HESI MS HESI Medical and Surgical Exam - Set 2 - Part 3

Correct Answer: IV calcium gluconate

IV calcium gluconate acts within minutes to stabilize the myocardial cell membrane against hyperkalemia-induced irritability. It does not lower the serum potassium level but provides immediate cardiac protection while other measures are prepared to actually remove potassium from the body. Option a is incorrect because sodium bicarbonate can shift potassium into cells by correcting acidosis, but it takes longer to act than calcium gluconate and does not directly stabilize the cardiac membrane. It is a secondary measure, not the fastest protection against dysrhythmias. Option b is incorrect because sodium polystyrene sulfonate is an exchange resin that binds potassium in the gut and excretes it, which takes hours. It will lower the total body potassium but cannot protect the heart from immediate dysrhythmia risk during that waiting period. Option d is incorrect because furosemide promotes renal potassium excretion over hours in a client with sufficient renal function, but in advanced CKD

Correct Answer: Moon face, truncal obesity, purple striae, hypertension

Cushing's syndrome results from chronic cortisol excess, which causes moon face, buffalo hump, truncal obesity with thin extremities, purple abdominal striae from skin fragility, hypertension, hyperglycemia, and hypokalemia. These findings distinguish it from hypocortisolism and other endocrine disorders. Option a is incorrect because weight loss, bronze hyperpigmentation, and hypotension are characteristic findings of Addison's disease, which involves cortisol deficiency — the polar opposite of the cortisol excess seen in Cushing's syndrome. Option b is incorrect because exophthalmos, goiter, and tachycardia are associated with hyperthyroidism and Graves' disease, not with cortisol excess. These findings reflect elevated thyroid hormone activity on the eyes, gland, and cardiovascular system — an entirely separate endocrine disorder. Option c is incorrect because while weight gain is present in Cushing's, hyponatremia and hyperkalemia are actually features of A

Correct Answer: Avoid contact with anyone who is infected.

Lifelong immunosuppression leaves kidney transplant recipients with significantly blunted immune defenses. Avoiding contact with infected individuals is essential because infections that healthy immune systems control easily can become life-threatening in an immunosuppressed client and may also trigger graft rejection. Option b is incorrect because while adequate protein supports healing, indiscriminate high-protein intake stresses the transplanted kidney and may accelerate nephron damage. Post-transplant dietary guidance should come from a renal dietitian, not a blanket instruction to increase protein. Option c is incorrect because contact sports are specifically contraindicated for kidney transplant recipients indefinitely, not merely for six weeks. The transplanted kidney is placed in the iliac fossa without bony protection, making it vulnerable to trauma from any direct blow or fall during contact activities. Option d is incorrect because stopping prednisone independently is extrem

Correct Answer: Enlarged hands, feet, and jaw; thickened skin

Acromegaly results from GH hypersecretion by a pituitary adenoma in an adult, causing bony overgrowth that enlarges the hands and feet, protrudes the jaw, thickens the tongue and skin, deepens the voice, and may cause arthritis, hypertension, and sleep apnea over time. Option a is incorrect because acromegaly enlarges rather than decreases hand size and causes voice deepening, not softening. Decreased hand size and voice softening would not result from growth hormone excess, and weight loss is uncommon in this condition. Option c is incorrect because fine tremors, heat intolerance, and exophthalmos are signs of hyperthyroidism and Graves' disease. These reflect thyroid hormone excess acting on the nervous system and orbital tissues, not the skeletal overgrowth pattern of growth hormone excess. Option d is incorrect because central adiposity with moon face and easy bruising are features of Cushing's syndrome from cortisol excess. Acromegaly involves GH excess acting on bone an

Correct Answer: Notify PHCP of elevated creatinine before contrast.

Contrast dye is potentially nephrotoxic, and the risk is significantly higher in clients with existing renal impairment. A creatinine of 3.2 mg/dL represents substantial renal dysfunction. The nurse must notify the PHCP so the risks can be weighed and protective measures — such as hydration protocols or alternative imaging — can be considered before contrast is administered. Option a is incorrect because administering contrast without flagging the existing renal impairment is a patient safety failure. Monitoring urine output after the fact is reactive rather than preventive and does nothing to mitigate the nephrotoxicity that could cause irreversible harm or push the client toward dialysis. Option b is incorrect because the nurse has an independent professional obligation to identify and communicate safety risks regardless of which service ordered the test. Deferring to radiology without communicating the creatinine result abdicates the nursing advocacy role and violates patient safety

Correct Answer: Increase dialysis rate to clear the air.

The priority nursing actions for air embolism during hemodialysis in order are: stop the dialysis immediately, turn the client to the left lateral decubitus position with the head lower than the feet, and then administer oxygen. This position traps air in the right atrium and prevents it from entering the pulmonary circulation. Option a is incorrect because Option a is incorrect in sequencing because stopping the dialysis must be the first action, before positioning or oxygen administration. Continuing to run the machine while repositioning and giving oxygen allows more air to enter the bloodstream, worsening the embolism. Option b is incorrect because increasing the dialysis rate would drive more air into the client's bloodstream, turning a small embolism into a fatal one. Air must never be intentionally advanced through the circulation; it must be trapped and prevented from reaching the pulmonary vasculature. Option c is incorrect because clamping the tubing alone without stoppi

Correct Answer: Exercise after glucose from meal peaks.

Timing exercise when meal-derived glucose is peaking matches increased glucose utilization during physical activity with increased glucose availability, minimizing hypoglycemia risk. Exercising during peak medication action amplifies the glucose-lowering effect and dramatically increases the likelihood of a hypoglycemic episode. Option b is incorrect because exercising while insulin or oral hypoglycemic agents are at peak effect compounds the glucose-lowering action. Physical activity itself lowers blood glucose, and stacking it on top of peak medication effect is a reliable way to induce symptomatic hypoglycemia. Option c is incorrect because exercising in a fasted state in the morning means blood glucose is at its lowest daily point and medication may still be active from the prior evening. This combination increases hypoglycemia risk, especially in clients on sulfonylureas or insulin. Option d is incorrect because exercise is actively beneficial for clients with type 2 diabetes, low

Correct Answer: Redness, warmth, purulent drainage at exit site

Redness, warmth, and purulent drainage at the Tenckhoff catheter exit site are signs of localized catheter tunnel or exit site infection, which must be reported immediately to prevent ascending peritonitis. Early detection and treatment can preserve catheter function and prevent a life-threatening complication. Option a is incorrect because clear fluid leaking around the catheter exit site is a known early complication of catheter placement related to incomplete fibroblast adherence, not infection. It signals dialysate leakage requiring a reduction in fill volume, not antibiotic treatment. Option c is incorrect because mild periumbilical cramping during the first few exchanges is an expected side effect of cold dialysate contacting the peritoneum and typically resolves within one to two weeks. It is not an indicator of infection and should be managed by warming the dialysate. Option d is incorrect because brown-tinged outflow is a danger sign for bowel perforation, not catheter site in

Correct Answer: Administer 1 mg glucagon intramuscularly.

For a client with severe hypoglycemia who is unconscious and cannot swallow safely, 1 mg of glucagon administered subcutaneously or intramuscularly is the correct intervention when IV access is unavailable. Glucagon stimulates hepatic glycogenolysis, raising blood glucose within 10 to 15 minutes. Option a is incorrect because attempting to give oral liquids to an unconscious or unresponsive client risks aspiration pneumonia. The airway is not protected in this state, and no oral treatment — including juice or glucose gel placed in the mouth — should be given to a client who cannot swallow. Option b is incorrect because nasogastric tube insertion in an unresponsive client without airway protection is dangerous and time-consuming. The priority is rapidly raising blood glucose; glucagon injection provides a far faster and safer route when IV access has not been established. Option d is incorrect because no approved topical dextrose formulation exists for emergency glucose correction. Tran

Correct Answer: Hold dose; contact PHCP immediately.

Metformin is contraindicated when GFR falls below 30 mL/min due to the risk of life-threatening lactic acidosis from drug accumulation. With a GFR of 24 mL/min, this client is well below the safety threshold; the nurse must hold the dose and contact the PHCP urgently so an alternative agent can be prescribed. Option a is incorrect because administering metformin at a GFR of 24 mL/min is a medication safety violation. Weekly creatinine monitoring does not mitigate the risk of lactic acidosis that accumulates when metformin cannot be renally cleared; the drug must be stopped, not continued under observation. Option b is incorrect because IV metformin is not a clinical formulation that exists for glucose management. Metformin is an oral medication only; suggesting an IV route reflects a fundamental misunderstanding of the drug and would expose the client to an unsafe improvised intervention. Option c is incorrect because dose reduction does not eliminate the contraindication at this GFR.