EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALE UPDATED
A 20-year-old female client calls the nurse to report a lump she found in her breast. Which
response is the best for the nurse to provide?
A) Check it again in one month, and if it is still there schedule an appointment.
B) Most lumps are benign, but it is always best to come in for an examination.
C) Try not to worry too much about it, because usually, most lumps are benign.
D) If you are in your menstrual period it is not a good time to check for lumps. - (ANSWER)B)
Most lumps are benign, but it is always best to come in for an examination.
(B) provides the best response because it addresses the client's anxiety most effectively and
encourages prompt and immediate action for a potential problem. (A) postpones treatment if the
lump is malignant, and does not relieve the client's anxiety. (C and D) provide false reassurance
and do not help relieve anxiety.
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. (*&^tr
B) blood pressure is 104/68. dfghjk
C) serum potassium level is 3. lkjnb
D) apical pulse is 68/min. - (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).
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the
laboratory test results to indicate a decreased serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose. - (ANSWER)C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium
(C) (hypokalemia)--hypertension is the most prominent and universal sign. (A) is normal or
elevated, depending on the amount of water reabsorbed with the sodium. (B) is decreased with
diabetes insipidus. (D) is not affected by primary aldosteronism.
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for
which treatment protocol?
,EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALE UPDATED
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
D) Cardiac catheterization. - (ANSWER)C) Anticoagulation therapy.
The client is experiencing atrial fibrillation, and the nurse should prepare the client for
anticoagulation therapy (C) which should be prescribed before rhythm control therapies to
prevent cardioembolic events which result from blood pooling in the fibrillating atria. (A, B, and
D) are not indicated.
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. - (*&^tr
(ANSWER)C) Yearly mammograms should be done regardless of previous normal x-rays. dfghjk
lkjnb
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.
In assessing cancer risk, the nurse identifies which woman as being at greatest risk of developing
breast cancer?
A) A 35-year-old multipara who never breastfed.
B) A 50-year-old whose mother had unilateral breast cancer.
C) A 55-year-old whose mother-in-law had bilateral breast cancer.
D) A 20-year-old whose menarche occurred at age 9. - (ANSWER)B) A 50-year-old whose
mother had unilateral breast cancer.
The most predictive risk factors for development of breast cancer are over 40 years of age and a
positive family history (occurrence in the immediate family, i.e., mother or sister). Other risk
factors include nulliparity, no history of breastfeeding, early menarche and late menopause.
Although all of the women described have one of the risk factors for developing breast cancer,
(B) has the greater risk over (A, C, and D).
, EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALE UPDATED
Which reaction should the nurse identify in a client who is responding to stimulation of the
sympathetic nervous system?
A) Pupil constriction.
B) Increased heart rate.
C) Bronchial constriction.
D) Decreased blood pressure. - (ANSWER)B) Increased heart rate.
Any stressor that is perceived as threatening to homeostasis acts to stimulate the sympathetic
nervous system and manifests as a flight-or-fight response, which includes an increase in heart
rate (B). (A, C, and D) are responses of the parasympathetic nervous system.
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what
vitamin deficiency?
A) K. @#$
B) B12. %^&*
C) B6. (*&^tr
D) C. - (ANSWER)A) K. dfghjk
lkjnb
Clients should be monitored for an increased prothrombin time and prolonged bleeding times
which would alert the nurse to a vitamin K deficiency (A). These drugs reduce absorption of the
fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are not fat soluble vitamins.
A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit. What initial
medication should the nurse anticipate administering to the client?
A) Xylocaine (Lidocaine).
B) Procainamide (Pronestyl).
C) Phenytoin (Dilantin).
D) Digoxin (Lanoxin). - (ANSWER)D) Digoxin (Lanoxin).
Digoxin (Lanoxin) (D) is administered for uncontrolled, symptomatic atrial fibrillation resulting
in a decreased cardiac output. Digoxin slows the rate of conduction by prolonging the refractory
period of the AV node, thus slowing the ventricular response, decreasing the heart rate, and
effecting cardiac output. (A, B, and C) are not indicated in the initial treatment of uncontrolled
atrial fibrillation.
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.
WITH RATIONALE UPDATED
A 20-year-old female client calls the nurse to report a lump she found in her breast. Which
response is the best for the nurse to provide?
A) Check it again in one month, and if it is still there schedule an appointment.
B) Most lumps are benign, but it is always best to come in for an examination.
C) Try not to worry too much about it, because usually, most lumps are benign.
D) If you are in your menstrual period it is not a good time to check for lumps. - (ANSWER)B)
Most lumps are benign, but it is always best to come in for an examination.
(B) provides the best response because it addresses the client's anxiety most effectively and
encourages prompt and immediate action for a potential problem. (A) postpones treatment if the
lump is malignant, and does not relieve the client's anxiety. (C and D) provide false reassurance
and do not help relieve anxiety.
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. (*&^tr
B) blood pressure is 104/68. dfghjk
C) serum potassium level is 3. lkjnb
D) apical pulse is 68/min. - (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).
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the
laboratory test results to indicate a decreased serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose. - (ANSWER)C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium
(C) (hypokalemia)--hypertension is the most prominent and universal sign. (A) is normal or
elevated, depending on the amount of water reabsorbed with the sodium. (B) is decreased with
diabetes insipidus. (D) is not affected by primary aldosteronism.
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for
which treatment protocol?
,EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALE UPDATED
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
D) Cardiac catheterization. - (ANSWER)C) Anticoagulation therapy.
The client is experiencing atrial fibrillation, and the nurse should prepare the client for
anticoagulation therapy (C) which should be prescribed before rhythm control therapies to
prevent cardioembolic events which result from blood pooling in the fibrillating atria. (A, B, and
D) are not indicated.
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. - (*&^tr
(ANSWER)C) Yearly mammograms should be done regardless of previous normal x-rays. dfghjk
lkjnb
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.
In assessing cancer risk, the nurse identifies which woman as being at greatest risk of developing
breast cancer?
A) A 35-year-old multipara who never breastfed.
B) A 50-year-old whose mother had unilateral breast cancer.
C) A 55-year-old whose mother-in-law had bilateral breast cancer.
D) A 20-year-old whose menarche occurred at age 9. - (ANSWER)B) A 50-year-old whose
mother had unilateral breast cancer.
The most predictive risk factors for development of breast cancer are over 40 years of age and a
positive family history (occurrence in the immediate family, i.e., mother or sister). Other risk
factors include nulliparity, no history of breastfeeding, early menarche and late menopause.
Although all of the women described have one of the risk factors for developing breast cancer,
(B) has the greater risk over (A, C, and D).
, EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALE UPDATED
Which reaction should the nurse identify in a client who is responding to stimulation of the
sympathetic nervous system?
A) Pupil constriction.
B) Increased heart rate.
C) Bronchial constriction.
D) Decreased blood pressure. - (ANSWER)B) Increased heart rate.
Any stressor that is perceived as threatening to homeostasis acts to stimulate the sympathetic
nervous system and manifests as a flight-or-fight response, which includes an increase in heart
rate (B). (A, C, and D) are responses of the parasympathetic nervous system.
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what
vitamin deficiency?
A) K. @#$
B) B12. %^&*
C) B6. (*&^tr
D) C. - (ANSWER)A) K. dfghjk
lkjnb
Clients should be monitored for an increased prothrombin time and prolonged bleeding times
which would alert the nurse to a vitamin K deficiency (A). These drugs reduce absorption of the
fat soluble (lipid) vitamins A, D, E, and K. (B, C, and D) are not fat soluble vitamins.
A client experiencing uncontrolled atrial fibrillation is admitted to the telemetry unit. What initial
medication should the nurse anticipate administering to the client?
A) Xylocaine (Lidocaine).
B) Procainamide (Pronestyl).
C) Phenytoin (Dilantin).
D) Digoxin (Lanoxin). - (ANSWER)D) Digoxin (Lanoxin).
Digoxin (Lanoxin) (D) is administered for uncontrolled, symptomatic atrial fibrillation resulting
in a decreased cardiac output. Digoxin slows the rate of conduction by prolonging the refractory
period of the AV node, thus slowing the ventricular response, decreasing the heart rate, and
effecting cardiac output. (A, B, and C) are not indicated in the initial treatment of uncontrolled
atrial fibrillation.
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.
