HESI E2 HESI Exit Exam - Set 5 - Part 3

Correct Answer: Fat embolism syndrome developing

Long bone fractures release fat globules that lodge in the pulmonary capillaries, producing the classic triad of hypoxia, neurologic changes, and a petechial rash. Onset between twelve and seventy-two hours after injury fits the clinical picture in this scenario precisely. Option a is incorrect because wound infection presents with local redness, warmth, drainage, and fever rather than respiratory failure and a chest rash. The dramatic systemic features described here point well beyond any simple surgical site complication near the incision. Option b is incorrect because contact allergy produces a local rash at the site of contact, not a petechial pattern over the trunk with dyspnea and confusion. Allergic reactions also lack the acute pulmonary and neurologic findings featured here. Option d is incorrect because urinary infections produce dysuria, frequency, and possible flank pain rather than the constellation described in this clinical case. Systemic features of urosepsis would also

Correct Answer: Compartment syndrome in the affected extremity

Pain out of proportion to injury, unresponsive to opioids, and worsened by passive stretch is the hallmark of acute compartment syndrome. The nurse should notify the provider immediately for cast bivalving and assessment for fasciotomy of the involved compartment. Option b is incorrect because pressure injuries cause localized soreness rather than severe diffuse pain unresponsive to medication. Repositioning the affected limb cannot address rising pressure increases inside a closed and confined fascial muscle compartment at all. Option c is incorrect because anxiety pain typically responds to comfort measures and reassurance rather than escalating with any passive stretch maneuver. Dismissing this presentation as merely emotional misses a limb-threatening complication that demands urgent surgical intervention now. Option d is incorrect because routine post-cast pain responds to analgesics and does not worsen specifically with passive movement of the toes. The opioid-resistant character

Correct Answer: Approximately forty-five percent

The anterior trunk equals eighteen percent, the entire left arm contributes nine percent, and a full leg adds eighteen percent for a total of forty-five percent. This estimate guides Parkland formula fluid resuscitation during the emergent burn phase. Option a is incorrect because that estimate omits either the leg or the trunk from the totals. Underestimating burn surface area leads to inadequate fluid replacement and increases the risk of burn shock during the critical first day of resuscitation. Option b is incorrect because that total overestimates by adding extra surface beyond what the rule of nines specifies. Overestimating burn area causes fluid overload and pulmonary complications during resuscitation, including pulmonary edema and compartment syndromes from third-spacing fluids. Option d is incorrect because that figure leaves out the arm percentage from the calculation. Missing nine percent in a major burn means hundreds of milliliters less fluid than the Parkland formula re

Correct Answer: Contact precautions with private room

Localized herpes zoster requires standard plus contact precautions, with covering of the lesions and ideally a private room to protect non-immune individuals. Disseminated zoster or zoster in immunocompromised clients requires airborne and contact precautions instead of contact alone. Option a is incorrect because standard precautions alone do not address the contact spread of vesicular fluid from any active zoster lesions. Failing to add contact precautions could expose susceptible visitors and staff to varicella infection through direct lesion contact. Option c is incorrect because droplet precautions target respiratory pathogens spread by large particles such as influenza or pertussis. Localized vesicular shingles requires direct contact transmission isolation rather than droplet barriers around the bed or face. Option d is incorrect because negative pressure rooms are reserved for confirmed airborne pathogens such as pulmonary tuberculosis or disseminated zoster cases. Routine derm

Correct Answer: Tumor lysis syndrome developing

Rapid cell death from chemotherapy releases intracellular contents that produce hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia. Hydration, allopurinol or rasburicase, and electrolyte management form the backbone of prevention and treatment for tumor lysis syndrome in this client. Option a is incorrect because the serum calcium is low rather than high, the opposite of hypercalcemia of malignancy. The full electrolyte pattern here only fits one specific oncologic emergency that follows the start of cytotoxic chemotherapy. Option b is incorrect because allergic chemotherapy reactions present with rash, bronchospasm, hypotension, or anaphylaxis rather than this electrolyte pattern. The mechanism of immune-mediated reaction has no direct link to these specific biochemical shifts shown on labs. Option d is incorrect because contrast nephropathy raises creatinine and urea but does not produce this specific tetrad of electrolytes. The triggering event in this scenar

Correct Answer: Metabolic alkalosis without compensation

Prolonged vomiting loses hydrochloric acid, raising the bicarbonate level and producing metabolic alkalosis. The unchanged PaCO2 reflects minimal respiratory compensation by the lungs, fitting the pattern of an acute metabolic disturbance from gastric acid loss through repeated vomiting. Option b is incorrect because respiratory alkalosis features a low PaCO2 from increased ventilation through the lungs. The carbon dioxide level here remains normal, ruling out a primary respiratory cause for the alkaline pH that the gas displays clearly. Option c is incorrect because metabolic acidosis presents with a low pH and low bicarbonate, the opposite of these laboratory values. Dehydration can cause acidosis when perfusion fails, but this blood gas does not show that pattern. Option d is incorrect because respiratory acidosis includes a low pH and elevated PaCO2 from inadequate ventilation of the lungs. The actual pH here is alkalotic and the carbon dioxide is normal, so this respiratory patter

Correct Answer: Initiate norepinephrine infusion through central line

Persistent hypotension after adequate fluid resuscitation in septic shock requires vasopressor support to maintain a mean arterial pressure of at least 65 mmHg. Norepinephrine is the first-line vasopressor per current Surviving Sepsis Campaign guidelines for this indication. Option a is incorrect because withholding fluids while the client remains hypotensive risks worsening tissue hypoperfusion in major organs. Reassessment guides further fluid use carefully, but blanket restriction does not address the persistent shock state described in the scenario. Option b is incorrect because oral medications have unpredictable absorption in shock states, and corticosteroids are reserved for refractory cases only. Intravenous hydrocortisone may be added later when vasopressors fail to stabilize the hemodynamics adequately for the client. Option c is incorrect because transfusion targets active bleeding or hemoglobin below seven in critically ill patients. Without active bleeding or severe anemia

Correct Answer: Intramuscular epinephrine to lateral thigh

Intramuscular epinephrine in the lateral thigh is the immediate first-line treatment for anaphylaxis and reverses bronchospasm, vasodilation, and hypotension within minutes. The standard adult dose is 0.3 to 0.5 mg using the 1 mg per mL concentration injected promptly. Option b is incorrect because oral antihistamines act too slowly and cannot rescue from acute airway compromise from edema. Diphenhydramine has an adjunct role intravenously after epinephrine has been given but never replaces the immediate lifesaving injection of epinephrine itself. Option c is incorrect because corticosteroids have a delayed onset measured in hours and prevent biphasic reactions rather than treating the acute event. Their place in management follows epinephrine, not as the primary rescue medication during shock and airway compromise. Option d is incorrect because insulin treats hyperglycemia and has no role in anaphylaxis management at any point during the reaction. Mistakenly delivering insulin during

Correct Answer: Neurogenic shock from sympathetic loss

Neurogenic shock from a high spinal cord injury removes sympathetic tone, producing the unusual combination of bradycardia and hypotension with warm dry skin below the lesion. Treatment includes intravenous fluids, vasopressors, and atropine for symptomatic bradycardia in the acute phase. Option a is incorrect because anaphylaxis brings tachycardia, urticaria, and bronchospasm rather than bradycardia paired with warm dry skin. The IgE-mediated picture would also include some recent exposure history that the scenario described above does not mention at all. Option b is incorrect because hypovolemic shock causes tachycardia from compensation and cool clammy skin from vasoconstriction in the periphery. The opposite physiologic findings here indicate a different mechanism altogether driving the circulatory failure in this client. Option c is incorrect because cardiogenic shock features pump failure with pulmonary congestion, elevated venous pressures, and cool extremities. None of these si

Correct Answer: Establish patent airway with cervical spine protection

Trauma assessment follows the ABCDE sequence, and airway with cervical spine stabilization always comes first. Stridor signals a compromised upper airway that requires immediate intervention before circulation, neurologic checks, or extremity injuries are addressed in sequence. Option b is incorrect because femur stabilization belongs to the secondary survey after life threats are resolved. Orthopedic care matters greatly but cannot precede establishing a protected airway when the client presents with obvious upper airway compromise. Option c is incorrect because external bleeding from a scalp wound is rarely the immediate threat to life. Pressure dressings come during the circulation step after the airway has been secured and breathing has been assessed. Option d is incorrect because vascular access supports the circulation phase of the assessment sequence. Establishing IV lines without first addressing a partially obstructed airway risks rapid deterioration into hypoxia and cardiac a