EVOLVE ELSEVIER HESI MEDICAL-SURGICAL ACTUAL EXAM
PREPARATION 200 EXAM QUESTIONS WITH COMPREHENSIVE
ANSWERS AND ELABORATED RATIONALES
1. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates the client is experiencing oxygen toxicity?
A. Increased respiratory rate
B. Cyanosis of the nail beds
C. Nonproductive cough and substernal pain
D. Bradycardia and hypotension
Correct Answer: C
Rationale: Oxygen toxicity is characterized by nonproductive cough,
substernal pain, nausea, vomiting, fatigue, and headache. These
symptoms occur when high concentrations of oxygen are administered
for extended periods. Option A indicates hypoxia or anxiety. Option B
indicates poor oxygenation. Option D is not associated with oxygen
toxicity.
2. A client with heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding requires immediate nursing intervention
before administering this medication?
A. Serum potassium level of 3.2 mEq/L
B. Blood pressure of 138/88 mm Hg
,C. Urine output of 30 mL/hour
D. Weight gain of 1 kg in 24 hours
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
A serum potassium level of 3.2 mEq/L is below normal (3.5-5.0 mEq/L)
and places the client at risk for cardiac dysrhythmias. The nurse should
notify the healthcare provider before administering the medication.
Option B is slightly elevated but not immediately concerning. Option C
is adequate urine output. Option D indicates fluid retention but does
not contraindicate furosemide administration.
3. The nurse is caring for a client with acute pancreatitis. Which
laboratory value is most indicative of this condition?
A. Elevated serum amylase
B. Decreased serum glucose
C. Elevated serum potassium
D. Decreased serum calcium
Correct Answer: A
Rationale: Serum amylase and lipase levels are elevated in acute
pancreatitis due to leakage of these enzymes from damaged pancreatic
cells. Serum amylase typically rises within 2-12 hours of onset and
remains elevated for 3-5 days. Option B would be seen in hypoglycemia.
Option C is not specific to pancreatitis. Option D may occur but is not
the primary diagnostic indicator.
,4. A client is 2 hours post-operative following a thyroidectomy. The
nurse assesses the client and notes stridor, hoarseness, and difficulty
breathing. What is the nurse's priority action?
A. Administer prescribed pain medication
B. Place the client in high Fowler's position
C. Prepare for emergency tracheostomy
D. Assess the surgical dressing for bleeding
Correct Answer: C
Rationale: Stridor, hoarseness, and difficulty breathing after
thyroidectomy indicate laryngeal edema or tracheal compression, which
can lead to airway obstruction. The nurse must prepare for emergency
tracheostomy while notifying the healthcare provider. Option B may
help but is not sufficient for this emergency. Option A would mask
symptoms. Option D does not address the immediate airway concern.
5. A client with diabetes mellitus type 1 is receiving insulin lispro
(Humalog). When should the nurse administer this medication in
relation to meals?
A. 30 minutes before meals
B. 60 minutes before meals
C. Immediately before meals or within 15 minutes after starting the
meal
D. 2 hours after meals
Correct Answer: C
, Rationale: Insulin lispro is a rapid-acting insulin with an onset of action
within 15 minutes, peak effect in 1-2 hours, and duration of 3-4 hours. It
should be administered immediately before meals or within 15 minutes
after starting the meal to match the postprandial glucose rise. Option A
is appropriate for regular insulin. Option B is too early. Option D is too
late.
6. The nurse is assessing a client with suspected pulmonary embolism.
Which finding is most consistent with this diagnosis?
A. Pleuritic chest pain and hemoptysis
B. Bradycardia and hypertension
C. Decreased respiratory rate and shallow breathing
D. Absent breath sounds in the right lower lobe
Correct Answer: A
Rationale: Pulmonary embolism typically presents with sudden onset of
pleuritic chest pain, dyspnea, tachypnea, tachycardia, and hemoptysis.
The classic triad includes pleuritic chest pain, dyspnea, and hemoptysis.
Option B describes bradycardia and hypertension, which is not typical.
Option C is opposite of expected tachypnea. Option D may indicate
atelectasis or pneumothorax rather than PE.
7. A client with cirrhosis has an order for spironolactone. Which
finding indicates the medication is having the desired effect?
A. Decreased abdominal girth
B. Increased serum potassium level
PREPARATION 200 EXAM QUESTIONS WITH COMPREHENSIVE
ANSWERS AND ELABORATED RATIONALES
1. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates the client is experiencing oxygen toxicity?
A. Increased respiratory rate
B. Cyanosis of the nail beds
C. Nonproductive cough and substernal pain
D. Bradycardia and hypotension
Correct Answer: C
Rationale: Oxygen toxicity is characterized by nonproductive cough,
substernal pain, nausea, vomiting, fatigue, and headache. These
symptoms occur when high concentrations of oxygen are administered
for extended periods. Option A indicates hypoxia or anxiety. Option B
indicates poor oxygenation. Option D is not associated with oxygen
toxicity.
2. A client with heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding requires immediate nursing intervention
before administering this medication?
A. Serum potassium level of 3.2 mEq/L
B. Blood pressure of 138/88 mm Hg
,C. Urine output of 30 mL/hour
D. Weight gain of 1 kg in 24 hours
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
A serum potassium level of 3.2 mEq/L is below normal (3.5-5.0 mEq/L)
and places the client at risk for cardiac dysrhythmias. The nurse should
notify the healthcare provider before administering the medication.
Option B is slightly elevated but not immediately concerning. Option C
is adequate urine output. Option D indicates fluid retention but does
not contraindicate furosemide administration.
3. The nurse is caring for a client with acute pancreatitis. Which
laboratory value is most indicative of this condition?
A. Elevated serum amylase
B. Decreased serum glucose
C. Elevated serum potassium
D. Decreased serum calcium
Correct Answer: A
Rationale: Serum amylase and lipase levels are elevated in acute
pancreatitis due to leakage of these enzymes from damaged pancreatic
cells. Serum amylase typically rises within 2-12 hours of onset and
remains elevated for 3-5 days. Option B would be seen in hypoglycemia.
Option C is not specific to pancreatitis. Option D may occur but is not
the primary diagnostic indicator.
,4. A client is 2 hours post-operative following a thyroidectomy. The
nurse assesses the client and notes stridor, hoarseness, and difficulty
breathing. What is the nurse's priority action?
A. Administer prescribed pain medication
B. Place the client in high Fowler's position
C. Prepare for emergency tracheostomy
D. Assess the surgical dressing for bleeding
Correct Answer: C
Rationale: Stridor, hoarseness, and difficulty breathing after
thyroidectomy indicate laryngeal edema or tracheal compression, which
can lead to airway obstruction. The nurse must prepare for emergency
tracheostomy while notifying the healthcare provider. Option B may
help but is not sufficient for this emergency. Option A would mask
symptoms. Option D does not address the immediate airway concern.
5. A client with diabetes mellitus type 1 is receiving insulin lispro
(Humalog). When should the nurse administer this medication in
relation to meals?
A. 30 minutes before meals
B. 60 minutes before meals
C. Immediately before meals or within 15 minutes after starting the
meal
D. 2 hours after meals
Correct Answer: C
, Rationale: Insulin lispro is a rapid-acting insulin with an onset of action
within 15 minutes, peak effect in 1-2 hours, and duration of 3-4 hours. It
should be administered immediately before meals or within 15 minutes
after starting the meal to match the postprandial glucose rise. Option A
is appropriate for regular insulin. Option B is too early. Option D is too
late.
6. The nurse is assessing a client with suspected pulmonary embolism.
Which finding is most consistent with this diagnosis?
A. Pleuritic chest pain and hemoptysis
B. Bradycardia and hypertension
C. Decreased respiratory rate and shallow breathing
D. Absent breath sounds in the right lower lobe
Correct Answer: A
Rationale: Pulmonary embolism typically presents with sudden onset of
pleuritic chest pain, dyspnea, tachypnea, tachycardia, and hemoptysis.
The classic triad includes pleuritic chest pain, dyspnea, and hemoptysis.
Option B describes bradycardia and hypertension, which is not typical.
Option C is opposite of expected tachypnea. Option D may indicate
atelectasis or pneumothorax rather than PE.
7. A client with cirrhosis has an order for spironolactone. Which
finding indicates the medication is having the desired effect?
A. Decreased abdominal girth
B. Increased serum potassium level
