Question

A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

Answer 1

Correct Answers:

Glucose

Rationale :

💉Hydrocortisone, a corticosteroid, increases glucose levels by promoting gluconeogenesis and reducing insulin sensitivity.

📊Clients with Addison's disease taking hydrocortisone require glucose monitoring to detect potential hyperglycemia early.

🧪While other labs like osmolarity, albumin, and platelets may be relevant in other contexts, they are not primary concerns for steroid therapy monitoring.

🔍Monitoring serum glucose ensures that the therapy does not lead to metabolic complications.

📌Core Message

Hydrocortisone therapy in Addison’s disease requires monitoring for hyperglycemia via serum glucose levels.

Answer 2

Correct Answers:

Avoid the consumption of wine, beer, and coffee.

Rationale :

🍷Alcohol and purine-rich beverages like wine and beer increase uric acid levels, exacerbating gout attacks.

☕Coffee also affects uric acid metabolism, and limiting all three helps reduce inflammation and prevent future episodes.

🚫During an acute gout attack, rest—not active movement—is essential to reduce pain and swelling.

💊Pain medication should be taken regularly as prescribed, not after exercise, and salt substitutes have no role in gout control.

📌Core Message

Clients with gout should avoid alcohol and purine-rich beverages to prevent attacks.

Answer 3

Correct Answers:

Teach strategies for aseptic administration of the eye drops.
Teach to apply pressure over the inner eye corner after eye drops.
Explain the need to continue eye drops for the rest of their life.

Rationale :

🧴Clients with primary open-angle glaucoma (POAG) require lifelong use of eye drops to prevent optic nerve damage.

🧼Teaching aseptic techniques reduces infection risks from improper drop application.

👁️Applying pressure on the inner eye (punctal occlusion) prevents systemic absorption and enhances local effect.

📝A low-sodium diet or promises of vision improvement are not applicable, as drops do not restore lost vision.

📌Core Message

Managing POAG involves lifelong drops, aseptic application, and punctal occlusion to preserve vision.

Answer 4

Correct Answers:

Normal saline mouth rinses as swish and spit after meals and bedtime.

Rationale :

🧂Saline rinses help soothe mucositis, reduce bacterial load, and promote oral healing in clients receiving radiotherapy.

🌡️Commercial mouthwashes often contain alcohol, which can worsen mucosal irritation.

🍽️Caloric intake is important but doesn’t address mucosal inflammation directly.

📏Head positioning during meals may help dysphagia, but is unrelated to mucositis management.

📌Core Message

For radiation-induced mucositis, use saline mouth rinses to promote healing and comfort.

Answer 5

Correct Answers:

Give the client six ounces of non-diet carbonated soda and instruct the client to drink it entirely.

Rationale :

🍹A glucose level of 56 mg/dL signals hypoglycemia, which must be corrected immediately with fast-acting carbohydrates.

⏱️Non-diet soda delivers rapid glucose absorption, reversing symptoms quickly.

💉Administering insulin or delaying treatment with lab draws can worsen the crisis.

🖥️Documentation follows treatment, not precedes it, in emergencies.

📌Core Message

Severe hypoglycemia requires immediate correction using rapid-acting carbohydrates like soda.

Answer 6

Correct Answers:

Tracheostomy placement.

Rationale :

🚨Stridor following parathyroidectomy suggests life-threatening airway obstruction, often due to hypocalcemia-induced laryngeal spasm.

💨A tracheostomy provides an emergent airway when intubation is difficult or ineffective.

🧪NG tube or central line does not address the airway threat, and a pacemaker is unrelated to airway compromise.

👃Airway support is the top priority in post-op complications like this.

📌Core Message

Stridor after parathyroidectomy signals an emergency airway threat, often requiring tracheostomy.

Answer 7

Correct Answers:

Higher doses of insulin

Rationale :

🔥Infections trigger stress responses, leading to insulin resistance and elevated blood glucose levels.

💉Clients often need more insulin, not less, to maintain glycemic control during illness.

💧While hydration is encouraged, it is not the primary adjustment to glucose management.

🩺More frequent monitoring—not fewer—is needed to catch fluctuations early.

📌Core Message

Illness increases insulin requirements in diabetics due to stress-induced hyperglycemia.

Answer 8

Correct Answers:

Serum creatinine 1.6 mg/dL (141.44 umol/L).

Rationale :

🧪A creatinine level above 1.1 mg/dL in diabetics suggests kidney damage, possibly diabetic nephropathy.

💉This is a known complication of long-standing hypertension and diabetes.

📈While an A1C of 6.9% and FBS of 140 mg/dL show mild hyperglycemia, they are not acute complications.

🦠WBC elevation might signal infection but is less critical than renal dysfunction in this case.

📌Core Message

Elevated serum creatinine in diabetics signals renal complications like diabetic nephropathy.

Answer 9

Correct Answers:

Whole milk and dairy servings of ice cream.

Rationale :

🥛High-fat foods like whole milk and ice cream stimulate gallbladder contractions, worsening cholecystitis symptoms.

🛑Clients are advised to follow a low-fat diet to reduce gallbladder inflammation.

🍝Pasta with light toppings and fruits are typically well-tolerated.

🧂Salt intake is a secondary concern and does not affect gallbladder function directly.

📌Core Message

In cholecystitis, clients should eliminate high-fat foods like ice cream and whole milk.

Answer 10

Correct Answers:

Confirmation of the autoimmune disease process.

Rationale :

🔬A positive rheumatoid factor (RF) indicates an autoimmune process, typical of rheumatoid arthritis (RA).

📈It confirms the diagnosis but does not indicate worsening or organ spread.

🦴Joint degeneration is associated with imaging, not RF levels directly.

🧪Kidney involvement is rare in RA and is not assessed by RF levels.

📌Core Message

Elevated rheumatoid factor confirms autoimmune activity in RA diagnosis.

HESI RN Medical Surgical 2023 Exam-4

No.

1 :
A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

2 :
A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

4 :
A client with oral cancer is receiving radiotherapy (RT) prior to surgery. Which intervention should the nurse teach the client to implement in managing mucositis related to RT?

6 :
The nurse is assessing a client who is one day postoperative parathyroidectomy and finds that the client is experiencing stridor. After notifying the healthcare provider (HCP), the nurse should prepare for which procedure?

7 :
A client with diabetes mellitus is admitted with an upper respiratory infection. Which changes in blood glucose management should the nurse tell the client to expect?

9 :
After teaching a client newly diagnosed with cholecystitis about recommended diet changes, the nurse evaluates the client's learning. Which food choices eliminated by the client indicate to the nurse that teaching has been successful?

10 :
A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

HESI RN Medical Surgical 2023 Exam-4

No.

1 : A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

2 : A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

4 : A client with oral cancer is receiving radiotherapy (RT) prior to surgery. Which intervention should the nurse teach the client to implement in managing mucositis related to RT?

6 : The nurse is assessing a client who is one day postoperative parathyroidectomy and finds that the client is experiencing stridor. After notifying the healthcare provider (HCP), the nurse should prepare for which procedure?

7 : A client with diabetes mellitus is admitted with an upper respiratory infection. Which changes in blood glucose management should the nurse tell the client to expect?

9 : After teaching a client newly diagnosed with cholecystitis about recommended diet changes, the nurse evaluates the client's learning. Which food choices eliminated by the client indicate to the nurse that teaching has been successful?

10 : A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

1 :
A client with Addison's disease started taking hydrocortisone in a divided daily dose last week. It is most important for the nurse to monitor which serum laboratory value?

2 :
A client who is experiencing a first gouty arthritis attack reports excruciating pain in the right great toe. The nurse inspects the inflamed joint and administers ibuprofen 800mg PO as prescribed. Which instruction should the nurse include in the discharge teaching?

4 :
A client with oral cancer is receiving radiotherapy (RT) prior to surgery. Which intervention should the nurse teach the client to implement in managing mucositis related to RT?

6 :
The nurse is assessing a client who is one day postoperative parathyroidectomy and finds that the client is experiencing stridor. After notifying the healthcare provider (HCP), the nurse should prepare for which procedure?

7 :
A client with diabetes mellitus is admitted with an upper respiratory infection. Which changes in blood glucose management should the nurse tell the client to expect?

9 :
After teaching a client newly diagnosed with cholecystitis about recommended diet changes, the nurse evaluates the client's learning. Which food choices eliminated by the client indicate to the nurse that teaching has been successful?

10 :
A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?