HESI RN
Leadership HESI
1. Which of the following laboratory values should the nurse monitor in a client with Cushing's syndrome?
- A. Blood glucose levels
- B. Serum calcium levels
- C. Serum potassium levels
- D. Serum sodium levels
Correct answer: A
Rationale: The correct answer is A: Blood glucose levels. In Cushing's syndrome, there is excess cortisol in the body which leads to increased blood glucose levels due to its effect on glucose metabolism. Elevated blood glucose levels are a common finding in individuals with Cushing's syndrome. Monitoring blood glucose levels is crucial as it helps in assessing and managing hyperglycemia in these patients. Choice B, serum calcium levels, is not typically a priority in monitoring for Cushing's syndrome. While abnormalities in calcium levels can occur in some endocrine disorders, hypercalcemia is not a hallmark of Cushing's syndrome. Choice C, serum potassium levels, and Choice D, serum sodium levels, are not directly associated with Cushing's syndrome. While electrolyte imbalances can occur in various conditions, they are not specifically linked to Cushing's syndrome as blood glucose levels are.
2. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which clinical finding requires immediate intervention?
- A. Serum glucose of 300 mg/dL
- B. Serum potassium of 5.5 mEq/L
- C. Serum bicarbonate of 18 mEq/L
- D. Positive urine ketones
Correct answer: C
Rationale: A serum bicarbonate level of 18 mEq/L indicates metabolic acidosis in a client with DKA, requiring immediate intervention. In DKA, the body produces excess ketones, leading to metabolic acidosis, which is reflected by a low serum bicarbonate level. Correcting the low serum bicarbonate is crucial to normalize the metabolic acidosis and improve the client's condition. While elevated serum glucose (choice A) and urine ketones (choice D) are characteristic of DKA, addressing the metabolic acidosis takes precedence. Serum potassium (choice B) levels may also need monitoring and management, but correcting the acidosis is the priority to prevent complications like cardiovascular collapse.
3. A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which clinical finding is most concerning?
- A. Serum glucose of 500 mg/dL
- B. Serum glucose of 600 mg/dL
- C. Serum potassium of 5.5 mEq/L
- D. Serum bicarbonate of 18 mEq/L
Correct answer: D
Rationale: A serum bicarbonate level of 18 mEq/L is most concerning in a client with DKA as it indicates metabolic acidosis, requiring immediate intervention. In DKA, the body produces excess ketones, leading to metabolic acidosis. A low serum bicarbonate level is a key indicator of this acid-base imbalance. Elevated serum glucose levels are expected in DKA but are managed through insulin therapy. Serum potassium levels can fluctuate in DKA due to insulin deficiency, but a value of 5.5 mEq/L is not as immediately concerning as metabolic acidosis. Therefore, the most critical finding in this scenario is the low serum bicarbonate level.
4. A client with adrenal crisis has a temperature of 102°F, heart rate of 138 bpm, and blood pressure of 80/60 mmHg. Which action should the nurse implement first?
- A. Obtain an analgesic prescription.
- B. Infuse intravenous fluid bolus.
- C. Administer PRN oral antipyretic.
- D. Cover the client with a cooling blanket.
Correct answer: B
Rationale: In a client with adrenal crisis presenting with a high temperature, tachycardia, and hypotension, the priority action for the nurse to implement first is to infuse an intravenous fluid bolus. This intervention aims to address the hypotension by increasing the circulating volume and improving perfusion. Obtaining an analgesic prescription (Choice A) is not the priority in this situation. Administering an oral antipyretic (Choice C) may help reduce the fever but does not address the primary issue of hypotension. Covering the client with a cooling blanket (Choice D) may help with temperature control but does not address the hemodynamic instability caused by the adrenal crisis.
5. During a follow-up visit, a client with diabetes reports difficulty maintaining a healthy diet. What should the nurse do first?
- A. Provide the client with meal planning resources
- B. Explore the client's dietary habits and challenges
- C. Refer the client to a nutritionist
- D. Educate the client on the importance of a healthy diet
Correct answer: B
Rationale: When a client with diabetes reports difficulty in maintaining a healthy diet, the initial action should be to explore the client's dietary habits and challenges. By doing so, the nurse can identify specific issues and barriers the client faces, which is crucial in developing a personalized and effective intervention plan. Providing meal planning resources (Choice A) can be beneficial later but should come after understanding the client's unique situation. Referring the client to a nutritionist (Choice C) may be necessary in some cases but should follow an assessment of the client's current challenges. Simply educating the client on the importance of a healthy diet (Choice D) does not address the specific difficulties the client is facing and may not lead to sustainable behavior change.