HESI MED SURG EVOLVE EXAM QUESTIONS AND
ANSWERS LATEST 2025
48. The 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?
A.
Increased serum albumin level B.
Decreased serum creatinine C.
Decreased serum ammonia level D.
Increased liver function test results-Answer:- C
Rationale:-The breakdown of glutamine in the intestine and the increased
activity of colonic bacteria from the digestion of proteins increase ammonia
levels in clients with advanced liver disease, so removal of blood, a protein
source, from the intestine results in a reduced level of ammonia. Options A, B,
and D will not be significantly affected by the removal of blood.
49. Which change in laboratory values indicates to the nurse that a client
with rheumatoid arthritis may be experiencing an adverse effect of
methotrexate (Mexate) therapy?
A.
Increase in rheumatoid factor B.
Decrease in hemoglobin level
C.
Increase in blood glucose level D.
Decrease in erythrocyte sedimentation rate (ESR; sed rate)-Answer:- B
Rationale:-Methotrexate is an immunosuppressant. A common side effect is
bone marrow depression, which would be reflected by a decrease in the
hemoglobin level. Option A indicates disease progression but is not a side
effect of the medication.
,Option C is not related to methotrexate. Option D indicates that inflammation
associated with the disease has diminished.
50. A client diagnosed with chronic kidney disease (CKD) 2 years ago is
regularly treated at a community hemodialysis facility. Before his scheduled
dialysis treatment, which electrolyte imbalance should the nurse anticipate?
A.
Hypophosphatemia B.
Hypocalcemia C.
Hyponatremia D.
Hypokalemia-Answer:- B
Rationale:-Hypocalcemia develops in CKD because of chronic
hyperphosphatemia, not option A. Increased phosphate levels cause the
peripheral deposition of calcium and resistance to vitamin D absorption
needed for calcium absorption. Prior to dialysis, the nurse would expect to
find the client hypernatremic and hyperkalemic, not with option C or D.
51. 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?
A.
Document this expected decrease in drainage. B.
Clamp the chest tube while assessing for air leaks. C.
Milk the tube to remove any excessive blood clot buildup. D.
Assess for kinks or dependent loops in the tubing.-Answer:- D
Rationale:-The least invasive nursing action should be performed first to
determine why the drainage has diminished. Option A is completed after
assessing for any problems causing the decrease in drainage. Option B is no
longer considered
,standard protocol because the increase in pressure may be harmful to the
client. Option C is an appropriate nursing action after the tube has been
assessed for kinks or dependent loops.
52. The nurse is caring for a client with a fractured right elbow. Which
assess- ment finding has the highest priority and requires immediate
intervention? A.
Ecchymosis over the right elbow area B.
Deep unrelenting pain in the right arm C.
An edematous right elbow D.
The presence of crepitus in the right elbow-Answer:- B
Rationale:-Compartment syndrome is a condition involving increased
pressure and constriction of the nerves and vessels within an anatomic
compartment, causing pain uncontrolled by opioids and neurovascular
compromise. Option A is an expect- ed finding. Option C related to
compartment syndrome cannot be seen, and any visible edema is an expected
finding related to the injury. Option D is an expected finding.
53. Which abnormal laboratory finding indicates that a client with diabetes
needs further evaluation for diabetic nephropathy?
A.
Hypokalemia B.
Microalbuminuria C.
Elevated serum lipid levels D.
Ketonuria-Answer:- B
Rationale:-Microalbuminuria is the earliest sign of diabetic nephropathy and
indi- cates the need for follow-up evaluation. Hyperkalemia, not option A, is
associated with end-stage renal disease caused by diabetic nephropathy.
Option C may be elevated in end-stage renal disease. Option D may signal the
onset of diabetic ketoacidosis (DKA).
, 54. A male client has just undergone a laryngectomy and has a cuffed tra-
cheostomy tube in place. When initiating bolus tube feedings postoperatively,
when should the nurse inflate the cuff?
A.
Immediately after feeding
B.
Just prior to tube feeding C.
Continuous inflation is required D.
Inflation is not required-Answer:- B
Rationale:-The cuff should be inflated before the feeding to block the trachea
and prevent food from entering if oral feedings are started while a cuffed
tracheostomy tube is in place. It should remain inflated throughout the
feeding to prevent aspiration of food into the respiratory system. Options A
and D place the client at risk for aspiration. Option C places the client at risk
for tracheal wall necrosis.
55. The nurse includes frequent oral care in the plan of care for a client
sched- uled for an esophagogastrostomy for esophageal cancer. This
intervention is included in the client's plan of care to address which nursing
diagnosis?
A.
Fluid volume deficit B.
Self-care deficit C.
Risk for infection D.
Impaired nutrition-Answer:- C
ANSWERS LATEST 2025
48. The 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?
A.
Increased serum albumin level B.
Decreased serum creatinine C.
Decreased serum ammonia level D.
Increased liver function test results-Answer:- C
Rationale:-The breakdown of glutamine in the intestine and the increased
activity of colonic bacteria from the digestion of proteins increase ammonia
levels in clients with advanced liver disease, so removal of blood, a protein
source, from the intestine results in a reduced level of ammonia. Options A, B,
and D will not be significantly affected by the removal of blood.
49. Which change in laboratory values indicates to the nurse that a client
with rheumatoid arthritis may be experiencing an adverse effect of
methotrexate (Mexate) therapy?
A.
Increase in rheumatoid factor B.
Decrease in hemoglobin level
C.
Increase in blood glucose level D.
Decrease in erythrocyte sedimentation rate (ESR; sed rate)-Answer:- B
Rationale:-Methotrexate is an immunosuppressant. A common side effect is
bone marrow depression, which would be reflected by a decrease in the
hemoglobin level. Option A indicates disease progression but is not a side
effect of the medication.
,Option C is not related to methotrexate. Option D indicates that inflammation
associated with the disease has diminished.
50. A client diagnosed with chronic kidney disease (CKD) 2 years ago is
regularly treated at a community hemodialysis facility. Before his scheduled
dialysis treatment, which electrolyte imbalance should the nurse anticipate?
A.
Hypophosphatemia B.
Hypocalcemia C.
Hyponatremia D.
Hypokalemia-Answer:- B
Rationale:-Hypocalcemia develops in CKD because of chronic
hyperphosphatemia, not option A. Increased phosphate levels cause the
peripheral deposition of calcium and resistance to vitamin D absorption
needed for calcium absorption. Prior to dialysis, the nurse would expect to
find the client hypernatremic and hyperkalemic, not with option C or D.
51. 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?
A.
Document this expected decrease in drainage. B.
Clamp the chest tube while assessing for air leaks. C.
Milk the tube to remove any excessive blood clot buildup. D.
Assess for kinks or dependent loops in the tubing.-Answer:- D
Rationale:-The least invasive nursing action should be performed first to
determine why the drainage has diminished. Option A is completed after
assessing for any problems causing the decrease in drainage. Option B is no
longer considered
,standard protocol because the increase in pressure may be harmful to the
client. Option C is an appropriate nursing action after the tube has been
assessed for kinks or dependent loops.
52. The nurse is caring for a client with a fractured right elbow. Which
assess- ment finding has the highest priority and requires immediate
intervention? A.
Ecchymosis over the right elbow area B.
Deep unrelenting pain in the right arm C.
An edematous right elbow D.
The presence of crepitus in the right elbow-Answer:- B
Rationale:-Compartment syndrome is a condition involving increased
pressure and constriction of the nerves and vessels within an anatomic
compartment, causing pain uncontrolled by opioids and neurovascular
compromise. Option A is an expect- ed finding. Option C related to
compartment syndrome cannot be seen, and any visible edema is an expected
finding related to the injury. Option D is an expected finding.
53. Which abnormal laboratory finding indicates that a client with diabetes
needs further evaluation for diabetic nephropathy?
A.
Hypokalemia B.
Microalbuminuria C.
Elevated serum lipid levels D.
Ketonuria-Answer:- B
Rationale:-Microalbuminuria is the earliest sign of diabetic nephropathy and
indi- cates the need for follow-up evaluation. Hyperkalemia, not option A, is
associated with end-stage renal disease caused by diabetic nephropathy.
Option C may be elevated in end-stage renal disease. Option D may signal the
onset of diabetic ketoacidosis (DKA).
, 54. A male client has just undergone a laryngectomy and has a cuffed tra-
cheostomy tube in place. When initiating bolus tube feedings postoperatively,
when should the nurse inflate the cuff?
A.
Immediately after feeding
B.
Just prior to tube feeding C.
Continuous inflation is required D.
Inflation is not required-Answer:- B
Rationale:-The cuff should be inflated before the feeding to block the trachea
and prevent food from entering if oral feedings are started while a cuffed
tracheostomy tube is in place. It should remain inflated throughout the
feeding to prevent aspiration of food into the respiratory system. Options A
and D place the client at risk for aspiration. Option C places the client at risk
for tracheal wall necrosis.
55. The nurse includes frequent oral care in the plan of care for a client
sched- uled for an esophagogastrostomy for esophageal cancer. This
intervention is included in the client's plan of care to address which nursing
diagnosis?
A.
Fluid volume deficit B.
Self-care deficit C.
Risk for infection D.
Impaired nutrition-Answer:- C
