EVOLVE HESI MEDICAL-SURGICAL SPECIALTY EXAM NEXT-
GENERATION NCLEX-STYLE QUESTIONS WITH CORRECT
ANSWERS AND WELL-ELABORATED RATIONALES
1. A client who is 2 days post-operative following abdominal surgery
reports sudden onset of chest pain and dyspnea. The client appears
anxious and restless. Which condition should the nurse suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Incisional pain
Correct Answer: B Pulmonary embolism is a life-threatening
complication of surgery and immobility. The sudden onset of chest pain,
dyspnea, anxiety, and restlessness are classic signs of a pulmonary
embolism (PE). Atelectasis and pneumonia typically develop more
gradually with fever and productive cough. Incisional pain would not
cause sudden dyspnea and cyanosis.
2. A client with heart failure has crackles in the lung bases, jugular
venous distention, and 3+ pitting edema in the lower extremities.
Which medication should the nurse prepare to administer first?
A) Digoxin
B) Metoprolol
C) Furosemide
D) Spironolactone
Correct Answer: C Furosemide is a loop diuretic that rapidly reduces
,preload by promoting fluid excretion, relieving pulmonary congestion
and edema. Digoxin and beta-blockers are chronic therapies;
spironolactone is a potassium-sparing adjunctive diuretic.
3. A client with atrial fibrillation is prescribed warfarin. The nurse should
teach the client to avoid which food?
A) Apples
B) Rice
C) Broccoli
D) Chicken
Correct Answer: C Broccoli and other green leafy vegetables are high in
vitamin K, which can antagonize warfarin's effect and increase the risk
of clotting. Consistent intake is key, but large amounts should be
avoided. Apples, rice, and chicken have minimal vitamin K content.
4. A client with chronic kidney disease (CKD) is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
healthcare provider immediately before the procedure?
A) Serum potassium of 5.1 mEq/L
B) Serum sodium of 135 mEq/L
C) Hemoglobin of 10.2 g/dL
D) Serum calcium of 8.5 mg/dL
Correct Answer: A A serum potassium of 5.1 mEq/L is elevated. While
dialysis is used to correct hyperkalemia, a level approaching or
exceeding 5.0 mEq/L places the client at high risk for cardiac
dysrhythmias and requires immediate attention prior to initiating the
treatment. The other values are within or very close to normal ranges.
5. The nurse is caring for a client with severe cirrhosis who is exhibiting
asterixis and confusion. Which dietary modification is most appropriate
,for this client?
A) High-protein, high-sodium diet
B) Low-protein, low-sodium diet
C) High-carbohydrate, high-fat diet
D) Low-potassium, low-phosphorus diet
Correct Answer: B The client is showing signs of hepatic
encephalopathy. A low-protein diet is prescribed to reduce the buildup
of ammonia in the bloodstream. Sodium is restricted to prevent fluid
retention and worsening ascites. High-protein diets will exacerbate the
confusion.
6. A client with diabetes mellitus type 1 has a blood glucose level of 48
mg/dL and is unconscious. Which action should the nurse take first?
A) Administer 50% dextrose IV push
B) Give 4 ounces of orange juice orally
C) Administer glucagon 1 mg intramuscularly
D) Recheck the blood glucose level in 15 minutes
Correct Answer: A The client is unconscious and cannot safely swallow
oral fluids. The priority is to rapidly increase the blood glucose level.
Administering 50% dextrose IV push is the fastest and safest way to
reverse severe hypoglycemia in an unconscious patient.
7. A client with chronic obstructive pulmonary disease (COPD) has a
pulse oximetry reading of 86% on room air. The nurse should first:
A) Increase the oxygen flow rate to 4 L/min via nasal cannula
B) Apply a non-rebreather mask at 15 L/min
C) Assess the client's respiratory rate and depth
D) Notify the healthcare provider immediately
Correct Answer: C The first action is to assess the client. The nurse must
evaluate the client's overall respiratory status, including rate, depth,
, and effort, as well as auscultate lung sounds, to determine the cause of
the desaturation before intervening. Oxygen therapy is then adjusted
based on the assessment.
8. A client is receiving a continuous heparin infusion for a deep vein
thrombosis. The nurse should monitor which laboratory value most
closely to evaluate the therapeutic effect of the medication?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C aPTT is the primary laboratory test used to monitor
heparin therapy. The therapeutic range for aPTT on heparin is typically
1.5 to 2.5 times the control value. PT and INR monitor warfarin therapy.
9. A client with a history of alcohol abuse is admitted with acute
pancreatitis. Which finding is most indicative of this condition?
A) Pain in the right upper quadrant radiating to the right shoulder
B) Severe epigastric pain radiating to the back
C) Intermittent lower abdominal cramping
D) Burning pain in the midepigastric region relieved by food
Correct Answer: B Severe epigastric or mid-abdominal pain that
radiates to the back is the hallmark symptom of acute pancreatitis. The
pain is often described as boring or penetrating. Right upper quadrant
pain is associated with gallbladder disease.
10. A client is prescribed furosemide (Lasix) for heart failure. Which of
the following foods should the nurse encourage to prevent a potential
side effect of this medication?
A) Bananas
GENERATION NCLEX-STYLE QUESTIONS WITH CORRECT
ANSWERS AND WELL-ELABORATED RATIONALES
1. A client who is 2 days post-operative following abdominal surgery
reports sudden onset of chest pain and dyspnea. The client appears
anxious and restless. Which condition should the nurse suspect?
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Incisional pain
Correct Answer: B Pulmonary embolism is a life-threatening
complication of surgery and immobility. The sudden onset of chest pain,
dyspnea, anxiety, and restlessness are classic signs of a pulmonary
embolism (PE). Atelectasis and pneumonia typically develop more
gradually with fever and productive cough. Incisional pain would not
cause sudden dyspnea and cyanosis.
2. A client with heart failure has crackles in the lung bases, jugular
venous distention, and 3+ pitting edema in the lower extremities.
Which medication should the nurse prepare to administer first?
A) Digoxin
B) Metoprolol
C) Furosemide
D) Spironolactone
Correct Answer: C Furosemide is a loop diuretic that rapidly reduces
,preload by promoting fluid excretion, relieving pulmonary congestion
and edema. Digoxin and beta-blockers are chronic therapies;
spironolactone is a potassium-sparing adjunctive diuretic.
3. A client with atrial fibrillation is prescribed warfarin. The nurse should
teach the client to avoid which food?
A) Apples
B) Rice
C) Broccoli
D) Chicken
Correct Answer: C Broccoli and other green leafy vegetables are high in
vitamin K, which can antagonize warfarin's effect and increase the risk
of clotting. Consistent intake is key, but large amounts should be
avoided. Apples, rice, and chicken have minimal vitamin K content.
4. A client with chronic kidney disease (CKD) is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
healthcare provider immediately before the procedure?
A) Serum potassium of 5.1 mEq/L
B) Serum sodium of 135 mEq/L
C) Hemoglobin of 10.2 g/dL
D) Serum calcium of 8.5 mg/dL
Correct Answer: A A serum potassium of 5.1 mEq/L is elevated. While
dialysis is used to correct hyperkalemia, a level approaching or
exceeding 5.0 mEq/L places the client at high risk for cardiac
dysrhythmias and requires immediate attention prior to initiating the
treatment. The other values are within or very close to normal ranges.
5. The nurse is caring for a client with severe cirrhosis who is exhibiting
asterixis and confusion. Which dietary modification is most appropriate
,for this client?
A) High-protein, high-sodium diet
B) Low-protein, low-sodium diet
C) High-carbohydrate, high-fat diet
D) Low-potassium, low-phosphorus diet
Correct Answer: B The client is showing signs of hepatic
encephalopathy. A low-protein diet is prescribed to reduce the buildup
of ammonia in the bloodstream. Sodium is restricted to prevent fluid
retention and worsening ascites. High-protein diets will exacerbate the
confusion.
6. A client with diabetes mellitus type 1 has a blood glucose level of 48
mg/dL and is unconscious. Which action should the nurse take first?
A) Administer 50% dextrose IV push
B) Give 4 ounces of orange juice orally
C) Administer glucagon 1 mg intramuscularly
D) Recheck the blood glucose level in 15 minutes
Correct Answer: A The client is unconscious and cannot safely swallow
oral fluids. The priority is to rapidly increase the blood glucose level.
Administering 50% dextrose IV push is the fastest and safest way to
reverse severe hypoglycemia in an unconscious patient.
7. A client with chronic obstructive pulmonary disease (COPD) has a
pulse oximetry reading of 86% on room air. The nurse should first:
A) Increase the oxygen flow rate to 4 L/min via nasal cannula
B) Apply a non-rebreather mask at 15 L/min
C) Assess the client's respiratory rate and depth
D) Notify the healthcare provider immediately
Correct Answer: C The first action is to assess the client. The nurse must
evaluate the client's overall respiratory status, including rate, depth,
, and effort, as well as auscultate lung sounds, to determine the cause of
the desaturation before intervening. Oxygen therapy is then adjusted
based on the assessment.
8. A client is receiving a continuous heparin infusion for a deep vein
thrombosis. The nurse should monitor which laboratory value most
closely to evaluate the therapeutic effect of the medication?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C aPTT is the primary laboratory test used to monitor
heparin therapy. The therapeutic range for aPTT on heparin is typically
1.5 to 2.5 times the control value. PT and INR monitor warfarin therapy.
9. A client with a history of alcohol abuse is admitted with acute
pancreatitis. Which finding is most indicative of this condition?
A) Pain in the right upper quadrant radiating to the right shoulder
B) Severe epigastric pain radiating to the back
C) Intermittent lower abdominal cramping
D) Burning pain in the midepigastric region relieved by food
Correct Answer: B Severe epigastric or mid-abdominal pain that
radiates to the back is the hallmark symptom of acute pancreatitis. The
pain is often described as boring or penetrating. Right upper quadrant
pain is associated with gallbladder disease.
10. A client is prescribed furosemide (Lasix) for heart failure. Which of
the following foods should the nurse encourage to prevent a potential
side effect of this medication?
A) Bananas
