HESI MS HESI Medical and Surgical Exam - Set 2 - Part 1

Correct Answer: Serum potassium of 6.8 mEq/L

During the oliguric phase of AKI, the kidneys cannot excrete potassium, causing hyperkalemia. A serum potassium of 6.8 mEq/L is a classic finding that places the client at serious risk for life-threatening cardiac dysrhythmias. Option b is incorrect because hypertension, not hypotension, is the expected cardiovascular finding during the oliguric phase. Fluid retention and sodium accumulation elevate blood pressure as the kidneys fail to excrete excess volume. Option c is incorrect because hypokalemia is a hallmark of the diuretic phase of AKI, not the oliguric phase. During oliguria, the kidneys retain rather than excrete potassium, driving the level upward. Option d is incorrect because a specific gravity of 1.001 indicates maximally dilute urine, which is associated with diabetes insipidus or the diuretic phase of AKI. In the oliguric phase, urine concentration varies and often reflects the underlying cause rather than dropping this low.

Correct Answer: Continue insulin as prescribed.

Illness and physiological stress increase counterregulatory hormones, which raise blood glucose even without food intake. Insulin must be continued as prescribed to prevent diabetic ketoacidosis, and the provider should be notified of persistent illness. Option a is incorrect because withholding insulin during illness is one of the most dangerous misconceptions a diabetic client can have. Without insulin, fat breakdown accelerates, producing ketones and precipitating DKA regardless of caloric intake. Option b is incorrect because arbitrarily halving the insulin dose without PHCP guidance is unsafe. Illness-related stress hormones can actually raise insulin requirements, and self-adjusting doses based on eating status alone increases the risk of DKA. Option d is incorrect because oral hypoglycemic agents are not indicated for type 1 diabetes mellitus at any time. Type 1 requires insulin because of absolute beta-cell destruction, and switching to oral agents would provide no coverage wha

Correct Answer: Hypocalcemia from parathyroid trauma

Parathyroid glands lie adjacent to the thyroid and can be inadvertently damaged or removed during thyroidectomy. The resulting drop in parathyroid hormone causes hypocalcemia, evidenced by perioral tingling, muscle cramping, and a positive Chvostek's sign. Option b is incorrect because laryngeal nerve damage produces voice changes such as hoarseness, high-pitched speech, or stridor from airway compromise. It does not cause the neuromuscular irritability pattern seen here. Option c is incorrect because wound hemorrhage after thyroidectomy presents with neck swelling, a sensation of pressure, and signs of hemodynamic instability. The tingling and carpopedal cramping this client reports point specifically to calcium depletion. Option d is incorrect because thyroid storm presents with fever, severe tachycardia, and agitation, not with perioral tingling or a positive Chvostek's sign. Thyroid storm reflects a massive release of thyroid hormone, not a calcium deficit.

Correct Answer: Peritonitis; obtain outflow culture.

Cloudy outflow is the earliest and most reliable sign of peritonitis in peritoneal dialysis. Abdominal pain accompanying cloudy effluent confirms the suspicion; a culture and sensitivity of the outflow should be obtained immediately to identify the causative organism. Option a is incorrect because normal dialysate outflow is clear. Any cloudiness or opacity is treated as peritonitis until proven otherwise, and telling the client this is normal would delay a potentially life-saving intervention. Option b is incorrect because brown outflow signals bowel perforation, not cloudy yellow effluent. Clamping without first identifying the complication correctly wastes critical time and does not address the infectious process most consistent with the described presentation. Option d is incorrect because urine-colored outflow indicates bladder perforation. While stopping dialysis may eventually be appropriate, the priority action with cloudy outflow and abdominal pain is obtaining a specimen for

Correct Answer: Addisonian crisis

Addisonian crisis is triggered by stress, surgery, or trauma in a client with adrenal insufficiency. The combination of hypoglycemia, hyponatremia, and hyperkalemia reflects the acute loss of both glucocorticoid and mineralocorticoid function and requires immediate IV glucocorticoid administration. Option a is incorrect because Cushing's syndrome features hyperglycemia, hypernatremia, and hypokalemia—essentially the mirror image of the values seen here. Exacerbation of Cushing's would not produce hypoglycemia or a sodium level below normal. Option b is incorrect because pheochromocytoma produces paroxysmal or sustained hypertension driven by catecholamine excess, along with palpitations, diaphoresis, and headache. The presenting glucose and electrolyte values are not characteristic of catecholamine excess. Option c is incorrect because hyperaldosteronism causes sodium retention, potassium excretion, and hypertension. The electrolyte pattern in hyperaldosteronism is hypokalemi

Correct Answer: Notify the PHCP immediately.

A previous contrast reaction with systemic symptoms such as throat tightness represents a significant allergy risk that must be communicated to the PHCP before any contrast is administered. The PHCP must determine whether premedication, an alternative imaging method, or contraindication is appropriate. Option b is incorrect because proceeding without notifying the PHCP when a client has experienced a prior anaphylactoid reaction to contrast is unsafe and violates the standard of informed care. Monitoring alone does not mitigate the risk of a more severe subsequent reaction. Option c is incorrect because administering diphenhydramine independently—before notifying the provider—is outside nursing scope and does not constitute proper allergy management. The PHCP must prescribe a premedication protocol after being informed of the history. Option d is incorrect because increasing IV fluids protects renal function from contrast nephrotoxicity in at-risk clients, but it does nothing to preven

Correct Answer: Fluid restriction and hypertonic saline

SIADH causes dilutional hyponatremia from excess ADH-driven water retention. When sodium drops below 125 mEq/L and neurological changes appear, fluid restriction combined with careful administration of hypertonic saline is indicated to correct the deficit and protect the brain from further cerebral edema. Option a is incorrect because hypotonic saline adds free water to an already overhydrated client, worsening the dilutional hyponatremia and increasing cerebral edema risk. Providing more hypotonic fluid to a client whose sodium is already critically low is directly harmful. Option b is incorrect because oral free water is also hypotonic and would further dilute the serum sodium in a client who already has fluid excess from ADH over-secretion. Oral fluids are contraindicated; fluid restriction is the cornerstone of SIADH management. Option d is incorrect because furosemide may be prescribed in SIADH only when sodium is at least 125 mEq/L. Using it without fluid restriction at this crit

Correct Answer: Notify the PHCP immediately.

Absence of a previously palpable thrill combined with coolness in the extremity strongly suggests fistula clotting, which requires immediate PHCP notification. Clotting threatens the access site and may require surgical or radiological intervention within a narrow time window. Option a is incorrect because a warm compress cannot restore blood flow through a clotted fistula. Applying heat wastes time and may give false reassurance, delaying notification of the PHCP who can prescribe declotting measures. Option b is incorrect because elevation addresses swelling from lymphedema or venous outflow obstruction but does not restore patency to a clotted vessel. The coolness and absent thrill point to arterial inflow compromise, which elevation cannot correct. Option c is incorrect because auscultating for a bruit alone does not constitute an intervention and merely confirms what palpation already suggests. The nurse must act on the finding by notifying the PHCP, not continue to assess without

Correct Answer: Tachycardia, chest pain, insomnia

Excessive levothyroxine mimics hyperthyroidism, producing tachycardia, chest pain, restlessness, nervousness, and insomnia. The client must report these symptoms promptly so the dose can be adjusted to avoid cardiovascular complications. Option b is incorrect because cold intolerance, lethargy, and dry skin are classic findings of underreplacement or untreated hypothyroidism. A client experiencing these symptoms needs a higher dose, not a dose reduction for overdose. Option c is incorrect because bradycardia, constipation, and weight gain are the manifestations of undertreated hypothyroidism, not overdose. These findings indicate the current dose is insufficient, the opposite situation from what the question asks about. Option d is incorrect because periorbital edema and deepening of the voice reflect the myxedematous state of chronic hypothyroidism, not thyroid hormone excess. These findings would prompt the nurse to assess for underreplacement rather than toxicity.

Correct Answer: Hold calcium carbonate; notify provider.

Calcium carbonate acts as a phosphate binder and is constipating, but a serum calcium of 10.9 mg/dL suggests hypercalcemia is developing. Holding the agent and notifying the PHCP prevents further calcium elevation while also stopping the source of the constipation, addressing both problems simultaneously. Option a is incorrect because giving a stool softener treats only the constipation symptom while doing nothing about the rising calcium level. Continuing calcium carbonate with a stool softener alone ignores the hypercalcemia risk, which can worsen cardiac irritability in a CKD client. Option b is incorrect because magnesium-containing products such as magnesium hydroxide laxatives are specifically avoided in CKD clients. Impaired renal excretion allows magnesium to accumulate, leading to hypermagnesemia, which can cause bradycardia, hypotension, and loss of deep tendon reflexes. Option d is incorrect because the serum calcium is already trending high; adding dietary calcium would exa

Correct Answer: Provide 15 g of fast-acting carbohydrate orally.

When a client is conscious and able to swallow, the first step of the 15/15 rule is to give 15 g of a fast-acting simple carbohydrate orally, such as half a cup of fruit juice or glucose tablets, then recheck the blood glucose in 15 minutes. Option a is incorrect because glucagon by injection is reserved for clients who are semiconscious, unconscious, or cannot swallow safely. Administering an injection when the client is awake and can take oral treatment bypasses the safer first-line intervention. Option b is incorrect because IV dextrose 50% is a hospital-based intervention used for severe hypoglycemia with altered consciousness. This client is awake and shaking but cognizant, making oral treatment the appropriate starting point. Option c is incorrect because withholding all food while the blood glucose reads 54 mg/dL allows the level to fall further, risking progression to severe hypoglycemia and loss of consciousness. Immediate treatment is the priority, followed by rechecking.

Correct Answer: Notify the PHCP of hemorrhage signs.

Tachycardia, hypotension, and gross hematuria with clots after renal biopsy indicate hemorrhage, the most serious postprocedure complication. The PHCP must be notified immediately so emergency interventions can be ordered before the client deteriorates further. Option b is incorrect because encouraging oral fluids does not address active bleeding. Fluid replacement in hemorrhage requires IV access and prescribed IV fluids or blood products, not oral hydration, which would be inadequate and inappropriately delayed. Option c is incorrect because pain management is not the priority when the client is hemodynamically unstable. Administering analgesics before addressing the underlying hemorrhage misses the urgency of the clinical picture and delays life-saving intervention. Option d is incorrect because the prone position is used during the renal biopsy procedure itself, not after. Positioning a client with signs of hemorrhage and hemodynamic instability prone would worsen cardiovascular co

Correct Answer: Add dextrose to IV fluids.

When blood glucose falls to 250 to 300 mg/dL during DKA management, dextrose is added to the IV solution to prevent hypoglycemia while the insulin drip continues until ketosis resolves. Continuing plain normal saline without dextrose at this point risks driving glucose dangerously low. Option a is incorrect because waiting another hour without addressing the approaching critical glucose threshold risks precipitating hypoglycemia. The 250 to 300 mg/dL range is the established point at which the care plan must change to include a dextrose-containing solution. Option b is incorrect because switching to hypotonic saline in DKA management carries a risk of cerebral edema, particularly if done too rapidly. Hypotonic solutions are not the standard intervention at this stage; dextrose addition to the existing IV is the appropriate step. Option d is incorrect because the insulin drip should not be stopped until the client transitions back to subcutaneous insulin and can tolerate oral intake, pr

Correct Answer: Uremic pericarditis

Uremic pericarditis occurs when nitrogenous waste accumulates in the pericardial space, irritating the pericardial lining. The classic triad of a friction rub, chest pain that worsens with inspiration, and low-grade fever is a well-recognized complication of advanced chronic kidney disease. Option a is incorrect because pulmonary edema presents with crackles on auscultation, severe dyspnea, and frothy sputum, not a friction rub. The auscultatory finding and pleuritic chest pain pattern specifically indicate pericardial rather than pulmonary pathology. Option b is incorrect because pleural effusion produces diminished breath sounds and dullness to percussion over the affected area. A friction rub is a pericardial sound heard over the precordium, not a finding associated with fluid accumulation in the pleural space. Option c is incorrect because myocardial infarction typically presents with pressure-like chest pain, diaphoresis, and ST-segment changes on ECG. The friction rub and pleurit

Correct Answer: Desmopressin acetate

Desmopressin acetate is a synthetic ADH analog used to treat central diabetes insipidus. It restores tubular water reabsorption, reducing massive urine output and correcting the hyperosmolality that drives the client's intense thirst. Option b is incorrect because furosemide is a loop diuretic that promotes water and electrolyte loss in the urine. Administering it to a client already excreting 1800 mL in two hours from a water-reabsorption deficit would accelerate dehydration and hasten vascular collapse. Option c is incorrect because spironolactone is a potassium-sparing aldosterone antagonist used for fluid overload and hyperaldosteronism, not for replacing missing ADH. It has no mechanism that corrects the tubular insensitivity to water reabsorption seen in diabetes insipidus. Option d is incorrect because thiazide diuretics are paradoxically used in nephrogenic DI, not central DI, and even then only in selected cases. This client's injury-related ADH deficit requires horm

Correct Answer: Damaged kidneys cannot adequately excrete both.

As functioning nephrons are destroyed in CKD, the kidney loses its ability to excrete potassium and phosphorus. Accumulation leads to hyperkalemia, which risks cardiac dysrhythmias, and hyperphosphatemia, which triggers bone demineralization through parathyroid hormone stimulation. Option a is incorrect because CKD causes retention, not excessive excretion, of these minerals. Impaired filtration and tubular secretion mean the kidneys hold onto potassium and phosphorus rather than eliminating them efficiently. Option c is incorrect because hypokalemia is a concern during dialysis sessions, not the reason for the chronic dietary restriction. The dietary limit on potassium is imposed because the diseased kidneys cannot clear it between sessions, not to protect against dialysis-induced losses. Option d is incorrect because while sodium restriction is central to blood pressure management in CKD, potassium and phosphorus restriction primarily addresses dysrhythmia risk and metabolic bone dis

Correct Answer: Somogyi; decrease insulin or add snack.

Night sweats and morning headache are clues to early morning hypoglycemia, which triggers counterregulatory hormone release and a rebound glucose spike by 7 a.m. — the Somogyi phenomenon. Treatment involves reducing the insulin dose or adding a bedtime snack to prevent the 2 to 3 a.m. nadir. Option a is incorrect because the dawn phenomenon involves early morning hyperglycemia from normal cortisol and growth hormone surges without preceding hypoglycemia. The client's night sweats and headache point instead to nocturnal hypoglycemia followed by rebound, which is the defining feature of the Somogyi response. Option b is incorrect because adding a daytime NPH dose addresses daytime insulin coverage, not the nighttime problem. Dawn phenomenon management typically involves adjusting or delaying the evening dose, but the symptoms here—night sweats, morning headache—indicate Somogyi, not dawn phenomenon. Option d is incorrect because increasing the morning dose worsens the underlying iss

Correct Answer: Draw blood from fistula between sessions.

Arteriovenous fistulas must be protected from venipuncture, blood draws, IV placement, and blood pressure measurement. Drawing blood from the fistula outside of dialysis compromises its integrity and increases clotting and infection risk; lab draws should use alternative sites. Option a is incorrect because this is a correct and essential practice. Blood pressure measurements in the fistula arm compress the access site, risk thrombosis, and can permanently damage the vessel. The student correctly understands to avoid it. Option b is incorrect because this is also correct nursing practice. Palpating for a thrill and auscultating for a bruit before each dialysis session confirms patency; absence of either finding must trigger immediate PHCP notification. Option c is incorrect because this reflects appropriate care as well. Pressure dressings are placed after dialysis to prevent post-needle bleeding, but tight dressings between sessions can compress and thrombose the fistula, so avoidance

Correct Answer: Obtain a urine culture and sensitivity specimen.

A urine culture and sensitivity must be obtained before the first dose of antibiotic is given. Starting an antibiotic without culturing the specimen can suppress bacterial growth, yielding false-negative results and preventing identification of the causative organism and optimal drug selection. Option b is incorrect because while encouraging fluids is an appropriate intervention for cystitis, it does not take precedence over obtaining a diagnostic specimen. Fluid intake addresses symptom management and helps prevent crystal formation with sulfonamides but does not guide antibiotic selection. Option c is incorrect because heat application for comfort is a supportive measure that can follow after the diagnostic specimen is secured. Applying heat before obtaining the culture wastes critical time when the antibiotic is waiting to be administered. Option d is incorrect because phenazopyridine is a urinary analgesic that treats the burning discomfort of cystitis but has no antibacterial effe

Correct Answer: Administer prescribed IV potassium replacement.

Hypokalemia at 2.9 mEq/L poses the most immediate physiological threat because low potassium causes serious cardiac dysrhythmias. While hyperglycemia and hypernatremia also require management, correcting the potassium deficit is the most urgent priority given the cardiovascular risk. Option a is incorrect because sodium restriction is appropriate long-term but is not the most urgent action when the client has life-threatening hypokalemia. Diet modification for sodium takes hours to take effect, whereas cardiac dysrhythmias from potassium depletion can occur at any moment. Option c is incorrect because insulin therapy for a glucose of 248 mg/dL is important but secondary to correcting the potassium level. Administering insulin without addressing hypokalemia first can shift potassium further into cells, driving the level even lower and increasing arrhythmia risk. Option d is incorrect because dietary protein for wound healing is a preoperative education and nutritional concern, not an em