EVOLVE ELSEVIER HESI MED SURG EXAM CERTIFICATION EVALUATION TESTED
QUESTIONS FULL SOLUTION GUIDE
Question:
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.
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:
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.
Question:
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for which
treatment protocol? 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.
Question:
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.
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.
Question:
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).
Question:
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.
Question:
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what
vitamin deficiency? A) K. B) B12. C) B6. D) C.
Answer:
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.
Question:
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.
Question:
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.
Answer:
QUESTIONS FULL SOLUTION GUIDE
Question:
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.
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:
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.
Question:
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for which
treatment protocol? 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.
Question:
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.
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.
Question:
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).
Question:
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.
Question:
A client receiving cholestyramine (Questran) for hyperlipidemia should be evaluated for what
vitamin deficiency? A) K. B) B12. C) B6. D) C.
Answer:
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.
Question:
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.
Question:
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.
Answer:
