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Nursing Elites

HESI RN

HESI Medical Surgical Test Bank

1. In a patient with type 1 diabetes, which of the following is a sign of diabetic ketoacidosis (DKA)?

Correct answer: D

Rationale: Tachycardia is a sign of diabetic ketoacidosis (DKA) in a patient with type 1 diabetes. In DKA, the body responds to hyperglycemia and dehydration by increasing heart rate. Polyuria (increased urination) is a symptom of diabetes but not specific to DKA. Bradycardia (slow heart rate) and dry skin are not typical signs of DKA; instead, tachycardia and other signs of volume depletion are more common.

2. Four days following an abdominal aortic aneurysm repair, the client is exhibiting edema of both lower extremities, and pedal pulses are not palpable. Which action should the nurse implement first?

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to assess pulses with a vascular Doppler. The absence of palpable pedal pulses following an abdominal aortic aneurysm repair raises concerns about compromised blood flow, which could lead to serious complications like ischemia or thrombosis. Evaluating and confirming the presence or absence of pulses is crucial to guide further interventions. Elevating extremities on pillows (Choice A) may be beneficial for managing edema, but it is not the immediate priority when pulses are not palpable. Evaluating edema for pitting (Choice B) can provide additional information about fluid status but does not address the primary concern of absent pulses. Wrapping the feet with warmed blankets (Choice D) is not appropriate in this situation and may not address the underlying vascular issue.

3. The client with chronic renal failure is being educated on dietary restrictions. Which of the following foods should the client avoid?

Correct answer: A

Rationale: The correct answer is A: Bananas. Bananas are high in potassium, and clients with chronic renal failure are often advised to follow a low-potassium diet to prevent hyperkalemia. Oranges and apples are also high in potassium and should be avoided by clients with renal issues. Rice, on the other hand, is low in potassium and is generally considered safe for individuals with chronic renal failure to consume in moderation.

4. The nurse is caring for a client with chronic renal failure who is on a low-potassium diet. Which of the following foods should the client avoid?

Correct answer: A

Rationale: Bananas are high in potassium content, which can lead to hyperkalemia in clients with chronic renal failure who are on a low-potassium diet. Therefore, it is crucial for these clients to avoid bananas. Potatoes, rice, and apples are lower in potassium compared to bananas and are generally considered safe for consumption in clients with chronic renal failure on a low-potassium diet.

5. A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the:

Correct answer: D

Rationale: The correct answer is D: Upper gingival mucosa in the space between the upper gums and lip. A transsphenoidal hypophysectomy involves accessing the pituitary gland through an incision in the upper gingival mucosa, providing direct access to the pituitary gland without external scars. Choices A, B, and C are incorrect because the surgery is not performed through the back of the mouth, the nose, or the sinus channel below the right eye. It is crucial for the client to understand the specific location of the incision to ensure accurate preoperative education and expectations.

Similar Questions

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. The nurse should instruct the client that the surgery will be performed through an incision in the:
Following the diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. Which of the following measures would most likely help the client prevent this problem?
The nurse is obtaining a health history from a new client who has a history of kidney stones. Which statement by the client indicates an increased risk for renal calculi?
While assessing a female client who is chronically fatigued and was recently diagnosed with adrenal insufficiency, the client tells the nurse that she is very nervous that her hospitalization will cause her to lose her job. Which intervention should the nurse implement first?
The healthcare provider is unable to palpate the client's left pedal pulses. Which of the following actions should the healthcare provider take next?
A client with chronic renal failure is on a low-protein diet. Which of the following is the best response by the nurse when the client asks why this diet is necessary?
ATI TEAS 7 Exam Overview

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