HESI RN
HESI Medical Surgical Practice Exam Quizlet
1. In assessing cancer risk, which woman is at greatest risk of developing breast cancer?
- A. A 35-year-old multipara who never breastfed.
- B. A 50-year-old whose mother had unilateral breast cancer.
- C. A 55-year-old whose mother-in-law had bilateral breast cancer.
- D. A 20-year-old whose menarche occurred at age 9.
Correct answer: B
Rationale: The correct answer is B because family history of breast cancer, specifically in the mother, is a significant risk factor for developing breast cancer. The age of 50 is also a risk factor for breast cancer. Choice A is less likely as breastfeeding can actually reduce the risk of breast cancer. Choice C is less relevant since the risk is higher with a direct family member. Choice D, although early menarche is a risk factor, the age of the individual is much lower compared to the other age-related risk factors.
2. In a patient with anemia, which of the following is the primary symptom to assess?
- A. Fever.
- B. Chest pain.
- C. Shortness of breath.
- D. Muscle cramps.
Correct answer: C
Rationale: The correct answer is C: Shortness of breath. In a patient with anemia, the primary symptom to assess is shortness of breath. Anemia leads to a reduced oxygen-carrying capacity of the blood, resulting in tissues not receiving adequate oxygen. This can manifest as shortness of breath, especially during physical exertion. Fever (Choice A), chest pain (Choice B), and muscle cramps (Choice D) are not typically primary symptoms of anemia. Fever may suggest an infection, chest pain can be indicative of cardiac issues, and muscle cramps may be related to electrolyte imbalances or neuromuscular disorders.
3. A nurse reviews a client’s urinalysis report. Which finding does the nurse recognize as abnormal?
- A. pH of 6.0
- B. An absence of protein
- C. The presence of ketones
- D. Specific gravity of 1.018
Correct answer: C
Rationale: The correct answer is C. The presence of ketones in the urine is abnormal. Ketones in the urine may indicate a state of ketosis, which is commonly seen in uncontrolled diabetes, fasting, or a low-carbohydrate diet. A normal pH range of urine is 4.5 to 7.8, making a pH of 6.0 within the normal range. An absence of protein is a normal finding in urine, as proteinuria (presence of protein) is abnormal. A specific gravity of 1.018 falls within the normal range of 1.016 to 1.022. Therefore, the presence of ketones is the abnormal finding in this scenario.
4. A pregnant client tells the nurse, “I am experiencing a burning pain when I urinate.” How should the nurse respond?
- A. This means labor will start soon. Prepare to go to the hospital.
- B. You probably have a urinary tract infection. Drink more cranberry juice.
- C. Make an appointment with your provider to have your infection treated.
- D. Your pelvic wall is weakening. Pelvic muscle exercises should help.
Correct answer: C
Rationale: Pregnant clients with a urinary tract infection require prompt and aggressive treatment because cystitis can lead to acute pyelonephritis during pregnancy. The nurse should encourage the client to make an appointment and have the infection treated. Burning pain when urinating does not indicate the start of labor or weakening of pelvic muscles. Choice A is incorrect because burning pain during urination does not signify the start of labor. Choice B is incorrect because while cranberry juice may help prevent urinary tract infections, it is not a treatment. Choice D is incorrect because burning pain when urinating is not indicative of weakening pelvic muscles.
5. The client with chronic renal failure is receiving instruction on dietary restrictions. Which of the following food items should the client be instructed to avoid?
- A. Bananas.
- B. Apples.
- C. Rice.
- D. Potatoes.
Correct answer: A
Rationale: The correct answer is A: Bananas. Bananas are high in potassium, and individuals with chronic renal failure are often advised to limit potassium intake to prevent hyperkalemia. Apples, rice, and potatoes are lower in potassium and can be included in moderation in the diet of clients with chronic renal failure.
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