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 :

⚠️Sodium polystyrene sulfonate (Kayexalate) is indicated for the emergency management of hyperkalemia, which this client has (6.7 mEq/L).

👨‍🔬Hyperkalemia poses an immediate risk to cardiac function, and treatment must begin promptly to prevent life-threatening arrhythmias or cardiac arrest.

💊This medication works by exchanging sodium for potassium in the colon, promoting potassium excretion via the GI tract and gradually lowering serum potassium.

🧂While other medications like calcium acetate and epoetin alfa are important for managing chronic kidney disease, they do not address the acute, life-threatening potassium elevation seen in this case.

⏱️Sevelamer is used for phosphate control and has no effect on potassium, making it non-priority in acute hyperkalemia.

📌Core Message

Hyperkalemia in AKI requires immediate intervention with agents like sodium polystyrene sulfonate to prevent life-threatening cardiac complications.

Answer 2

Correct Answers:

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

Rationale :

🧫Contrast used in MRIs can be nephrotoxic, especially in clients with preexisting kidney impairment.

📉A creatinine of 1.9 mg/dL is significantly above the normal range, suggesting reduced renal clearance and increased risk for contrast-induced nephropathy (CIN).

🔍Before administering contrast, it is essential to report and evaluate renal function indicators, especially creatinine, as compromised kidneys may be unable to eliminate contrast effectively.

🧪While elevated glucose and A1C levels are concerning for diabetes management, they do not pose an immediate risk related to MRI contrast administration.

💉BUN elevation is mild and less specific; creatinine is the key marker that must be flagged urgently.

📌Core Message

Elevated creatinine signals kidney dysfunction, making it a priority to report before administering contrast for MRI.

Answer 3

Correct Answers:

Expect the insulin dosage to be reduced.

Rationale :

🧪Chronic kidney disease and hemodialysis reduce insulin clearance, leading to increased insulin sensitivity and risk of hypoglycemia.

💉Clients who begin dialysis often require a reduction in their insulin dosage to prevent hypoglycemic episodes.

🛑Continuing usual doses without adjustment can result in dangerous drops in blood glucose, especially post-dialysis.

🍽️Potassium-rich foods should be restricted, not encouraged, due to the kidneys' inability to excrete potassium efficiently.

🔌Abdominal catheters are used in peritoneal dialysis, not hemodialysis, so that instruction is incorrect for this case.

📌Core Message

Insulin dosing must be adjusted in dialysis patients due to decreased clearance and increased hypoglycemia risk.

Answer 4

Correct Answers:

Pupillary changes to ipsilateral dilation.

Rationale :

👁️Ipsilateral pupillary dilation suggests increased intracranial pressure (ICP) and potential brainstem herniation, which is a life-threatening emergency.

💢Prompt recognition and intervention are essential to prevent neurologic deterioration or death.

🧠Facial drooping and dysphagia are expected post-stroke findings and not immediately life-threatening.

🖐️Unequal hand grip or limited orientation are signs of stroke impact but do not demand the same urgent intervention as signs of brain herniation.

🚨Changes in pupil size and responsiveness are among the earliest indicators of serious brain compromise.

📌Core Message

Pupillary changes indicate increased ICP and require immediate intervention to prevent brain herniation.

Answer 5

Correct Answers:

Begin preparing the client for discharge home.

Rationale :

🏠The client demonstrates stable vitals, effective fluid volume, cognitive readiness, and understanding of medication adherence, all of which support safe discharge.

📈A blood pressure of 132/88 is acceptable in Addison’s and suggests adequate corticosteroid coverage.

🧠Understanding the importance of daily medications is critical in preventing an Addisonian crisis, indicating effective education.

🚰There’s no indication for fluid restriction, so limiting fluids or monitoring I&Os strictly would be unnecessary and inappropriate.

📋A referral to social services is not indicated unless the client lacks support or resources, which is not evident here.

📌Core Message

Stability of vitals, hydration, and understanding of care in Addison’s supports safe discharge planning.

Answer 6

Correct Answers:

Complaint of poor night vision.

Rationale :

🌙Poor night vision may reflect a deficiency of fat-soluble vitamins, particularly vitamin A, which is malabsorbed after biliopancreatic diversion (BPD).

💉This is a serious deficiency that can lead to permanent visual impairment and signals malnutrition-related complications of BPD.

🧪Although gastroccult-positive emesis, foul-smelling flatus, and loose stools are expected side effects, vitamin deficiency is a long-term risk that must be corrected quickly.

🌡️Clients post-BPD need routine vitamin supplementation, especially of A, D, E, and K, to prevent neurologic and visual sequelae.

👁️Vitamin A deficiency may progress quickly, particularly in clients with limited dietary intake and poor absorption post-surgery.

📌Core Message

Night blindness suggests vitamin A deficiency, a dangerous complication following biliopancreatic diversion requiring urgent attention.

Answer 7

Correct Answers:

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

Rationale :

⚖️A sudden weight gain suggests fluid retention, which is a hallmark of SIADH, due to excessive water reabsorption.

💧Clients with SIADH retain water without sodium, leading to dilutional hyponatremia and fluid overload.

🚫Urine specific gravity would typically be high (not low) in SIADH due to concentrated urine, so 1.004 is inconsistent with this condition.

🧂A sodium of 150 is hypernatremia, which is not characteristic of SIADH; instead, hyponatremia is expected.

🔍Fremitus is a pulmonary finding, unrelated to fluid regulation or SIADH.

📌Core Message

SIADH causes fluid retention, and a sudden weight gain is an early indicator of this electrolyte-fluid imbalance.

Answer 8

Correct Answers:

Continue to monitor the drainage system.

Rationale :

📉The described tidaling (water level rises with inspiration and falls with expiration) in the water-seal chamber is a normal finding after chest tube placement.

✅It indicates that the system is patent and reflects intrapleural pressure changes, not a complication.

🔍No air leaks or obstruction are described, so there's no need to inspect or clear the tubing at this time.

🎧Unequal breath sounds should still be assessed periodically, but they are not triggered by this specific finding.

📋This is a typical response following the relief of a hemothorax, and the nurse should continue observation.

📌Core Message

Tidaling in the chest tube system reflects normal function, and the appropriate response is to continue monitoring.

Answer 9

Correct Answers:

High-pitched sound heard upon inspiration.

Rationale :

🔊A high-pitched inspiratory sound indicates stridor, which suggests upper airway obstruction, a potentially life-threatening emergency.

🚨Postoperative swelling or bleeding can cause airway compromise, requiring immediate intervention to maintain patency.

🩹Redness or edema at the incision, mild tachycardia, or pain are expected postoperative findings and do not signal an emergency.

👂Stridor is a priority finding due to the risk of rapid progression to respiratory failure if untreated.

💨Early identification allows for rapid response including airway support or surgical re-evaluation.

📌Core Message

Inspiratory stridor after surgery signals airway obstruction, demanding immediate action to secure breathing.

Answer 10

Correct Answers:

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

Rationale :

🦴A calcium level of 6.5 mg/dL is critically low, indicating hypocalcemia, which can cause tetany, muscle cramps, and stridor—all seen in the client.

🔋This is likely due to citrate binding from stored blood transfusions, which chelates calcium.

🗣️Stridor and cramping point toward neuromuscular irritability, classic signs of severe hypocalcemia.

💉This requires urgent replacement to prevent laryngospasm, seizures, or cardiac dysrhythmias.

🧪Potassium and magnesium levels are within normal range; sodium is slightly low but not emergent like calcium.

📌Core Message

Severe hypocalcemia after transfusion causes stridor and cramping and requires immediate correction to prevent airway and cardiac emergencies.

RN HESI Medical Surgical 2023 Exam-2

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 HESI Medical Surgical 2023 Exam-2

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?