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2025 EVOLVE ELSEVIER HESI MED SURG EXAM
NEWEST 2025 COMPLETE 200 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
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The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the patient's respiratory status is improving?
- Wheezing becomes louder
- Vesicular breath sounds decrease
- Aerosol bronchodilators stimulate coughing
- The cough remains nonproductive - Correct Answer - A. Wheezing becomes louder
The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange.
The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. The nurse assesses for which of the following etiologic factor for this nursing diagnosis in patients with asthma?
- Anxiety and restlessness
- Effects of medications
- Fear of suffocation
- Work of breathing - Correct Answer - D. Work of breathing When the patient does
not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity.
The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate which of the following is likely to be the next step in treatment? 1 / 4
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- Pulmonary function testing
- Systemic corticosteroids
- Biofeedback therapy
- Intravenous fluids - Correct Answer - B. Systemic corticosteroids Systemic
corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient.
A patient with acute exacerbation of COPD needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use?
- Venturi mask
- Partial non-rebreather mask
- Oxygen tent
- Nasal cannula - Correct Answer - A. Venturi mask The Venturi mask delivers
precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.
Which of the following positions is most appropriate for the nurse to place a patient experiencing an asthma exacerbation?
- Supine
- Lithotomy
- High-Fowler's
- Reverse Trendelenburg - Correct Answer - C. High-Fowler's The patient
experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration.
A patient with an acute pharyngitis is seen at the clinic with fever and severe throat pain that affects swallowing. On inspection the throat is reddened and edematous with patchy yellow exudates. The nurse anticipates that collaborative management will include
- treatment with antibiotics.
- treatment with antifungal agents. 2 / 4
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- a throat culture or rapid strep antigen test.
- treatment with medication only if the pharyngitis does not resolve in 3 to 4 days. -
Correct Answer - C. a throat culture or rapid strep antigen test. Although inadequately treated β-hemolytic streptococcal infections may lead to rheumatic heart disease or glomerulonephritis, antibiotic treatment is not recommended until strep infections are definitely diagnosed with culture or antigen tests. The manifestations of viral and bacterial infections are similar, and appearance is not diagnostic except when candidiasis is present.
Following a supraglottic laryngectomy, the patient is taught how to use the supraglottic swallow to minimize the risk of aspiration. In teaching the patient about this technique, the nurse instructs the patient to
- perform Valsalva maneuver immediately after swallowing.
- breathe between each Valsalva maneuver and cough sequence.
- cough after swallowing to remove food from the top of the vocal cords.
- practice swallowing thin, watery fluids before attempting to swallow solid foods. -
Correct Answer - C. cough after swallowing to remove food from the top of the vocal cords. A supraglottic laryngectomy involves removal of the epiglottis and false vocal cords, and the removal of the epiglottis allows food to enter the trachea. Supraglottic swallowing requires performance of the Valsalva maneuver before placing food in the mouth and swallowing. The patient then coughs to remove food from the top of the vocal cords, swallows again, and then breathes after the food has been removed from the vocal cords.
A patient is admitted to the hospital with fever, chills, a productive cough with rusty sputum, and pleuritic chest pain. Pneumococcal pneumonia is suspected. An appropriate nursing diagnosis for the patient based on the patient's manifestations is
- hyperthermia related to acute infectious process.
- chronic pain related to ineffective pain management.
- risk for injury related to disorientation and confusion.
- ineffective airway clearance related to retained secretions. - Correct Answer - A.
hyperthermia related to acute infectious process. The patient with pneumococcal pneumonia is acutely ill with fever and the systemic manifestations of fever, such as chills, thirst, headache, and malaise. Interventions that monitor temperature and aid in lowering body temperature are appropriate. Ineffective airway clearance would be manifested by adventitious breath sounds and difficulty 3 / 4
pg. 4 producing secretions. Disorientation and confusion are not noted in this patient and are not typical unless the patient is very hypoxemic. Pleuritic pain is an acute pain that is due to inflammation of the pleura.
The resurgence in TB resulting from the emergence of multidrug-resistant strains of Mycobacterium tuberculosis is primarily the result of
- a lack of effective means to diagnose TB.
- poor compliance with drug therapy in patients with TB.
- the increased population of immunosuppressed individuals with AIDS.
- indiscriminate use of antitubercular drugs in treatment of other infections. - Correct
Answer - B. poor compliance with drug therapy in patients with TB. Drug-resistant strains of TB have developed because TB patients' compliance to drug therapy has been poor and there has been general decreased vigilance in monitoring and follow-up of TB treatment. Antitubercular drugs are almost exclusively used for TB infections. TB can be effectively diagnosed with sputum cultures. The incidence of TB is at epidemic proportions in patients with HIV, but this does not account for drug-resistant strains of TB.
The chronic inflammation of the bronchi characteristic of chronic obstructive pulmonary disease (COPD) results in
- collapse of small bronchioles on expiration.
- permanent, abnormal dilation of the bronchi.
- hyperplasia of mucus-secreting cells and bronchial edema.
- destruction of the elastic and muscular structures of the bronchial wall. - Correct
Answer - C. hyperplasia of mucus-secreting cells and bronchial edema. Chronic bronchitis is characterized by chronic inflammation of the bronchial lining, with edema and increased mucus production. Collapse of small bronchioles on expiration is common in emphysema, and abnormal dilation of the bronchi because of destruction of the elastic and muscular structures is characteristic of bronchiectasis.
While teaching a patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to do which of the following?
- Use the flow meter each morning after taking medications to evaluate their
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effectiveness.