2025 EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM WITH REAL EXAM QUESTIONS AND CORRECT ANSWERS WITH WELL-ELABORATED RATIONALES/ EVOLVE HESI MEDICAL SURGICAL LATEST EXAM

2025 EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM WITH REAL EXAM QUESTIONS AND CORRECT ANSWERS WITH WELL-ELABORATED RATIONALES/ EVOLVE HESI MEDICAL SURGICAL LATEST EXAM A nurse is assisting an 82-year-old client with ambulation and is concerned that the client may fall. Which area contains the older person's center of gravity? A. Head and neck B. Upper torso C. Bilateral arms D. Feet and legs Upper torso Rationale: Stooped posture results in the upper torso becoming the center of gravity for older persons. The center of gravity for adults is the hips. However, as a person grows older, a stooped posture is common because of changes caused by osteoporosis and normal bone degeneration. Furthermore, the knees, hips, and elbows flex. The head and neck and feet and legs are not the center of gravity in the older adult. Although the arms comprise a part of the upper torso, they do not reflect the best and most complete answer. A female client with a nasogastric tube attached to low suction states that she is nauseated. The nurse assesses that there has been no drainage through the nasogastric tube in the last 2 hours. Which action should the nurse take first? A. Irrigate the nasogastric tube with sterile normal saline B. Reposition the client on her side C. Advance the nasogastric tube 5cm D. Administer an intravenous antiemetic as prescribed Reposition the client on her side Rationale: The immediate priority is to determine if the tube is functioning correctly, which would then relieve the client's nausea. The least invasive intervention, repositioning the client, should be attempted first, followed by options A and C, unless either of these interventions is contraindicated. If these measures are unsuccessful, the client may require option D. A client with hypertension has been receiving ramipril (Altace), 5 mg PO, daily for 2 weeks and is scheduled to receive a dose at 0900. At 0830, the client's blood pressure is 120/70 mm Hg. Which action should the nurse take? Administer the prescribed dose at the scheduled time Rationale: The client's blood pressure is within normal limits, indicating that the ramipril, an antihypertensive, is having the desired effect and should be administered The nurse teaches a client with type 2 diabetes nutritional strategies to decrease obesity. Which food items chosen by the client indicate understanding of the teaching? (Select all that apply.) A. White bread B. Salmon C. Broccoli D. Whole milk E. Banana Salmon, Broccoli, and Banana Rationale: Provides fresh fruits, lean meats and fish, vegetables, whole grains, and low-fat dairy products. Which condition should the nurse anticipate as a potential problem in a female client with a neurogenic bladder? A. Stress incontinence B. Infection C. Painless gross hematuria D. Peritonitis Infection B. Infection is the major complication resulting from stasis of urine and subsequent catheterization. Option A is the involuntary loss of urine through an intact urethra as a result of a sudden increase in intraabdominal pressure. Option C is the most common symptom of bladder cancer. Option D is the most common and serious complication of peritoneal dialysis. Which instruction should the nurse teach a female client about the prevention of toxic shock syndrome? A. "Get immunization against HPV B. "Change your tampon frequently" C. "Empty your bladder after intercourse" D. "Obtain a yearly flu vaccination "Change your tampon frequently" Rationale: Certain strains of Staphylococcus aureus produce a toxin that can enter the bloodstream through the vaginal mucosa. Changing the tampon frequently reduces the exposure to these toxins, which are the primary cause of toxic shock syndrome. Option A helps prevent cervical cancer, not toxic shock syndrome. Option C can lessen the incidence of urinary tract infection. Option D can help prevent some individuals from contracting the flu and pneumonia, but no relationship to toxic shock syndrome has been proven. The home health nurse is assessing a male client being treated for Parkinson disease with carbidopa-levodopa. The nurse observes that he does not demonstrate any apparent emotion when speaking and rarely blinks. Which intervention should the nurse implement? A. Perform a complete cranial nerve assessment B. Instruct the client that he may be experiencing medication toxicity C. Document the presence of these assessment findings D. Advise the client to seek immediate medical evaluation Document the presence of these assessment findings. Rationale: A masklike expression and infrequent blinking are common clinical features of parkinsonism. The nurse should document these expected findings. Signs of toxicity of levodopa-carbidopa include: dyskinesia, hallucinations, and psychosis A client with type 2 diabetes takes metformin (Glucophage) daily. The client is scheduled for major surgery requiring general anesthesia the next day. The nurse anticipates which approach to manage the client's diabetes best while the client is NPO during the perioperative period? A. NPO except for metformin and regular B. NPO except for oral antidiabetic agent C. Novolin N insulin SQ BID D. Regular insulin SQ per sliding scale Regular insulin SQ per sliding scale Rationale: Regular insulin dosing based on the client's blood glucose levels (sliding scale) is the best method to achieve control of the client's blood glucose while the client is NPO and coping with the major stress of surgery. Option A increases the risk of vomiting and aspiration. Options B and C provide less precise control of the blood glucose level. During report, the nurse learns that a client with tumor lysis syndrome is receiving an IV infusion containing insulin. Which assessment should the nurse complete first? A. Review the client's history for diabetes mellitus B. Observe the extremity distal to the IV site C. Monitor the client's serum potassium and blood glucose levels D. Evaluate the client's oxygen saturation and breath sounds Monitor the client's serum potassium and blood glucose levels Rationale: Clients with tumor lysis syndrome may experience hyperkalemia, requiring the addition of insulin to the IV solution to reduce the serum potassium level. It is most important for the nurse to monitor the client's serum potassium and blood glucose levels to ensure that they are not at dangerous levels. Options A, B, and D provide valuable assessment data but are of less priority than option C. Which description of symptoms is characteristic of a client diagnosed with trigeminal neuralgia (tic douloureux)? A. Tinnitus, vertigo, and hearing difficulties B. Sudden, stabbing, severe pain over the lip and chin C. Unilateral facial weakness and paralysis D. Difficulty in chewing, talking, and swallowing Sudden, stabbing, severe pain over the lip and chin Rationale: Trigeminal neuralgia is characterized by paroxysms of pain, similar to an electric shock, in the area innervated by one or more branches of the trigeminal nerve (cranial V). Option A would be characteristic of Ménière syndrome (cranial nerve VIII). Option C would be characteristic of Bell palsy (cranial nerve VII). Option D would be characteristic of disorders of the hypoglossal (cranial nerve XII). An 81-year-old male client has emphysema. He lives at home with his cat and manages self-care with no difficulty. When making a home visit, the nurse notices that this client's tongue is somewhat cracked and his eyeballs appear sunken into his head. Which nursing intervention is indicated? A. Help the client determine ways to increase his fluid intake B. Obtain an appointment for the client to have an eye exam C. Instruct the client to use oxygen at night and increase the humidification D. Schedule the client for tests to determine his sensitivity to cat hair Help the client determine ways to increase his fluid intake Rationale: Clients with COPD should ingest 3 L of fluids daily but may experience a fluid deficit because of shortness of breath. The nurse should suggest creative methods to increase the intake of fluids, such as having fruit juices in disposable containers readily available. Option B is not indicated. Humidified oxygen will not effectively treat the client's fluid deficit, and there is no indication that the client needs supplemental oxygen at night. These symptoms are not indicative of option D and may unnecessarily upset the client, who depends on his pet for socialization.