HESI Med Surgical Practice
(evolve) Comprehensive
Questions (Frequently Tested)
with Verified Answers Graded
A+
Which assessment is most important for the nurse to perform on a client who is hospitalized for
Guillain-Barre syndrome that is rapidly progressing?
a. Respiratory effort.
b. Unsteady gait.
c. Intensity of pain.
d. Ability to eat. - Answer: a. Respiratory effort.
Guillain-Barre syndrome causes paralysis or weakness that typically starts at the feet and
progresses upwards. As the condition progresses, the nurse must ensure that the client is able
to breathe effectively.
While caring for a client who has esophageal varices, which nursing intervention is most
important for the nurse to implement?
a. Monitor infusing IV fluids and any replacement blood products.
,b. Prepare for esophagogastroduodenoscopy (EGD).
c. Maintain the client on strict bedrest.
d. Insert a nasogastric tube (NGT) for intermittent suction. - Answer: a. Monitor infusing IV fluids
and any replacement blood products.
Maintaining hemodynamic stability in a client with esophageal varices can precipitate a life-
threatening crisis if esophageal varies leak or rupture and can result in hemorrhage. The priority
is assessing and monitoring infusions of IV fluids and any replacement blood products.
A client with chest pain, dizziness, and vomiting for the last 2 hours is admitted for evaluation
for Acute Coronary Syndrome (ACS). Which cardiac biomarker should the nurse anticipate to be
elevated if the client experienced myocardial damage?
a. Creatine Kinase (CK-MB).
b. Serum troponin.
c. Myoglobin.
d. Ischemia-modified albumin. - Answer: b. Serum troponin
Troponin is the most sensitive and specific test for myocardial damage. Troponin elevation is
more specific than CK-MB.
A nurse is preparing a teaching plan for a client who is postmenopausal. Which measure is most
important for the nurse to include to prevent osteoporosis?
a. Take a multivitamin daily.
b. Use only low fat milk products.
c. Perform weight resistance exercises.
d. Bicycle for at least 3 miles every day. - Answer: c. Perform weight resistance exercises.
,Weight-bearing on the skeletal system stimulates bone formation, so recommending weight-
resistance exercise is the most important in the prevention of osteoporosis in postmenopausal
women.
The unlicensed assistive personnel (UAP) reports that an 87-year-old female client who is sitting
in a chair at the bedside has an oral temperature of 97.2 °F (36.2 °C). Which intervention should
the nurse implement?
a. Document the temperature reading on the vital sign graphic sheet.
b. Report the temperature to the healthcare provider immediately.
c. Instruct the UAP to take the client's temperature again in 30 minutes.
d. Advise the UAP to assist the client in returning to her bed. - Answer: a. Document the
temperature reading on the vital sign graphic sheet.
A subnormal temperature of 97.2 °F (36.2 °C) (orally) is a common finding in older clients, so the
nurse should document the findings and continue with the plan of care.
Based on an analysis of the client's rhythm, 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 which should be prescribed before rhythm control therapies to prevent
cardioembolic events which result from blood pooling in the fibrillating atria.
, Which dietary assessment finding is most important for the nurse to address when caring for a
client with diabetic nephropathy?
a. Drinks a six-pack of beer every day.
b. Enjoys a hamburger once a month.
c. Eats fortified breakfast cereal daily.
d. Consumes beans and rice every day. - Answer: a. Drinks a six-pack of beer every day.
Drinking six beers every day is the dietary assessment finding most important for the nurse to
address when caring for a client with diabetic nephropathy. The usual can of beer is 12 ounces
(360 mL). Clients with diabetes are recommended to drink no more than 12 ounces of beer per
day because beer contains carbohydrates that can create unhealthy fluctuations in blood
glucose and promote poor glucose control. Nephropathy is exacerbated by poor blood glucose
control.
When planning care for a client with right renal calculi, which nursing problem has the highest
priority?
a. Acute pain related to movement of the stone.
b. Impaired urinary elimination related to the obstructed flow of urine.
c. Risk for infection related to urinary stasis.
d. Deficient knowledge related to the need for prevention of recurrence of calculi. - Answer: a.
Acute pain related to movement of the stone.
The nursing problem of the highest priority is "Acute pain related to the renal calculi's
movement".
(evolve) Comprehensive
Questions (Frequently Tested)
with Verified Answers Graded
A+
Which assessment is most important for the nurse to perform on a client who is hospitalized for
Guillain-Barre syndrome that is rapidly progressing?
a. Respiratory effort.
b. Unsteady gait.
c. Intensity of pain.
d. Ability to eat. - Answer: a. Respiratory effort.
Guillain-Barre syndrome causes paralysis or weakness that typically starts at the feet and
progresses upwards. As the condition progresses, the nurse must ensure that the client is able
to breathe effectively.
While caring for a client who has esophageal varices, which nursing intervention is most
important for the nurse to implement?
a. Monitor infusing IV fluids and any replacement blood products.
,b. Prepare for esophagogastroduodenoscopy (EGD).
c. Maintain the client on strict bedrest.
d. Insert a nasogastric tube (NGT) for intermittent suction. - Answer: a. Monitor infusing IV fluids
and any replacement blood products.
Maintaining hemodynamic stability in a client with esophageal varices can precipitate a life-
threatening crisis if esophageal varies leak or rupture and can result in hemorrhage. The priority
is assessing and monitoring infusions of IV fluids and any replacement blood products.
A client with chest pain, dizziness, and vomiting for the last 2 hours is admitted for evaluation
for Acute Coronary Syndrome (ACS). Which cardiac biomarker should the nurse anticipate to be
elevated if the client experienced myocardial damage?
a. Creatine Kinase (CK-MB).
b. Serum troponin.
c. Myoglobin.
d. Ischemia-modified albumin. - Answer: b. Serum troponin
Troponin is the most sensitive and specific test for myocardial damage. Troponin elevation is
more specific than CK-MB.
A nurse is preparing a teaching plan for a client who is postmenopausal. Which measure is most
important for the nurse to include to prevent osteoporosis?
a. Take a multivitamin daily.
b. Use only low fat milk products.
c. Perform weight resistance exercises.
d. Bicycle for at least 3 miles every day. - Answer: c. Perform weight resistance exercises.
,Weight-bearing on the skeletal system stimulates bone formation, so recommending weight-
resistance exercise is the most important in the prevention of osteoporosis in postmenopausal
women.
The unlicensed assistive personnel (UAP) reports that an 87-year-old female client who is sitting
in a chair at the bedside has an oral temperature of 97.2 °F (36.2 °C). Which intervention should
the nurse implement?
a. Document the temperature reading on the vital sign graphic sheet.
b. Report the temperature to the healthcare provider immediately.
c. Instruct the UAP to take the client's temperature again in 30 minutes.
d. Advise the UAP to assist the client in returning to her bed. - Answer: a. Document the
temperature reading on the vital sign graphic sheet.
A subnormal temperature of 97.2 °F (36.2 °C) (orally) is a common finding in older clients, so the
nurse should document the findings and continue with the plan of care.
Based on an analysis of the client's rhythm, 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 which should be prescribed before rhythm control therapies to prevent
cardioembolic events which result from blood pooling in the fibrillating atria.
, Which dietary assessment finding is most important for the nurse to address when caring for a
client with diabetic nephropathy?
a. Drinks a six-pack of beer every day.
b. Enjoys a hamburger once a month.
c. Eats fortified breakfast cereal daily.
d. Consumes beans and rice every day. - Answer: a. Drinks a six-pack of beer every day.
Drinking six beers every day is the dietary assessment finding most important for the nurse to
address when caring for a client with diabetic nephropathy. The usual can of beer is 12 ounces
(360 mL). Clients with diabetes are recommended to drink no more than 12 ounces of beer per
day because beer contains carbohydrates that can create unhealthy fluctuations in blood
glucose and promote poor glucose control. Nephropathy is exacerbated by poor blood glucose
control.
When planning care for a client with right renal calculi, which nursing problem has the highest
priority?
a. Acute pain related to movement of the stone.
b. Impaired urinary elimination related to the obstructed flow of urine.
c. Risk for infection related to urinary stasis.
d. Deficient knowledge related to the need for prevention of recurrence of calculi. - Answer: a.
Acute pain related to movement of the stone.
The nursing problem of the highest priority is "Acute pain related to the renal calculi's
movement".
