HESI Fundamentals - Set 4 - Part 3

Correct Answer: Give within fifteen minutes of meals

Rapid-acting insulin is given within about fifteen minutes of the meal because onset is fast. The nurse confirms the patient will be eating before administering and reassesses glucose response after the dose has been given. Option b is incorrect because Giving rapid-acting insulin two hours before a meal produces hypoglycemia before food arrives. The medication peaks before glucose enters the bloodstream and creates a serious mismatch with the timing of nutrient absorption. Option c is incorrect because Bedtime administration of rapid-acting insulin without food causes nighttime hypoglycemia. The medication is matched to a meal, and giving it apart from food creates a high risk of falling glucose during sleep. Option d is incorrect because Once-weekly administration does not match the pharmacokinetics of rapid-acting insulin. The medication is given multiple times per day with meals, not on a weekly schedule, since the duration is just a few hours.

Correct Answer: Give fifteen grams carbohydrate, recheck fifteen minutes

Fifteen grams of carbohydrate raises glucose, and rechecking after fifteen minutes confirms whether the response is adequate. If the glucose remains low, the nurse repeats the dose and continues to monitor while planning a follow-up snack. Option a is incorrect because A full meal contains too much carbohydrate, fat, and protein for fast correction. The fat and protein slow absorption, and the patient may overshoot or remain low while waiting for the meal to take effect. Option c is incorrect because Waiting thirty minutes without giving carbohydrate worsens hypoglycemia. The patient could become unresponsive or seize, and the nurse must intervene with carbohydrate immediately rather than delaying treatment for any reason. Option d is incorrect because Holding all food and only notifying the provider misses the immediate intervention. Glucose at fifty in an alert patient calls for prompt oral carbohydrate while the team is being notified for follow-up management.

Correct Answer: Activated partial thromboplastin time

Activated partial thromboplastin time guides intravenous unfractionated heparin therapy. The nurse adjusts the infusion rate based on the result and monitors for bleeding, including occult signs like bruising, hematuria, and gastrointestinal blood. Option a is incorrect because International normalized ratio is the test for warfarin, not heparin. The two anticoagulants act through different mechanisms, so the monitoring tests differ and confusing them leads to incorrect dosing in patients. Option b is incorrect because Platelet count tracks for heparin-induced thrombocytopenia, but it does not titrate the heparin infusion. The activated partial thromboplastin time is the dynamic measure used to guide rate changes during therapy. Option c is incorrect because Bleeding time is not used to guide heparin therapy. The test is rarely used in modern practice, and heparin titration relies on activated partial thromboplastin time as the standard laboratory measure for adjustment.

Correct Answer: Administer naloxone per protocol

Naloxone reverses opioid-induced respiratory depression. The nurse administers per protocol, supports breathing, applies oxygen, monitors for re-narcotization since naloxone is shorter-acting than many opioids, and continues to assess respiratory status closely. Option a is incorrect because Waiting fifteen minutes leaves the patient at risk of further hypoventilation and arrest. The current findings are critical and require immediate reversal rather than passive observation during the event right now. Option b is incorrect because Increasing the opioid dose deepens respiratory depression and worsens the situation. The action is exactly the opposite of what the patient needs, since the depression is opioid induced and reversal is the priority. Option d is incorrect because Walking the patient is impractical and unsafe at this point. The patient cannot safely ambulate while obtunded, and the priority is reversing the opioid effect, not stimulating physical activity at the bedside.

Correct Answer: Hold the next dose and notify provider

Bradycardia, nausea, and visual changes signal possible digoxin toxicity. The nurse holds the next dose, checks the apical pulse and digoxin level, evaluates potassium, and notifies the provider for further direction and orders. Option b is incorrect because Giving a higher dose worsens toxicity and could cause severe arrhythmia. The action contradicts safe practice, since the cues already indicate too much medication relative to the patient's tolerance and metabolism today. Option c is incorrect because Continuing routine care quietly misses a developing emergency. The findings require immediate action, including holding the dose and contacting the provider, rather than passive monitoring while toxicity progresses unchecked at the bedside. Option d is incorrect because Encouraging extra dietary potassium loss worsens the risk of toxicity. Hypokalemia potentiates digoxin toxicity, so the nurse maintains potassium in the normal range rather than promoting loss of the electrolyte.

Correct Answer: Identify discrepancies between home and new orders

Medication reconciliation identifies discrepancies between home medications and new orders. The nurse verifies the list with the patient and provider, ensuring nothing important is missed, duplicated, or contraindicated as the new plan begins during the admission. Option a is incorrect because Ordering new medications is the provider's role, not the goal of reconciliation. The nurse compiles and verifies the list, then communicates with the provider, who writes orders to address any identified gaps. Option b is incorrect because Canceling home medications without review removes therapy that the patient may need. Some chronic medications must continue during the stay, and the reconciliation identifies what to keep, change, or stop in collaboration. Option c is incorrect because Skipping allergies during admission is unsafe and is part of the reconciliation step. Allergies, reactions, and intolerances all need to be confirmed alongside the medication list to protect the patient from

Correct Answer: Adverse event is unexpected and harmful

An adverse drug event is unexpected and harmful, often outside the routine known side effect profile. A severe skin reaction warrants reporting, halting the medication, and possible follow-up to prevent recurrence in future encounters. Option a is incorrect because Side effects and adverse events differ in expected severity and predictability. Dry mouth is expected and tolerable, while a severe skin reaction is unexpected and harmful, so equating them misses the clinical distinction. Option b is incorrect because Side effects are typically predictable and known, not rare and harmful. The label of side effect implies it has been described in the medication's profile, with low to moderate impact most of the time. Option d is incorrect because Adverse events are not predictable or routine; they are unexpected and harmful. The label implies a problem outside the usual experience, prompting reporting and reconsideration of the therapy plan as appropriate.

Correct Answer: Sign out, witness waste, document administration

Sign-out, witnessed waste of any unused portion, and documentation of administration form the chain of custody for controlled substances. Two nurses witness waste together, and the dispensing system tracks all activity for audit and review. Option b is incorrect because Throwing away the unused portion alone is unsafe and against policy. Controlled substance waste requires a witness to prevent diversion, and documentation captures the disposal as part of the regulatory paper trail every time. Option c is incorrect because Allowing another nurse to sign out the medication shifts responsibility incorrectly. The nurse who will administer the medication is the one who signs it out and bears responsibility for the dose and its administration. Option d is incorrect because Skipping the witness for partial doses creates a gap in the chain of custody. Whether the dose is full or partial, the witness requirement applies whenever any amount is wasted from the system today.

Correct Answer: Report the error per institutional policy

Reporting the error per institutional policy supports patient safety and system improvement. The nurse documents, monitors the patient, and contributes to root cause analysis under just culture, which separates human error from reckless behavior. Option a is incorrect because Hiding the error blocks system learning and leaves the patient at risk. Just culture exists specifically so honest reporting can lead to better processes, and concealment undermines the entire safety framework around the system. Option c is incorrect because Harsh punishment discourages reporting and does not address contributing system factors. Just culture distinguishes human error from reckless behavior and uses the event for learning rather than blame against the nurse involved. Option d is incorrect because Ignoring the error because no apparent harm has occurred misses the point of near-miss reporting. Today's stable patient might have a delayed reaction, and the system gains nothing without disclosure

Correct Answer: Stop infusion and prepare epinephrine

Anaphylaxis requires stopping the infusion immediately and preparing epinephrine as the first-line treatment. The nurse maintains airway, applies oxygen, supports circulation, and prepares additional medications and equipment as the team responds to the emergency. Option a is incorrect because Continuing the infusion delivers more of the offending drug. The action worsens the reaction by maintaining exposure to the trigger, exactly when removal of the trigger is the most important first step in management. Option b is incorrect because Encouraging fluids cannot reverse a systemic allergic reaction in progress. The patient has airway swelling and circulatory compromise; oral hydration is unsafe and irrelevant during the acute event that is unfolding right now. Option c is incorrect because A cool compress to the face does not address airway compromise or hypotension. Topical comfort measures have no role in treating systemic allergic reactions, which require immediate medication adminis