Evolve Elsevier Original Exams

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Sample questions from Evolve Elsevier Original Exams

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client in the emergency department has pneumonia, confusion, and urine output of 15 mL/hr. Temperature is 39.1 C, heart rate is 124/min, blood pressure is 82/46 mm Hg, and lactate is 4.8 mmol/L. Oxygen has been applied and blood cultures collected. Which prescribed intervention should the nurse initiate first?

   • A.Infuse 30 mL/kg of IV isotonic crystalloid
   • B.Administer oral acetaminophen
   • C.Obtain a sputum specimen before additional treatment
   • D.Insert an indwelling urinary catheter

   Rationale: The client has septic shock cues, and prompt isotonic fluid resuscitation addresses critically impaired perfusion. Acetaminophen treats fever but not shock, and collecting sputum must not delay resuscitation or antibiotics. A urinary catheter helps monitor response but does not restore circulation. Prioritize treatment of immediate perfusion threats while implementing the remaining sepsis interventions promptly.

2. 2.A 59-year-old client on a medical unit develops crushing chest pain rated 8/10. Blood pressure is 88/54 mm Hg, heart rate is 106/min, and oxygen saturation is 96% on room air. The client reports taking sildenafil 6 hours ago. Which prescription should the nurse question?

   • A.Obtain a 12-lead ECG
   • B.Administer chewable aspirin 324 mg
   • C.Administer sublingual nitroglycerin 0.4 mg
   • D.Obtain a serum troponin level

   Rationale: Nitroglycerin is unsafe with recent sildenafil use and existing hypotension because profound hypotension can occur. An ECG and troponin measurement are appropriate for suspected acute coronary syndrome. Aspirin is appropriate when no allergy or active bleeding is present. Check blood pressure and recent phosphodiesterase inhibitor use before administering nitrates.

3. 3.A 72-year-old client arrives at a stroke center 50 minutes after sudden right-sided weakness and difficulty speaking. Blood pressure is 174/96 mm Hg, glucose is 112 mg/dL, and oxygen saturation is 97%. Which action has the highest priority?

   • A.Perform a bedside swallow screening
   • B.Arrange an immediate noncontrast head CT
   • C.Administer prescribed oral aspirin
   • D.Lower the blood pressure to 120/80 mm Hg

   Rationale: An immediate noncontrast head CT distinguishes hemorrhagic from ischemic stroke and guides time-sensitive treatment. Swallow screening is necessary before oral intake but should not delay imaging. Aspirin should wait until hemorrhage is excluded, and rapidly lowering this blood pressure to normal can compromise cerebral perfusion. Acute stroke priorities include rapid imaging, glucose assessment, and evaluation for reperfusion therapy.

4. 4.A 24-year-old client in the emergency department has diabetic ketoacidosis. Glucose is 486 mg/dL, potassium is 2.9 mEq/L, pH is 7.19, and blood pressure is 96/58 mm Hg. Isotonic fluids are infusing. Which action should the nurse take next?

   • A.Begin the prescribed IV regular insulin infusion
   • B.Administer IV sodium bicarbonate immediately
   • C.Change the infusion to dextrose 5% in water
   • D.Administer prescribed potassium before starting insulin

   Answer and rationale are in the full material.

5. 5.A 63-year-old client with chronic obstructive pulmonary disease is admitted with an exacerbation. The client is alert, respiratory rate is 30/min, oxygen saturation is 84% on room air, and arterial blood gas results show pH 7.32 and PaCO2 58 mm Hg. Which oxygen plan is most appropriate initially?

   • A.Withhold oxygen until repeat arterial blood gases are available
   • B.Apply controlled oxygen and titrate to a saturation of 88% to 92%
   • C.Apply oxygen at 15 L/min indefinitely to maintain a saturation of 100%
   • D.Encourage pursed-lip breathing without administering oxygen

   Answer and rationale are in the full material.