NGN RN MEDICAL SURGICAL HESI EXAM 2024 WITH 100% CORRECT ANSWERS AND EXPLANATIONS Question 1: A client with acute renal injury (AKI) weighs 110.3 pounds (50 kg) and has a potassium level of 6.7 mEq/L (6.7 mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first? Reference Range: Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)] A. Sodium polystyrene sulfonate 15 grams by mouth. B. Sevelamer one tablet by mouth. C. Calcium acetate one tablet by mouth. D. Epoetin alfa, recombinant 2,500 units subcutaneously. Explanation Choice A reason: Sodium polystyrene sulfonate is a medication that binds to excess potassium in the gastrointestinal tract and removes it from the body through feces. It is used to treat hyperkalemia, which is a high level of potassium in t he blood. Hyperkalemia can cause cardiac arrhythmias and muscle weakness, and it is a common complication of AKI. Therefore, this medication should be administered first to lower the potassium level and prevent life-threatening complications. Choice B re ason: Sevelamer is a medication that binds to phosphorus in the gastrointestinal tract and removes it from the body through feces. It is used to treat hyperphosphatemia, which is a high level of phosphorus in the blood. Hyperphosphatemia can cause bone los s and soft tissue calcification, and it is a common complication of chronic kidney disease (CKD). However, it is not an urgent issue in AKI, and it does not affect the potassium level. Choice C reason: Calcium acetate is a medication that also binds to pho sphorus in the gastrointestinal tract and removes it from the body through feces. It has the same effect and indication as sevelamer, but it also provides calcium supplementation. However, it is not an urgent issue in AKI, and it does not affect the potass ium level. Choice D reason: Epoetin alfa, recombinant is a medication that stimulates the production of red blood cells in the bone marrow. It is used to treat anemia, which is a low level of hemoglobin or red blood cells in the blood. Anemia can cause fat igue, weakness, and shortness of breath, and it is a common complication of CKD and AKI. However, it is not an urgent issue in AKI, and it does not affect the potassium level. Question 2: The nurse is preparing an older client for a magnetic resonance imaging (MRI) with contrast. Which laboratory value should the nurse report to the healthcare provider before the scan is performed? Reference Range: Glycosylated hemoglobin (A1C) [4% to 5.9%] Creatinine [0.5 to 1.1 mg/dL (44 to 97 umol/L)] Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)] Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)] A. Fasting blood sugar of 200 mg/dL (11.1 mmol/L). B. Glycosylated hemoglobin A1c of 8%. C. Blood urea nitrogen of 22 mg/dL (7.9 mmol/L). D. Serum creatinine of 1.9 mg/dL (169 umol/L). Explanation Choice A reason: Fasting blood sugar of 200 mg/dL (1 1.1 mmol/L) indicates hyperglycemia, which is a high level of glucose in the blood. It can be caused by diabetes mellitus, stress, infection, or medication. Hyperglycemia can cause symptoms such as thirst, hunger, frequent urination, fatigue, and blurred v ision. However, it does not affect the safety or accuracy of MRI with contrast. Choice B reason: Glycosylated hemoglobin A1c of 8% indicates poor glycemic control over the past three months. It can be caused by diabetes mellitus, chronic kidney disease, or hemoglobinopathy. Glycosylated hemoglobin A1c reflects the average blood glucose level over the lifespan of red blood cells, which is about 120 days. However, it does not affect the safety or accuracy of MRI with contrast. Choice C reason: Blood urea nitr ogen of 22 mg/dL (7.9 mmol/L) indicates mild azotemia, which is a high level of nitrogenous waste products in the blood. It can be caused by dehydration, high protein intake, gastrointestinal bleeding, or kidney impairment. Azotemia can cause symptoms such as nausea, vomiting, confusion, and lethargy. However, it does not affect the safety or accuracy of MRI with contrast. Choice D reason: Serum creatinine of 1.9 mg/dL (169 umol/L) indicates moderate renal insufficiency, which is a reduced ability of the ki dneys to filter and excrete waste products and fluids from the body. It can be caused by diabetes mellitus, hypertension, glomerulonephritis, or nephrotoxic drugs. Renal insufficiency can cause symptoms such as edema, anemia, electrolyte imbalance, and aci dosis. It can also increase the risk of contrast -induced nephropathy, which is a sudden deterioration of kidney function after exposure to contrast media used for imaging studies such as MRI. Contrast -induced nephropathy can lead to acute kidney injury, di alysis requirement, or even death. Therefore, serum creatinine should be reported to the healthcare provider before MRI with contrast to assess the risk and benefit of the procedure and to take preventive measures such as hydration, medication adjustment, or alternative imaging modalities. Question 3: A client with type 1 diabetes mellitus, hypertension, and chronic kid ney disease is to begin hemodialysis treatment. Which statement should the nurse include in client education? A. Prepare for an abdominal catheter. B. Continue routine medications. C. Expect the insulin dosage to be reduced. D. Include potassium -rich foods in the diet. Explanation Choice A reason: An abdominal catheter is used for peritoneal dialysis, not hemodialysis. Hemodialysis requires access to a large blood vessel, usually in the arm or leg. Choice B reason: Routine m edications may need to be adjusted or avoided before or after hemodialysis, depending on their effects on blood pressure, fluid balance, and electrolytes. Choice C reason: Insulin dosage may need to be reduced during hemodialysis because insulin is removed by the dialyzer and blood glucose levels may drop. This is the correct statement to include in client education. Choice D reason: Potassium -rich foods should be limited in the diet of clients with chronic kidney disease and hemodialysis, because potassium can build up in the blood and cause cardiac arrhythmias. Question 4: A patient is admitted to the hospital with sympt oms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse? A. Pupillary changes to ipsilateral dilation. B. Left-sided facial drooping and dysphagia. C. Orientation to person and place only. D. Unequal bilateral hand grip strengths. Explanation Choice A reason: Pupillary changes to ipsilateral dilation indicate increased intracranial pressure, which is a life -threatening complication of stroke. The nurse should notify the physician and prepare for emergency measures. Choice B reason: Left -sided facial drooping and dysphagia are common signs of right hemisphere stroke, but they do not require immediate intervention by the nurse. The nurse should monitor the patient's swallowing ability and provide oral care. Choice C reason: Orientation to person and place only is a sign of impaired cognition, which is also common in right hemisphere stroke. The nurse should assess the patient's memory, judgment, and attention s pan. Choice D reason: Unequal bilateral hand grip strengths are a sign of hemiparesis, which is a weakness on one side of the body. The nurse should assist the patient with mobility and prevent contractures. Question 5: After performing a head -to-toe assessment for a client with Addison's disease, the nurse reports findings to the healthcare provider. The findings include moist mucous membranes, strong palpable peripheral pulses, and blood pressure 132/88 mm Hg. The client verbalizes unde rstanding of the illness and importance of taking medications every day. Which action should the nurse implement? A. Make a referral for social services at home. B. Continue to limit daily fluid intake to 500 mL. C. Begin preparing the client for discharge home. D. Recommend strict intake and output monitoring. Explanation Choice A reason: A referral for social services at home is not necessary for a client with Addison's disease who has stable vital signs, adequate hydra tion, and good self -care knowledge. Choice B reason: Limiting daily fluid intake to 500 mL is not appropriate for a client with Addison's disease, who is at risk of dehydration and hypotension. The client should drink fluids according to thirst and urine o utput. Choice C reason: Preparing the client for discharge home is the best action for the nurse to implement, as the client has no signs of complications or deterioration from Addison's disease. The client should be able to manage the condition at home wi th regular follow -up and medication adherence. Choice D reason: Strict intake and output monitoring is not required for a client with Addison's disease who has normal blood pressure, moist mucous membranes, and strong peripheral pulses. These indicate adeq uate fluid balance and renal function. Question 6: A client who had a biliopancreatic diversion procedure (BPD) 3 months ago is admitted with severe dehydration. Which assessment finding warrants immediate intervention by the nurse? A. Gastroccult positive emesis. B. Strong foul smelling flatus. C. Complaint of poor night vision. D. Loose bowel movements. Explanation Choice A reason: Gastroccult positive emesis indicates the presence of blood in the vomit , which is a sign of a serious complication such as anastomotic leak, ulcer, or bleeding. The nurse should notify the physician and monitor the client's vital signs and hemoglobin level. Choice B reason: Strong foul smelling flatus is a common side effect of BPD, which involves bypassing a large portion of the small intestine and creating a connection between the stomach and the colon. This results in malabsorption and bacterial overgrowth, which produce gas and odor. Choice C reason: Complaint of poor nigh t vision is a sign of vitamin A deficiency, which can occur after BPD due to reduced absorption of fat -soluble vitamins. The nurse should advise the client to take vitamin supplements and eat foods rich in vitamin A, such as carrots, sweet potatoes, and spinach.
