HESI MILESTONE 2 PRACTICE EXAM |
QUESTION AND VERIFIED ANSWERS |
RATED A+ | 2024/2025 GUIDE
The nurse notes that a client who is scheduled for surgery the next morning
has an elevated blood urea nitrogen (BUN) level. Which condition is most
likely to have contributed to this finding?
A. Myocardial infarction 2 months ago
B. Anorexia and vomiting for the past 2 days
C. Recently diagnosed type 2 diabetes mellitus
D. Skeletal traction for a right hip fracture
Rationale: The blood urea nitrogen (BUN) level indicates the effectiveness
of the kidneys in filtering waste from the blood. Dehydration, which could be
caused by vomiting, would cause an increased BUN level. Option A would
affect serum enzyme levels, not the BUN level. Option C would primarily
affect the blood glucose level; renal failure that could increase the BUN
level would be unlikely in a client newly diagnosed with type 2 diabetes.
Effects of option D might affect the complete blood count (CBC) but would
not directly increase the BUN level.
Which nursing action would be appropriate for a client who is newly
diagnosed with Cushing syndrome?
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
,D. Offer the client a sodium-enriched menu.
Rationale: Cushing syndrome results from a hypersecretion of
glucocorticoids in the adrenal cortex. Clients with Cushing syndrome often
develop diabetes mellitus. Monitoring of serum glucose levels assesses for
increased blood glucose levels so that treatment can begin early. A
common finding in Cushing syndrome is generalized edema. Although
potassium is needed, it is generally obtained from food intake, not by
offering potassium-enhanced fluids. Fatigue is usually not an overwhelming
factor in Cushing syndrome, so an emphasis on the need for rest is not
indicated. A low-calorie, low-carbohydrate, low-sodium diet is not
recommended.
A client with type 2 diabetes takes metformin daily. The client is scheduled
for major surgery requiring general anesthesia the next day. The nurse
anticipates which approach to manage the client's diabetes best while the
client is NPO during the perioperative period?
A. NPO except for metformin and regular snacks
B. NPO except for oral antidiabetic agent
C. Novolin N insulin subcutaneously twice daily
D. Regular insulin subcutaneously per sliding scale
Rationale: Regular insulin dosing based on the client's blood glucose levels
(sliding scale) is the best method to achieve control of the client's blood
glucose while the client is NPO and coping with the major stress of surgery.
Option A increases the risk of vomiting and aspiration. Options B and C
provide less precise control of the blood glucose level.
,The nurse is caring for a critically ill client with cirrhosis of the liver who has
a nasogastric tube draining bright red blood. The nurse notes that the
client's serum hemoglobin and hematocrit levels are decreased. Which
additional change in laboratory data should the nurse expect?
A. Increased serum albumin level
B. Decreased serum creatinine
C. Decreased serum ammonia level
D. Increased liver function test results
Rationale: The breakdown of glutamine in the intestine and the increased
activity of colonic bacteria from the digestion of proteins increase ammonia
levels in clients with advanced liver disease, so removal of blood, a protein
source, from the intestine results in a reduced level of ammonia. Options A,
B, and D will not be significantly affected by the removal of blood.
The nurse is reviewing routine medications taken by a client with chronic
angle-closure glaucoma. Which medication prescription should the nurse
question?
A. Antianginal with a therapeutic effect of vasodilation
B. Anticholinergic with a side effect of pupillary dilation
C. Antihistamine with a side effect of sedation
D. Corticosteroid with a side effect of hyperglycemia
Rationale: Clients with angle-closure glaucoma should not take
medications that dilate the pupil because this can precipitate acute and
severely increased intraocular pressure. Options A, C, and D do not cause
increased intracranial pressure, which is the primary concern with angle-
closure glaucoma.
, A 77-year-old client is admitted to the hospital with confusion and anorexia
of several days' duration. Additional symptoms reported are nausea and
vomiting, and current complaints of a headache. The client's pulse rate is
43 beats/min. The nurse is most concerned about the client's history
related to which medication?
A. Warfarin
B. Ibuprofen
C. Nitroglycerin
D. Digoxin
Rationale: Older persons are particularly susceptible to the buildup of
cardiac glycosides, such as digoxin or digitoxin (medications derived from
digitalis), to a toxic level in their systems. Toxicity can cause anorexia,
nausea, vomiting, diarrhea, headache, and fatigue. Options A, B, and C are
unlikely to result in the symptoms described.
The nurse is planning care for a client with diabetes mellitus who has
gangrene of the toes to the midfoot. Which goal should be included in this
client's plan of care?
A. Restore skin integrity.
B. Prevent infection.
C. Promote healing.
D. Improve nutrition.
Rationale: The prevention of infection is a priority goal for this client.
Gangrene is the result of necrosis (tissue death). If infection develops,
there is insufficient circulation to fight the infection and the infection can
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