2026 UPDATED QUESTIONS DOWNLOAD
Evolve Elsevier HESI Med-Surg Specialty Exam 300+
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 300 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which finding is most concerning?
A) Respiration rate of 22 breaths/min
B) Pulse oximetry of 91%
C) Increased lethargy and confusion
D) Productive cough with clear sputum
Answer: C
Rationale: In COPD patients, "CO2 narcosis" can occur if oxygen therapy is too high,
leading to somnolence and confusion. This indicates a failure in the respiratory drive
and requires immediate intervention.
Which laboratory value should the nurse monitor most closely for a patient taking
Digoxin and Furosemide?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Answer: C
Rationale: Furosemide is a loop diuretic that wastes potassium. Low potassium
(hypokalemia) significantly increases the risk of Digoxin toxicity, which can lead to life-
threatening arrhythmias.
A patient is 12 hours post-thyroidectomy. The nurse notes the patient has a positive
Chvostek’s sign. Which action should the nurse take first?
A) Check the surgical dressing for bleeding.
B) Administer Calcium Gluconate IV.
C) Request a STAT Thyroid Stimulating Hormone (TSH) level.
,2026 UPDATED QUESTIONS DOWNLOAD
D) Place the patient in a High-Fowler's position.
Answer: B
Rationale: A positive Chvostek’s sign indicates hypocalcemia, a common complication
of thyroid surgery due to accidental parathyroid damage. This can lead to laryngospasm
and seizures, making IV Calcium Gluconate the priority.
The nurse is caring for a patient with a suspected Deep Vein Thrombosis (DVT).
Which assessment finding requires immediate notification of the provider?
A) Calf pain on dorsiflexion
B) Warmth and redness of the affected leg
C) Sudden onset of shortness of breath and chest pain
D) 2+ pitting edema in the affected ankle
Answer: C
Rationale: Sudden chest pain and dyspnea suggest a Pulmonary Embolism (PE), where
the DVT has broken loose and traveled to the lungs. This is a medical emergency.
A patient with Type 1 Diabetes is found unconscious and diaphoretic. What is the
nurse's priority action?
A) Check the blood glucose level.
B) Administer 15g of simple carbohydrates orally.
C) Administer Glucagon IM or Subcutaneous.
D) Call the Rapid Response Team.
Answer: C
Rationale: For an unconscious patient with suspected hypoglycemia, nothing should be
given by mouth to avoid aspiration. Glucagon is the standard emergency treatment to
raise blood sugar rapidly.
Which finding is an early sign of increased intracranial pressure (ICP) in a patient
with a head injury?
A) Cushing's Triad
B) Fixed, dilated pupils
C) Decreased Level of Consciousness (LOC)
D) Decerebrate posturing
Answer: C
Rationale: Changes in LOC (restlessness, irritability, or confusion) are the most
sensitive and earliest indicators of rising ICP. Cushing's Triad is a late, terminal sign.
A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8
mEq/L. Which medication should the nurse be prepared to administer?
A) Epoetin Alfa
B) Sodium Polystyrene Sulfonate (Kayexalate)
,2026 UPDATED QUESTIONS DOWNLOAD
C) Spironolactone
D) Calcium Carbonate
Answer: B
Rationale: Kayexalate is used to lower dangerously high potassium levels by
exchanging sodium for potassium ions in the intestine. Spironolactone would worsen
the hyperkalemia.
A patient is admitted with a diagnosis of Acute Pancreatitis. Which position is most
likely to reduce the patient's pain?
A) Supine with legs extended
B) Side-lying with knees drawn up (fetal position)
C) Semi-Fowler's with head elevated 30 degrees
D) Prone
Answer: B
Rationale: The fetal position or sitting up and leaning forward relieves pressure on the
peritoneum and the inflamed pancreas, decreasing abdominal pain.
When assessing a patient with a Chest Tube, the nurse notes continuous bubbling in
the water-seal chamber. What does this indicate?
A) The system is functioning normally.
B) The lung has fully re-expanded.
C) There is an air leak in the system.
D) The suction is set too high.
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates a leak between the
patient and the drainage system. Intermittent bubbling during expiration or coughing is
normal.
A patient is being treated for a Myocardial Infarction (MI). Which cardiac biomarker is
most specific for diagnosing myocardial injury?
A) CK-MB
B) Myoglobin
C) Troponin I
D) LDH
Answer: C
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer
than CK-MB, making it the gold standard for MI diagnosis.
The nurse is monitoring a patient receiving a blood transfusion. Five minutes into
the infusion, the patient reports lower back pain and chills. What is the priority
action?
, 2026 UPDATED QUESTIONS DOWNLOAD
A) Slow the rate of infusion.
B) Administer Diphenhydramine.
C) Stop the transfusion immediately.
D) Document the reaction and continue monitoring.
Answer: C
Rationale: Lower back pain and chills are signs of a hemolytic transfusion reaction. The
nurse must stop the infusion and disconnect the tubing at the hub to prevent further
exposure.
Which diet is most appropriate for a patient with Diverticulitis during the acute
phase?
A) High-fiber diet with nuts and seeds
B) Low-fat, low-cholesterol diet
C) NPO or Clear Liquid diet
D) High-protein, high-calorie diet
Answer: C
Rationale: During the acute inflammatory phase of diverticulitis, the bowel needs to
"rest," so patients are typically NPO or on clear liquids before transitioning to a low-fiber
diet, then eventually high-fiber once healed.
A patient with Heart Failure is prescribed Enalapril. Which side effect is a priority for
the nurse to monitor?
A) Dry, hacking cough
B) Hyperkalemia
C) Angioedema
D) Hypotension
Answer: C
Rationale: While all listed are side effects of ACE inhibitors, angioedema (swelling of the
face, lips, or tongue) is a life-threatening airway emergency.
What is the primary goal of nursing care for a patient in the "Ictal Phase" of a
generalized seizure?
A) Documenting the duration of the seizure.
B) Inserting a padded tongue blade.
C) Maintaining patient safety and airway patency.
D) Administering Phenytoin IV.
Answer: C
Rationale: Safety is the priority. The nurse should protect the head, loosen tight
clothing, and turn the patient to their side to prevent aspiration. Never insert anything
into the mouth.
Evolve Elsevier HESI Med-Surg Specialty Exam 300+
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 300 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which finding is most concerning?
A) Respiration rate of 22 breaths/min
B) Pulse oximetry of 91%
C) Increased lethargy and confusion
D) Productive cough with clear sputum
Answer: C
Rationale: In COPD patients, "CO2 narcosis" can occur if oxygen therapy is too high,
leading to somnolence and confusion. This indicates a failure in the respiratory drive
and requires immediate intervention.
Which laboratory value should the nurse monitor most closely for a patient taking
Digoxin and Furosemide?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Answer: C
Rationale: Furosemide is a loop diuretic that wastes potassium. Low potassium
(hypokalemia) significantly increases the risk of Digoxin toxicity, which can lead to life-
threatening arrhythmias.
A patient is 12 hours post-thyroidectomy. The nurse notes the patient has a positive
Chvostek’s sign. Which action should the nurse take first?
A) Check the surgical dressing for bleeding.
B) Administer Calcium Gluconate IV.
C) Request a STAT Thyroid Stimulating Hormone (TSH) level.
,2026 UPDATED QUESTIONS DOWNLOAD
D) Place the patient in a High-Fowler's position.
Answer: B
Rationale: A positive Chvostek’s sign indicates hypocalcemia, a common complication
of thyroid surgery due to accidental parathyroid damage. This can lead to laryngospasm
and seizures, making IV Calcium Gluconate the priority.
The nurse is caring for a patient with a suspected Deep Vein Thrombosis (DVT).
Which assessment finding requires immediate notification of the provider?
A) Calf pain on dorsiflexion
B) Warmth and redness of the affected leg
C) Sudden onset of shortness of breath and chest pain
D) 2+ pitting edema in the affected ankle
Answer: C
Rationale: Sudden chest pain and dyspnea suggest a Pulmonary Embolism (PE), where
the DVT has broken loose and traveled to the lungs. This is a medical emergency.
A patient with Type 1 Diabetes is found unconscious and diaphoretic. What is the
nurse's priority action?
A) Check the blood glucose level.
B) Administer 15g of simple carbohydrates orally.
C) Administer Glucagon IM or Subcutaneous.
D) Call the Rapid Response Team.
Answer: C
Rationale: For an unconscious patient with suspected hypoglycemia, nothing should be
given by mouth to avoid aspiration. Glucagon is the standard emergency treatment to
raise blood sugar rapidly.
Which finding is an early sign of increased intracranial pressure (ICP) in a patient
with a head injury?
A) Cushing's Triad
B) Fixed, dilated pupils
C) Decreased Level of Consciousness (LOC)
D) Decerebrate posturing
Answer: C
Rationale: Changes in LOC (restlessness, irritability, or confusion) are the most
sensitive and earliest indicators of rising ICP. Cushing's Triad is a late, terminal sign.
A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8
mEq/L. Which medication should the nurse be prepared to administer?
A) Epoetin Alfa
B) Sodium Polystyrene Sulfonate (Kayexalate)
,2026 UPDATED QUESTIONS DOWNLOAD
C) Spironolactone
D) Calcium Carbonate
Answer: B
Rationale: Kayexalate is used to lower dangerously high potassium levels by
exchanging sodium for potassium ions in the intestine. Spironolactone would worsen
the hyperkalemia.
A patient is admitted with a diagnosis of Acute Pancreatitis. Which position is most
likely to reduce the patient's pain?
A) Supine with legs extended
B) Side-lying with knees drawn up (fetal position)
C) Semi-Fowler's with head elevated 30 degrees
D) Prone
Answer: B
Rationale: The fetal position or sitting up and leaning forward relieves pressure on the
peritoneum and the inflamed pancreas, decreasing abdominal pain.
When assessing a patient with a Chest Tube, the nurse notes continuous bubbling in
the water-seal chamber. What does this indicate?
A) The system is functioning normally.
B) The lung has fully re-expanded.
C) There is an air leak in the system.
D) The suction is set too high.
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates a leak between the
patient and the drainage system. Intermittent bubbling during expiration or coughing is
normal.
A patient is being treated for a Myocardial Infarction (MI). Which cardiac biomarker is
most specific for diagnosing myocardial injury?
A) CK-MB
B) Myoglobin
C) Troponin I
D) LDH
Answer: C
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer
than CK-MB, making it the gold standard for MI diagnosis.
The nurse is monitoring a patient receiving a blood transfusion. Five minutes into
the infusion, the patient reports lower back pain and chills. What is the priority
action?
, 2026 UPDATED QUESTIONS DOWNLOAD
A) Slow the rate of infusion.
B) Administer Diphenhydramine.
C) Stop the transfusion immediately.
D) Document the reaction and continue monitoring.
Answer: C
Rationale: Lower back pain and chills are signs of a hemolytic transfusion reaction. The
nurse must stop the infusion and disconnect the tubing at the hub to prevent further
exposure.
Which diet is most appropriate for a patient with Diverticulitis during the acute
phase?
A) High-fiber diet with nuts and seeds
B) Low-fat, low-cholesterol diet
C) NPO or Clear Liquid diet
D) High-protein, high-calorie diet
Answer: C
Rationale: During the acute inflammatory phase of diverticulitis, the bowel needs to
"rest," so patients are typically NPO or on clear liquids before transitioning to a low-fiber
diet, then eventually high-fiber once healed.
A patient with Heart Failure is prescribed Enalapril. Which side effect is a priority for
the nurse to monitor?
A) Dry, hacking cough
B) Hyperkalemia
C) Angioedema
D) Hypotension
Answer: C
Rationale: While all listed are side effects of ACE inhibitors, angioedema (swelling of the
face, lips, or tongue) is a life-threatening airway emergency.
What is the primary goal of nursing care for a patient in the "Ictal Phase" of a
generalized seizure?
A) Documenting the duration of the seizure.
B) Inserting a padded tongue blade.
C) Maintaining patient safety and airway patency.
D) Administering Phenytoin IV.
Answer: C
Rationale: Safety is the priority. The nurse should protect the head, loosen tight
clothing, and turn the patient to their side to prevent aspiration. Never insert anything
into the mouth.
