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EVOLVE ELSEVIER HESI MED SURG
ACTUAL NEWEST EXAM | 200
QUESTIONS AND CORRECT DETAILED
ANSWERS | ALREADY A GRADED | NEW
AND REVISED
1. A patient with chronic obstructive pulmonary disease
(COPD) presents with increased dyspnea, productive
cough, and wheezing. The nurse notes a respiratory rate of
28 breaths/min and oxygen saturation of 88% on room air.
Which nursing intervention should be prioritized first?
A. Encourage the patient to perform pursed-lip breathing
B. Administer a prescribed short-acting bronchodilator
(Correct)
C. Initiate chest physiotherapy
D. Increase oral fluid intake
Rationale: The priority is to improve oxygenation and airway
patency. Administering a short-acting bronchodilator provides
rapid relief of bronchospasm and improves ventilation.
Pursed-lip breathing is supportive but not immediately
effective in acute distress.
2. A patient who underwent a total hip replacement reports
sudden calf pain, swelling, and redness in the left leg.
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Which action should the nurse take first?
A. Apply warm compresses to the leg
B. Elevate the leg and monitor symptoms
C. Notify the healthcare provider immediately (Correct)
D. Encourage ambulation
Rationale: The patient demonstrates signs of deep vein
thrombosis (DVT). Immediate notification of the provider is
critical to prevent complications such as pulmonary embolism.
3. A 68-year-old patient with type 2 diabetes mellitus presents
with fruity-smelling breath, polyuria, and confusion. Which
lab value would the nurse expect to be elevated?
A. Serum potassium
B. Serum glucose (Correct)
C. Serum sodium
D. Serum calcium
Rationale: These are signs of hyperglycemia and diabetic
ketoacidosis (DKA), characterized by markedly elevated blood
glucose levels.
4. The nurse is caring for a patient with heart failure who is
prescribed furosemide. Which assessment finding requires
immediate intervention?
A. Weight gain of 1 kg over 2 days
B. Blood pressure 110/70 mmHg
C. Serum potassium 2.8 mEq/L (Correct)
D. Mild ankle edema
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Rationale: Furosemide can cause hypokalemia, which may
lead to life-threatening arrhythmias. A potassium level of 2.8
mEq/L is critically low and requires urgent intervention.
5. A patient with chronic kidney disease is scheduled for
hemodialysis. Which of the following assessments is most
important before initiating treatment?
A. Blood pressure and heart rate (Correct)
B. Oxygen saturation
C. Blood glucose
D. Bowel sounds
Rationale: Hemodialysis can cause hypotension; monitoring
vital signs before the procedure ensures patient safety.
6. A patient is receiving morphine for post-operative pain.
Which assessment indicates a potential adverse effect that
requires immediate attention?
A. Pain rating of 3/10
B. Respiratory rate of 8 breaths/min (Correct)
C. Heart rate of 80 bpm
D. Blood pressure of 130/78 mmHg
Rationale: Morphine can cause respiratory depression. A
respiratory rate below 10 breaths per minute requires
immediate intervention.
7. The nurse is preparing to administer a unit of packed red
blood cells. Which action is essential before starting the
transfusion?
A. Infuse with 5% dextrose
B. Verify patient identification and blood type (Correct)
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C. Administer antihistamine prophylactically
D. Warm the blood to 40°C
Rationale: Verifying patient identity and blood type is critical
to prevent transfusion reactions. Dextrose can cause hemolysis
and warming to 40°C is unsafe.
8. A patient is admitted with suspected myocardial infarction.
Which initial laboratory test provides the most specific
information for cardiac injury?
A. Creatine kinase-MB
B. Troponin I (Correct)
C. Myoglobin
D. Lactate dehydrogenase
Rationale: Troponin I is highly specific and sensitive for
myocardial injury, rising within hours of infarction.
9. A postoperative patient has a new prescription for incentive
spirometry every hour while awake. Which statement
indicates the patient understands proper use?
A. “I should exhale quickly before using the device.”
B. “I should inhale slowly and deeply, then hold my breath
for a few seconds.” (Correct)
C. “I will use it only if I feel short of breath.”
D. “I should perform it only after ambulating.”
Rationale: Incentive spirometry promotes lung expansion and
prevents atelectasis. Proper technique involves slow deep
inhalation with breath-holding.
10. A patient with pneumonia is prescribed azithromycin.
Which teaching point is most important to prevent adverse
EVOLVE ELSEVIER HESI MED SURG
ACTUAL NEWEST EXAM | 200
QUESTIONS AND CORRECT DETAILED
ANSWERS | ALREADY A GRADED | NEW
AND REVISED
1. A patient with chronic obstructive pulmonary disease
(COPD) presents with increased dyspnea, productive
cough, and wheezing. The nurse notes a respiratory rate of
28 breaths/min and oxygen saturation of 88% on room air.
Which nursing intervention should be prioritized first?
A. Encourage the patient to perform pursed-lip breathing
B. Administer a prescribed short-acting bronchodilator
(Correct)
C. Initiate chest physiotherapy
D. Increase oral fluid intake
Rationale: The priority is to improve oxygenation and airway
patency. Administering a short-acting bronchodilator provides
rapid relief of bronchospasm and improves ventilation.
Pursed-lip breathing is supportive but not immediately
effective in acute distress.
2. A patient who underwent a total hip replacement reports
sudden calf pain, swelling, and redness in the left leg.
,2|Page
Which action should the nurse take first?
A. Apply warm compresses to the leg
B. Elevate the leg and monitor symptoms
C. Notify the healthcare provider immediately (Correct)
D. Encourage ambulation
Rationale: The patient demonstrates signs of deep vein
thrombosis (DVT). Immediate notification of the provider is
critical to prevent complications such as pulmonary embolism.
3. A 68-year-old patient with type 2 diabetes mellitus presents
with fruity-smelling breath, polyuria, and confusion. Which
lab value would the nurse expect to be elevated?
A. Serum potassium
B. Serum glucose (Correct)
C. Serum sodium
D. Serum calcium
Rationale: These are signs of hyperglycemia and diabetic
ketoacidosis (DKA), characterized by markedly elevated blood
glucose levels.
4. The nurse is caring for a patient with heart failure who is
prescribed furosemide. Which assessment finding requires
immediate intervention?
A. Weight gain of 1 kg over 2 days
B. Blood pressure 110/70 mmHg
C. Serum potassium 2.8 mEq/L (Correct)
D. Mild ankle edema
,3|Page
Rationale: Furosemide can cause hypokalemia, which may
lead to life-threatening arrhythmias. A potassium level of 2.8
mEq/L is critically low and requires urgent intervention.
5. A patient with chronic kidney disease is scheduled for
hemodialysis. Which of the following assessments is most
important before initiating treatment?
A. Blood pressure and heart rate (Correct)
B. Oxygen saturation
C. Blood glucose
D. Bowel sounds
Rationale: Hemodialysis can cause hypotension; monitoring
vital signs before the procedure ensures patient safety.
6. A patient is receiving morphine for post-operative pain.
Which assessment indicates a potential adverse effect that
requires immediate attention?
A. Pain rating of 3/10
B. Respiratory rate of 8 breaths/min (Correct)
C. Heart rate of 80 bpm
D. Blood pressure of 130/78 mmHg
Rationale: Morphine can cause respiratory depression. A
respiratory rate below 10 breaths per minute requires
immediate intervention.
7. The nurse is preparing to administer a unit of packed red
blood cells. Which action is essential before starting the
transfusion?
A. Infuse with 5% dextrose
B. Verify patient identification and blood type (Correct)
, 4|Page
C. Administer antihistamine prophylactically
D. Warm the blood to 40°C
Rationale: Verifying patient identity and blood type is critical
to prevent transfusion reactions. Dextrose can cause hemolysis
and warming to 40°C is unsafe.
8. A patient is admitted with suspected myocardial infarction.
Which initial laboratory test provides the most specific
information for cardiac injury?
A. Creatine kinase-MB
B. Troponin I (Correct)
C. Myoglobin
D. Lactate dehydrogenase
Rationale: Troponin I is highly specific and sensitive for
myocardial injury, rising within hours of infarction.
9. A postoperative patient has a new prescription for incentive
spirometry every hour while awake. Which statement
indicates the patient understands proper use?
A. “I should exhale quickly before using the device.”
B. “I should inhale slowly and deeply, then hold my breath
for a few seconds.” (Correct)
C. “I will use it only if I feel short of breath.”
D. “I should perform it only after ambulating.”
Rationale: Incentive spirometry promotes lung expansion and
prevents atelectasis. Proper technique involves slow deep
inhalation with breath-holding.
10. A patient with pneumonia is prescribed azithromycin.
Which teaching point is most important to prevent adverse
