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EVOLVE ELSEVIER HESI MED SURG EXAM WITH REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES/ EVOLVE HESI MEDICAL SURGICAL
LATEST EXAM 2025
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 - ANSWER: Correct Answer: B
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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.
Which instruction is best for the nurse to provide to a client with emphysema and
chronic fatigue?
A."Pace your activities and schedule rest periods." B."Increase the amount of
oxygen you use at night."
C."Obtain medical evaluation for antibiotic therapy."
D."Reduce your intake of fluids containing caffeine." - ANSWER: Correct
Answer: A
Rationale: Manifestations of emphysema include an increase in AP diameter
(referred to as a barrel chest), nail bed clubbing, and fatigue. The nurse can provide
instructions to promote energy management, such as pacing activities and
scheduling rest periods. Option B may result in a decreased drive to breathe. The
client is not exhibiting any symptoms of infection, so option C is not necessary.
Option D is less beneficial than option A.
Which nursing action would be appropriate for a client who is newly diagnosed
with Cushing syndrome?
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A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu. - ANSWER: Correct Answer: A
Rationale: Cushing syndrome results from a hypersecretion of glucocorticoids in
the adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus.
Monitoring of serum glucose levels assesses for increased blood glucose levels so
that treatment can begin early. A common finding in Cushing syndrome is
generalized edema. Although potassium is needed, it is generally obtained from
food intake, not by offering potassium-enhanced fluids. Fatigue is usually not an
overwhelming factor in Cushing syndrome, so an emphasis on the need for rest is
not indicated. A low-calorie, low-carbohydrate, low-sodium diet is not
recommended.
During the change of shift report, the charge nurse reviews the infusions being
received by clients on the oncology unit. The client receiving which infusion
should be assessed first?
A. Continuous IV infusion of magnesium
B. One-time infusion of albumin
C. Continuous epidural infusion of morphine
D. Intermittent infusion of IV vancomycin - ANSWER: Correct Answer: C
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Rationale: All four of these clients have the potential to have significant
complications. The client with the morphine epidural infusion is at highest risk for
respiratory depression and should be assessed first. Option A can cause
hypotension. The client receiving option B is at lowest risk for serious
complications. Although option D can cause nephrotoxicity and phlebitis, these
problems are not as immediately life threatening as option C.
A client who received a nephrotoxic drug is admitted with acute renal failure and
asks the nurse if dialysis will always be needed. Which pathophysiologic
consequence should the nurse explain that supports the need for temporary dialysis
until acute tubular necrosis subsides?
.
A. Azotemia
B. Oliguria
C. Hyperkalemia
D. Nephron obstruction - ANSWER: Correct Answer: D
Rationale:CKD is characterized by progressive and irreversible destruction of
nephrons, frequently caused by hypertension and diabetes mellitus. Nephrotoxins
cause acute tubular necrosis, a reversible acute renal failure, which creates renal
tubular obstruction from endothelial cells that are sloughed or become edematous.
The obstruction of urine flow will resolve with the return of an adequate
EVOLVE ELSEVIER HESI MED SURG EXAM WITH REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES/ EVOLVE HESI MEDICAL SURGICAL
LATEST EXAM 2025
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 - ANSWER: Correct Answer: B
,2|Page
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.
Which instruction is best for the nurse to provide to a client with emphysema and
chronic fatigue?
A."Pace your activities and schedule rest periods." B."Increase the amount of
oxygen you use at night."
C."Obtain medical evaluation for antibiotic therapy."
D."Reduce your intake of fluids containing caffeine." - ANSWER: Correct
Answer: A
Rationale: Manifestations of emphysema include an increase in AP diameter
(referred to as a barrel chest), nail bed clubbing, and fatigue. The nurse can provide
instructions to promote energy management, such as pacing activities and
scheduling rest periods. Option B may result in a decreased drive to breathe. The
client is not exhibiting any symptoms of infection, so option C is not necessary.
Option D is less beneficial than option A.
Which nursing action would be appropriate for a client who is newly diagnosed
with Cushing syndrome?
,3|Page
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu. - ANSWER: Correct Answer: A
Rationale: Cushing syndrome results from a hypersecretion of glucocorticoids in
the adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus.
Monitoring of serum glucose levels assesses for increased blood glucose levels so
that treatment can begin early. A common finding in Cushing syndrome is
generalized edema. Although potassium is needed, it is generally obtained from
food intake, not by offering potassium-enhanced fluids. Fatigue is usually not an
overwhelming factor in Cushing syndrome, so an emphasis on the need for rest is
not indicated. A low-calorie, low-carbohydrate, low-sodium diet is not
recommended.
During the change of shift report, the charge nurse reviews the infusions being
received by clients on the oncology unit. The client receiving which infusion
should be assessed first?
A. Continuous IV infusion of magnesium
B. One-time infusion of albumin
C. Continuous epidural infusion of morphine
D. Intermittent infusion of IV vancomycin - ANSWER: Correct Answer: C
, 4|Page
Rationale: All four of these clients have the potential to have significant
complications. The client with the morphine epidural infusion is at highest risk for
respiratory depression and should be assessed first. Option A can cause
hypotension. The client receiving option B is at lowest risk for serious
complications. Although option D can cause nephrotoxicity and phlebitis, these
problems are not as immediately life threatening as option C.
A client who received a nephrotoxic drug is admitted with acute renal failure and
asks the nurse if dialysis will always be needed. Which pathophysiologic
consequence should the nurse explain that supports the need for temporary dialysis
until acute tubular necrosis subsides?
.
A. Azotemia
B. Oliguria
C. Hyperkalemia
D. Nephron obstruction - ANSWER: Correct Answer: D
Rationale:CKD is characterized by progressive and irreversible destruction of
nephrons, frequently caused by hypertension and diabetes mellitus. Nephrotoxins
cause acute tubular necrosis, a reversible acute renal failure, which creates renal
tubular obstruction from endothelial cells that are sloughed or become edematous.
The obstruction of urine flow will resolve with the return of an adequate
