EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM WITH QUESTIONS AND VERIFIED
ANSWERS
Question 1
The nurse is teaching a female client who uses a contraceptive diaphragm about
reducing the risk for toxic shock syndrome (TSS). Which information should the nurse
include? (Select all that apply.)
A) Remove the diaphragm immediately after intercourse.
B) Wash the diaphragm with an alcohol solution.
C) Use the diaphragm to prevent conception during the menstrual cycle.
D) Do not leave the diaphragm in place longer than 8 hours after intercourse.
E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears.
F) Replace the old diaphragm every 3 months.
Correct Answer
D) Do not leave the diaphragm in place longer than 8 hours after intercourse.
E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears.
Correct selections are (D and E). The diaphragm needs to remain against the cervix
for 6 to 8 hours to prevent pregnancy but should not remain for longer than 8
hours (D) to avoid the risk of TSS. If a sudden fever occurs, the client should notify
the healthcare provider (E). (A) increases the risk of pregnancy, and (B) can reduce
the integrity of the barrier contraceptive but neither prevents the risk of TSS. The
diaphragm should not be used during menses (C) because it obstructs the
menstrual flow and is not indicated because conception does not occur during this
time. (F) is not necessary.
Page 1 of 126
,Question 2
What instruction should the nurse give a client who is diagnosed with fibrocystic
changes of the breast?
A) Observe cyst size fluctuations as a sign of malignancy.
B) Use estrogen supplements to reduce breast discomfort.
C) Notify the healthcare provider if whitish nipple discharge occurs.
D) Perform a breast self-exam (BSE) procedure monthly.
Correct Answer
D) Perform a breast self-exam (BSE) procedure monthly.
Fibrocystic changes in the breast are related to excess fibrous tissue, proliferation of
mammary ducts and cyst formation that cause edema and nerve irritation. These
changes obscure typical diagnostic tests, such as mammography, due to an
increased breast density. Women with fibrocystic breasts should be instructed to
carefully perform monthly BSE (D) and consider changes in any previous
"lumpiness." Fibrocystic disease does not increase the risk of breast cancer (A). Cyst
size fluctuates with the menstrual cycle, and typically lessens after menopause, and
responds with a heightened sensitivity to circulating estrogen (B), which is not
indicated. Nipple discharge associated with fibrocystic breasts is often milky or
watery-milky and is an expected finding (C).
Question 3
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.
Correct 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.
Page 2 of 126
,Question 4
A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse rate
is 43 beats per minute. Which question is a priority for the nurse to ask this client or
her family on admission? "Does the client
A) have her own teeth or dentures?"
B) take aspirin and if so, how much?"
C) take nitroglycerin?"
D) take digitalis?"
Correct Answer
D) take digitalis?"
Elderly persons are particularly susceptible to digitalis intoxication (D) which
manifests itself in such symptoms as anorexia, nausea, vomiting, diarrhea, headache,
and fatigue. Although it is important to obtain a complete medication history (B and
C), the symptoms described are classic for digitalis toxicity, and assessment of this
problem should be made promptly. (A) is irrelevant.
Question 5
Which postmenopausal client's complaint should the nurse refer to the healthcare
provider?
A) Breasts feel lumpy when palpated.
B) History of white nipple discharge.
C) Episodes of vaginal bleeding.
D) Excessive diaphoresis occurs at night.
Correct Answer
C) Episodes of vaginal bleeding.
Postmenopausal vaginal bleeding (C) may be an indication of endometrial cancer,
which should be reported to the healthcare provider. Compared to a new-onset of a
single lump, breasts that feel lumpy (A) overall may be a normal variant or a finding
consistent with nonmalignant fibrocystic disease. Up to 80% of women experience
(B), depending on sexual stimulation or hormonal levels, and is no longer
recommended as a reportable symptom when discovered during breast self-exam
(BSE). The client may need further teaching concerning (D), a disturbing symptom,
but it is not as important as (C).
Page 3 of 126
, Question 6
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.
Correct 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 7
The nurse is assessing a client's laboratory values following administration of
chemotherapy. Which lab value leads the nurse to suspect that the client is
experiencing tumor lysis syndrome (TLS)?
A) Serum PTT of 10 seconds.
B) Serum calcium of 5 mg/dl.
C) Oxygen saturation of 90%.
D) Hemoglobin of 10 g/dl.
Correct Answer
B) Serum calcium of 5 mg/dl.
TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia.
A serum calcium level of 5 (B), which is low, is an indicator of possible tumor lysis
syndrome. (A, C, and D) are not particularly related to TLS.
Page 4 of 126
EXAM WITH QUESTIONS AND VERIFIED
ANSWERS
Question 1
The nurse is teaching a female client who uses a contraceptive diaphragm about
reducing the risk for toxic shock syndrome (TSS). Which information should the nurse
include? (Select all that apply.)
A) Remove the diaphragm immediately after intercourse.
B) Wash the diaphragm with an alcohol solution.
C) Use the diaphragm to prevent conception during the menstrual cycle.
D) Do not leave the diaphragm in place longer than 8 hours after intercourse.
E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears.
F) Replace the old diaphragm every 3 months.
Correct Answer
D) Do not leave the diaphragm in place longer than 8 hours after intercourse.
E) Contact a healthcare provider a sudden onset of fever grater than 101º F appears.
Correct selections are (D and E). The diaphragm needs to remain against the cervix
for 6 to 8 hours to prevent pregnancy but should not remain for longer than 8
hours (D) to avoid the risk of TSS. If a sudden fever occurs, the client should notify
the healthcare provider (E). (A) increases the risk of pregnancy, and (B) can reduce
the integrity of the barrier contraceptive but neither prevents the risk of TSS. The
diaphragm should not be used during menses (C) because it obstructs the
menstrual flow and is not indicated because conception does not occur during this
time. (F) is not necessary.
Page 1 of 126
,Question 2
What instruction should the nurse give a client who is diagnosed with fibrocystic
changes of the breast?
A) Observe cyst size fluctuations as a sign of malignancy.
B) Use estrogen supplements to reduce breast discomfort.
C) Notify the healthcare provider if whitish nipple discharge occurs.
D) Perform a breast self-exam (BSE) procedure monthly.
Correct Answer
D) Perform a breast self-exam (BSE) procedure monthly.
Fibrocystic changes in the breast are related to excess fibrous tissue, proliferation of
mammary ducts and cyst formation that cause edema and nerve irritation. These
changes obscure typical diagnostic tests, such as mammography, due to an
increased breast density. Women with fibrocystic breasts should be instructed to
carefully perform monthly BSE (D) and consider changes in any previous
"lumpiness." Fibrocystic disease does not increase the risk of breast cancer (A). Cyst
size fluctuates with the menstrual cycle, and typically lessens after menopause, and
responds with a heightened sensitivity to circulating estrogen (B), which is not
indicated. Nipple discharge associated with fibrocystic breasts is often milky or
watery-milky and is an expected finding (C).
Question 3
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.
Correct 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.
Page 2 of 126
,Question 4
A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse rate
is 43 beats per minute. Which question is a priority for the nurse to ask this client or
her family on admission? "Does the client
A) have her own teeth or dentures?"
B) take aspirin and if so, how much?"
C) take nitroglycerin?"
D) take digitalis?"
Correct Answer
D) take digitalis?"
Elderly persons are particularly susceptible to digitalis intoxication (D) which
manifests itself in such symptoms as anorexia, nausea, vomiting, diarrhea, headache,
and fatigue. Although it is important to obtain a complete medication history (B and
C), the symptoms described are classic for digitalis toxicity, and assessment of this
problem should be made promptly. (A) is irrelevant.
Question 5
Which postmenopausal client's complaint should the nurse refer to the healthcare
provider?
A) Breasts feel lumpy when palpated.
B) History of white nipple discharge.
C) Episodes of vaginal bleeding.
D) Excessive diaphoresis occurs at night.
Correct Answer
C) Episodes of vaginal bleeding.
Postmenopausal vaginal bleeding (C) may be an indication of endometrial cancer,
which should be reported to the healthcare provider. Compared to a new-onset of a
single lump, breasts that feel lumpy (A) overall may be a normal variant or a finding
consistent with nonmalignant fibrocystic disease. Up to 80% of women experience
(B), depending on sexual stimulation or hormonal levels, and is no longer
recommended as a reportable symptom when discovered during breast self-exam
(BSE). The client may need further teaching concerning (D), a disturbing symptom,
but it is not as important as (C).
Page 3 of 126
, Question 6
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.
Correct 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 7
The nurse is assessing a client's laboratory values following administration of
chemotherapy. Which lab value leads the nurse to suspect that the client is
experiencing tumor lysis syndrome (TLS)?
A) Serum PTT of 10 seconds.
B) Serum calcium of 5 mg/dl.
C) Oxygen saturation of 90%.
D) Hemoglobin of 10 g/dl.
Correct Answer
B) Serum calcium of 5 mg/dl.
TLS results in hyperkalemia, hypocalcemia, hyperuricemia, and hyperphosphatemia.
A serum calcium level of 5 (B), which is low, is an indicator of possible tumor lysis
syndrome. (A, C, and D) are not particularly related to TLS.
Page 4 of 126
