HESI Med-Surg 3 Final

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Sample questions from HESI Med-Surg 3 Final

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A client with diabetic ketoacidosis has a blood glucose of 540 mg/dL, potassium of 3.1 mEq/L, and a prescription for IV regular insulin. Which action should the nurse take first?

   • A.Begin the insulin infusion as prescribed
   • B.Administer potassium replacement as prescribed and notify the provider
   • C.Give IV sodium bicarbonate
   • D.Restrict IV fluids until glucose decreases

   Rationale: The client's potassium is dangerously low, and insulin will drive potassium into cells, worsening hypokalemia and risking dysrhythmias. Potassium replacement and provider notification are priorities before starting insulin. Bicarbonate is not routinely indicated, and fluid restriction is inappropriate because DKA causes severe volume depletion.

2. 2.A client with SIADH has a serum sodium of 118 mEq/L and becomes increasingly confused. Which intervention should the nurse anticipate?

   • A.Encourage oral fluids
   • B.Administer a hypotonic IV solution
   • C.Institute seizure precautions and anticipate hypertonic saline as prescribed
   • D.Administer desmopressin

   Rationale: Severe symptomatic hyponatremia can cause cerebral edema and seizures, so seizure precautions and carefully controlled hypertonic saline may be needed. Oral fluids and hypotonic IV solutions can further lower sodium. Desmopressin is used for diabetes insipidus and would worsen water retention in SIADH.

3. 3.A client with diabetes insipidus has urine output of 700 mL/hr, intense thirst, and a rising serum sodium. Which prescription should the nurse expect?

   • A.Fluid restriction
   • B.Desmopressin
   • C.Tolvaptan
   • D.Regular insulin

   Rationale: Diabetes insipidus causes deficient antidiuretic hormone activity or renal response, producing large volumes of dilute urine and hypernatremia. Desmopressin replaces antidiuretic hormone in central diabetes insipidus. Fluid restriction worsens dehydration, while tolvaptan is used to treat selected cases of hyponatremia.

4. 4.A client with Addison disease arrives with vomiting, profound weakness, blood pressure 78/42 mm Hg, sodium 126 mEq/L, and potassium 6.0 mEq/L. Which intervention is the priority?

   • A.Administer IV hydrocortisone and isotonic fluids as prescribed
   • B.Restrict sodium and administer a loop diuretic
   • C.Give oral levothyroxine
   • D.Place the client on fluid restriction

   Answer and rationale are in the full material.

5. 5.A client with Graves disease develops a temperature of 40.1 C (104.2 F), severe tachycardia, agitation, and diarrhea. Which action is most appropriate?

   • A.Apply warming blankets and encourage ambulation
   • B.Administer aspirin for fever
   • C.Notify the provider and prepare for treatment of thyroid storm
   • D.Hold all medications until the client's temperature normalizes

   Answer and rationale are in the full material.