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, can increase blood glucose levels due to its effects on carbohydrate metabolism.

🩺Clients with Addison’s disease receiving steroid therapy must be monitored for hyperglycemia, a potential side effect.

🔬Monitoring serum glucose helps detect early signs of metabolic imbalance caused by glucocorticoid therapy.

📊This is more critical than osmolarity, platelets, or albumin in the context of Addison’s treatment with steroids.

📌Core Message

Glucose levels must be closely monitored in Addison’s clients taking hydrocortisone due to its potential to cause hyperglycemia.

Answer 2

Correct Answers:

Avoid the consumption of wine, beer, and coffee.

Rationale :

🍷Alcohol, especially beer and wine, increases uric acid production, worsening gout attacks.

⚠️Alcohol also contributes to dehydration, which can lead to more uric acid crystal formation in joints.

🥃Caffeine may act as a mild diuretic, so clients are often advised to use it with caution during gout treatment.

🥗Avoiding high-purine foods and beverages is essential to reduce the frequency and severity of attacks.

📌Core Message

Eliminating alcohol and limiting purine-rich drinks helps prevent gout exacerbations by reducing uric acid buildup.

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 :

🧴Proper technique and aseptic eye drop administration prevent ocular infections, which can worsen visual impairment.

👁️Applying pressure to the inner canthus (punctal occlusion) limits systemic absorption and enhances local drug effect.

🔁Because glaucoma is chronic, lifelong use of prescribed eye drops is needed to preserve remaining vision.

📚These interventions promote adherence and prevent further optic nerve damage in POAG.

📌Core Message

Managing POAG requires lifelong adherence, aseptic drop technique, and punctal occlusion to maintain vision.

Answer 4

Correct Answers:

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

Rationale :

🧂Saline rinses soothe oral tissues affected by radiotherapy-induced mucositis without causing irritation.

🦷They help remove food particles and reduce bacterial colonization, lowering infection risk.

🌿Unlike commercial mouthwashes, saline lacks alcohol, which can worsen inflammation in oral tissues.

🩹Consistent rinsing promotes healing and comfort, making eating and speaking less painful.

📌Core Message

Saline mouth rinses provide safe, non-irritating relief and promote healing in RT-induced mucositis.

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 reading of 56 mg/dL indicates hypoglycemia, which requires immediate administration of fast-acting carbs.

🧃Non-diet soda delivers rapid glucose to quickly raise blood sugar and prevent neurologic deterioration.

⛑️Delaying treatment to document or draw labs can result in worsening symptoms or loss of consciousness.

🕒Administering insulin in this situation is contraindicated and can lead to severe hypoglycemia.

📌Core Message

Immediate treatment of hypoglycemia with fast-acting carbohydrates is a priority over all other tasks.

Answer 6

Correct Answers:

Tracheostomy placement.

Rationale :

🚨Stridor after parathyroidectomy indicates airway compromise, often due to laryngeal nerve damage or hypocalcemia.

🔓A tracheostomy is an emergency airway intervention that bypasses the obstruction and restores breathing.

💁‍♂️Other options like central line or NGT do not address the urgent airway threat.

📞The nurse must prepare immediately after notifying the HCP for potential emergency airway placement.

📌Core Message

Stridor post-parathyroidectomy signals airway obstruction, often requiring tracheostomy for ventilation.

Answer 7

Correct Answers:

Higher doses of insulin

Rationale :

💉During infection, the body releases stress hormones like cortisol, causing insulin resistance and hyperglycemia.

📈Therefore, insulin requirements increase even if caloric intake remains the same or decreases.

🦠Illness protocols often include temporarily adjusting insulin dosing to maintain glucose control.

🩺Clients should also be taught to check glucose more frequently, not less.

📌Core Message

Infections increase insulin needs in diabetics due to stress hormone–induced hyperglycemia.

Answer 8

Correct Answers:

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

Rationale :

🧪This level is above normal and signals impaired renal function, a known complication of diabetes and hypertension.

🚨Chronic high glucose and pressure damage nephrons, leading to diabetic nephropathy.

🧬Even mildly elevated creatinine can indicate early kidney damage needing immediate attention.

🧾The other values are either within range or less directly tied to kidney function in this context.

📌Core Message

Elevated creatinine indicates renal impairment, a serious complication of diabetes and hypertension.

Answer 9

Correct Answers:

Whole milk and dairy servings of ice cream.

Rationale :

🥛High-fat dairy products stimulate the gallbladder, worsening inflammation in cholecystitis.

🍦Eliminating these from the diet aligns with low-fat dietary recommendations to prevent biliary colic.

🍋Citrus fruits and pasta without meat are generally acceptable unless otherwise contraindicated.

🧂Salt intake is a different concern and doesn't directly affect gallbladder irritation.

📌Core Message

High-fat dairy increases symptoms in cholecystitis, and avoiding them supports low-fat dietary control.

Answer 10

Correct Answers:

Confirmation of the autoimmune disease process.

Rationale :

🧬An elevated rheumatoid factor is an antibody commonly seen in rheumatoid arthritis (RA).

🧠Its presence confirms the autoimmune nature of the disease, though not necessarily its severity.

🦴It does not indicate disease spread, joint degeneration, or prognosis—it is a diagnostic biomarker.

🔍Further testing may assess disease activity, but RF elevation supports initial diagnosis.

📌Core Message

Elevated rheumatoid factor supports the diagnosis of RA by confirming its autoimmune basis.

HESI RN Medical -surgical 2023 Exam-5

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-5

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?