EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM TEST PAPER FULL QUESTIONS
CORRECT RESPONSES
Question:
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. 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. -✓✓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). 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.
-✓✓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. D) C. -✓✓A) K. 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). -✓✓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. D) Perform a breast self-exam
(BSE) procedure monthly. -✓✓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). 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. -✓✓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. A
client has undergone insertion of a permanent pacemaker. When developing a discharge teaching
plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which
symptoms are most important to teach the client? A) Facial flushing. B) Fever. C) Pounding
headache. D) Feelings of dizziness. -✓✓D) Feelings of dizziness. Feelings of dizziness may occur
as the result of a decreased heart rate, leading to decreased cardiac output (D). (A and C) will not
occur as the result of pacemaker failure. (B) may be an indication of infection postoperatively, but is
not an indication of pacemaker failure. A client taking a thiazide diuretic for the past six months has
a serum potassium level of 3. The nurse anticipates which change in prescription for the client? A)
The dosage of the diuretic will be decreased. B) The diuretic will be discontinued. C) A potassium
supplement will be prescribed. D) The dosage of the diuretic will be increased. -✓✓C) A potassium
supplement will be prescribed. This client's potassium level is too low (normal is 3.5 to 5). Taking a
thiazide diuretic often results in a loss of potassium, so a potassium supplement needs to be
prescribed to restore a normal serum potassium level (C). (A, B, and D) are not recommended
actions for restoring a normal serum potassium level. A client taking furosemide (Lasix), reports
difficulty sleeping. What question is important for the nurse to ask the client? A) What dose of
medication are you taking? B) Are you eating foods rich in potassium? C) Have you lost weight
recently? D) At what time do you take your medication? -✓✓D) At what time do you take your
medication? The nurse needs to first determine at what time of day the client takes the Lasix (D).
Because of the diuretic effect of Lasix, clients should take the medication in the morning to prevent
nocturia. The actual dose of medication (A) is of less importance than the time taken. (B) is not
related to the insomnia. (C) is valuable information about the effect of the diuretic, but is not likely
to be related to insomnia. The nurse working in a postoperative surgical clinic is assessing a woman
CORRECT RESPONSES
Question:
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. 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. -✓✓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). 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.
-✓✓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. D) C. -✓✓A) K. 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). -✓✓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. D) Perform a breast self-exam
(BSE) procedure monthly. -✓✓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). 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. -✓✓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. A
client has undergone insertion of a permanent pacemaker. When developing a discharge teaching
plan, the nurse writes a goal of, "The client will verbalize symptoms of pacemaker failure." Which
symptoms are most important to teach the client? A) Facial flushing. B) Fever. C) Pounding
headache. D) Feelings of dizziness. -✓✓D) Feelings of dizziness. Feelings of dizziness may occur
as the result of a decreased heart rate, leading to decreased cardiac output (D). (A and C) will not
occur as the result of pacemaker failure. (B) may be an indication of infection postoperatively, but is
not an indication of pacemaker failure. A client taking a thiazide diuretic for the past six months has
a serum potassium level of 3. The nurse anticipates which change in prescription for the client? A)
The dosage of the diuretic will be decreased. B) The diuretic will be discontinued. C) A potassium
supplement will be prescribed. D) The dosage of the diuretic will be increased. -✓✓C) A potassium
supplement will be prescribed. This client's potassium level is too low (normal is 3.5 to 5). Taking a
thiazide diuretic often results in a loss of potassium, so a potassium supplement needs to be
prescribed to restore a normal serum potassium level (C). (A, B, and D) are not recommended
actions for restoring a normal serum potassium level. A client taking furosemide (Lasix), reports
difficulty sleeping. What question is important for the nurse to ask the client? A) What dose of
medication are you taking? B) Are you eating foods rich in potassium? C) Have you lost weight
recently? D) At what time do you take your medication? -✓✓D) At what time do you take your
medication? The nurse needs to first determine at what time of day the client takes the Lasix (D).
Because of the diuretic effect of Lasix, clients should take the medication in the morning to prevent
nocturia. The actual dose of medication (A) is of less importance than the time taken. (B) is not
related to the insomnia. (C) is valuable information about the effect of the diuretic, but is not likely
to be related to insomnia. The nurse working in a postoperative surgical clinic is assessing a woman
