EVOLVE ELSEVIER HESI MED SURG EXAM 3
2026 REVIEW PAPER COMPLETE QUESTIONS
WITH EXPERT SOLUTIONS AND MARKING
SCHEME
◉ The nurse should be correct in withholding a dose of digoxin in a
client with congestive heart failure without specific instruction from
the healthcare provider if the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min.
Answer: C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons
receiving digoxin which will increase the chance of dangerous
dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). The
therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels= >2
ng/ml); (A) is within this range. (B) would not warrant the nurse
withholding the digoxin. The nurse should withhold the digoxin if
the apical pulse is less than 60/min (D).
,◉ In assessing a client diagnosed with primary hyperaldosteronism,
the nurse expects the laboratory test results to indicate a decreased
serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose.
Answer: C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the
serum levels of potassium (C) (hypokalemia)--hypertension is the
most prominent and universal sign. (A) is normal or elevated,
depending on the amount of water reabsorbed with the sodium. (B)
is decreased with diabetes insipidus. (D) is not affected by primary
aldosteronism.
◉ Based on the analysis of the client's atrial fibrillation, the nurse
should prepare the client for which treatment protocol?
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
D) Cardiac catheterization.
Answer: C) Anticoagulation therapy.
,The client is experiencing atrial fibrillation, and the nurse should
prepare the client for anticoagulation therapy (C) which should be
prescribed before rhythm control therapies to prevent
cardioembolic events which result from blood pooling in the
fibrillating atria. (A, B, and D) are not indicated.
◉ Which information about mammograms is most important to
provide a post-menopausal female client?
A) Breast self-examinations are not needed if annual mammograms
are obtained.
B) Radiation exposure is minimized by shielding the abdomen with a
lead-lined apron.
C) Yearly mammograms should be done regardless of previous
normal x-rays.
D) Women at high risk should have annual routine and ultrasound
mammograms.
Answer: C) Yearly mammograms should be done regardless of
previous normal x-rays.
The current breast screening recommendation is a yearly
mammogram after age 40 (C). Breast self-exam (A) continues to be a
priority recommendation for all women because a small lump (or
tumor) is often first felt by a woman before a mammogram is
obtained. The radiation exposure from a mammogram is low, so (B)
is not normally provided. The frequency of using routine and
ultrasound mammograms (D) in women with high-risk variables,
, such as a history of breast cancer, the presence of BRC1 and BRC2
genes, or 2 first-degree relatives with breast cancer, should be
recommended and followed closely by the healthcare provider.
◉ In assessing cancer risk, the nurse identifies which woman as
being at greatest risk of developing breast cancer?
A) A 35-year-old multipara who never breastfed.
B) A 50-year-old whose mother had unilateral breast cancer.
C) A 55-year-old whose mother-in-law had bilateral breast cancer.
D) A 20-year-old whose menarche occurred at age 9.
Answer: B) A 50-year-old whose mother had unilateral breast
cancer.
The most predictive risk factors for development of breast cancer
are over 40 years of age and a positive family history (occurrence in
the immediate family, i.e., mother or sister). Other risk factors
include nulliparity, no history of breastfeeding, early menarche and
late menopause. Although all of the women described have one of
the risk factors for developing breast cancer, (B) has the greater risk
over (A, C, and D).
◉ Which reaction should the nurse identify in a client who is
responding to stimulation of the sympathetic nervous system?
A) Pupil constriction.
B) Increased heart rate.
2026 REVIEW PAPER COMPLETE QUESTIONS
WITH EXPERT SOLUTIONS AND MARKING
SCHEME
◉ The nurse should be correct in withholding a dose of digoxin in a
client with congestive heart failure without specific instruction from
the healthcare provider if the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min.
Answer: C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons
receiving digoxin which will increase the chance of dangerous
dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). The
therapeutic range for digoxin is 0.8 to 2 ng/ml (toxic levels= >2
ng/ml); (A) is within this range. (B) would not warrant the nurse
withholding the digoxin. The nurse should withhold the digoxin if
the apical pulse is less than 60/min (D).
,◉ In assessing a client diagnosed with primary hyperaldosteronism,
the nurse expects the laboratory test results to indicate a decreased
serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose.
Answer: C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the
serum levels of potassium (C) (hypokalemia)--hypertension is the
most prominent and universal sign. (A) is normal or elevated,
depending on the amount of water reabsorbed with the sodium. (B)
is decreased with diabetes insipidus. (D) is not affected by primary
aldosteronism.
◉ Based on the analysis of the client's atrial fibrillation, the nurse
should prepare the client for which treatment protocol?
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
D) Cardiac catheterization.
Answer: C) Anticoagulation therapy.
,The client is experiencing atrial fibrillation, and the nurse should
prepare the client for anticoagulation therapy (C) which should be
prescribed before rhythm control therapies to prevent
cardioembolic events which result from blood pooling in the
fibrillating atria. (A, B, and D) are not indicated.
◉ Which information about mammograms is most important to
provide a post-menopausal female client?
A) Breast self-examinations are not needed if annual mammograms
are obtained.
B) Radiation exposure is minimized by shielding the abdomen with a
lead-lined apron.
C) Yearly mammograms should be done regardless of previous
normal x-rays.
D) Women at high risk should have annual routine and ultrasound
mammograms.
Answer: C) Yearly mammograms should be done regardless of
previous normal x-rays.
The current breast screening recommendation is a yearly
mammogram after age 40 (C). Breast self-exam (A) continues to be a
priority recommendation for all women because a small lump (or
tumor) is often first felt by a woman before a mammogram is
obtained. The radiation exposure from a mammogram is low, so (B)
is not normally provided. The frequency of using routine and
ultrasound mammograms (D) in women with high-risk variables,
, such as a history of breast cancer, the presence of BRC1 and BRC2
genes, or 2 first-degree relatives with breast cancer, should be
recommended and followed closely by the healthcare provider.
◉ In assessing cancer risk, the nurse identifies which woman as
being at greatest risk of developing breast cancer?
A) A 35-year-old multipara who never breastfed.
B) A 50-year-old whose mother had unilateral breast cancer.
C) A 55-year-old whose mother-in-law had bilateral breast cancer.
D) A 20-year-old whose menarche occurred at age 9.
Answer: B) A 50-year-old whose mother had unilateral breast
cancer.
The most predictive risk factors for development of breast cancer
are over 40 years of age and a positive family history (occurrence in
the immediate family, i.e., mother or sister). Other risk factors
include nulliparity, no history of breastfeeding, early menarche and
late menopause. Although all of the women described have one of
the risk factors for developing breast cancer, (B) has the greater risk
over (A, C, and D).
◉ Which reaction should the nurse identify in a client who is
responding to stimulation of the sympathetic nervous system?
A) Pupil constriction.
B) Increased heart rate.
