HESI E2 HESI Exit Exam - Set 5 - Part 2

Correct Answer: Cholinergic crisis from overmedication

Cholinergic crisis from anticholinesterase overdose produces SLUDGE symptoms of salivation, lacrimation, urination, defecation, GI distress, and emesis with miosis. Treatment includes holding the drug and administering atropine to reverse the excessive cholinergic effects on the body. Option b is incorrect because myasthenic crisis from undermedication shows weakness without the SLUDGE pattern of muscarinic excess. Distinguishing these crises rests on the cholinergic features such as miosis and excessive secretions seen prominently in the scenario described above. Option c is incorrect because anaphylaxis manifests with urticaria, bronchospasm, angioedema, and hypotension within minutes of exposure. The chronic medication this client takes is unlikely to produce IgE-mediated allergy after months of demonstrated drug tolerance. Option d is incorrect because pancreatitis causes severe epigastric pain radiating to the back along with elevated lipase. The constellation of secretions, pupil

Correct Answer: Forced vital capacity at bedside

Ascending paralysis threatens respiratory muscle function, and falling vital capacity warns of impending respiratory failure requiring intubation. Continuous monitoring of pulmonary mechanics catches the decline before crisis develops in this very preventable airway compromise scenario. Option a is incorrect because urinary retention warrants attention but cannot match the urgency of failing ventilation in real time. Bladder problems sit behind airway and breathing concerns in the priority sequence nurses apply during high-risk neurologic assessment. Option b is incorrect because pressure injury prevention is important during prolonged immobility but does not threaten survival within the next hour. Pulmonary status changes can become life-threatening within minutes, which demands the closest possible monitoring frequency. Option d is incorrect because Guillain-Barre typically preserves cognition while disabling motor function across the body. Frequent neurologic checks beyond motor ass

Correct Answer: I will use long hot tub soaks

Heat exposure worsens multiple sclerosis symptoms by slowing nerve conduction through demyelinated fibers in the central nervous system. Clients should avoid hot baths, saunas, and overheating during exercise, choosing instead cool environments to maintain normal neurologic function. Option b is incorrect because energy conservation through scheduled rest periods is a cornerstone of multiple sclerosis self-care. The fatigue from this disease is profound, and pacing activity helps maintain participation in normal daily life across the week. Option c is incorrect because regular moderate exercise within tolerance preserves strength and reduces deconditioning over time. Clinicians actively encourage physical activity that the client can manage comfortably without overheating or pushing into exhaustion during sessions. Option d is incorrect because stress is a recognized trigger for symptom exacerbations and relapses of multiple sclerosis. Building reliable coping strategies such as mindfu

Correct Answer: Provide soft foods and thickened liquids

Soft foods with thickened liquids reduce aspiration risk when swallowing muscles weaken from disease progression. Sitting upright during and after meals uses gravity to keep food moving safely down the esophagus rather than into the airway and lungs. Option a is incorrect because thin liquids are most likely to be aspirated when swallowing coordination fails. Rushing meals also increases the chance of choking by allowing food to enter the airway before the protective reflexes have time to engage. Option b is incorrect because lying flat eliminates gravity assistance and dramatically raises aspiration risk during eating. Standard practice positions clients with swallowing difficulty upright at ninety degrees throughout the meal and for at least thirty minutes after. Option d is incorrect because unsupervised meals for clients with progressive bulbar weakness can lead to silent aspiration that goes unnoticed. A caregiver or nurse should remain present to monitor swallowing efficacy and r

Correct Answer: Use short statements and one direction

Simplifying language into brief direct phrases matches the processing ability of a brain affected by Alzheimer disease at this stage. Giving one instruction at a time reduces frustration and supports the client's success with daily tasks during the hospital stay. Option a is incorrect because long detailed sentences overwhelm working memory and produce confusion rather than understanding for this client. The communication style that works well for cognitively intact adults fails in dementia and may increase agitation noticeably. Option b is incorrect because arguing with confabulation provokes distress without restoring accurate memory in any meaningful way. Validation therapy redirects attention to feelings behind the words rather than challenging the person's perceived current reality about events. Option c is incorrect because complex reasoning is precisely what dementia erodes, so demanding it sets up failure and embarrassment. Simple closed-ended questions or yes-or-no c

Correct Answer: Continuous regular IV insulin infusion

After fluid resuscitation, an intravenous regular insulin infusion lowers glucose and reverses ketosis in a controlled, predictable manner. Insulin also drives potassium into cells, which means careful electrolyte monitoring and replacement become critical as serum potassium falls. Option b is incorrect because subcutaneous long-acting insulin has too slow an onset to address the acute metabolic crisis at hand. The titratable intravenous route provides immediate effect that subcutaneous depot insulin simply cannot match during a life-threatening emergency presentation. Option c is incorrect because the serum potassium will fall on its own as insulin moves it into cells. Adding a binder risks dangerous hypokalemia and is not part of standard diabetic ketoacidosis protocols during this early treatment phase. Option d is incorrect because bicarbonate is reserved for severe acidosis with pH below 6.9 in most current guidelines. The pH here does not yet meet that threshold, and routine bica

Correct Answer: Hyperosmolar hyperglycemic syndrome

Hyperosmolar hyperglycemic syndrome typically appears in older adults with type 2 diabetes and produces extreme hyperglycemia, profound dehydration, and elevated osmolality without significant ketosis. Treatment centers on aggressive fluid replacement plus an intravenous insulin infusion to lower glucose. Option a is incorrect because hypoglycemia produces glucose levels below 70 with adrenergic symptoms such as sweating and tremors. Glucose readings near 1000 lie at the opposite end of the spectrum entirely from any low blood sugar emergency scenario. Option c is incorrect because SIADH produces water retention with low serum sodium and low osmolality on labs. The dehydrated, hyperosmolar state here matches the opposite physiologic profile from inappropriate antidiuretic hormone secretion in the brain or lungs. Option d is incorrect because ketoacidosis includes prominent ketonuria, fruity breath, and Kussmaul respirations from underlying metabolic acidosis. The minimal ketones and th

Correct Answer: Hypocalcemia from parathyroid injury

Inadvertent disruption of the parathyroid glands during thyroidectomy can cause hypocalcemia within hours, producing perioral tingling and a positive Chvostek sign. The nurse should anticipate orders for intravenous calcium gluconate while monitoring closely for airway emergencies such as laryngospasm. Option a is incorrect because recurrent laryngeal nerve injury produces hoarseness, voice change, or stridor depending on severity of the trauma. Facial twitching and perioral tingling are not features of this specific cranial nerve complication after a thyroid procedure. Option b is incorrect because thyroid storm presents with high fever, severe tachycardia, agitation, and hypertension from hormone surge. Calcium-related signs do not appear in this hyperadrenergic emergency, which carries different management priorities focused on blocking thyroid hormone action. Option c is incorrect because surgical site infection brings local redness, warmth, drainage, and fever rather than neuromus

Correct Answer: Intravenous hydrocortisone and saline with dextrose

Adrenal crisis is reversed by immediate corticosteroid replacement with intravenous hydrocortisone alongside normal saline with dextrose to correct multiple deficits. This combination addresses deficient cortisol, fluid loss, hyponatremia, and hypoglycemia together in one coordinated emergency approach. Option b is incorrect because fluid restriction worsens the existing volume depletion and dangerous hypotension. The crisis demands aggressive volume expansion rather than holding back fluids while the client teeters on the edge of cardiovascular collapse from shock. Option c is incorrect because oral medication has unreliable absorption in a hypotensive critically ill client at this stage. Hydrocortisone given intravenously delivers a far faster, more predictable response when adrenal failure threatens the client's immediate survival. Option d is incorrect because the potassium is already elevated, and replacement would worsen hyperkalemia and risk life-threatening dysrhythmias. C

Correct Answer: Implement fluid restriction per protocol

Water retention from excess antidiuretic hormone dilutes serum sodium, so restricting fluid intake corrects the dilutional hyponatremia at its source. The nurse coordinates with the provider regarding hypertonic saline only when severe neurologic symptoms persist after fluid restriction begins. Option a is incorrect because additional fluids deepen the dilutional state and lower the sodium further toward seizure-inducing levels. The pathophysiology hinges on too much water in the system, not too little hydration in the client at the bedside. Option b is incorrect because loop diuretics may help in selected cases but are not the first nursing intervention here. Standard initial management always starts with strict fluid restriction and treats the underlying cause before adding any further pharmacotherapy. Option d is incorrect because positioning does not directly correct an electrolyte imbalance from inappropriate antidiuretic hormone release. Body position affects perfusion and comfor

Correct Answer: Keep client NPO and maintain IV fluids

Resting the pancreas by withholding oral intake reduces enzyme stimulation and pain in acute pancreatitis. Aggressive intravenous fluid resuscitation prevents shock and end-organ failure during the early inflammatory phase of the illness when fluid losses are highest. Option a is incorrect because any oral intake stimulates pancreatic secretion and worsens the inflammation that is already underway. Even clear liquids drive enzyme release and prolong recovery during the acute phase of pancreatic injury and severe pain. Option b is incorrect because external heat does not address the inflammatory process and offers minimal pain relief in severe pancreatitis. Pharmacologic analgesia and pancreatic rest accomplish far more for symptom management than a heating pad ever could here. Option c is incorrect because gastric feeding directly stimulates pancreatic enzyme secretion in acute pancreatitis. When enteral feeding becomes appropriate later, the tube is positioned beyond the duodenum into

Correct Answer: Administer lactulose titrated to soft stools

Lactulose acidifies the colon and traps ammonia in the stool for elimination, lowering the serum ammonia in hepatic encephalopathy. The nurse titrates the dose to produce two or three soft stools each day as the therapeutic endpoint for treatment. Option a is incorrect because severe protein restriction risks malnutrition without clearly improving encephalopathy under current guidelines. Moderate protein intake combined with lactulose now represents the preferred approach for most clients with chronic liver disease and rising ammonia. Option b is incorrect because adding protein when the brain is already affected by ammonia worsens the mental status further. Branched-chain amino acids may be considered cautiously, but bulk protein supplementation is not first-line therapy during active encephalopathy episodes. Option d is incorrect because paracentesis treats tense ascites rather than reducing ammonia or reversing encephalopathy. Draining peritoneal fluid does not address the central p

Correct Answer: Provide oral care and limit moisture

Frequent oral care with swabs or mouthwash relieves the dry mouth without overloading the obstructed bowel. Limiting any ingestion preserves the function of the nasogastric decompression and prevents worsening distention, vomiting, or further aspiration risk during recovery. Option a is incorrect because oral intake during active obstruction increases gastric contents that the tube must continuously suction out. Liberal fluids defeat the decompression strategy and may worsen distention or trigger vomiting that leads to aspiration into the lungs. Option c is incorrect because warm broth still adds substantial volume to a bowel that cannot move contents distally past the blockage. The thermal comfort does nothing to change the underlying mechanical block requiring continued decompression by suction. Option d is incorrect because removing the nasogastric tube without medical orders risks worsening distention and vomiting. Decompression remains necessary until the obstruction resolves and

Correct Answer: Proton pump inhibitor and antibiotics weeks

Current treatment combines a proton pump inhibitor with multiple antibiotics for up to fourteen days to eradicate H. pylori. Quadruple therapy has become preferred over older triple regimens because of rising clarithromycin resistance reported across many world regions today. Option a is incorrect because aspirin damages gastric mucosa and is itself a known cause of peptic ulcer disease. Recommending it to a person with an active ulcer represents the opposite of appropriate care and would worsen bleeding. Option b is incorrect because chronic sodium bicarbonate use causes metabolic alkalosis and sodium overload without eradicating the bacterium. Antacids may provide brief symptom relief but cannot address the actual infectious cause of this peptic ulcer disease. Option d is incorrect because H2 blockers alone do not eradicate Helicobacter pylori, and ulcers will recur without antibiotic coverage. Acid suppression must always be paired with appropriate antimicrobial therapy to clear the

Correct Answer: Toxic megacolon with bowel perforation

Severe abdominal rigidity, rebound tenderness, and hemodynamic collapse suggest bowel perforation, often from toxic megacolon in inflammatory bowel disease. Immediate surgical consultation and aggressive resuscitation are necessary to prevent rapid clinical deterioration and death from peritonitis or sepsis. Option a is incorrect because hemorrhoidal disease produces local rectal pain or bleeding without systemic instability or peritoneal signs. The widespread peritoneal findings here clearly indicate a process far beyond anorectal pathology in this acutely unstable hospitalized client. Option c is incorrect because routine flares cause crampy abdominal pain and diarrhea without peritoneal signs or hemodynamic collapse from blood loss. The acute peritoneal picture demands an entirely different level of urgency and surgical intervention here. Option d is incorrect because constipation produces gradual discomfort and distention rather than sudden rigid abdomen with shock. The contrast be

Correct Answer: Avoid restraints and IV starts left arm

Protecting an AV fistula means avoiding compression, blood pressure cuffs, intravenous starts, blood draws, and restraints on that arm. These activities compromise blood flow through the access and significantly raise the risk of clotting or rupture at the anastomosis. Option b is incorrect because cuff inflation over a fistula can damage the anastomosis and obstruct flow during dialysis sessions. The opposite arm is always used for blood pressure measurements in any client with a known functioning dialysis fistula. Option c is incorrect because applying cold therapy slows blood flow through the fistula and significantly raises clotting risk. The access depends on continuous brisk blood flow, which cold contracts vessels and impairs through vasoconstriction over time. Option d is incorrect because compressive wrapping decreases the flow that defines a functional fistula in the first place. The bruit and thrill that confirm patency disappear under pressure, signaling impending failure o

Correct Answer: Come to clinic with cloudy drainage

Cloudy effluent in peritoneal dialysis strongly signals peritonitis and requires prompt evaluation with culture, sensitivity testing, and intraperitoneal antibiotics. Bringing the drainage sample to the clinic shortens the diagnostic process and starts targeted treatment without delay or further deterioration. Option a is incorrect because delaying assessment of suspected peritonitis allows infection to spread and damage the peritoneum itself permanently. Waiting until tomorrow could lead to sepsis or permanent loss of the dialysis modality for this stable home dialysis client. Option b is incorrect because drinking water does not address an intra-abdominal infection in any meaningful way at all. Hydration alone changes nothing about the cellular response within the peritoneal cavity that is causing the cloudy appearance of the effluent. Option c is incorrect because skipping exchanges does not treat infection and may allow uremia to develop quickly in the meantime. The cloudy appearan

Correct Answer: Calcium gluconate intravenously over minutes

Calcium gluconate stabilizes the cardiac membrane during dangerous hyperkalemia accompanied by electrocardiogram changes such as peaked T waves. Subsequent interventions include insulin with dextrose to drive potassium into cells while dialysis is arranged for definitive potassium removal from the body. Option b is incorrect because cation exchange resins act over hours and cannot address an acute cardiac threat in any meaningful timeframe. Their role has narrowed under current guidelines because of bowel necrosis risk and limited evidence. Option c is incorrect because erythropoietin treats anemia of chronic kidney disease but has no role in acute potassium management. The timing of this question targets the immediate cardiac emergency, not the long-term hematologic care of chronic renal disease. Option d is incorrect because phosphate binders help control hyperphosphatemia, not hyperkalemia, in chronic kidney disease patients. Their slower mechanism is entirely unrelated to the acute

Correct Answer: Begin aggressive intravenous hydration

Hydration reduces blood viscosity and helps unblock the microcirculation during a sickle cell vaso-occlusive crisis. Combined with pain management and oxygen as needed, fluid therapy interrupts the sickling cascade and shortens the duration of each painful crisis episode. Option a is incorrect because fluid restriction increases blood viscosity and intensifies the sickling and stasis driving the crisis. The therapeutic direction in sickle cell disease always moves toward generous hydration, not limitation of fluid intake. Option b is incorrect because cold causes vasoconstriction and worsens the microvascular occlusion at the heart of sickle cell crisis. Warm packs may help relieve pain locally, but cold therapy is contraindicated and intensifies the underlying physiologic problem. Option d is incorrect because forcing ambulation during severe vaso-occlusive pain is impractical and lacks therapeutic benefit. Bed rest with comfort positioning and adequate oxygenation supports recovery d

Correct Answer: Obtain blood cultures and notify provider

Fever in a neutropenic client is a medical emergency requiring blood cultures and prompt broad-spectrum antibiotics within one hour. Even minor temperature elevations warrant immediate workup because untreated infection can become rapidly fatal in this severely immunosuppressed cancer population. Option a is incorrect because suppressing fever with acetaminophen masks the body's response to infection without addressing the underlying threat. Delaying culture collection and antibiotics jeopardizes survival when the immune system cannot fight infection on its own at all. Option c is incorrect because casual home remedies cannot substitute for emergent antimicrobial therapy in neutropenic fever. The window for effective intervention is brief, and supportive measures alone are completely inadequate during a high-risk fever event for cancer patients. Option d is incorrect because the neutropenic client needs protection from environmental organisms rather than droplet isolation for tran