NR 324: Adult Health II HESI Benchmark Final Exam Comprehensive The Complete Exam Preparation Mastery Manual: Advanced Study Guide, Extensive Test Bank Review, Full-Length Practice Questions, and Final Knowledge Assessment

A client with diabetes insipidus has a urine output of 500 mL/hour, severe thirst, dry mucous membranes, and tachycardia. Which laboratory finding requires the nurse to intervene most urgently? A. Serum sodium of 185 mEq/L B. Urine specific gravity of 1.002 C. Serum glucose of 118 mg/dL D. Hematocrit of 48% Correct Answer: A. Serum sodium of 185 mEq/L Rationale: A serum sodium level of 185 mEq/L indicates severe, potentially life-threatening hypernatremia resulting from significant free-water loss. Severe hypernatremia can cause cerebral dehydration, seizures, coma, and death and requires prompt fluid replacement and treatment of the underlying hormone deficiency. Very dilute urine is expected with diabetes insipidus. The glucose level is within normal limits, while the mildly elevated hematocrit reflects dehydration but is less immediately critical. Question 2 A client reports recurrent upper abdominal discomfort during an admission assessment. Which description is most suggestive of peptic ulcer disease? A. Cramping lower abdominal pain relieved by defecation B. Gnawing or burning epigastric pain associated with meals C. Sharp right upper-quadrant pain after eating fatty foods D. Diffuse abdominal pain accompanied by bloody diarrhea Correct Answer: B. Gnawing or burning epigastric pain associated with meals Rationale: Peptic ulcer disease commonly causes gnawing, aching, or burning pain in the epigastric region. The relationship between pain and meals may vary depending on whether the ulcer is gastric or duodenal. Lower abdominal cramping is more characteristic of intestinal disorders. Right upper-quadrant pain after fatty meals suggests gallbladder disease, while bloody diarrhea may occur with inflammatory or infectious intestinal disorders. Question 3 A client newly diagnosed with Graves disease has exophthalmos, eye irritation, and difficulty completely closing the eyelids. Which intervention should the nurse include in the care plan? A. Restrict oral fluid intake B. Administer levothyroxine as prescribed C. Apply artificial tears at regular intervals D. Keep the client in a darkened room continuously Correct Answer: C. Apply artificial tears at regular intervals Rationale: Exophthalmos can prevent complete eyelid closure, exposing the cornea to excessive dryness and increasing the risk of irritation, ulceration, and infection. Artificial tears and lubricating ointments help protect the corneal surface. Levothyroxine is used to treat hypothyroidism rather than Graves disease. Fluid restriction does not address the eye manifestations, and continuous darkness is unnecessary, although sunglasses may help reduce photophobia and environmental irritation. Question 4 A client with amyotrophic lateral sclerosis (ALS) is developing progressive respiratory muscle weakness. Which interventions should the nurse implement to decrease the risk of pulmonary complications? Select all that apply. A. Encourage the use of an incentive spirometer B. Teach deep-breathing and coughing exercises C. Provide chest physiotherapy as indicated D. Restrict fluids to decrease respiratory secretions E. Maintain the client in a flat supine position F. Monitor respiratory effort and vital capacity Correct Answers: A, B, C, and F Rationale: ALS progressively weakens the respiratory and bulbar muscles, increasing the risk of retained secretions, atelectasis, aspiration, and respiratory failure. Incentive spirometry, deep-breathing exercises, assisted coughing, chest physiotherapy, and respiratory monitoring can help maintain ventilation and secretion clearance. Fluids are generally encouraged unless contraindicated. A flat supine position may impair breathing and increase aspiration risk, particularly when bulbar dysfunction is present. Question 5 A client hospitalized with acute decompensated heart failure has severe dyspnea and bilateral pulmonary crackles. Which position should the nurse use to promote lung expansion and decrease venous return to the heart? A. Flat supine position B. High-Fowler position with the legs dependent C. Trendelenburg position D. Prone position with the head turned laterally Correct Answer: B. High-Fowler position with the legs dependent Rationale: High-Fowler positioning promotes maximum lung expansion and allows blood to pool in the lower extremities, decreasing venous return and cardiac preload. This can reduce pulmonary congestion and improve breathing. Supine and Trendelenburg positions increase venous return and may worsen dyspnea. Although prone positioning can improve oxygenation in selected respiratory conditions, it is not the first positioning intervention for acute heart failure. Question 6 A client with a fractured femur is immobilized in a traction splint while awaiting surgery. The nurse notices that the pedal pulse in the affected extremity is weaker than it was one hour earlier. Which actions should the nurse take? Select all that apply. A. Assess the pulse using a Doppler device B. Inspect the splint for excessive pressure C. Document the finding and reassess in eight hours D. Assess for pain, pallor, paresthesia, paralysis, and coolness E. Increase the traction weight immediately F. Notify the healthcare provider of the change Correct Answers: A, B, D, and F Rationale: A diminished distal pulse may indicate neurovascular compromise caused by swelling, arterial injury, compartment syndrome, or excessive pressure from the splint. The nurse should verify the pulse, perform a complete neurovascular assessment, inspect the splint, and promptly report the deterioration. Delaying reassessment could result in permanent tissue damage. Traction weights should not be changed without an appropriate prescription. Question 7 A client's chest radiograph confirms pneumonia. Which diagnostic test is most useful for selecting targeted antimicrobial therapy? A. Sputum culture and sensitivity B. Computed tomography of the chest C. Pulmonary function testing D. Serum electrolyte measurement Correct Answer: A. Sputum culture and sensitivity Rationale: A sputum culture can identify the causative organism, while sensitivity testing helps determine which antimicrobial agents are likely to be effective. The specimen should ideally be collected before antibiotic therapy begins. CT imaging may identify structural abnormalities or complications but does not routinely determine the appropriate antibiotic. Pulmonary function testing and electrolyte measurements provide additional clinical information but do not identify the infectious organism. Question 8 A client with chronic bronchitis and asthma reports thick, tenacious respiratory secretions and increasing shortness of breath with activity. Which self-care instruction is most important for improving secretion clearance? A. Limit oral fluid intake after 6:00 p.m. B. Increase oral fluid intake if not contraindicated C. Remain in bed until the cough resolves D. Use cough suppressants at regular intervals Correct Answer: B. Increase oral fluid intake if not contraindicated Rationale: Adequate hydration helps thin thick respiratory secretions, making them easier to mobilize and expectorate. Bed rest may contribute to secretion retention, while routine cough suppression can interfere with effective airway clearance. Fluids should be restricted only when another condition, such as severe heart or kidney failure, requires restriction. Humidification, prescribed bronchodilators, and controlled coughing may also assist with secretion clearance. Question 9 A client is learning to self-administer insulin into the abdomen. Which action demonstrates correct understanding of injection-site management? A. Injecting repeatedly into the exact same location B. Rotating injection points within the same anatomical region C. Massaging the injection site vigorously after each injection D. Injecting through clothing to reduce discomfort Correct Answer: B. Rotating injection points within the same anatomical region Rationale: Rotating injection sites within the same anatomical region promotes predictable insulin absorption while reducing the risk of lipohypertrophy and tissue damage. Repeated injections into one location can cause abnormal fatty deposits and inconsistent absorption. Vigorous massage may alter absorption and cause bruising. Insulin should be administered through clean, exposed skin rather than through clothing. Question 10 A nurse observes an increasing number of blood clots in the tubing of a client receiving continuous bladder irrigation after a transurethral resection of the prostate (TURP). What should the nurse do first? A. Stop the irrigation completely B. Increase the irrigation flow rate C. Remove the urinary catheter D. Administer an antispasmodic medication Correct Answer: B. Increase the irrigation flow rate Rationale: Increasing the irrigation flow rate helps prevent blood clots from accumulating and obstructing the catheter, which could lead to bladder distention. The nurse should then assess urinary drainage, bladder fullness, and catheter patency. Stopping the irrigation may promote further clot accumulation. Catheter removal is inappropriate during the immediate postoperative period, and an antispasmodic does not resolve clot-related obstruction.