Page 1 of 318
HESI MED SURG EVOLVE ELSEVIER EXAM VERSION 1-
VERSION 8 COMPLETE 600 QUESTIONS WITH DETAILED
SOLUTIONS JUST RELEASED THIS YEAR
EVOLVE MED SURG HESI (Elsevier) – 2 versions
In assessing a client diagnosed with primary aldosteronism, the nurse expects the laboratory
test results to indicate a decreased serum level of which substance?
A. Sodium
B. Phosphate
C. Potassium
D. Glucose
C
Rationale: Clients with primary aldosteronism exhibit a profound decline in serum levels of
potassium; hypokalemia; hypertension is the most prominent and universal sign. The serum
sodium level is normal or elevated, depending on the amount of water resorbed with the
sodium. Option B is influenced by parathyroid hormone (PTH). Option D is not affected by
primary aldosteronism.
During assessment of a client in the intensive care unit, the nurse notes that the client's
breath sounds are clear on auscultation, but jugular vein distention and muffled heart sounds
are present. Which intervention should the nurse implement?
A. Prepare the client for a pericardial tap.
B. Administer intravenous furosemide (Lasix).
C. Assist the client to cough and breathe deeply.
D. Instruct the client to restrict oral fluid intake.
A
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Rationale: The client is exhibiting symptoms of cardiac tamponade, a collection of fluid in the
pericardial sac that results in a reduction in cardiac output, which is a potentially fatal
complication of pericarditis. Treatment for tamponade is a pericardial tap. Lasix IV is not
indicated for treatment of pericarditis. Because the client's breath sounds are clear, option C is
not a priority. Fluids are frequently increased in the initial treatment of tamponade to
compensate for the decrease in cardiac output, but this is not the same priority as option A.
A central venous catheter has been inserted via a jugular vein, and a radiograph has
confirmed placement of the catheter. A prescription has been received for a medication STAT,
but IV fluids have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular venous distention.
B. Obtain the needed intravenous solution.
C. Flush the line with heparinized solution.
D. Flush the line with normal saline.
D
Rationale:Medication can be administered via a central line without additional IV fluids. The
line should first be flushed with a normal saline solution to ensure patency. Insufficient evidence
exists on the effectiveness of flushing catheters with heparin. Option A will not affect the
decision to administer the medication and is not a priority. Administration of the medication
STAT is of greater priority than option B.
Which data would the nurse expect to find when reviewing laboratory values of an 80-year-
old man who is in good health overall?
A. Complete blood count reveals increased white blood cell (WBC) and decreased red blood
cell (RBC) counts.
B. Chemistries reveal an increased serum bilirubin level with slightly increased liver enzyme
levels.
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C. Urinalysis reveals slight protein in the urine and bacteriuria, with pyuria.
D. Serum electrolytes reveal a decreased sodium level and increased potassium level.
C
Rationale: In older adults, the protein found in urine slightly rises, probably as a result of kidney
changes or subclinical urinary tract infections, and clients frequently experience asymptomatic
bacteriuria and pyuria as a result of incomplete bladder emptying. Laboratory findings in
options A, B, and D are not considered to be normal findings in an older adult.
When educating a client after a total laryngectomy, which instruction would be most
important for the nurse to include in the discharge teaching?
A. Recommend that the client carry suction equipment at all times.
B. Instruct the client to have writing materials with him at all times.
C. Tell the client to carry a medical alert card that explains his condition.
D. Caution the client not to travel outside the United States alone.
C
Rationale: Neck breathers carry a medical alert card that notifies health care personnel of the
need to use mouth to stoma breathing in the event of a cardiac arrest in this client. Mouth to
mouth resuscitation will not establish a patent airway. Options A and D are not necessary. There
are many alternative means of communication for clients who have had a laryngectomy;
dependence on writing messages is probably the least effective.
The nurse receives the client's next scheduled bag of TPN labeled with the additive NPH
insulin. Which action should the nurse implement?
A. Hang the solution at the current rate.
B. Refrigerate the solution until needed.
C.Prepare the solution with new tubing.
D.Return the solution to the pharmacy.
D
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Rationale: Only regular insulin is administered by the IV route, so the TPN solution containing
NPH insulin should be returned to the pharmacy. Options A, B, and C are not indicated because
the solution should not be administered.
A postoperative client receives a Schedule II opioid analgesic for pain. Which assessment
finding requires the most immediate intervention by the nurse?
A. Hypoactive bowel sounds with abdominal distention
B. Client reports continued pain of 8 on a 10-point scale
C. Respiratory rate of 12 breaths/min, with O2 saturation of 85%
D. Client reports nausea after receiving the medication
C
Rationale: Administration of a Schedule II opioid analgesic can result in respiratory depression,
which requires immediate intervention by the nurse to prevent respiratory arrest. Options A, B,
and D require action by the nurse but are of less priority than option C.
A client is placed on a mechanical ventilator following a cerebral hemorrhage, and
vecuronium bromide, 0.04 mg/kg every 12 hours IV, is prescribed. What is the priority nursing
diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles
B. High risk for infection related to increased intracranial pressure
C. Potential for injury related to impaired lung expansion
D. Social isolation related to inability to communicate
A
Rationale:To increase the client's tolerance of endotracheal intubation and/or mechanical
ventilation, a skeletal muscle relaxant such as vecuronium is usually prescribed. Option A is a
serious outcome because the client cannot communicate his or her needs. Although this client
might also experience option D, it is not a priority when compared with option A. Infection is
4
SUCCESS!
HESI MED SURG EVOLVE ELSEVIER EXAM VERSION 1-
VERSION 8 COMPLETE 600 QUESTIONS WITH DETAILED
SOLUTIONS JUST RELEASED THIS YEAR
EVOLVE MED SURG HESI (Elsevier) – 2 versions
In assessing a client diagnosed with primary aldosteronism, the nurse expects the laboratory
test results to indicate a decreased serum level of which substance?
A. Sodium
B. Phosphate
C. Potassium
D. Glucose
C
Rationale: Clients with primary aldosteronism exhibit a profound decline in serum levels of
potassium; hypokalemia; hypertension is the most prominent and universal sign. The serum
sodium level is normal or elevated, depending on the amount of water resorbed with the
sodium. Option B is influenced by parathyroid hormone (PTH). Option D is not affected by
primary aldosteronism.
During assessment of a client in the intensive care unit, the nurse notes that the client's
breath sounds are clear on auscultation, but jugular vein distention and muffled heart sounds
are present. Which intervention should the nurse implement?
A. Prepare the client for a pericardial tap.
B. Administer intravenous furosemide (Lasix).
C. Assist the client to cough and breathe deeply.
D. Instruct the client to restrict oral fluid intake.
A
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Rationale: The client is exhibiting symptoms of cardiac tamponade, a collection of fluid in the
pericardial sac that results in a reduction in cardiac output, which is a potentially fatal
complication of pericarditis. Treatment for tamponade is a pericardial tap. Lasix IV is not
indicated for treatment of pericarditis. Because the client's breath sounds are clear, option C is
not a priority. Fluids are frequently increased in the initial treatment of tamponade to
compensate for the decrease in cardiac output, but this is not the same priority as option A.
A central venous catheter has been inserted via a jugular vein, and a radiograph has
confirmed placement of the catheter. A prescription has been received for a medication STAT,
but IV fluids have not yet been started. Which action should the nurse take prior to
administering the prescribed medication?
A. Assess for signs of jugular venous distention.
B. Obtain the needed intravenous solution.
C. Flush the line with heparinized solution.
D. Flush the line with normal saline.
D
Rationale:Medication can be administered via a central line without additional IV fluids. The
line should first be flushed with a normal saline solution to ensure patency. Insufficient evidence
exists on the effectiveness of flushing catheters with heparin. Option A will not affect the
decision to administer the medication and is not a priority. Administration of the medication
STAT is of greater priority than option B.
Which data would the nurse expect to find when reviewing laboratory values of an 80-year-
old man who is in good health overall?
A. Complete blood count reveals increased white blood cell (WBC) and decreased red blood
cell (RBC) counts.
B. Chemistries reveal an increased serum bilirubin level with slightly increased liver enzyme
levels.
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C. Urinalysis reveals slight protein in the urine and bacteriuria, with pyuria.
D. Serum electrolytes reveal a decreased sodium level and increased potassium level.
C
Rationale: In older adults, the protein found in urine slightly rises, probably as a result of kidney
changes or subclinical urinary tract infections, and clients frequently experience asymptomatic
bacteriuria and pyuria as a result of incomplete bladder emptying. Laboratory findings in
options A, B, and D are not considered to be normal findings in an older adult.
When educating a client after a total laryngectomy, which instruction would be most
important for the nurse to include in the discharge teaching?
A. Recommend that the client carry suction equipment at all times.
B. Instruct the client to have writing materials with him at all times.
C. Tell the client to carry a medical alert card that explains his condition.
D. Caution the client not to travel outside the United States alone.
C
Rationale: Neck breathers carry a medical alert card that notifies health care personnel of the
need to use mouth to stoma breathing in the event of a cardiac arrest in this client. Mouth to
mouth resuscitation will not establish a patent airway. Options A and D are not necessary. There
are many alternative means of communication for clients who have had a laryngectomy;
dependence on writing messages is probably the least effective.
The nurse receives the client's next scheduled bag of TPN labeled with the additive NPH
insulin. Which action should the nurse implement?
A. Hang the solution at the current rate.
B. Refrigerate the solution until needed.
C.Prepare the solution with new tubing.
D.Return the solution to the pharmacy.
D
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Rationale: Only regular insulin is administered by the IV route, so the TPN solution containing
NPH insulin should be returned to the pharmacy. Options A, B, and C are not indicated because
the solution should not be administered.
A postoperative client receives a Schedule II opioid analgesic for pain. Which assessment
finding requires the most immediate intervention by the nurse?
A. Hypoactive bowel sounds with abdominal distention
B. Client reports continued pain of 8 on a 10-point scale
C. Respiratory rate of 12 breaths/min, with O2 saturation of 85%
D. Client reports nausea after receiving the medication
C
Rationale: Administration of a Schedule II opioid analgesic can result in respiratory depression,
which requires immediate intervention by the nurse to prevent respiratory arrest. Options A, B,
and D require action by the nurse but are of less priority than option C.
A client is placed on a mechanical ventilator following a cerebral hemorrhage, and
vecuronium bromide, 0.04 mg/kg every 12 hours IV, is prescribed. What is the priority nursing
diagnosis for this client?
A. Impaired communication related to paralysis of skeletal muscles
B. High risk for infection related to increased intracranial pressure
C. Potential for injury related to impaired lung expansion
D. Social isolation related to inability to communicate
A
Rationale:To increase the client's tolerance of endotracheal intubation and/or mechanical
ventilation, a skeletal muscle relaxant such as vecuronium is usually prescribed. Option A is a
serious outcome because the client cannot communicate his or her needs. Although this client
might also experience option D, it is not a priority when compared with option A. Infection is
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