HESI RN
HESI Medical Surgical Test Bank
1. Which client is at greatest risk for coronary artery disease?
- A. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
- B. A 43-year-old male with a family history of CAD and a cholesterol level of 158 (8.8 mmol/L).
- C. A 56-year-old male with an HDL of 60 (3.3 mmol/L) who takes atorvastatin.
- D. A 65-year-old female who is obese with an LDL of 188 (10.4 mmol/L).
Correct answer: D
Rationale: The 65-year-old female who is obese with a high LDL level of 188 (10.4 mmol/L) is at the greatest risk for coronary artery disease. Obesity and high LDL cholesterol levels are significant risk factors for developing coronary artery disease. While factors like mitral valve prolapse (choice A) and a family history of CAD (choice B) can contribute to the risk, they are not as significant as obesity and high LDL levels. Choice C, a 56-year-old male with high HDL and taking atorvastatin, is actually at lower risk due to the high HDL levels and being on statin therapy, which helps reduce cholesterol levels and lower the risk of coronary artery disease.
2. What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?
- A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
- B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
- C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
- D. It regulates the threshold for water reabsorption in the kidneys.
Correct answer: C
Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.
3. The nurse has completed the diet teaching of a client who is being discharged following treatment of a leg wound. A high-protein diet is encouraged to promote wound healing. Which lunch choice by the client indicates that the teaching was effective?
- A. A tuna fish sandwich with chips and ice cream
- B. A vegetable salad with croutons and ranch dressing
- C. A grilled chicken breast with steamed vegetables
- D. A peanut butter and jelly sandwich with soda
Correct answer: C
Rationale: The correct answer is C. Grilled chicken is an excellent source of protein, which is important for wound healing. Choices A, B, and D are less ideal for wound healing. Choice A contains high-fat and high-sugar components like chips and ice cream, which may not support wound healing effectively. Choice B includes croutons and ranch dressing, which may not provide as much protein as needed for wound healing. Choice D with a peanut butter and jelly sandwich and soda lacks a balanced meal with adequate protein to promote wound healing.
4. What is the smallest and most basic unit of matter?
- A. Micromolecule
- B. Atom
- C. Organelle
- D. Molecule
Correct answer: B
Rationale: The correct answer is B, Atom. An atom is the smallest unit of matter that retains the properties of an element. Choice A, Micromolecule, is incorrect because molecules are composed of atoms bonded together, making them larger than individual atoms. Choice C, Organelle, is incorrect as organelles are structures within cells, not the basic unit of matter. Choice D, Molecule, is incorrect as molecules are made up of atoms bonded together, so they are not the smallest unit of matter.
5. The nurse is providing care for a client receiving total parenteral nutrition (TPN). Which action should the nurse include in the client's plan of care?
- A. Increase the TPN infusion rate if the client is hungry
- B. Administer TPN via a peripheral IV line
- C. Monitor blood glucose levels regularly
- D. Ensure the TPN solution is refrigerated at all times
Correct answer: C
Rationale: The correct action the nurse should include in the client's plan of care is to monitor blood glucose levels regularly. Clients receiving TPN are at risk for hyperglycemia due to the high glucose content of the solution. Regular monitoring of blood glucose levels is essential to ensure appropriate management of blood sugar. Choice A is incorrect because increasing the TPN infusion rate based on hunger is not a valid parameter for adjusting TPN. Choice B is incorrect because TPN should be administered through a central line, not a peripheral IV line, to prevent complications. Choice D is incorrect because TPN solutions should be stored at room temperature, not refrigerated.