HESI Medical Surgical Specialty Exam

Questions 45

HESI RN

HESI RN Test Bank

HESI Medical Surgical Specialty Exam Questions

Question 1 of 5

The patient is being educated on taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching?

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.

Question 2 of 5

A client has just returned to the nursing unit after bronchoscopy. To which intervention should the nurse give priority?

Correct Answer: A

Rationale: After bronchoscopy, the priority intervention for the nurse is to assess the client for the return of the gag reflex. This assessment is crucial to ensure the client's safety and prevent aspiration. Keeping the client on nothing-by-mouth status until the gag reflex returns is essential. Administering pain medication, encouraging fluid intake, and ambulating the client are important interventions but assessing the gag reflex takes precedence due to the risk of aspiration post-bronchoscopy.

Question 3 of 5

A nursing assistant is measuring the blood pressure (BP) of a hypertensive client while a nurse observes. Which action on the part of the assistant would interfere with accurate measurement and prompt the nurse to intervene? Select all that apply.

Correct Answer: C

Rationale: To ensure accurate blood pressure (BP) measurement, the cuff used should have a rubber bladder that encircles at least 80% of the limb being measured. This ensures proper compression and accurate readings. Choices A and B are correct practices as it is recommended to measure BP after the client has sat quietly for 5 minutes and to have the client sit with the arm bared and supported at heart level. Choice D is also a correct reason for intervention as the client should not have consumed caffeine or smoked tobacco within 30 minutes before BP measurement, as it can affect the accuracy of the reading.

Question 4 of 5

A client is brought to the emergency department by a neighbor. The client is lethargic and has a fruity odor on the breath. The client's arterial blood gas (ABG) results are pH 7.25, PCO2 34 mm Hg, PO2 86 mm Hg, HCO3 14 mEq/L. Which of the following acid-base disturbances does the nurse recognize in these results?

Correct Answer: A

Rationale: The correct answer is 'Metabolic acidosis.' Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (HCO3 <22 mEq/L). In this case, the client's ABG results show a pH of 7.25 and an HCO3 level of 14 mEq/L, indicating metabolic acidosis. The PCO2 of 34 mm Hg is normal, ruling out respiratory acidosis or alkalosis. The PO2 of 86 mm Hg is also within the normal range and is not indicative of a respiratory problem. Therefore, the client is experiencing metabolic acidosis based on the ABG results provided.

Question 5 of 5

A client was admitted for a myocardial infarction and cardiogenic shock 2 days ago. Which laboratory test result should a nurse expect to find?

Correct Answer: A

Rationale: In cardiogenic shock, decreased renal perfusion leads to an elevated BUN. Choice A is correct. Creatinine remains normal in cardiogenic shock as it signifies kidney damage, which has not occurred in this case. A low BUN indicates overhydration, malnutrition, or liver damage, which are not typically seen in cardiogenic shock. A low BUN/creatinine ratio is associated with fluid volume excess or acute renal tubular acidosis, not specifically indicative of cardiogenic shock.

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