Evolve Hesi Med Surg WITH CORRECT ANSWERS
(Latest 2025/2026| VERIFIED ANSWERS &
RATIONALE’S
A 55-year-old male client has been admitted to the hospital with a medical diagnosis of chronic
obstructive pulmonary disease (COPD). Which risk factor is the most significant in the
development of this client's COPD?
A.
The client's father was diagnosed with COPD in his 50s.
B.
A close family member contracted tuberculosis last year.
C.
The client smokes one to two packs of cigarettes per day.
D.
The client has been 40 pounds overweight for 15 years.
C
Rationale: Smoking, considered to be a modifiable risk factor, is the most significant risk factor
for the development of COPD. The exact mechanism of genetic and hereditary implications for
the development of COPD is still under investigation, although exposure to similar predisposing
factors (e.g., smoking or inhaling secondhand smoke) may increase the likelihood of COPD
incidence among family members. Options B and D do not exceed the risks associated with
cigarette smoking in the development of COPD.
A 43-year-old homeless, malnourished female client with a history of alcoholism is transferred
to the ICU. She is placed on telemetry, and the rhythm strip shown is obtained. The nurse
palpates a heart rate of 160 beats/min, and the client's blood pressure is 90/54 mm Hg. Based
on these findings, which IV medication should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
,Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl)
B
Rationale: Because the client has chronic alcoholism, she is likely to have hypomagnesemia.
Option B is the recommended drug for torsades de pointes, which is a form of polymorphic
ventricular tachycardia (VT) usually associated with a prolonged QT interval that occurs with
hypomagnesemia. Options A and D increase the QT interval, which can cause the torsades to
worsen. Option C is the antiarrhythmic of choice in most cases of drug-induced monomorphic
VT, not torsades.
.
The nurse is caring for a client who is one day post-acute myocardial infarction. The client is
receiving oxygen at 2 L/min via nasal cannula and has a peripheral saline lock. The nurse
notes that the client is having eight premature ventricular contractions (PVCs) per minute.
Which intervention should the nurse implement first?
A.
Obtain an IV pump for antiarrhythmic infusion.
B.
Increase the client's oxygen flow rate.
C.
Prepare for immediate countershock.
D.
Gather equipment for endotracheal intubation.
B
Rationale: Increasing the oxygen flow rate provides more oxygen to the client's myocardium
and may decrease myocardial irritability as manifested by the frequent PVCs. Option A can be
delegated and is a lower priority action than option B. Defibrillation may eventually be
necessary, but option C is not the immediate treatment for frequent PVCs. Option D may
become necessary if the client stops breathing but is not indicated at this time.
,The nurse is caring for a client with a chest tube to water seal drainage that was inserted 10
days ago because of a ruptured bullae and pneumothorax. Which finding should the nurse
report to the health care provider before the chest tube is removed?
A.
Tidaling of water in water seal chamber
B.
Bilateral muffled breath sounds at bases
C.
Temperature of 101° F
D.
Absence of chest tube drainage for 2 days
A
Rationale: Tidaling (rising and falling of water with respirations) in the water seal chamber
should be reported to the health care provider before the chest tube is removed to rule out an
unresolved pneumothorax or persistent air leak, which is characteristic of a ruptured bullae
caused by abnormally wide changes in negative intrathoracic pressure. Option B may indicate
hypoventilation from chest tube discomfort and usually improves when the chest tube is
removed. Option C usually indicates an infection, which may not be related to the chest tube.
Option D is an expected finding.
A 77-year-old female client is admitted to the hospital with confusion and anorexia of several
days' duration. She has symptoms of nausea and vomiting and is currently complaining of a
headache. The client's pulse rate is 43 beats/min. The nurse is most concerned about the
client's history related to which medication?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin
, D
Rationale: Older persons are particularly susceptible to the buildup of cardiac glycosides, such
as digoxin or digitoxin (medications derived from digitalis), to a toxic level in their systems.
Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and fatigue. Options A, B,
and C are unlikely to result in the symptoms described.
.
A nurse is assisting an 82-year-old client with ambulation and is concerned that the client may
fall. Which area contains the older person's center of gravity?
A.
Head and neck
B.
Upper torso
C.
Bilateral arms
D.
Feet and legs
B
Rationale: Stooped posture results in the upper torso becoming the center of gravity for older
persons. The center of gravity for adults is the hips. However, as a person grows older, a
stooped posture is common because of changes caused by osteoporosis and normal bone
degeneration. Furthermore, the knees, hips, and elbows flex. The head and neck and feet and
legs are not the center of gravity in the older adult. Although the arms comprise a part of the
upper torso, they do not reflect the best and most complete answer.
After attending a class on reducing cancer risk factors, a client selects bran flakes with 2%
milk and orange slices from a breakfast menu. In evaluating the client's learning, the nurse
affirms that the client has made good choices and makes what additional recommendation?
A.
Switch to skim milk.
(Latest 2025/2026| VERIFIED ANSWERS &
RATIONALE’S
A 55-year-old male client has been admitted to the hospital with a medical diagnosis of chronic
obstructive pulmonary disease (COPD). Which risk factor is the most significant in the
development of this client's COPD?
A.
The client's father was diagnosed with COPD in his 50s.
B.
A close family member contracted tuberculosis last year.
C.
The client smokes one to two packs of cigarettes per day.
D.
The client has been 40 pounds overweight for 15 years.
C
Rationale: Smoking, considered to be a modifiable risk factor, is the most significant risk factor
for the development of COPD. The exact mechanism of genetic and hereditary implications for
the development of COPD is still under investigation, although exposure to similar predisposing
factors (e.g., smoking or inhaling secondhand smoke) may increase the likelihood of COPD
incidence among family members. Options B and D do not exceed the risks associated with
cigarette smoking in the development of COPD.
A 43-year-old homeless, malnourished female client with a history of alcoholism is transferred
to the ICU. She is placed on telemetry, and the rhythm strip shown is obtained. The nurse
palpates a heart rate of 160 beats/min, and the client's blood pressure is 90/54 mm Hg. Based
on these findings, which IV medication should the nurse administer?
A.
Amiodarone (Cordarone)
B.
Magnesium sulfate
C.
,Lidocaine (Xylocaine)
D.
Procainamide (Pronestyl)
B
Rationale: Because the client has chronic alcoholism, she is likely to have hypomagnesemia.
Option B is the recommended drug for torsades de pointes, which is a form of polymorphic
ventricular tachycardia (VT) usually associated with a prolonged QT interval that occurs with
hypomagnesemia. Options A and D increase the QT interval, which can cause the torsades to
worsen. Option C is the antiarrhythmic of choice in most cases of drug-induced monomorphic
VT, not torsades.
.
The nurse is caring for a client who is one day post-acute myocardial infarction. The client is
receiving oxygen at 2 L/min via nasal cannula and has a peripheral saline lock. The nurse
notes that the client is having eight premature ventricular contractions (PVCs) per minute.
Which intervention should the nurse implement first?
A.
Obtain an IV pump for antiarrhythmic infusion.
B.
Increase the client's oxygen flow rate.
C.
Prepare for immediate countershock.
D.
Gather equipment for endotracheal intubation.
B
Rationale: Increasing the oxygen flow rate provides more oxygen to the client's myocardium
and may decrease myocardial irritability as manifested by the frequent PVCs. Option A can be
delegated and is a lower priority action than option B. Defibrillation may eventually be
necessary, but option C is not the immediate treatment for frequent PVCs. Option D may
become necessary if the client stops breathing but is not indicated at this time.
,The nurse is caring for a client with a chest tube to water seal drainage that was inserted 10
days ago because of a ruptured bullae and pneumothorax. Which finding should the nurse
report to the health care provider before the chest tube is removed?
A.
Tidaling of water in water seal chamber
B.
Bilateral muffled breath sounds at bases
C.
Temperature of 101° F
D.
Absence of chest tube drainage for 2 days
A
Rationale: Tidaling (rising and falling of water with respirations) in the water seal chamber
should be reported to the health care provider before the chest tube is removed to rule out an
unresolved pneumothorax or persistent air leak, which is characteristic of a ruptured bullae
caused by abnormally wide changes in negative intrathoracic pressure. Option B may indicate
hypoventilation from chest tube discomfort and usually improves when the chest tube is
removed. Option C usually indicates an infection, which may not be related to the chest tube.
Option D is an expected finding.
A 77-year-old female client is admitted to the hospital with confusion and anorexia of several
days' duration. She has symptoms of nausea and vomiting and is currently complaining of a
headache. The client's pulse rate is 43 beats/min. The nurse is most concerned about the
client's history related to which medication?
A.
Warfarin
B.
Ibuprofen
C.
Nitroglycerin
D.
Digoxin
, D
Rationale: Older persons are particularly susceptible to the buildup of cardiac glycosides, such
as digoxin or digitoxin (medications derived from digitalis), to a toxic level in their systems.
Toxicity can cause anorexia, nausea, vomiting, diarrhea, headache, and fatigue. Options A, B,
and C are unlikely to result in the symptoms described.
.
A nurse is assisting an 82-year-old client with ambulation and is concerned that the client may
fall. Which area contains the older person's center of gravity?
A.
Head and neck
B.
Upper torso
C.
Bilateral arms
D.
Feet and legs
B
Rationale: Stooped posture results in the upper torso becoming the center of gravity for older
persons. The center of gravity for adults is the hips. However, as a person grows older, a
stooped posture is common because of changes caused by osteoporosis and normal bone
degeneration. Furthermore, the knees, hips, and elbows flex. The head and neck and feet and
legs are not the center of gravity in the older adult. Although the arms comprise a part of the
upper torso, they do not reflect the best and most complete answer.
After attending a class on reducing cancer risk factors, a client selects bran flakes with 2%
milk and orange slices from a breakfast menu. In evaluating the client's learning, the nurse
affirms that the client has made good choices and makes what additional recommendation?
A.
Switch to skim milk.
