HESI RN
HESI Medical Surgical Specialty Exam
1. The patient is being educated on taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?
- A. I may need additional sodium and calcium while taking this medication.
- B. I should consume plenty of fruits and vegetables while taking this drug.
- C. I should be cautious when getting up from a bed or chair while on this medication.
- D. I will take the medication in the morning to reduce certain side effects.
Correct answer: A
Rationale: The correct answer is A because patients do not require extra sodium or calcium while taking hydrochlorothiazide, a thiazide diuretic. This medication actually promotes the excretion of sodium and water. Choices B, C, and D are correct statements regarding the use of hydrochlorothiazide. Patients are encouraged to have a diet rich in fruits and vegetables, be careful with position changes due to potential orthostatic hypotension, and take the medication in the morning to reduce the need for frequent urination during nighttime.
2. In a patient with asthma, which of the following is the most important indicator of respiratory function?
- A. Oxygen saturation.
- B. Respiratory rate.
- C. Arterial blood gases.
- D. Peak expiratory flow rate.
Correct answer: D
Rationale: The peak expiratory flow rate is the most important indicator of respiratory function in asthma because it measures how quickly air can be exhaled, reflecting the severity of airflow limitation. Oxygen saturation (Choice A) is important in assessing oxygenation, but it does not directly reflect respiratory function. Respiratory rate (Choice B) can provide information on breathing patterns but does not quantify airflow limitation. Arterial blood gases (Choice C) give information about gas exchange but are not as specific for assessing asthma control and severity as peak expiratory flow rate.
3. After three days of persistent epigastric pain, a female client presents to the clinic. She has been taking oral antacids without relief. Her vital signs are heart rate 122 beats/minute, respirations 16 breaths/minute, oxygen saturation 96%, and blood pressure 116/70. The nurse obtains a 12-lead electrocardiogram (ECG). Which assessment finding is most critical?
- A. Irregular pulse rhythm
- B. Bile-colored emesis
- C. ST elevation in three leads
- D. Complaint of radiating jaw pain
Correct answer: C
Rationale: ST elevation in three leads is a critical finding that suggests myocardial infarction, requiring immediate attention. This finding indicates ischemia or injury to the heart muscle. Choices A, B, and D are not as critical in this scenario. Irregular pulse rhythm may be concerning but does not indicate an immediate life-threatening condition like myocardial infarction. Bile-colored emesis and complaint of radiating jaw pain are relevant but not as indicative of a myocardial infarction as ST elevation in three leads.
4. A client with chronic kidney disease starts on hemodialysis. During the first dialysis treatment, the client's blood pressure drops from 150/90 to 80/30. Which action should the nurse take first?
- A. Stop the dialysis treatment
- B. Administer 5% albumin IV
- C. Monitor blood pressure every 45 minutes
- D. Lower the head of the chair and elevate feet
Correct answer: D
Rationale: The initial action the nurse should take when a client's blood pressure drops significantly during hemodialysis is to lower the head of the chair and elevate the feet. This position adjustment helps improve blood flow to the brain and vital organs, assisting in stabilizing blood pressure. Stopping the dialysis treatment immediately may not be necessary if the blood pressure can be managed effectively by position changes. Administering 5% albumin IV is not the first-line intervention for hypotension during dialysis. Monitoring blood pressure every 45 minutes is important but not the immediate action needed to address the significant drop in blood pressure observed during the dialysis session.
5. After a lumbar puncture, into which position does the nurse assist the client?
- A. Flat
- B. Semi-Fowler
- C. Side-lying with the head of the bed elevated
- D. Sitting up in a recliner with the feet elevated
Correct answer: A
Rationale: After a lumbar puncture, the client should be positioned flat. This position helps prevent post-procedure spinal headaches and cerebrospinal fluid leakage. Keeping the client flat for up to 12 hours is crucial in minimizing these risks. Choices B, C, and D are incorrect because elevating the head of the bed or sitting up can increase the risk of complications by altering the pressure in the spinal canal, potentially leading to headaches and fluid leakage.
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