Question

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)]

Answer 1

Correct Answers:

Sodium polystyrene sulfonate 15 grams by mouth.

Rationale :

⚠️The client's potassium level of 6.7 mEq/L is critically high and poses an immediate risk for life-threatening cardiac arrhythmias.

💊Sodium polystyrene sulfonate works by binding potassium in the gut and promoting its excretion, making it a priority medication.

📉Although other medications address chronic kidney disease issues (like sevelamer or epoetin alfa), they do not acutely lower potassium.

🩺Rapid reduction of serum potassium is essential in acute renal injury to stabilize cardiac and neuromuscular function.

📌Core Message

In cases of critically high potassium, administer a medication that promotes potassium excretion immediately.

Answer 2

Correct Answers:

Serum creatinine of 1.9 mg/dL (169 umol/L).

Rationale :

🧪Creatinine is a key indicator of renal function, and a level of 1.9 mg/dL is significantly elevated, signaling impaired clearance.

⚠️MRI contrast agents can be nephrotoxic, and administering them in the presence of renal dysfunction increases the risk of contrast-induced nephropathy.

📋Other values (A1C, glucose, BUN) may be abnormal but do not pose immediate risk with contrast administration.

🩺The nurse must notify the provider before proceeding with MRI to avoid potential kidney injury or worsening renal function.

📌Core Message

Always report elevated creatinine before contrast imaging due to the risk of contrast-induced renal damage.

Answer 3

Correct Answers:

Expect the insulin dosage to be reduced.

Rationale :

💉Clients undergoing hemodialysis often experience reduced insulin requirements due to improved glucose clearance and decreased renal insulin degradation.

📉Without dose adjustments, clients are at high risk for hypoglycemia post-dialysis.

🧠Client education should focus on realistic medication changes during dialysis, including insulin regimen adjustment.

📋Other statements like continuing all meds or eating potassium-rich foods are inappropriate and potentially harmful.

📌Core Message

Hemodialysis reduces insulin needs, requiring adjustment to avoid hypoglycemia.

Answer 4

Correct Answers:

Pupillary changes to ipsilateral dilation.

Rationale :

⚠️Ipsilateral pupil dilation suggests increasing intracranial pressure and possible herniation, requiring immediate action.

🧠It indicates compression of the oculomotor nerve on the same side of the brain, a life-threatening neurologic emergency.

🚨This finding takes priority over motor or orientation changes, which may be expected in stroke.

📋Prompt intervention can be life-saving and prevent permanent brainstem damage.

📌Core Message

Pupillary dilation on the affected side is a critical sign of brain herniation and requires urgent response.

Answer 5

Correct Answers:

Begin preparing the client for discharge home.

Rationale :

🧾The client demonstrates clinical stability: normal BP, moist mucosa, and adequate understanding of disease management.

📋These findings indicate effective treatment and readiness for safe discharge planning.

🏠No signs suggest the need for continued hospitalization or social work referral at this time.

📈Daily fluid restriction is not appropriate unless hyponatremia or volume overload exists, which is not indicated here.

📌Core Message

A client with stable vitals and good medication adherence may be safely prepared for discharge.

Answer 6

Correct Answers:

Complaint of poor night vision.

Rationale :

👁️Night blindness is a sign of vitamin A deficiency, a serious complication of biliopancreatic diversion (BPD) due to malabsorption.

⚠️Vitamin A is fat-soluble and may not be absorbed adequately after BPD, leading to neurologic and visual complications.

📋While loose stools and strong flatus are expected post-surgery, ocular symptoms are not and warrant urgent intervention.

💡Early identification of nutritional deficiencies can prevent irreversible complications like vision loss.

📌Core Message

Poor night vision post-BPD signals a serious vitamin A deficiency and requires immediate evaluation.

Answer 7

Correct Answers:

Weight gain of 2 pounds (0.91 kg) in one day.

Rationale :

⚖️A sudden weight gain is a hallmark sign of fluid retention, commonly seen in SIADH.

💧SIADH results in water retention and dilutional hyponatremia, often seen after head injuries.

📋Urine is typically concentrated, not dilute, and serum sodium is usually low, not high.

🧠Close monitoring of fluid status and sodium levels is essential in preventing complications like cerebral edema.

📌Core Message

Rapid fluid retention and weight gain are early indicators of SIADH in neuro-injured patients.

Answer 8

Correct Answers:

Continue to monitor the drainage system.

Rationale :

🌬️In a chest tube system, tidaling (rising/falling water) in the water-seal chamber is a normal finding, indicating patent tubing.

📋No signs of leakage or obstruction are present, and there’s no reason to manipulate the system unnecessarily.

🧠Monitoring ensures early detection if the situation changes, such as absent tidaling or excessive bubbling.

🩺Immediate intervention would only be needed if abnormal findings or respiratory compromise were present.

📌Core Message

Tidaling in the chest tube water-seal chamber is expected and requires continued observation only.

Answer 9

Correct Answers:

High-pitched sound heard upon inspiration.

Rationale :

💨A high-pitched inspiratory sound suggests stridor, which may result from airway obstruction or laryngeal spasm.

⚠️This is a life-threatening respiratory issue and takes priority over pain or surgical site findings.

🧠Immediate airway assessment and possible intervention are critical to prevent hypoxia.

📋Post-operative stridor can indicate swelling or foreign body obstruction needing urgent airway management.

📌Core Message

Inspiratory stridor is a red flag for airway compromise and requires immediate nursing action.

Answer 10

Correct Answers:

Calcium 6.5 mg/dL (1.63 mmol/L).

Rationale :

🦴A serum calcium of 6.5 mg/dL is significantly below normal and indicates hypocalcemia, a potential life-threatening condition.

😮Symptoms like muscle cramps, shortness of breath, and stridor suggest tetany or laryngospasm from low calcium.

💉Clients receiving large-volume transfusions can develop citrate toxicity, which binds calcium and lowers serum levels.

📋Other labs are within acceptable limits or not directly life-threatening at the moment.

📌Core Message

Severe hypocalcemia following transfusion causes neuromuscular and respiratory symptoms that require urgent treatment.

RN Medical Surgical HESI 2023 Exam-1

No.

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)]

3 :
A client with type 1 diabetes mellitus, hypertension, and chronic kidney disease is to begin hemodialysis treatment. Which statement should the nurse include in client education?

4 :
A patient is admitted to the hospital with symptoms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse?

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?

7 :
A client with a closed head injury demonstrates signs of syndrome of inappropriate antidiuretic hormone (SIADH). Which additional finding should the nurse expect to obtain?

9 :
The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?

RN Medical Surgical HESI 2023 Exam-1

No.

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 RangePotassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]

3 : A client with type 1 diabetes mellitus, hypertension, and chronic kidney disease is to begin hemodialysis treatment. Which statement should the nurse include in client education?

4 : A patient is admitted to the hospital with symptoms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse?

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?

7 : A client with a closed head injury demonstrates signs of syndrome of inappropriate antidiuretic hormone (SIADH). Which additional finding should the nurse expect to obtain?

9 : The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?

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)]

3 :
A client with type 1 diabetes mellitus, hypertension, and chronic kidney disease is to begin hemodialysis treatment. Which statement should the nurse include in client education?

4 :
A patient is admitted to the hospital with symptoms consistent with a right hemisphere stroke. Which neurovascular assessment requires immediate intervention by the nurse?

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?

7 :
A client with a closed head injury demonstrates signs of syndrome of inappropriate antidiuretic hormone (SIADH). Which additional finding should the nurse expect to obtain?

9 :
The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?