EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM
WITH 150 REAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH WELL -ELABORATED RATIONALES/
EVOLVE HESI MEDICAL SURGICAL LATEST EXAM
2025-2026 (BRAND NEW!!)
When assigning clients on a medical-surgical floor to an RN and a PN, it is best for the charge nurse to assign which client to the PN?A.A young adult with bacterial meningitis with recent seizures B.An older adult client with pneumonia and viral meningitis C.A female client in isolation with meningococcal meningitis D.A male client 1 day postoperative after drainage of a brain abscess - CORRECT ANSWER-CORRECT
ANSWER: B
Rationale:The most stable client is option B. Options A, C, and D are all at high risk for increased intracranial pressure and require the expertise of the RN for assessment and management of care.
The nurse notes that the client's drainage has decreased from 50 to 5 mL/hr 12 hours after chest tube insertion for hemothorax. What is the best initial action for the nurse to take?A.Document this expected decrease in drainage.B.Clamp the chest tube while assessing for air leaks.C.Milk the tube to remove any excessive blood clot buildup.D.Assess for kinks or dependent loops in the tubing - CORRECT ANSWER-CORRECT ANSWER: D Rationale:The least invasive nursing action should be performed first to determine why the drainage has diminished. Option A is completed after assessing for any problems causing the decrease in drainage. Option B is no longer considered standard protocol because the increase in pressure may be harmful to the client. Option C is an appropriate nursing action after the tube has been assessed for kinks or dependent loops.
A 43-year-old homeless, malnourished client with a history of alcoholism is transferred to the ICU.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 1 / 4
C.Lidocaine (Xylocaine)
D.Procainamide (Pronestyl) - CORRECT ANSWER-CORRECT ANSWER: B
Rationale:The client with chronic alcoholism 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 hears the presence of secretions in the lungs and determines the client, post thoracotomy, needs to be suctioned. What steps will the nurse include in the suctioning procedure?(Select all that apply.)
A.Perform hand hygiene.B.Position in no less than a semi-Fowler's position.C.Lubricate the suction catheter with a petroleum-based product.D.Insert the catheter with the suction on.E.Listen for breath sounds.
F.Hyperoxygenate the client. - CORRECT ANSWER-CORRECT ANSWER: A,B,E,F
Rationale:The suction catheter does need to be lubricated, but with a water-based product, not a petroleum-based product. The suction catheter needs to be inserted with the suction off, not on.Suction should be applied intermittently while withdrawing the catheter. The remainder are steps in the suction process.
Which consideration is most important when the nurse is assigning a room for a client being admitted with progressive systemic sclerosis (scleroderma)?A.Provide a room that can be kept warm.B.Make sure that the room can be kept dark.C.Keep the client close to the nursing unit.D.Select a room that is visible from the nurses' desk. - CORRECT ANSWER-CORRECT ANSWER: A Rationale:Abnormal blood flow in response to cold (Raynaud phenomenon) is precipitated in clients with scleroderma. Option B is not a significant factor. Stress can also precipitate the severe pain of Raynaud phenomenon, so a quiet environment is preferred to option C, which is often very noisy.Option D is not necessary.
The nurse is reviewing routine medications taken by a client with chronic angle-closure glaucoma.Which medication prescription should the nurse question? 2 / 4
A.Antianginal with a therapeutic effect of vasodilation B.Anticholinergic with a side effect of pupillary dilation C.Antihistamine with a side effect of sedation D.Corticosteroid with a side effect of hyperglycemia - CORRECT ANSWER-CORRECT ANSWER: B Rationale:Clients with angle-closure glaucoma should not take medications that dilate the pupil because this can precipitate acute and severely increased intraocular pressure. Options A, C, and D do not cause increased intracranial pressure, which is the primary concern with angle-closure glaucoma.
The nurse is preparing a client for discharge after a right total knee replacement. Which client statements about use of a walker indicate to the nurse the teaching was effective? (Select all that apply.) A."I will walk in the middle of the walker." B."I will make sure all four feet of the walker are on the floor before I use the hand pieces." C."I will move my right foot forward into the walker, and then my left foot." D."I will collapse the walker and put it in the chair opposite the bed at night." E."I will use a silicone-based cleaning product to clean the hand pieces and rubber tips." - CORRECT
ANSWER-CORRECT ANSWER: A,B,C
Rationale:The nurse is teaching about use of a walker. Having the walker collapsed at night does not help with nighttime ambulation to the restroom. The client is at risk for falling. Silicone is a slippery material and placing silicone on the rubber tips of the walker places the client at risk for falling. The remaining client statements about use of a walker are correct.
A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment?A.Administer lidocaine, 75 mg intravenous push.B.Perform synchronized cardioversion.C.Defibrillate the client as soon as possible.D.Administer atropine, 0.4 mg intravenous push. - CORRECT ANSWER-CORRECT ANSWER: B Rationale:With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A is a medication used for ventricular dysrhythmias. Option C is not for a client with atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug of choice in symptomatic sinus bradycardia, not atrial fibrillation.
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Which change in laboratory values indicates to the nurse that a client with rheumatoid arthritis may be experiencing an adverse effect of methotrexate therapy?A.Increase in rheumatoid factor B.Decrease in hemoglobin level C.Increase in blood glucose level D.Decrease in erythrocyte sedimentation rate (ESR; sed rate) - CORRECT ANSWER-CORRECT
ANSWER: B
Rationale:Methotrexate is an immunosuppressant. A common side effect is bone marrow depression, which would be reflected by a decrease in the hemoglobin level. Option A indicates disease progression but is not a side effect of the medication. Option C is not related to methotrexate. Option D indicates that inflammation associated with the disease has diminished.
A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of 102°F/38.9°C. What other assessments should the nurse include in the client's focused assessment?(Select all that apply.) A.Nausea and vomiting B.Loss of appetite C.Abdominal cramping D.Guarding with abdominal palpation E.Low urine output
F.Cool, clammy skin - CORRECT ANSWER-CORRECT ANSWER: A,B,C,D
Rationale:The client is showing signs of peritonitis with the sudden spike in temperature. Low urine output and cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the health care provider must be notified immediately.
Which nursing action is necessary for the client with a flail chest?A.Withhold prescribed analgesic medications.B.Percuss the fractured rib area with light taps.C.Avoid implementing pulmonary suctioning.
D.Encourage coughing and deep breathing. - CORRECT ANSWER-CORRECT ANSWER: D
Rationale:Treatment of flail chest is focused on preventing atelectasis and related complications of compromised ventilation by encouraging coughing and deep breathing. This condition is typically diagnosed in clients with three or more rib fractures, resulting in paradoxic movement of a segment of the chest wall. Option C should not be avoided because suctioning is necessary to maintain pulmonary toilet in clients who require mechanical ventilation. Option A should not be withheld.Option B should not be applied because the fractures are clearly visible on the chest radiograph.
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