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EVOLVE ELSEVIER HESI MED SURG EXAM QUESTIONS AND ANSWERS 2024
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EVOLVE ELSEVIER HESI MED SURG EXAM QUESTIONS AND ANSWERS 2024
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EVOLVE ELSEVIER HESI MED SURGEXAM
A 74-year-old male client is admitted to the intensive care unit (ICU) with a
diagnosis of respiratory failure secondary to pneumonia. Currently, he is
ventilator-dependent, with settings of tidal volume (VT) of 750 mL and an
intermittent mandatory ventilation (IMV) rate of 10 breaths/min. Arterial blood
gas (ABG) results are as follows: pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg;
HCO3, 25 mEq/L; and FiO2, 0.80. Which intervention should the nurse implement
first?
A.
Increase the ventilator VT to 850 mL.
B.
Decrease the ventilator IMV to a rate of 8 breaths/min.
C.
Reduce the FiO2 to 0.70 and redraw ABGs.
D.
Add 5 cm positive end-expiratory pressure (PEEP).
D
Rationale: Adding PEEP helps improve oxygenation while reducing FiO2 to a less
toxic level. Options A, B, and C will not result in improved oxygenation and could
cause further complications for this client, who is experiencing respiratory failure.
,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 blood
pressure is 120/70 mm Hg. Which action should the nurse take?
A.
Administer the prescribed dose at the scheduled time.
B.
Hold the dose and contact the health care provider.
C.
Hold the dose and recheck the blood pressure in 1 hour.
D.
Check the health care provider's prescription to clarify the dose.
A
Rationale: The client's blood pressure is within normal limits, indicating that the
ramipril, an antihypertensive, is having the desired effect and should be
administered. Options B and C would be appropriate if the client's blood pressure
was excessively low (<100 mm Hg systolic) or if the client were exhibiting signs of
hypotension such as dizziness. This prescribed dose is within the normal dosage
range, as defined by the manufacturer; therefore, option D is not necessary.
The nurse notes that a client who is scheduled for surgery the next morning has
an elevated blood urea nitrogen (BUN) level. Which condition is most likely to
have contributed to this finding?
A.
Myocardial infarction 2 months ago
B.
Anorexia and vomiting for the past 2 days
,C.
Recently diagnosed type 2 diabetes mellitus
D.
Skeletal traction for a right hip fracture
B
Rationale: The blood urea nitrogen (BUN) level indicates the effectiveness of the
kidneys in filtering waste from the blood. Dehydration, which could be caused by
vomiting, would cause an increased BUN level. Option A would affect serum
enzyme levels, not the BUN level. Option C would primarily affect the blood
glucose level; renal failure that could increase the BUN level would be unlikely in a
client newly diagnosed with type 2 diabetes. Effects of option D might affect the
complete blood count (CBC) but would not directly increase the BUN level.
A client with type 2 diabetes takes metformin (Glucophage) daily. The client is
scheduled for major surgery requiring general anesthesia the next day. The nurse
anticipates which approach to manage the client's diabetes best while the client is
NPO during the perioperative period?
A.
NPO except for metformin and regular snacks
B.
NPO except for oral antidiabetic agent
C.
Novolin N insulin subcutaneously twice daily
D.
Regular insulin subcutaneously per sliding scale
D
, Rationale: Regular insulin dosing based on the client's blood glucose levels (sliding
scale) is the best method to achieve control of the client's blood glucose while the
client is NPO and coping with the major stress of surgery. Option A increases the
risk of vomiting and aspiration. Options B and C provide less precise control of the
blood glucose level.
The nurse teaches a client with type 2 diabetes nutritional strategies to decrease
obesity. Which food items chosen by the client indicate understanding of the
teaching? (Select all that apply.)
A.
White bread
B.
Salmon
C.
Broccoli
D.
Whole milk
E.
Banana
B,C,E
Rationale: Options B, C, and E provide fresh fruits, lean meats and fish,
vegetables, whole grains, and low-fat dairy products. All are recommended by the
American Diabetes Association (ADA) and are a part of the My Plate guidelines
recommended by the U.S. Department of Agriculture (USDA). Whole milk is high
in fat and is not recommended by the ADA. White bread is milled, a process that
removes the essential nutrients. It should be avoided for weight loss and is a poor
choice for the client with diabetes.
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