EVOLVE ELSEVIER HESI MED
SURG WITH REAL EXAM
QUESTIONS AND CORRECT
ANSWERS WITH WELL-
ELABORATED RATIONALES
2025
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,1. 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?
Correct Answer: A. 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.
2. Which instruction should the nurse teach a female client about the prevention of
toxic shock syndrome?
Correct Answer: B. "Change your tampon frequently."
Rationale: Changing the tampon frequently reduces exposure to toxins produced
by certain strains of Staphylococcus aureus, which are the primary cause of
toxic shock syndrome.
3. 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?
Correct Answer: C. 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.
4. 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?
Correct Answer: B. 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.
5. 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.)
Correct Answer: B. Salmon, C. Broccoli, E. Banana
Rationale: These options provide fresh fruits, lean meats and fish, vegetables,
whole grains, and low-fat dairy products.
6. Which condition should the nurse anticipate as a potential problem in a female
client with a neurogenic bladder?
Correct Answer: B. Infection
Rationale: Infection is the major complication resulting from stasis of urine and
subsequent catheterization.
,7. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
Correct Answer: B. Perform synchronized cardioversion.
Rationale: Synchronized cardioversion is the treatment of choice to restore
normal sinus rhythm in uncontrolled atrial fibrillation.
8. A 25-year-old client was admitted yesterday after a motor vehicle collision.
Neurodiagnostic studies have shown a basal skull fracture in the middle fossa.
Assessment on admission revealed both halo and Battle signs. Which new
symptom indicates that the client is likely to be experiencing a common life-
threatening complication associated with a basal skull fracture?
Correct Answer: B. Oral temperature of 102°F
Rationale: An increased oral temperature indicates a high risk for infection due to
the open meninges.
9. 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?
Correct Answer: D. Regular insulin SQ per sliding scale.
Rationale: Regular insulin dosing based on blood glucose levels is the best way
to maintain blood glucose control when the client is NPO.
10. 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?
Correct Answer: C. Monitor the client's serum potassium and blood glucose
levels.
Rationale: It is crucial to monitor potassium and blood glucose levels
specifically, as tumor lysis syndrome can affect these.
11. Which description of symptoms is characteristic of a client diagnosed with
trigeminal neuralgia (tic douloureux)?
Correct Answer: B. Sudden, stabbing, severe pain over the lip and chin.
Rationale: Trigeminal neuralgia is characterized by sudden, intense pain in areas
innervated by the trigeminal nerve.
12. The nurse is caring for a client with a fractured right elbow. Which assessment
finding has the highest priority and requires immediate intervention?
Correct Answer: B. Deep unrelenting pain in the right arm.
Rationale: Unrelenting pain could indicate compartment syndrome, a serious
condition.
, 13. Based on the clinical manifestations of Cushing syndrome, which nursing
intervention would be appropriate for a client who is newly diagnosed with
Cushing syndrome?
Correct Answer: A. Monitor blood glucose levels daily.
Rationale: Clients with Cushing syndrome often develop hyperglycemia as a
major symptom.
14. The nurse notes that the client's drainage has decreased from 50 to 5 mL/hr 12
hours after chest tube insertion for hemothorax. What is the best initial action for
the nurse to take?
Correct Answer: D. Assess for kinks or dependent loops in the tubing.
Rationale: Assessing for kinks or loops in the tubing is the least invasive method
to evaluate drainage issues.
15. 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?
Correct Answer: B. Upper torso.
Rationale: The upper torso becomes the center of gravity due to changes in
posture and balance with age.
16. A client in the emergency department is bleeding profusely from a gunshot
wound to the abdomen. What action should the nurse immediately take to
promote maintenance of the client's blood pressure above a systolic pressure of
90 mm Hg?
Correct Answer: C. Maintain the client in a supine position to reduce
diaphragmatic pressure and visualize the wound.
Rationale: The supine position reduces pressure on the diaphragm and allows for
optimal breathing and access to the wound.
17. A nurse is caring for a critically ill client with cirrhosis of the liver who has a
nasogastric tube draining bright red blood. The nurse notes that the client's
serum hemoglobin and hematocrit levels are decreased. Which additional
change in laboratory data should the nurse expect?
Correct Answer: C. Decreased serum ammonia level.
Rationale: The removal of protein from the intestines can lead to a decreased
ammonia level.
18. The clinic nurse is providing care to a client admitted with a blood glucose level
of 40 mg/dL and is semiconscious. What action should the nurse take first?
Correct Answer: D. Administer glucagon as per the standing order.
Rationale: Glucagon can be given immediately to help raise blood glucose levels
in a semiconscious client.
SURG WITH REAL EXAM
QUESTIONS AND CORRECT
ANSWERS WITH WELL-
ELABORATED RATIONALES
2025
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
,1. 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?
Correct Answer: A. 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.
2. Which instruction should the nurse teach a female client about the prevention of
toxic shock syndrome?
Correct Answer: B. "Change your tampon frequently."
Rationale: Changing the tampon frequently reduces exposure to toxins produced
by certain strains of Staphylococcus aureus, which are the primary cause of
toxic shock syndrome.
3. 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?
Correct Answer: C. 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.
4. 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?
Correct Answer: B. 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.
5. 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.)
Correct Answer: B. Salmon, C. Broccoli, E. Banana
Rationale: These options provide fresh fruits, lean meats and fish, vegetables,
whole grains, and low-fat dairy products.
6. Which condition should the nurse anticipate as a potential problem in a female
client with a neurogenic bladder?
Correct Answer: B. Infection
Rationale: Infection is the major complication resulting from stasis of urine and
subsequent catheterization.
,7. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
Correct Answer: B. Perform synchronized cardioversion.
Rationale: Synchronized cardioversion is the treatment of choice to restore
normal sinus rhythm in uncontrolled atrial fibrillation.
8. A 25-year-old client was admitted yesterday after a motor vehicle collision.
Neurodiagnostic studies have shown a basal skull fracture in the middle fossa.
Assessment on admission revealed both halo and Battle signs. Which new
symptom indicates that the client is likely to be experiencing a common life-
threatening complication associated with a basal skull fracture?
Correct Answer: B. Oral temperature of 102°F
Rationale: An increased oral temperature indicates a high risk for infection due to
the open meninges.
9. 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?
Correct Answer: D. Regular insulin SQ per sliding scale.
Rationale: Regular insulin dosing based on blood glucose levels is the best way
to maintain blood glucose control when the client is NPO.
10. 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?
Correct Answer: C. Monitor the client's serum potassium and blood glucose
levels.
Rationale: It is crucial to monitor potassium and blood glucose levels
specifically, as tumor lysis syndrome can affect these.
11. Which description of symptoms is characteristic of a client diagnosed with
trigeminal neuralgia (tic douloureux)?
Correct Answer: B. Sudden, stabbing, severe pain over the lip and chin.
Rationale: Trigeminal neuralgia is characterized by sudden, intense pain in areas
innervated by the trigeminal nerve.
12. The nurse is caring for a client with a fractured right elbow. Which assessment
finding has the highest priority and requires immediate intervention?
Correct Answer: B. Deep unrelenting pain in the right arm.
Rationale: Unrelenting pain could indicate compartment syndrome, a serious
condition.
, 13. Based on the clinical manifestations of Cushing syndrome, which nursing
intervention would be appropriate for a client who is newly diagnosed with
Cushing syndrome?
Correct Answer: A. Monitor blood glucose levels daily.
Rationale: Clients with Cushing syndrome often develop hyperglycemia as a
major symptom.
14. The nurse notes that the client's drainage has decreased from 50 to 5 mL/hr 12
hours after chest tube insertion for hemothorax. What is the best initial action for
the nurse to take?
Correct Answer: D. Assess for kinks or dependent loops in the tubing.
Rationale: Assessing for kinks or loops in the tubing is the least invasive method
to evaluate drainage issues.
15. 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?
Correct Answer: B. Upper torso.
Rationale: The upper torso becomes the center of gravity due to changes in
posture and balance with age.
16. A client in the emergency department is bleeding profusely from a gunshot
wound to the abdomen. What action should the nurse immediately take to
promote maintenance of the client's blood pressure above a systolic pressure of
90 mm Hg?
Correct Answer: C. Maintain the client in a supine position to reduce
diaphragmatic pressure and visualize the wound.
Rationale: The supine position reduces pressure on the diaphragm and allows for
optimal breathing and access to the wound.
17. A nurse is caring for a critically ill client with cirrhosis of the liver who has a
nasogastric tube draining bright red blood. The nurse notes that the client's
serum hemoglobin and hematocrit levels are decreased. Which additional
change in laboratory data should the nurse expect?
Correct Answer: C. Decreased serum ammonia level.
Rationale: The removal of protein from the intestines can lead to a decreased
ammonia level.
18. The clinic nurse is providing care to a client admitted with a blood glucose level
of 40 mg/dL and is semiconscious. What action should the nurse take first?
Correct Answer: D. Administer glucagon as per the standing order.
Rationale: Glucagon can be given immediately to help raise blood glucose levels
in a semiconscious client.
