HESI RN
Leadership and Management HESI
1. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamines, Nurse April is most likely to detect:
- A. A blood pressure of 130/70 mm Hg
- B. A blood glucose level of 130 mg/dl
- C. Bradycardia
- D. A blood pressure of 176/88 mm Hg
Correct answer: D
Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamines, leading to symptoms such as hypertension. The normal blood pressure range is around 120/80 mm Hg, so a blood pressure reading of 176/88 mm Hg is most likely to be detected in a client with pheochromocytoma. Choices A, B, and C are incorrect because pheochromocytoma typically presents with hypertension, not a normal or low blood pressure (choice A), not related to blood glucose levels (choice B), and not bradycardia (choice C).
2. The community health nurse is planning a series of educational courses about the healthcare system and meeting healthcare needs for the community center. Which adjunct issue should the nurse address for a group of older adults?
- A. peer concerns
- B. adult daycare
- C. retirement issues
- D. vocational concerns
Correct answer: C
Rationale: Retirement often brings specific healthcare needs and concerns that are crucial to address for older adults. While peer concerns and adult daycare could be important aspects to consider, retirement issues are more directly related to the unique healthcare needs and challenges faced by older adults. Vocational concerns are typically more relevant to individuals who are still actively engaged in the workforce, rather than retired older adults.
3. Which symptoms should the nurse expect a client to exhibit who is diagnosed with a pheochromocytoma?
- A. Numbness, tingling, and cramps in the extremities.
- B. Headache, diaphoresis, and palpitations.
- C. Cyanosis, fever, and classic signs of shock.
- D. Nausea, vomiting, and muscular weakness.
Correct answer: B
Rationale: Correct. Pheochromocytoma is a catecholamine-secreting non-cancerous tumor of the adrenal medulla. The classic triad of symptoms includes headache, diaphoresis (excessive sweating), and palpitations, which result from the overproduction of catecholamines like epinephrine and norepinephrine. Numbness, tingling, and cramps in the extremities (Option A) are not characteristic of pheochromocytoma. Cyanosis, fever, and classic signs of shock (Option C) are not typical symptoms of this condition. Nausea, vomiting, and muscular weakness (Option D) are not commonly associated with pheochromocytoma.
4. A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best?
- A. Check the client’s digoxin (Lanoxin) level.
- B. Administer an anti-nausea medication.
- C. Ask if the client can eat crackers.
- D. Refer the client to a gastrointestinal specialist.
Correct answer: A
Rationale: In a client with chronic kidney disease experiencing symptoms like nausea, vomiting, visual changes, and anorexia, it is crucial for the nurse to suspect digoxin (Lanoxin) toxicity. These symptoms are indicative of digoxin toxicity. Therefore, the best action for the nurse to take is to check the client's digoxin level. Administering anti-nausea medication, asking about eating crackers, and referring to a gastrointestinal specialist may help with symptom management but do not address the underlying cause of the symptoms, which is digoxin toxicity in this case.
5. A client is receiving 30 mg of enoxaparin subcutaneously twice a day. In assessing adverse effects of the medication, which serum laboratory value is most important for the nurse to monitor?
- A. Hemoglobin level
- B. Platelet count
- C. Activated partial thromboplastin time (aPTT)
- D. Prothrombin time (PT)
Correct answer: B
Rationale: The correct answer is B: Platelet count. Enoxaparin can cause heparin-induced thrombocytopenia (HIT), making it crucial to monitor the platelet count for signs of thrombocytopenia. Monitoring the platelet count helps in early detection of this serious adverse effect. Choices A, C, and D are less relevant in this context. Hemoglobin level checks are more indicative of bleeding issues rather than thrombocytopenia caused by enoxaparin. Activated partial thromboplastin time (aPTT) and prothrombin time (PT) are less impacted by enoxaparin and are not typically used to monitor for HIT.