Evolve Elsevier HESI Med Surg
Exam Questions and Answers
Verified Solutions Latest Update
Question:
The nurse should be correct in withholding a dose of digoxin in a client with congestive
heart failure without specific instruction from the healthcare provider if the client's A)
serum digoxin level is 1.5. B) blood pressure is 104/68. C) serum potassium level is 3.
D) apical pulse is 68/min.
Answer:
C) serum potassium level is 3. Hypokalemia (C) can precipitate digitalis toxicity in
persons receiving digoxin which will increase the chance of dangerous dysrhythmias
(normal potassium level is 3.5 to 5.5 mEq/L). The therapeutic range for digoxin is 0.8 to
2 ng/ml (toxic levels= >2 ng/ml); (A) is within this range. (B) would not warrant the
nurse withholding the digoxin. The nurse should withhold the digoxin if the apical pulse
is less than 60/min (D).
Question:
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects
the laboratory test results to indicate a decreased serum level of which substance? A)
Sodium. B) Antidiuretic hormone. C) Potassium. D) Glucose.
Answer:
C) Potassium. Clients with primary aldosteronism exhibit a profound decline in the
serum levels of potassium (C) (hypokalemia)--hypertension is the most prominent and
universal sign. (A) is normal or elevated, depending on the amount of water reabsorbed
with the sodium. (B) is decreased with diabetes insipidus. (D) is not affected by primary
aldosteronism.
,Question:
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the
client for which treatment protocol? A) Diuretic therapy. B) Pacemaker implantation. C)
Anticoagulation therapy. D) Cardiac catheterization.
Answer:
C) Anticoagulation therapy. The client is experiencing atrial fibrillation, and the nurse
should prepare the client for anticoagulation therapy (C) which should be prescribed
before rhythm control therapies to prevent cardioembolic events which result from
blood pooling in the fibrillating atria. (A, B, and D) are not indicated.
Question:
Which information about mammograms is most important to provide a
post-menopausal female client? A) Breast self-examinations are not needed if annual
mammograms are obtained. B) Radiation exposure is minimized by shielding the
abdomen with a lead-lined apron. C) Yearly mammograms should be done regardless
of previous normal x-rays. D) Women at high risk should have annual routine and
ultrasound mammograms.
Answer:
C) Yearly mammograms should be done regardless of previous normal x-rays. The
current breast screening recommendation is a yearly mammogram after age 40 (C).
Breast self-exam (A) continues to be a priority recommendation for all women because
a small lump (or tumor) is often first felt by a woman before a mammogram is
obtained. The radiation exposure from a mammogram is low, so (B) is not normally
provided. The frequency of using routine and ultrasound mammograms (D) in women
with high-risk variables, such as a history of breast cancer, the presence of BRC1 and
BRC2 genes, or 2 first-degree relatives with breast cancer, should be recommended
and followed closely by the healthcare provider.
Question:
In assessing cancer risk, the nurse identifies which woman as being at greatest risk of
developing breast cancer? A) A 35-year-old multipara who never breastfed. B) A
50-year-old whose mother had unilateral breast cancer. C) A 55-year-old whose
mother-in-law had bilateral breast cancer. D) A 20-year-old whose menarche occurred
at age 9.
Answer:
B) A 50-year-old whose mother had unilateral breast cancer. The most predictive risk
factors for development of breast cancer are over 40 years of age and a positive family
history (occurrence in the immediate family, i.e., mother or sister). Other risk factors
include nulliparity, no history of breastfeeding, early menarche and late menopause.
, Although all of the women described have one of the risk factors for developing breast
cancer, (B) has the greater risk over (A, C, and D).
Question:
Which reaction should the nurse identify in a client who is responding to stimulation of
the sympathetic nervous system? A) Pupil constriction. B) Increased heart rate. C)
Bronchial constriction. D) Decreased blood pressure.
Answer:
B) Increased heart rate. Any stressor that is perceived as threatening to homeostasis
acts to stimulate the sympathetic nervous system and manifests as a flight-or-fight
response, which includes an increase in heart rate (B). (A, C, and D) are responses of
the parasympathetic nervous system.
Question:
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for
what vitamin deficiency? A) K. B) B12. C) B6. D) C.
Answer:
A) K. Clients should be monitored for an increased prothrombin time and prolonged
bleeding times which would alert the nurse to a vitamin K deficiency (A). These drugs
reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are not
fat soluble vitamins.
Question:
A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit.
What initial medication should the nurse anticipate administering to the client? A)
Xylocaine (Lidocaine). B) Procainamide (Pronestyl). C) Phenytoin (Dilantin). D) Digoxin
(Lanoxin).
Answer:
D) Digoxin (Lanoxin). Digoxin (Lanoxin) (D) is administered for uncontrolled,
symptomatic atrial fibrillation resulting in a decreased cardiac output. Digoxin slows
the rate of conduction by prolonging the refractory period of the AV node, thus slowing
the ventricular response, decreasing the heart rate, and effecting cardiac output. (A, B,
and C) are not indicated in the initial treatment of uncontrolled atrial fibrillation.
Exam Questions and Answers
Verified Solutions Latest Update
Question:
The nurse should be correct in withholding a dose of digoxin in a client with congestive
heart failure without specific instruction from the healthcare provider if the client's A)
serum digoxin level is 1.5. B) blood pressure is 104/68. C) serum potassium level is 3.
D) apical pulse is 68/min.
Answer:
C) serum potassium level is 3. Hypokalemia (C) can precipitate digitalis toxicity in
persons receiving digoxin which will increase the chance of dangerous dysrhythmias
(normal potassium level is 3.5 to 5.5 mEq/L). The therapeutic range for digoxin is 0.8 to
2 ng/ml (toxic levels= >2 ng/ml); (A) is within this range. (B) would not warrant the
nurse withholding the digoxin. The nurse should withhold the digoxin if the apical pulse
is less than 60/min (D).
Question:
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects
the laboratory test results to indicate a decreased serum level of which substance? A)
Sodium. B) Antidiuretic hormone. C) Potassium. D) Glucose.
Answer:
C) Potassium. Clients with primary aldosteronism exhibit a profound decline in the
serum levels of potassium (C) (hypokalemia)--hypertension is the most prominent and
universal sign. (A) is normal or elevated, depending on the amount of water reabsorbed
with the sodium. (B) is decreased with diabetes insipidus. (D) is not affected by primary
aldosteronism.
,Question:
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the
client for which treatment protocol? A) Diuretic therapy. B) Pacemaker implantation. C)
Anticoagulation therapy. D) Cardiac catheterization.
Answer:
C) Anticoagulation therapy. The client is experiencing atrial fibrillation, and the nurse
should prepare the client for anticoagulation therapy (C) which should be prescribed
before rhythm control therapies to prevent cardioembolic events which result from
blood pooling in the fibrillating atria. (A, B, and D) are not indicated.
Question:
Which information about mammograms is most important to provide a
post-menopausal female client? A) Breast self-examinations are not needed if annual
mammograms are obtained. B) Radiation exposure is minimized by shielding the
abdomen with a lead-lined apron. C) Yearly mammograms should be done regardless
of previous normal x-rays. D) Women at high risk should have annual routine and
ultrasound mammograms.
Answer:
C) Yearly mammograms should be done regardless of previous normal x-rays. The
current breast screening recommendation is a yearly mammogram after age 40 (C).
Breast self-exam (A) continues to be a priority recommendation for all women because
a small lump (or tumor) is often first felt by a woman before a mammogram is
obtained. The radiation exposure from a mammogram is low, so (B) is not normally
provided. The frequency of using routine and ultrasound mammograms (D) in women
with high-risk variables, such as a history of breast cancer, the presence of BRC1 and
BRC2 genes, or 2 first-degree relatives with breast cancer, should be recommended
and followed closely by the healthcare provider.
Question:
In assessing cancer risk, the nurse identifies which woman as being at greatest risk of
developing breast cancer? A) A 35-year-old multipara who never breastfed. B) A
50-year-old whose mother had unilateral breast cancer. C) A 55-year-old whose
mother-in-law had bilateral breast cancer. D) A 20-year-old whose menarche occurred
at age 9.
Answer:
B) A 50-year-old whose mother had unilateral breast cancer. The most predictive risk
factors for development of breast cancer are over 40 years of age and a positive family
history (occurrence in the immediate family, i.e., mother or sister). Other risk factors
include nulliparity, no history of breastfeeding, early menarche and late menopause.
, Although all of the women described have one of the risk factors for developing breast
cancer, (B) has the greater risk over (A, C, and D).
Question:
Which reaction should the nurse identify in a client who is responding to stimulation of
the sympathetic nervous system? A) Pupil constriction. B) Increased heart rate. C)
Bronchial constriction. D) Decreased blood pressure.
Answer:
B) Increased heart rate. Any stressor that is perceived as threatening to homeostasis
acts to stimulate the sympathetic nervous system and manifests as a flight-or-fight
response, which includes an increase in heart rate (B). (A, C, and D) are responses of
the parasympathetic nervous system.
Question:
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for
what vitamin deficiency? A) K. B) B12. C) B6. D) C.
Answer:
A) K. Clients should be monitored for an increased prothrombin time and prolonged
bleeding times which would alert the nurse to a vitamin K deficiency (A). These drugs
reduce absorption of the fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are not
fat soluble vitamins.
Question:
A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit.
What initial medication should the nurse anticipate administering to the client? A)
Xylocaine (Lidocaine). B) Procainamide (Pronestyl). C) Phenytoin (Dilantin). D) Digoxin
(Lanoxin).
Answer:
D) Digoxin (Lanoxin). Digoxin (Lanoxin) (D) is administered for uncontrolled,
symptomatic atrial fibrillation resulting in a decreased cardiac output. Digoxin slows
the rate of conduction by prolonging the refractory period of the AV node, thus slowing
the ventricular response, decreasing the heart rate, and effecting cardiac output. (A, B,
and C) are not indicated in the initial treatment of uncontrolled atrial fibrillation.
