HESI Milestone 3 Exam New 2025 Latest Version
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The nurse has provided medication instructions to a client with an iron deficiency anemia who
will be taking iron supplements. Which statement made by the client indicates an understanding
of this medication? ----------- Correct Answer ------------ "I need to increase my fluid intake."
Rationale:
Iron preparations can be very irritating to the stomach and are best taken between meals. Because
iron supplements may be associated with constipation, the client would increase fluids and fiber
in the diet to counteract this side effect of therapy. Iron preparations need to be taken with a
substance that is high in vitamin C to increase its absorption. The tablet is swallowed whole and
not chewed.
A client with acquired immunodeficiency syndrome (AIDS) has been started on therapy with
zidovudine. The nurse would monitor the results of which laboratory blood study for adverse
effects of therapy? ----------- Correct Answer ------------ CBC
Rationale:
Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency
virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and
malignancy. Common adverse effects of zidovudine are granulocytopenia and anemia. The nurse
would monitor the CBC count for these changes. Creatinine, potassium, and BUN are unrelated
to this medication.
A pt was started on IV gentamicin for osteomylitis. The RN informs the pt that frequent blood
work will be done to monitor the amount of med in the body. The RN knows which of the
following labs are a priority to check q3d for this pt?
a) BUN & creatinine
b) LFTs
c) H&H
d) Peak & trough levels ----------- Correct Answer ------------ d) Peak & trough
Peak & trough levels help determine the amount of med at specific times. Gentamicin is a very
potent abx, so it's crucial to keep track of blood levels. Too low is ineffective against the
bacterial & too high is HR toxicity.
Aminoglycosides (e.g., gentamicin) can cause nephrotoxicity, so checking BUN & creatinine
periodically is important. However, it wouldn't be necessary to check q3d.
Aminoglycosides rarely affect the liver, so LFTs aren't needed frequently.
,H&H levels are rarely impacted by aminoglycosides. Although an initial level may be obtained
before starting tx, additional levels aren't necessary.
A pt is taking benzphetamine. The RN teaches the pt which information about the drug?
a) May cause drowsiness
b) May lead to hypotension
c) It's a respiratory stimulant
d) It's safe during pregnancy ----------- Correct Answer ------------ b) May cause hypotension
When monitoring a pt for methylphenidate withdrawal, the RN should observe for which
condition?
a) Tremors
b) Insomnia
c) Weakness
d) Tachycardia ----------- Correct Answer ------------ c) Weakness
The RN is teaching a pt about common SEs of analeptics. Which of the following should be
included?
a) Bradycardia
b) Constipation
c) Nervousness
d) Urinary retention ----------- Correct Answer ------------ c) Nervousness
The RN is reinforcing dietary instructions for a pt on warfarin. Which food choices should be
avoided while on warfarin? (SATA)
a) Corn
b) Carrots
c) Spinach
d) Broccoli
e) Watermelon ----------- Correct Answer ------------ Correct:
c, d
Pt's on warfarin need to have reduced & consistent intake of vitamin K. High levels of vitamin K
interfere with warfarin by decreasing effectiveness to prevent blood clots. The vitamin K level of
1 cup of raw spinach is 144.87 mcg & in raw broccoli is 92.46 mcg. Because spinach & broccoli
are high in vitamin K, the pt should eat it sparingly or refrain from eating them.
Other high vitamin K foods include:
- Leafy greens (turnip greens, kale, spinach, broccoli, Brussels sprouts, cabbage, lettuce)
- Soybean & canola oil (including salad dressings with these two ingredients)
- Fortified meal replacement shakes
, - Liver
A RN is caring for a pt with hyperparathyroidism & notes that their serum Ca2+ is 13 mg/dL.
Which med should the RN prepare to give as prescribed?
a) Ca2+ chloride
b) Ca2+ gluconate
c) Calcitonin
d) Large doses of vit D ----------- Correct Answer ------------ c) Calcitonin
Normal serum Ca2+ = 8.6-10.0 mg/dL.
This pt has hypercalcemia. Ca2+ gluconate & Ca2+ chloride are meds used to tx tetany that
occurs d/t acute hypocalcemia.
In hypercalcemia, large doses of vit D should be avoided.
Calcitonin is a thyroid hormone that decreases the plasma Ca2+ level by inhibiting bone
resorption & lowering serum Ca2+ concentration.
PO Fe2+ supplements are ordered for a 6 yo with IDA. The RN instructs the mother to give the
Fe2+ with which of the following foods?
a) Milk
b) Water
c) Apple juice
d) OJ ----------- Correct Answer ------------ d) OJ
Vit C increases the absorption of Fe2+ by the body. The mom should give this med with a citrus
fruit or juice that's high in vit C, like OJ.
Milk may affect Fe2+ absorption. Water will not help with absorption. OJ has more vit C than
apple juice.
Salicylic acid is ordered for a pt with psoriasis. The RN monitors the pt, knowing that which of
the following would indicate systemic toxicity?
a) Tinnitus
b) Diarrhea
c) Constipation
d) Decreased respirations ----------- Correct Answer ------------ a) Tinnitus
Salicylic acid is absorbed readily through the skin & systemic toxicity (salicylism) can occur.
S/S of salicylate toxicity:
- Tinnitus
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