ESTUDYR
EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM
WITH WELL-ELABORATED RATIONALES/ EVOLVE
HESI MEDICAL SURGICAL
A client with hypertension has been receiving ramipril (Altace) 5 mg PO daily for 2 weeks and
is scheduled to receive a dose at 0900. At 0830 the client’s BP is 120/70 mm Hg. What should
the nurse do?
A. Hold the dose and notify the provider.
B. Give a half dose now.
C. Administer the prescribed dose at the scheduled time.
D. Delay the dose until BP rises above 130/80.
Rationale: BP is within acceptable/therapeutic range; continue scheduled antihypertensive.
Which instruction best prevents toxic shock syndrome in a female client?
A. Get immunization against HPV.
B. Change your tampon frequently.
C. Empty your bladder after intercourse.
D. Obtain a yearly flu vaccination.
Rationale: Frequent tampon changes reduce risk of staphylococcal toxin growth.
A home health nurse observes a client with Parkinson disease on carbidopa-levodopa who
has a masklike expression and rare blinking. The nurse should:
A. Perform a complete cranial nerve assessment.
B. Tell the client they may have medication toxicity.
C. Document the presence of these expected assessment findings.
D. Advise immediate emergency evaluation.
Rationale: Masklike facies and decreased blinking are typical Parkinsonian findings; document.
A client with an NG tube to low suction reports nausea; no drainage in 2 hours. Which action
first?
A. Irrigate NG tube with sterile saline.
B. Reposition the client on her side.
C. Advance the NG tube 5 cm.
D. Administer IV antiemetic as prescribed.
Rationale: Least invasive first—reposition to restore patency before irrigation or advancement.
A client with type 2 diabetes chooses foods to reduce obesity. Which indicate understanding?
(Select all that apply)
,ESTUDYR
A. White bread
B. Salmon
C. Broccoli
D. Whole milk
E. Banana
Rationale: Salmon (lean protein/omega-3), broccoli (vegetable), banana (fruit) align with
healthier choices; white bread is refined.
A female client with neurogenic bladder is at risk for which complication?
A. Stress incontinence
B. Infection
C. Painless gross hematuria
D. Peritonitis
Rationale: Urinary stasis and catheter use predispose to UTIs.
A telemetry client demonstrates uncontrolled A-fib with rapid ventricular response. Which
treatment will the nurse prepare to assist with?
A. Give lidocaine 75 mg IV push.
B. Perform synchronized cardioversion.
C. Defibrillate immediately.
D. Give atropine 0.4 mg IV push.
Rationale: Synchronized cardioversion is indicated for unstable or uncontrolled A-fib with RVR
to restore sinus rhythm.
A client with a basilar (basal skull) fracture develops a new oral temp of 102°F. This suggests:
A. Bilateral JVD
B. Infection (meningitis/brain infection)
C. Intermittent focal motor seizures
D. Intractable cervical pain
Rationale: Basilar skull fractures increase risk for CNS infection; fever is an early sign.
A type 2 diabetic on metformin is NPO for major surgery. Best perioperative glycemic
management:
A. NPO except for metformin and regular insulin.
B. NPO except for oral antidiabetic agent.
C. Novolin N SQ BID.
D. Regular insulin SQ per sliding scale.
Rationale: Sliding-scale regular insulin provides titratable control when NPO and under surgical
stress.
, ESTUDYR
Client with tumor lysis syndrome is receiving IV insulin. The nurse should first monitor:
A. Diabetes history
B. IV site distal extremity
C. Serum potassium and blood glucose levels
D. Oxygen saturation and breath sounds
Rationale: Insulin lowers serum potassium and blood glucose — these values are highest
priority.
Trigeminal neuralgia (tic douloureux) is characterized by:
A. Tinnitus, vertigo, hearing loss
B. Sudden, stabbing, severe facial pain over lip and chin
C. Unilateral facial weakness and paralysis
D. Difficulty chewing, talking, swallowing
Rationale: Classic paroxysmal electric-shock pain in trigeminal distribution.
A client with a fractured right elbow — which finding has highest priority?
A. Ecchymosis over the elbow
B. Deep unrelenting pain in the right arm
C. Edematous right elbow
D. Presence of crepitus
Rationale: Severe unrelieved pain suggests compartment syndrome — emergent.
For a newly diagnosed client with Cushing syndrome, an appropriate nursing intervention is:
A. Monitor blood glucose levels daily.
B. Increase intake of potassium-rich fluids.
C. Encourage activity without rest.
D. Offer a sodium-enriched menu.
Rationale: Cushing’s predisposes to hyperglycemia and glucose monitoring is essential.
For osteoporosis prevention in a healthy 30-yr-old woman, the most beneficial activity is:
A. Cross-country skiing
B. Scuba diving
C. Horseback riding
D. Kayaking
Rationale: Weight-bearing aerobic exercise (skiing) helps maintain bone density.
Chest tube drainage decreased from 50 to 5 mL/hr 12 hrs after insertion. Best initial action:
A. Document expected decrease
B. Clamp chest tube to check for air leaks
C. Milk the tube for clots
EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM
WITH WELL-ELABORATED RATIONALES/ EVOLVE
HESI MEDICAL SURGICAL
A client with hypertension has been receiving ramipril (Altace) 5 mg PO daily for 2 weeks and
is scheduled to receive a dose at 0900. At 0830 the client’s BP is 120/70 mm Hg. What should
the nurse do?
A. Hold the dose and notify the provider.
B. Give a half dose now.
C. Administer the prescribed dose at the scheduled time.
D. Delay the dose until BP rises above 130/80.
Rationale: BP is within acceptable/therapeutic range; continue scheduled antihypertensive.
Which instruction best prevents toxic shock syndrome in a female client?
A. Get immunization against HPV.
B. Change your tampon frequently.
C. Empty your bladder after intercourse.
D. Obtain a yearly flu vaccination.
Rationale: Frequent tampon changes reduce risk of staphylococcal toxin growth.
A home health nurse observes a client with Parkinson disease on carbidopa-levodopa who
has a masklike expression and rare blinking. The nurse should:
A. Perform a complete cranial nerve assessment.
B. Tell the client they may have medication toxicity.
C. Document the presence of these expected assessment findings.
D. Advise immediate emergency evaluation.
Rationale: Masklike facies and decreased blinking are typical Parkinsonian findings; document.
A client with an NG tube to low suction reports nausea; no drainage in 2 hours. Which action
first?
A. Irrigate NG tube with sterile saline.
B. Reposition the client on her side.
C. Advance the NG tube 5 cm.
D. Administer IV antiemetic as prescribed.
Rationale: Least invasive first—reposition to restore patency before irrigation or advancement.
A client with type 2 diabetes chooses foods to reduce obesity. Which indicate understanding?
(Select all that apply)
,ESTUDYR
A. White bread
B. Salmon
C. Broccoli
D. Whole milk
E. Banana
Rationale: Salmon (lean protein/omega-3), broccoli (vegetable), banana (fruit) align with
healthier choices; white bread is refined.
A female client with neurogenic bladder is at risk for which complication?
A. Stress incontinence
B. Infection
C. Painless gross hematuria
D. Peritonitis
Rationale: Urinary stasis and catheter use predispose to UTIs.
A telemetry client demonstrates uncontrolled A-fib with rapid ventricular response. Which
treatment will the nurse prepare to assist with?
A. Give lidocaine 75 mg IV push.
B. Perform synchronized cardioversion.
C. Defibrillate immediately.
D. Give atropine 0.4 mg IV push.
Rationale: Synchronized cardioversion is indicated for unstable or uncontrolled A-fib with RVR
to restore sinus rhythm.
A client with a basilar (basal skull) fracture develops a new oral temp of 102°F. This suggests:
A. Bilateral JVD
B. Infection (meningitis/brain infection)
C. Intermittent focal motor seizures
D. Intractable cervical pain
Rationale: Basilar skull fractures increase risk for CNS infection; fever is an early sign.
A type 2 diabetic on metformin is NPO for major surgery. Best perioperative glycemic
management:
A. NPO except for metformin and regular insulin.
B. NPO except for oral antidiabetic agent.
C. Novolin N SQ BID.
D. Regular insulin SQ per sliding scale.
Rationale: Sliding-scale regular insulin provides titratable control when NPO and under surgical
stress.
, ESTUDYR
Client with tumor lysis syndrome is receiving IV insulin. The nurse should first monitor:
A. Diabetes history
B. IV site distal extremity
C. Serum potassium and blood glucose levels
D. Oxygen saturation and breath sounds
Rationale: Insulin lowers serum potassium and blood glucose — these values are highest
priority.
Trigeminal neuralgia (tic douloureux) is characterized by:
A. Tinnitus, vertigo, hearing loss
B. Sudden, stabbing, severe facial pain over lip and chin
C. Unilateral facial weakness and paralysis
D. Difficulty chewing, talking, swallowing
Rationale: Classic paroxysmal electric-shock pain in trigeminal distribution.
A client with a fractured right elbow — which finding has highest priority?
A. Ecchymosis over the elbow
B. Deep unrelenting pain in the right arm
C. Edematous right elbow
D. Presence of crepitus
Rationale: Severe unrelieved pain suggests compartment syndrome — emergent.
For a newly diagnosed client with Cushing syndrome, an appropriate nursing intervention is:
A. Monitor blood glucose levels daily.
B. Increase intake of potassium-rich fluids.
C. Encourage activity without rest.
D. Offer a sodium-enriched menu.
Rationale: Cushing’s predisposes to hyperglycemia and glucose monitoring is essential.
For osteoporosis prevention in a healthy 30-yr-old woman, the most beneficial activity is:
A. Cross-country skiing
B. Scuba diving
C. Horseback riding
D. Kayaking
Rationale: Weight-bearing aerobic exercise (skiing) helps maintain bone density.
Chest tube drainage decreased from 50 to 5 mL/hr 12 hrs after insertion. Best initial action:
A. Document expected decrease
B. Clamp chest tube to check for air leaks
C. Milk the tube for clots
