HESI MS HESI Medical and Surgical Exam - Set 2 - Part 2

Correct Answer: Hypovolemia with hypokalemia

During the diuretic phase, recovering nephrons produce large volumes of urine, excreting fluid and electrolytes at a rate that can cause hypovolemia, hypotension, and hypokalemia. The tachycardia and low blood pressure confirm volume depletion requiring IV fluid replacement. Option a is incorrect because hyperkalemia and fluid overload are characteristic of the oliguric phase, when the kidneys cannot excrete water or potassium. The diuretic phase is defined by the opposite problem: excessive loss of both fluid and potassium. Option b is incorrect because urine specific gravity is typically low during the diuretic phase, reflecting the kidneys' still-limited ability to concentrate urine even as volume increases. An elevated specific gravity would suggest concentrated output incompatible with diuresis. Option d is incorrect because serum creatinine gradually declines during the diuretic phase as nephron function improves, though it remains elevated above normal. Worsening creatinine

Correct Answer: NSAIDs and aspirin

NSAIDs and aspirin are specifically avoided in polycystic kidney disease because both impair renal blood flow and can trigger bleeding from ruptured cysts. Their nephrotoxic and antiplatelet effects worsen renal function and increase hemorrhagic complications. Option a is incorrect because opioid analgesics are actually appropriate for managing significant cyst pain in PKD when other methods are insufficient. Their use is not specifically contraindicated in this disease and they do not carry the nephrotoxic or bleeding risks that NSAIDs do. Option b is incorrect because acetaminophen at moderate doses is generally the preferred non-opioid analgesic for mild pain in PKD clients, as it lacks the nephrotoxicity and antiplatelet effects of NSAIDs when used within safe dosing limits. Option c is incorrect because antihistamines are not a primary pain management tool in PKD and are not specifically contraindicated for cyst pain. Advising against antihistamines misses the clinically important

Correct Answer: Transition to oral glucocorticoids when stable.

As the acute crisis resolves and hemodynamic stability returns, the next step is transitioning from IV to oral glucocorticoid therapy. The client should receive oral hydrocortisone or equivalent once tolerating oral intake, and mineralocorticoid replacement can be addressed as well during this transition. Option b is incorrect because the potassium of 5.2 mEq/L is at the upper end of normal and reflects the resolving hyperkalemia typical of addisonian crisis. Adding IV potassium to a level that is already near the upper limit would risk inducing hyperkalemia and potentially fatal dysrhythmias. Option c is incorrect because discontinuing IV fluids precipitously when sodium is still below 135 mEq/L and the crisis is still resolving risks re-emergence of hypotension. IV fluid support should be tapered gradually based on serial sodium values and clinical assessment, not stopped abruptly at blood pressure improvement. Option d is incorrect because Option d is incorrect as a stand-alone prio

Correct Answer: Lisinopril given before dialysis

Antihypertensive medications such as lisinopril are withheld before hemodialysis because the dialysis process itself removes fluid and lowers blood pressure; adding an antihypertensive beforehand risks dangerous hypotension during the session. Option a is incorrect because giving digoxin after dialysis rather than before is actually appropriate practice. Dialysis can lower serum potassium, increasing digoxin toxicity risk, so post-dialysis administration along with electrolyte monitoring is the safer approach. Option c is incorrect because water-soluble vitamins are dialyzable and should be given after the session, not before, to prevent them from being removed from the bloodstream during treatment. Giving them before dialysis renders the dose ineffective. Option d is incorrect because withholding all medications without provider guidance is an independent nursing decision that may delay essential treatments. The nurse should clarify specific medications — particularly antihypertensive

Correct Answer: It controls catecholamine release during tumor manipulation.

Alpha-adrenergic blockade must be established before surgery on a pheochromocytoma. Without it, surgical manipulation of the tumor releases massive amounts of epinephrine and norepinephrine, causing hypertensive crisis that can result in stroke, myocardial infarction, or death on the operating table. Option a is incorrect because while phenoxybenzamine does lower blood pressure, the key purpose in this preoperative context is specifically to block the catecholamine surge triggered by tumor handling during surgery, not simply to protect the kidneys from chronic hypertension. Option b is incorrect because phenoxybenzamine acts on vascular alpha-1 receptors and has no therapeutic role in bladder relaxation. Urological agents such as tamsulosin target alpha-1 receptors in the prostate and bladder neck, which is an entirely different indication from preoperative pheochromocytoma management. Option d is incorrect because pheochromocytoma is an adrenal medulla tumor that causes catecholamine

Correct Answer: Limit oxalate-rich foods and maintain hydration.

Calcium oxalate stones form when urinary oxalate is elevated. Limiting foods high in oxalate such as spinach, chocolate, nuts, and tea — combined with drinking up to 3000 mL of fluid daily — dilutes the urine and reduces the supersaturation that drives stone formation. Option a is incorrect because dark leafy vegetables like spinach and nuts are among the highest oxalate-containing foods. Recommending them to a client who already formed an oxalate stone would accelerate recurrence rather than prevent it. Option b is incorrect because high-purine foods such as sardines and organ meats elevate urinary uric acid and are implicated in uric acid stone formation, not calcium oxalate stones. Recommending them is both irrelevant and counterproductive for this stone type. Option c is incorrect because consuming excess dairy actually increases urinary calcium excretion, which combines with oxalate in the urine to form more calcium oxalate crystals. While some research supports moderate calcium i

Correct Answer: Acute rejection

Fever, graft site tenderness, rapid weight gain from fluid retention, and a sharply rising creatinine within the first weeks post-transplant are the hallmark signs of acute rejection. Acute rejection can occur within one week and up to years later but is most common in the early post-transplant period, and it may be reversible with increased immunosuppression. Option b is incorrect because hyperacute rejection occurs within 48 hours of transplantation due to preformed antibodies and results in immediate graft failure requiring surgical removal. At one week post-transplant, hyperacute rejection is no longer the timeline in question. Option c is incorrect because a wound infection at the incision site would present primarily with local erythema, purulent drainage, and skin warmth without the systemic pattern of rising creatinine and rapid weight gain characteristic of renal graft dysfunction. Option d is incorrect because a urinary tract infection would cause dysuria, cloudy urine, and p

Correct Answer: Mix glargine with regular in one syringe.

Insulin glargine must never be mixed with any other insulin in the same syringe. Its clear, acidic formulation is chemically incompatible with other insulins, and mixing alters the pharmacokinetics of both agents, rendering the controlled long-acting release profile unpredictable. Option a is incorrect because rotating injection sites within one anatomical region is exactly what clients should do to prevent lipodystrophy. This practice is correct and requires no clarification. Option c is incorrect because open vials of insulin may be stored at room temperature for up to 28 days in most cases; refrigerating an open vial is optional and client preference-based. Storing at room temperature is an acceptable and common practice. Option d is incorrect because checking the expiration date before using a new vial is a correct and essential safety step. Expired insulin has degraded potency and can lead to poor glycemic control.

Correct Answer: Prepare for urinary catheterization.

Nine hours of urinary retention with a palpable, distended bladder constitutes acute urinary retention requiring immediate catheterization to decompress the bladder, prevent bladder rupture, and protect renal function from back-pressure injury. The medication takes time to work and cannot relieve an acute obstruction already present. Option a is incorrect because increasing fluid intake will worsen bladder distention when outflow is obstructed. Adding more volume to a bladder that cannot empty increases pain and risks bladder wall ischemia without any therapeutic benefit. Option b is incorrect because a warm compress may relax perineal musculature and is sometimes used for mild hesitancy, but it cannot overcome the anatomical obstruction from a hypertrophied prostate causing nine hours of retention with severe distension. It is not an appropriate first-line response to this degree of retention. Option d is incorrect because the Valsalva maneuver increases intra-abdominal pressure to in

Correct Answer: Levothyroxine overdose

A suppressed TSH of 0.2 mclU/mL combined with elevated T4 and symptoms of tachycardia and insomnia indicates the levothyroxine dose is excessive, creating an iatrogenic hyperthyroid state. The PHCP should be notified to reduce the dose before cardiovascular complications worsen. Option a is incorrect because adequate response to levothyroxine would normalize TSH into the 2 to 10 mclU/mL reference range without producing symptoms. A suppressed TSH and clinical signs of excess hormone activity confirm overdose, not a therapeutic response. Option b is incorrect because persistent hypothyroidism would produce an elevated TSH alongside low T4 and ongoing symptoms of cold intolerance, weight gain, and fatigue. All of these are the opposite of what this client is experiencing. Option c is incorrect because thyroid storm is a life-threatening emergency seen in uncontrolled hyperthyroidism, featuring fever above 38 degrees C, severe tachycardia, agitation, and risk of death. This client's

Correct Answer: Renal calculi on imaging

Hyperparathyroidism causes sustained hypercalcemia, which promotes calcium precipitation in the renal tubules and collecting system, forming calcium-based renal stones. Bone pain and hypercalcemia together with constipation are classic findings of PTH excess, and kidney stones are a well-known consequence. Option b is incorrect because Chvostek's and Trousseau's signs indicate neuromuscular irritability from hypocalcemia, which is the opposite of what hyperparathyroidism produces. Excess PTH elevates serum calcium, eliminating the stimulus for these tetanic signs. Option c is incorrect because carpopedal spasm and muscle twitching are manifestations of hypocalcemia-induced tetany, seen in hypoparathyroidism or post-thyroidectomy calcium depletion. With a calcium of 12.8 mg/dL, the client's neuromuscular activity is suppressed, not hyperexcitable. Option d is incorrect because Option d is incorrect in part — low serum phosphorus is expected with hyperparathyroidism becaus

Correct Answer: Test drainage for presence of glucose.

Clear nasal drainage after transsphenoidal hypophysectomy may represent a cerebrospinal fluid leak, which is a serious complication. Testing the fluid for glucose is the initial action because CSF contains glucose, and a positive result confirms the leak and requires immediate PHCP notification. Option a is incorrect because lowering the head of the bed would increase intracranial pressure and worsen any CSF leak by raising the pressure gradient driving fluid out of the meningeal space. Post-hypophysectomy clients should have the head of the bed elevated. Option c is incorrect because obtaining a culture is appropriate for purulent or infected drainage, not for clear watery drainage that suggests CSF. Culture results would not identify a CSF leak and delay the more urgent glucose test that can confirm the diagnosis quickly. Option d is incorrect because blowing the nose after transsphenoidal surgery is explicitly contraindicated. It increases intracranial pressure and can force air or

Correct Answer: Damaged nephrons fail to produce erythropoietin.

Healthy nephrons secrete erythropoietin, which stimulates bone marrow to produce red blood cells. As CKD destroys nephrons, erythropoietin production drops, leaving the bone marrow without the signal to generate sufficient red cells, causing normocytic normochromic anemia. Option a is incorrect because CKD anemia is a production failure, not a hemolytic process. While uremic toxins can mildly shorten RBC survival, the dominant mechanism is reduced erythropoietin synthesis, not excessive destruction of existing red blood cells. Option b is incorrect because while GI bleeding and dialysis-related losses do contribute to iron depletion in CKD, the primary cause of renal anemia is insufficient erythropoietin, not dietary iron loss. Iron deficiency can be a concurrent problem but is not the foundational mechanism. Option d is incorrect because uremic toxins do not suppress thyroid function as a mechanism of anemia. The pathway from CKD to anemia runs through nephron destruction and erythrop

Correct Answer: 0.9% normal saline

The priority in HHS is aggressive fluid volume replacement to restore circulating volume and prevent cardiovascular collapse. Normal saline 0.9% is administered first to rehydrate rapidly, the same initial approach used in DKA, before transitioning to more hypotonic solutions as the glucose and osmolality begin to correct. Option a is incorrect because 50% dextrose would catastrophically worsen an already extreme hyperglycemia of 1120 mg/dL. This concentration is used exclusively to treat severe hypoglycemia and would be directly harmful to this client. Option b is incorrect because 0.45% normal saline is a hypotonic solution used after initial volume resuscitation is underway, not as the first fluid bolus. Starting with a hypotonic solution before restoring vascular volume risks cerebral edema and inadequate organ perfusion. Option c is incorrect because hypertonic saline is reserved for severe dilutional hyponatremia such as in SIADH. In HHS, the serum osmolality is already dangerous

Correct Answer: Uremic frost from advanced CKD

Uremic frost is a late sign of severe CKD in which urate crystals are excreted through the skin as the body attempts to compensate for the kidneys' inability to eliminate nitrogenous waste. It typically appears as white or yellowish powdery deposits and signals a critical level of uremia. Option b is incorrect because allergic dermatitis presents with erythema, vesicles, and pruritus at sites of allergen contact, not with white powdery deposits distributed across the trunk and arms. The powdery crystalline appearance is specifically associated with urate excretion through sweat glands. Option c is incorrect because hypernatremia does not produce skin deposits. Sodium does not accumulate visibly on the skin surface; rather, it affects intravascular and intracellular fluid distribution. This finding cannot be explained by sodium dynamics. Option d is incorrect because tophi are firm nodular urate deposits that form over joints and bursae in chronic tophaceous gout. They are distinct

Correct Answer: Methimazole, iodine preparation, propranolol, and glucocorticoids

Before thyroidectomy for hyperthyroidism, the standard regimen includes an antithyroid agent such as methimazole to block synthesis, iodine preparations to reduce vascularity and inhibit hormone release, propranolol to control tachycardia, and glucocorticoids to prevent adrenal insufficiency and reduce inflammation, together preventing intraoperative thyroid storm. Option a is incorrect because metformin treats type 2 diabetes and has no role in thyroid disease management. Aspirin is avoided in thyroid storm because it displaces thyroid hormone from binding proteins, raising free hormone levels — the opposite of what is needed preoperatively. Option c is incorrect because levothyroxine is thyroid hormone replacement for hypothyroidism; administering it to a hyperthyroid client before surgery would add circulating hormone and dramatically increase the risk of thyroid storm rather than preventing it. Option d is incorrect because radioactive iodine ablates thyroid tissue over weeks and i

Correct Answer: Reflects average blood glucose over three months.

HbA1c measures the percentage of hemoglobin that has glucose bound to it, providing a reliable average of blood glucose control over the prior three to four months, the lifespan of a red blood cell. A value below 6% is considered normal, and sustained elevation signals poor glycemic control with increased complication risk. Option a is incorrect because HbA1c does not measure a single point-in-time glucose level. It is independent of what the client ate or did the day before testing, making it a fundamentally different test from fasting plasma glucose, which reflects glucose at one moment. Option b is incorrect because HbA1c measures glucose-hemoglobin binding, not antibody activity. Tests for insulin antibodies are separate immunological assays used in evaluating type 1 diabetes pathophysiology, not in routine glycemic monitoring. Option d is incorrect because gastric emptying rate and glucose absorption from food are assessed differently, through tests like the oral glucose tolerance

Correct Answer: Apply cardiac monitoring and notify the PHCP.

ECG changes from hypokalemia — flattened T waves and U waves — indicate the heart is electrically unstable. Placing the client on continuous cardiac monitoring and notifying the PHCP is the immediate priority, because severe hypokalemia can precipitate ventricular dysrhythmias at any moment and IV potassium replacement may be urgently required. Option a is incorrect because with ECG changes already present at a potassium of 2.6 mEq/L, the rate of correction matters as much as the route. Oral supplementation absorbs slowly and may be insufficient for this degree of instability; IV replacement ordered by the PHCP is likely needed, and monitoring must happen simultaneously. Option b is incorrect because adrenalectomy is the definitive surgical treatment but cannot be performed emergently without first correcting the potassium level and achieving hemodynamic stability. Operating on a client with active dysrhythmia risk from hypokalemia endangers life. Option c is incorrect because dietary

Correct Answer: Costovertebral angle tenderness, fever, flank pain

Acute pyelonephritis presents with costovertebral angle tenderness, high fever, chills, flank pain, dysuria, and cloudy foul-smelling urine from bacterial infection of the renal pelvis and parenchyma. These findings distinguish it from lower urinary tract infections, which lack the flank pain and systemic fever. Option b is incorrect because periorbital edema, severe proteinuria, and hypoalbuminemia describe nephrotic syndrome, in which the glomerular membrane fails to retain protein. This is a glomerular disorder rather than an infectious/inflammatory condition of the renal collecting system. Option c is incorrect because painless hematuria, a palpable mass, and unexplained weight loss are the classic triad of renal cell carcinoma. These features do not characterize pyelonephritis, which is an acute infectious process producing pain and systemic inflammatory signs. Option d is incorrect because hypertension, bilateral edema, and oliguria suggest either glomerulonephritis or AKI with f

Correct Answer: See podiatrist; cut nails straight across.

Toenails in a diabetic with neuropathy should be cut straight across and smoothed with an emery board to prevent ingrown nails and microlacerations that serve as infection entry points. Referral to a podiatrist is also recommended because impaired sensation makes self-cutting hazardous. Option a is incorrect because rounding toenail edges increases the risk of the nail edge growing into the adjacent skin, causing an ingrown nail. In a neuropathic foot with poor wound healing, even a minor ingrown nail can develop into a serious infection requiring hospitalization. Option c is incorrect because soaking feet in a diabetic with neuropathy is actually contraindicated. The client cannot reliably detect water temperature and risks thermal burns, and prolonged moisture between the toes promotes fungal infection and skin maceration. Option d is incorrect because avoiding nail care entirely allows nails to grow long and curl, increasing injury risk, and open-toed shoes fail to protect the feet