HESI Medical Surgical Specialty Exam

Questions 45

HESI RN

HESI RN Test Bank

HESI Medical Surgical Specialty Exam Questions

Question 1 of 5

A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the client's spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.)

Correct Answer: D

Rationale: In the oliguric phase of acute kidney injury (AKI), clients may require tube feedings with kidney-specific formulas. These formulations are lower in sodium and potassium, which are crucial considerations due to impaired kidney function. Higher phosphorus content is not a feature of kidney-specific formulations for AKI. Therefore, options A and B (lower sodium and lower potassium) should be discussed in the teaching plan. Option C, higher phosphorus, is incorrect as kidney-specific formulas are not intended to be higher in phosphorus content for AKI patients.

Question 2 of 5

A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurse's priority action?

Correct Answer: D

Rationale: The nurse should recognize that the client may be developing fluid overload and respiratory distress due to the rapid normal saline infusion. The priority action is to slow down the infusion to prevent worsening respiratory distress and potential fluid overload. While calculating the mean arterial pressure (MAP) is important to assess perfusion, addressing the immediate respiratory distress takes precedence. Inserting a pulmonary artery catheter would provide detailed hemodynamic information but is not the initial step in managing acute respiratory distress. Monitoring vital signs, including the client's pulse, is crucial after adjusting the intravenous infusion to ensure a safe response to the intervention.

Question 3 of 5

A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/hour. The nurse assuming care for the patient reviews the patient's serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?

Correct Answer: D

Rationale: The patient's potassium level is within normal limits, but the decreased urine output indicates the patient should not receive additional IV potassium. Increasing potassium chloride to 40 mEq/L is not needed as the level is normal. Stopping the IV fluids is appropriate due to the decreased urine output, which suggests potential fluid overload. The nurse should notify the provider of the assessment findings for further management. Increasing the rate of fluids to 200 mL/hour is not recommended without addressing the decreased urine output first.

Question 4 of 5

What action should the nurse take for a female patient experiencing vaginal itching and discharge while taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) for a urinary tract infection?

Correct Answer: C

Rationale: The correct action for the nurse to take in this situation is to report a possible superinfection to the healthcare provider. Vaginal itching and discharge can indicate a superinfection, which is a secondary infection that can occur while taking antibiotics. It is essential to notify the provider so that appropriate treatment can be initiated. Asking about pregnancy is not relevant in this context as vaginal itching and discharge are not typical signs of pregnancy. Simply reassuring the patient that these symptoms are normal side effects is inadequate as they may indicate a more serious issue like a superinfection. Suspecting a hematologic reaction is not warranted based on the symptoms described.

Question 5 of 5

Why is lactated Ringer's solution given to a patient experiencing vomiting and diarrhea?

Correct Answer: D

Rationale: Lactated Ringer's solution is an isotonic solution commonly used to replace water and electrolytes lost due to conditions like vomiting and diarrhea. It helps to restore fluid balance by replacing the lost volume and electrolytes. Option A is incorrect because hypotonic fluids, not lactated Ringer's solution, increase interstitial and intracellular hydration. Option B is incorrect as colloidal solutions, not lactated Ringer's solution, are used to maintain plasma volume over time. Option C is incorrect as hypertonic solutions, not lactated Ringer's solution, pull water from the interstitial space into the extracellular fluid.

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