Med Surg HESI Exam 3
A nurse is assessing a client with diabetes insipidus. Which signs indicative of diabetes insipidus should the nurse identify when assessing the client?
- Excessive thirst (Polyphagia) - Dry mucous membranes - Deceased urine specific gravity
A 9 year old child with type 1 diabetes is prone to having hypoglycemic episodes in the morning. Which intervention would be included in the school nurse's plan of care for this child?
Asking the child each day what was eaten for breakfast
Two clients with polydipsia and polyuria arrived at the hospital. Both were having similar symptoms but were diagnosed with different types of diabetes insipidus. Which assessment finding helped to differentiate the diagnosis? A) Urine output B) Specific gravity C) Urine osmolarity D) Serum osmolarity
C) Urine osmolarity
A nurse is teaching an older client about the proper medication use. Which statement made by the client indicates the need for further education?
"I will use over-the-counter medicines along with prescribed drugs"
A 6 year old child is found to have type 1 diabetes. In light of the child's cognitive developmental level, which explanation of the illness is most appropriate?
"Taking insulin for your diabetes is like getting new batteries for your superhero toys"
The nurse is teaching a client self-management care in preventing and spreading methicillin-resistant. Staphylococcus aureus (MRSA). Which statements made by the client indicate the need for further learning?
- "I can share athletic equipment" - "I can participate in contact sports" - "I should sit un upholstered furniture"
A client with severe diabetes insipidus is receiving desmopressin acetate, which is administered intranasally in a metered spray. During the follow-up visits, the client reports chest tightness to the primary healthcare provider. Which intervention would effectively reduce complications in the client?
- Administration of desmopressin acetate orally - Administration of desmopressin acetate subcutaneously
A client with gastroesophageal reflux disease (GERD) should make diet and lifestyle changes. Which instructions should the nurse include in the client's discharge teaching?
- Encourage to quit smoking - Avoid caffeine-containing products - Avoid lying down for 2 to 3 hours after eating
The nurse is teaching a diabetic client about the advantages of using an insulin pump. What information should the nurse include?
- It can improve A1C levels - Clients may be able to exercise without eating more carbohydrates
A client's serum potassium level is below the normal range. Which indicators should the nurse determine are consistent with hypokalemia?
-Abdominal cramping - Irregular heart rate - Muscular weakness - Decreased bowel sounds
the nurse is caring for a client with peritonitis who had surgery 2 hours ago due to a ruptured appendix. Which clinical findings should the nurse expect to observe when assessing the client?
-Fever - Urinary retention - Abdominal muscle rigidity
Which responses should a nurse expect a client experiencing hypoglycemia to exhibit?
-Palpitations -Tachycardia - Nervousness
The nurse in a health care facility have developed a new care plan to prevent the risk of infection in clients with an indwelling urinary catheter in place. To determine if the changes prevent infections, the nurse manager use the plan-to-study-act (PDSA). What is the order of steps that the nurse manager would follow to evaluate the changes?
1. Plan to test the change 2. Try out the change 3. Analyze what happened from the change 4. Determine what was learned
A client with a diagnosis of incarcerated hernia asks the nurse for an explanation of the diagnosis. What does the nurse explain is the meaning of an incarcerated hernia?
A piece of the intestine gets stuck in a hole in the abdominal wall
A hospitalized client develops an infection at a catheter insertion site. The nurse uses the term iatrogenic when describing this infection. What is the rationale for the nurse's comment?
A procedure performed at the hospital is the cause
A 7 year old child contracts a UTI. A sulfonamide preparation is prescribed. What is the priority nursing responsibility when the nurse is administering this drug?
Administering this drug at the prescribed times
A client with type 2 diabetes has been receiving insulin in the hospital while being treated for sepsis. The client's infection is resolving and the primary healthcare provider writes a prescription to discontinue the 7 am dose of insulin and to administer glyburide 5 mg twice daily (between 8 am & 8 om). The nurse on the day shift administers the glyburide at 8:30 am. When recording its administrations in the client's record, the nurse sees the insulin had already been given at 7 am. What initial action should the nurse take?
Check blood glucose for hypoglycemia
The nurse is preparing to insert an IV catheter in a client who is being admitted for uncontrolled diabetes. Upon assessment of the client's forearm for a potential insertion site, the nurse notes that the client has an excessive amount of hair. What should the nurse do to properly prepare the site for insertion?
Clip the hair
A self-help group of clients with IBS have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease gastrointestinal (GI) irritability?
Cola drinks
A client is admitted to the hospital with a diagnosis of peptic ulcer. Which most common complication should the nurse assess for in this client?
Hemorrhage
Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes?
Hyperglycemia and urine negative for ketones
4 days after abdominal surgery a client has not passes flatus and there are no bowel sounds. Paralytic ileus is suspected. What does the nurse conclude is the most likely cause of the ileus?
Impaired neural functioning
A client is hospitalized for IV antibiotic therapy and an incision and drainage of an abscess that developed at the site of a puncture wound. When should the nurse begin to teach the client about how to care for the wound?
In the preoperative period
A nurse is caring for a client with type 2 diabetes who developed ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?
Increased serum lipids (fat breakdown) Increased hematocrit level (Dehydration) Increased BUN (Dehydration)
The nurse is caring for a client who is receiving intermittent IV Piggyback doses of Vancomycin every 12 hours. The primary HCP prescribes tough levels of the antibiotic. The nurse schedules the blood sample to be obtained at what time?
Just before the medication is administered
Which personal protective equipment will the nurse wear when providing central venous access device site care?
Mask & sterile gloves
A client with colitis has had a hemicolectomy. 3 days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green visual fluid. The nurse contacts the primary HCP and recommends which interventions?
Nasogastric tube for decompression
On the 3rd postoperative day after a subtotal gastrectomy, a client reports having severe abdominal pain. The nurse palpates the client's abdomen and determines rigidity. What should be the nurse's first action?
Obtain the client's vital signs
The nurse is caring for an older client admitted to the hospital with type 2 diabetes. What is important for the nurse to remember about older adults and type 2 diabetes?
Older adults seldom develop ketoacidosis
The nurse is caring for a client who had a hip replacement 2 days prior. After removing a bedpan from under the client, what is a priority nursing intervention?
Provide perineal care
A 6 week old infant has just been found to have gastroesophageal reflux. What teaching is most important to discuss with the parents at the time?
Providing formula thickened with cereal
In her 36th week of gestation, a client with type 1 diabetes delivers a 9 lb baby (4366 g) infant via cesarean birth. For what condition should the nurse monitor this infant of diabetic mother?
Respiratory distress syndrom
The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes?
Retinopathy
A client who was exposed to hepatitis A asks why an injection of gamma globulin provides passive immunity?
The antigen is neutralized by the antibodies that it supplies
Which pharmacokinetic condition of a drug may result in a high intensity and long duration of response?
When absorption is rapid but elimination is delayed
A client is admitted to the hospital for a laparoscopic cholecystectomy. What should the nurse encourage the client to add to the diet to help normalize bowel function after surgery?
Whole bran
6 weeks after discharge, a client with a jejunoileal bypass for morbid obesity returns to the outpatient clinic reporting palpitations, abdominal cramps, diarrhea, and dizziness 30 minutes after meals. What complication should the nurse consider that the client is most likely experiencing?
Dumping syndrome
A client with radiation therapy for neck cancer reports, "I feel a lump while swallowing and foods get stuck." What does the nurse document in the client's medical history?
Dysphagia
A client has a history of gastroesophageal reflux disease (GERD). Why should the nurse also monitor the client for clinical manifestations of heart disease?
Esophageal pain may imitate the symptoms of a heart attack
While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process?
Decreasing fecal bulk
A client is admitted with cellulitis of the left leg and a temperature of 103F (39.4C). The primary HCP prescribes IV antibiotics. Which action is the priority before administering the antibiotics?
Determine the client's allergies
The nurse is educating the client newly diagnosed with type 2 diabetes on oral antidiabetic medications. What should the nurse include in the teaching plan?
- the client should obtain a finger stick blood glucose reading before each meal - The teaching plan should include signs and symptoms of hypoglycemia - The teaching plan should include sick day rules
The nurse is caring for a 76 year old obese client with a history of epigastric distress esophageal burning, binge drinking, and frequent episodes of bronchitis. A diagnosis of hiatal hernia is made. Which health problems most likely contributed to the development of hiatal hernia?
Aging Obesity
While obtaining the client's health history, which factor does the nurse identify that predisposes the client to type 2 diabetes?
Being 20 pounds (9kg) overweight
A HCP prescribes Vancomycin peak and trough levels for a client who is receiving Vancomycin intravenous piggyback (IVPB). When should the nurse have the laboratory obtain a blood sample to determine a peak level of the antibiotics?
Between 30 and 60 minutes after a dose
A client has a permanent sigmoid colostomy as a result of cancer of the rectum. the primary HCP prescribes daily colostomy irrigations. What does the nurse explain is the primary purpose of these irrigations?
Establish a regular elimination schedule
A nurse is caring for a client with type 1 diabetes who develops ketoacidosis. Which laboratory value supports the presence of diabetic ketoacidosis?
Increased blood urea nitrogen levels
A client with early-stage cancer of the esophagus is treated with laser therapy. Which type of food should the nurse instruct the client to select when oral intake is permitted?
Liquid
When changing a postoperative client's dressing, the nurse washes hands before changing the dressing. Which type of asepsis is the nurse using?
Medical asepsis
What criteria should the nurse consider when determining if an infection should be categorized as a health-care associated infection?
Occurred in conjunction with treatment for an illness
A nurse is caring for an elderly client who has constipation. Which independent nursing intervention helps to reestablish a normal pattern?
Offer a cup of prune juice
One month after abdominal surgery, a client is readmitted to the hospital with recurrent abdominal pain and fever. The medical diagnosis is fistula formation with peritonitis. The nurse should maintain the client in what position?
Semi-Fowler
"Polydipsia and polyuria related to diabetes mellitus are primarily due to: "a. The release of ketones from cells during fat metabolism b. Fluid shifts resulting from the osmotic effect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in RBCs resulting from attachment of excessive glucose to hemoglobin"
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
The primary HCP provider has prescribed fluticasone nasal spray for a client with sinusitis. Which of these instructions regarding the use of the spray are appropriate for the client?
- Use the drug on a regular basis, not PRN - Clear the nasal passages before using the drug - Discontinue use of the drug if nasal infection develops
A nurse is caring for a client admitted to the hospital for diabetic ketoacidosis. Which clinical findings related to this even should the nurse document in the client's clinical record?
- Acetone breath - Decreased arterial carbon dioxide level
the nurse is preparing to insert an IV catheter in a thin, emaciated client who is scheduled to begin IV fluid therapy. Which interventions should the nurse follow to provide high-quality care?
- Flush the IV line with normal saline - Stop the insertion procedure when there is a break in technique
A nurse is caring for a client who had a pancreaticoduodenectomy for cancer of the pancreas. the nurse provides education about hyperinsulinism, a long-term complication related to this type of surgery. The nurse evaluates that the teaching is understood when the client states that he will seek medical supervision if he experiences which symptom?
- Increased thirst
A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, " I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client?
- Leg ulcers - Loss of visual activity - Thick, yellow toenails - Decreased sensation in the feet
A nurse adds 20 mEq of potassium chloride to the IV solution of a client with diabetic ketoacidosis. What is the primary purpose for administering this drug?
- Replace excessive losses
A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?
Stress response
The nurse receives a report on a newly admitted client who is positive for Clostridium difficile. Which category of isolation would the nurse implement for this client?
Contact precautions