1|Page
EVOLVE ELSEVIER HESI MED-SURG TEST EXAM|| ACCURATE AND
FREQUENTLY TESTED QUESTIONS AND 100% CORRECT ANSWERS WITH
RATIONALES|| LATEST AND COMPLETE UPDATE WITH EXPERT
VERIFIED SOLUTIONS
The nurse notes that a client who is scheduled for surgery the next morning has an
elevated blood urea nitrogen (BUN) level. Which condition is most likely to have
contributed to this finding?
A. Myocardial infarction 2 months ago
B. Anorexia and vomiting for the past 2 days
C. Recently diagnosed type 2 diabetes mellitus
D. Skeletal traction for a right hip fracture - ANSWER: Correct Answer: B
Rationale: The blood urea nitrogen (BUN) level indicates the effectiveness of the
kidneys in filtering waste from the blood. Dehydration, which could be caused by
vomiting, would cause an increased BUN level. Option A would affect serum enzyme
levels, not the BUN level. Option C would primarily affect the blood glucose level;
renal failure that could increase the BUN level would be unlikely in a client newly
diagnosed with type 2 diabetes. Effects of option D might affect the complete blood
count (CBC) but would not directly increase the BUN level.
Which instruction is best for the nurse to provide to a client with emphysema and
chronic fatigue?
A."Pace your activities and schedule rest periods." B."Increase the amount of oxygen
you use at night."
C."Obtain medical evaluation for antibiotic therapy."
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D."Reduce your intake of fluids containing caffeine." - ANSWER: Correct Answer: A
Rationale: Manifestations of emphysema include an increase in AP diameter (referred
to as a barrel chest), nail bed clubbing, and fatigue. The nurse can provide instructions
to promote energy management, such as pacing activities and scheduling rest periods.
Option B may result in a decreased drive to breathe. The client is not exhibiting any
symptoms of infection, so option C is not necessary.
Option D is less beneficial than option A.
Which nursing action would be appropriate for a client who is newly diagnosed with
Cushing syndrome?
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu. - ANSWER: Correct Answer: A
Rationale: Cushing syndrome results from a hypersecretion of glucocorticoids in the
adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus.
Monitoring of serum glucose levels assesses for increased blood glucose levels so that
treatment can begin early. A common finding in Cushing syndrome is generalized
edema. Although potassium is needed, it is generally obtained from food intake, not
by offering potassium-enhanced fluids. Fatigue is usually not an overwhelming factor
in Cushing syndrome, so an emphasis on the need for rest is not indicated. A low-
calorie, low-carbohydrate, low-sodium diet is not recommended.
,3|Page
During the change of shift report, the charge nurse reviews the infusions being
received by clients on the oncology unit. The client receiving which infusion should be
assessed first?
A. Continuous IV infusion of magnesium
B. One-time infusion of albumin
C. Continuous epidural infusion of morphine
D. Intermittent infusion of IV vancomycin - ANSWER: Correct Answer: C
Rationale: All four of these clients have the potential to have significant
complications. The client with the morphine epidural infusion is at highest risk for
respiratory depression and should be assessed first. Option A can cause hypotension.
The client receiving option B is at lowest risk for serious
complications. Although option D can cause nephrotoxicity and phlebitis, these
problems are not as immediately life threatening as option C.
A client who received a nephrotoxic drug is admitted with acute renal failure and asks
the nurse if dialysis will always be needed. Which pathophysiologic consequence should
the nurse explain that supports the need for temporary dialysis until acute tubular
necrosis subsides?
.
A. Azotemia
B. Oliguria
, 4|Page
C. Hyperkalemia
D. Nephron obstruction - ANSWER: Correct Answer: D
Rationale:CKD is characterized by progressive and irreversible destruction of
nephrons, frequently caused by hypertension and diabetes mellitus. Nephrotoxins
cause acute tubular necrosis, a reversible acute renal failure, which creates renal
tubular obstruction from endothelial cells that are sloughed or become edematous.
The obstruction of urine flow will resolve with the return of an adequate glomerular
filtration rate, and when it does, dialysis will no longer be needed.
Options A, B, and C are manifestations seen in the acute and chronic forms of kidney
disease.
A 74-year-old male client is admitted to the intensive care unit (ICU) with a diagnosis
of respiratory failure secondary to pneumonia. Currently, the client is ventilator-
dependent, with settings of tidal volume (VT) of 750 mL and an intermittent mandatory
ventilation (IMV) rate of 10 breaths/min. Arterial blood gas (ABG) results are as follows:
pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg; HCO3, 25 mEq/L; and FiO2, 0.80.
Which action should the nurse take first?
A.
Increase the ventilator VT to 850 mL. B.
Decrease the ventilator IMV to a rate of 8 breaths/min. C.
Reduce the FiO2 to 0.70 and redraw ABGs. D.
Add 5 cm positive end-expiratory pressure (PEEP). - ANSWER: Correct Answer: D
Rationale:
EVOLVE ELSEVIER HESI MED-SURG TEST EXAM|| ACCURATE AND
FREQUENTLY TESTED QUESTIONS AND 100% CORRECT ANSWERS WITH
RATIONALES|| LATEST AND COMPLETE UPDATE WITH EXPERT
VERIFIED SOLUTIONS
The nurse notes that a client who is scheduled for surgery the next morning has an
elevated blood urea nitrogen (BUN) level. Which condition is most likely to have
contributed to this finding?
A. Myocardial infarction 2 months ago
B. Anorexia and vomiting for the past 2 days
C. Recently diagnosed type 2 diabetes mellitus
D. Skeletal traction for a right hip fracture - ANSWER: Correct Answer: B
Rationale: The blood urea nitrogen (BUN) level indicates the effectiveness of the
kidneys in filtering waste from the blood. Dehydration, which could be caused by
vomiting, would cause an increased BUN level. Option A would affect serum enzyme
levels, not the BUN level. Option C would primarily affect the blood glucose level;
renal failure that could increase the BUN level would be unlikely in a client newly
diagnosed with type 2 diabetes. Effects of option D might affect the complete blood
count (CBC) but would not directly increase the BUN level.
Which instruction is best for the nurse to provide to a client with emphysema and
chronic fatigue?
A."Pace your activities and schedule rest periods." B."Increase the amount of oxygen
you use at night."
C."Obtain medical evaluation for antibiotic therapy."
,2|Page
D."Reduce your intake of fluids containing caffeine." - ANSWER: Correct Answer: A
Rationale: Manifestations of emphysema include an increase in AP diameter (referred
to as a barrel chest), nail bed clubbing, and fatigue. The nurse can provide instructions
to promote energy management, such as pacing activities and scheduling rest periods.
Option B may result in a decreased drive to breathe. The client is not exhibiting any
symptoms of infection, so option C is not necessary.
Option D is less beneficial than option A.
Which nursing action would be appropriate for a client who is newly diagnosed with
Cushing syndrome?
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu. - ANSWER: Correct Answer: A
Rationale: Cushing syndrome results from a hypersecretion of glucocorticoids in the
adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus.
Monitoring of serum glucose levels assesses for increased blood glucose levels so that
treatment can begin early. A common finding in Cushing syndrome is generalized
edema. Although potassium is needed, it is generally obtained from food intake, not
by offering potassium-enhanced fluids. Fatigue is usually not an overwhelming factor
in Cushing syndrome, so an emphasis on the need for rest is not indicated. A low-
calorie, low-carbohydrate, low-sodium diet is not recommended.
,3|Page
During the change of shift report, the charge nurse reviews the infusions being
received by clients on the oncology unit. The client receiving which infusion should be
assessed first?
A. Continuous IV infusion of magnesium
B. One-time infusion of albumin
C. Continuous epidural infusion of morphine
D. Intermittent infusion of IV vancomycin - ANSWER: Correct Answer: C
Rationale: All four of these clients have the potential to have significant
complications. The client with the morphine epidural infusion is at highest risk for
respiratory depression and should be assessed first. Option A can cause hypotension.
The client receiving option B is at lowest risk for serious
complications. Although option D can cause nephrotoxicity and phlebitis, these
problems are not as immediately life threatening as option C.
A client who received a nephrotoxic drug is admitted with acute renal failure and asks
the nurse if dialysis will always be needed. Which pathophysiologic consequence should
the nurse explain that supports the need for temporary dialysis until acute tubular
necrosis subsides?
.
A. Azotemia
B. Oliguria
, 4|Page
C. Hyperkalemia
D. Nephron obstruction - ANSWER: Correct Answer: D
Rationale:CKD is characterized by progressive and irreversible destruction of
nephrons, frequently caused by hypertension and diabetes mellitus. Nephrotoxins
cause acute tubular necrosis, a reversible acute renal failure, which creates renal
tubular obstruction from endothelial cells that are sloughed or become edematous.
The obstruction of urine flow will resolve with the return of an adequate glomerular
filtration rate, and when it does, dialysis will no longer be needed.
Options A, B, and C are manifestations seen in the acute and chronic forms of kidney
disease.
A 74-year-old male client is admitted to the intensive care unit (ICU) with a diagnosis
of respiratory failure secondary to pneumonia. Currently, the client is ventilator-
dependent, with settings of tidal volume (VT) of 750 mL and an intermittent mandatory
ventilation (IMV) rate of 10 breaths/min. Arterial blood gas (ABG) results are as follows:
pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg; HCO3, 25 mEq/L; and FiO2, 0.80.
Which action should the nurse take first?
A.
Increase the ventilator VT to 850 mL. B.
Decrease the ventilator IMV to a rate of 8 breaths/min. C.
Reduce the FiO2 to 0.70 and redraw ABGs. D.
Add 5 cm positive end-expiratory pressure (PEEP). - ANSWER: Correct Answer: D
Rationale:
