart rate, difficulty sleeping, moist skin with fine hair, prominent eyes, lid retraction, and a staring expression are all indicative of hyperthyroidism. Choice B, Cushing's syndrome, is characterized by weight gain, hypertension, and a rounded face due to excess cortisol. Choice C, Addison's disease, presents with symptoms such as weight loss, fatigue, and hyperpigmentation due to adrenal insufficiency. Choice D, hypothyroidism, typically features symptoms opposite to those described in the client, such as weight gain, bradycardia, and dry skin.
4. What action should the nurse take after applying gloves to irrigate a client's indwelling urinary catheter using an open technique?
- A. Empty the client's urinary drainage bag.
- B. Draw up the irrigating solution into the syringe.
- C. Secure the client's catheter to the drainage tubing.
- D. Use aseptic technique to instill the irrigating solution.
Correct answer: B
Rationale: After applying gloves to irrigate an indwelling urinary catheter using an open technique, the next step for the nurse is to draw up the irrigating solution into the syringe. This step is crucial as it ensures that the solution is ready to be instilled through the catheter to maintain its patency and prevent blockages. Option A is incorrect as emptying the client's urinary drainage bag is not the immediate next step in the irrigation process. Option C is incorrect as securing the client's catheter to the drainage tubing is not necessary at this stage. Option D is incorrect as the question pertains to the action immediately after applying gloves and does not involve instilling the irrigating solution yet.
5. The public health nurse is creating a plan to increase state funding for a local health clinic. Which strategy is likely to be most effective in obtaining funding for the clinic?
- A. Run the health clinic economically and promote the services the clinic provides.
- B. Organize concerned citizens to write letters and call state representatives.
- C. Highlight to the media the valuable services offered by the community clinic.
- D. Hire a professional lobbyist to convince Congress of the local clinic's value.
Correct answer: B
Rationale: Organizing concerned citizens to contact state representatives is likely the most effective strategy to secure state funding for the local health clinic. By mobilizing a group of citizens who are directly impacted by the clinic's services, the public health nurse can create a strong advocacy group that can influence decision-makers. Option A, running the health clinic economically and promoting its services, may be necessary but does not directly address the funding aspect. Option C, highlighting services to the media, may raise awareness but does not guarantee funding. Option D, hiring a professional lobbyist, may be costly and may not have the same grassroots impact as organizing citizens.