Evolve Elsevier HESI Med Surg Final Exam – Best Practice
Questions with Answers and Rationales – RN Medical-
Surgical Nursing – 2026 Updated |PDF
INTRO:
This comprehensive practice exam is designed for students preparing for the Evolve
Elsevier HESI Medical-Surgical Nursing Final Exam. Based on the HESI RN Med Surg
exam blueprint, topics include cardiovascular, respiratory, gastrointestinal, endocrine, renal,
neurological, musculoskeletal, hematologic disorders, perioperative care, fluid/electrolyte
balance, prioritization, delegation, and Next Generation NCLEX (NGN)-style clinical
judgment scenarios. This resource includes scenario-based questions that challenge
application of theoretical knowledge to real-world patient presentations. Answers are in bold
italic * with detailed rationales in italic at the end of each question.
CARDIOVASCULAR SYSTEM
1. An adult client who is hospitalized after surgery reports sudden onset of chest
pain and dyspnea. The client appears anxious, restless, and mildly cyanotic. The
nurse should further assess the client for which condition?
Answer: Pulmonary embolism
Sudden onset of chest pain, dyspnea, anxiety, restlessness, and cyanosis in a
postoperative patient is classic for pulmonary embolism. Postoperative patients are at high
risk for VTE due to immobility, surgery, and hypercoagulability. Myocardial infarction
typically presents with substernal chest pain and ECG changes; pneumothorax presents
with diminished breath sounds and hyperresonance; atelectasis develops more gradually.
2. A 68-year-old male with a history of hypertension presents with dyspnea on
exertion, orthopnea, and peripheral edema. On auscultation, the nurse notes an S3
gallop. What is the most likely diagnosis?
Answer: Left-sided heart failure
Left-sided heart failure presents with dyspnea on exertion, orthopnea, and an S3 gallop,
which is a hallmark of decreased left ventricular compliance. Right-sided heart failure
presents with peripheral edema, jugular venous distention, and hepatomegaly. Pericarditis
presents with positional chest pain and friction rub. Myocarditis often follows a viral illness.
,3. A patient with heart failure is prescribed furosemide (Lasix). What is the
mechanism of action of this medication?
Answer: Loop diuretic that blocks sodium and chloride reabsorption in the thick
ascending limb of the loop of Henle
Furosemide is a loop diuretic that inhibits the Na+/K+/2Cl- cotransporter in the ascending
loop of Henle, reducing fluid volume and preload. It is the first-line diuretic for acute heart
failure exacerbations because of its rapid onset and potent diuretic effect. Potassium loss is
a common side effect, so potassium levels should be monitored.
4. A patient with atrial fibrillation is prescribed warfarin (Coumadin). What is the
therapeutic INR goal for this patient?
Answer: 2.0 to 3.0
For atrial fibrillation, the target INR range is 2.0–3.0 to reduce the risk of thromboembolic
stroke without excessive bleeding risk. INR levels below 2.0 increase stroke risk; levels
above 3.0 increase bleeding risk. Warfarin requires regular INR monitoring and dose
adjustments.
5. The nurse is caring for a patient with an acute myocardial infarction (STEMI). What
is the priority intervention within the first 90 minutes of symptom onset?
Answer: Percutaneous coronary intervention (PCI) with stent placement
STEMI requires immediate reperfusion with PCI within 90 minutes of symptom onset. Door-
to-balloon time should be under 90 minutes. If PCI is not available, fibrinolytics (tPA) should
be given within 30 minutes. Aspirin should be given immediately upon arrival.
6. The nurse is assessing a patient who had a cardiac catheterization via the femoral
artery. What is the most important post-procedure assessment?
Answer: Assessment of peripheral pulses and puncture site for bleeding
After femoral artery catheterization, the priority assessment is checking for bleeding,
hematoma, and distal pulses (dorsalis pedis and posterior tibialis). The patient should
remain flat with the affected leg straight for 4-6 hours. Loss of distal pulse may indicate
arterial occlusion.
7. A patient with chronic hypertension develops left ventricular hypertrophy (LVH).
What pathophysiologic principle explains this adaptation?
Answer: Prolonged pressure overload causing concentric hypertrophy
Chronic hypertension imposes sustained pressure overload on the left ventricle, stimulating
concentric hypertrophy (thickened walls, normal or reduced chamber size). This
, compensatory adaptation maintains cardiac output but eventually leads to diastolic
dysfunction and heart failure.
8. A patient presents with jugular venous distention, hepatomegaly, and peripheral
edema. Which type of heart failure is most likely?
Answer: Right-sided heart failure
Right-sided heart failure causes systemic venous congestion, resulting in jugular venous
distention, hepatomegaly (from liver congestion), and peripheral edema. Left-sided heart
failure presents with pulmonary congestion (crackles, orthopnea, dyspnea).
9. A patient is prescribed digoxin (Lanoxin) for heart failure. What is the therapeutic
serum digoxin level?
Answer: 0.8 to 2.0 ng/mL
The therapeutic range for digoxin is 0.8–2.0 ng/mL. Levels above 2.0 ng/mL increase the
risk of digoxin toxicity, which presents with nausea, vomiting, visual disturbances (yellow-
green halos), and cardiac arrhythmias. Toxicity is more likely in patients with renal
impairment or electrolyte disturbances (hypokalemia).
10. The nurse is caring for a patient in cardiogenic shock. What hemodynamic finding
would the nurse expect?
Answer: Decreased cardiac output and increased systemic vascular resistance
Cardiogenic shock is caused by pump failure, resulting in decreased cardiac output,
hypotension, and compensatory vasoconstriction (increased SVR). Pulmonary artery wedge
pressure (PAWP) is elevated, indicating left ventricular failure. IV fluids are given cautiously
to avoid volume overload.
RESPIRATORY SYSTEM
11. A patient with chronic obstructive pulmonary disease (COPD) has a PaO₂ of 55
mmHg and a PaCO₂ of 60 mmHg. What is the significance of these values?
Answer: Hypoxemia with chronic hypercapnic respiratory failure
COPD patients often develop chronic respiratory acidosis with PaCO₂ >45 mmHg. A PaO₂
<60 mmHg indicates hypoxemic respiratory failure requiring supplemental oxygen.
However, oxygen should be titrated to target SpO₂ of 88-92% to avoid suppressing the
hypoxic drive.
12. A patient with pneumonia is admitted with a CURB-65 score of 3. What is the
recommended management?
Questions with Answers and Rationales – RN Medical-
Surgical Nursing – 2026 Updated |PDF
INTRO:
This comprehensive practice exam is designed for students preparing for the Evolve
Elsevier HESI Medical-Surgical Nursing Final Exam. Based on the HESI RN Med Surg
exam blueprint, topics include cardiovascular, respiratory, gastrointestinal, endocrine, renal,
neurological, musculoskeletal, hematologic disorders, perioperative care, fluid/electrolyte
balance, prioritization, delegation, and Next Generation NCLEX (NGN)-style clinical
judgment scenarios. This resource includes scenario-based questions that challenge
application of theoretical knowledge to real-world patient presentations. Answers are in bold
italic * with detailed rationales in italic at the end of each question.
CARDIOVASCULAR SYSTEM
1. An adult client who is hospitalized after surgery reports sudden onset of chest
pain and dyspnea. The client appears anxious, restless, and mildly cyanotic. The
nurse should further assess the client for which condition?
Answer: Pulmonary embolism
Sudden onset of chest pain, dyspnea, anxiety, restlessness, and cyanosis in a
postoperative patient is classic for pulmonary embolism. Postoperative patients are at high
risk for VTE due to immobility, surgery, and hypercoagulability. Myocardial infarction
typically presents with substernal chest pain and ECG changes; pneumothorax presents
with diminished breath sounds and hyperresonance; atelectasis develops more gradually.
2. A 68-year-old male with a history of hypertension presents with dyspnea on
exertion, orthopnea, and peripheral edema. On auscultation, the nurse notes an S3
gallop. What is the most likely diagnosis?
Answer: Left-sided heart failure
Left-sided heart failure presents with dyspnea on exertion, orthopnea, and an S3 gallop,
which is a hallmark of decreased left ventricular compliance. Right-sided heart failure
presents with peripheral edema, jugular venous distention, and hepatomegaly. Pericarditis
presents with positional chest pain and friction rub. Myocarditis often follows a viral illness.
,3. A patient with heart failure is prescribed furosemide (Lasix). What is the
mechanism of action of this medication?
Answer: Loop diuretic that blocks sodium and chloride reabsorption in the thick
ascending limb of the loop of Henle
Furosemide is a loop diuretic that inhibits the Na+/K+/2Cl- cotransporter in the ascending
loop of Henle, reducing fluid volume and preload. It is the first-line diuretic for acute heart
failure exacerbations because of its rapid onset and potent diuretic effect. Potassium loss is
a common side effect, so potassium levels should be monitored.
4. A patient with atrial fibrillation is prescribed warfarin (Coumadin). What is the
therapeutic INR goal for this patient?
Answer: 2.0 to 3.0
For atrial fibrillation, the target INR range is 2.0–3.0 to reduce the risk of thromboembolic
stroke without excessive bleeding risk. INR levels below 2.0 increase stroke risk; levels
above 3.0 increase bleeding risk. Warfarin requires regular INR monitoring and dose
adjustments.
5. The nurse is caring for a patient with an acute myocardial infarction (STEMI). What
is the priority intervention within the first 90 minutes of symptom onset?
Answer: Percutaneous coronary intervention (PCI) with stent placement
STEMI requires immediate reperfusion with PCI within 90 minutes of symptom onset. Door-
to-balloon time should be under 90 minutes. If PCI is not available, fibrinolytics (tPA) should
be given within 30 minutes. Aspirin should be given immediately upon arrival.
6. The nurse is assessing a patient who had a cardiac catheterization via the femoral
artery. What is the most important post-procedure assessment?
Answer: Assessment of peripheral pulses and puncture site for bleeding
After femoral artery catheterization, the priority assessment is checking for bleeding,
hematoma, and distal pulses (dorsalis pedis and posterior tibialis). The patient should
remain flat with the affected leg straight for 4-6 hours. Loss of distal pulse may indicate
arterial occlusion.
7. A patient with chronic hypertension develops left ventricular hypertrophy (LVH).
What pathophysiologic principle explains this adaptation?
Answer: Prolonged pressure overload causing concentric hypertrophy
Chronic hypertension imposes sustained pressure overload on the left ventricle, stimulating
concentric hypertrophy (thickened walls, normal or reduced chamber size). This
, compensatory adaptation maintains cardiac output but eventually leads to diastolic
dysfunction and heart failure.
8. A patient presents with jugular venous distention, hepatomegaly, and peripheral
edema. Which type of heart failure is most likely?
Answer: Right-sided heart failure
Right-sided heart failure causes systemic venous congestion, resulting in jugular venous
distention, hepatomegaly (from liver congestion), and peripheral edema. Left-sided heart
failure presents with pulmonary congestion (crackles, orthopnea, dyspnea).
9. A patient is prescribed digoxin (Lanoxin) for heart failure. What is the therapeutic
serum digoxin level?
Answer: 0.8 to 2.0 ng/mL
The therapeutic range for digoxin is 0.8–2.0 ng/mL. Levels above 2.0 ng/mL increase the
risk of digoxin toxicity, which presents with nausea, vomiting, visual disturbances (yellow-
green halos), and cardiac arrhythmias. Toxicity is more likely in patients with renal
impairment or electrolyte disturbances (hypokalemia).
10. The nurse is caring for a patient in cardiogenic shock. What hemodynamic finding
would the nurse expect?
Answer: Decreased cardiac output and increased systemic vascular resistance
Cardiogenic shock is caused by pump failure, resulting in decreased cardiac output,
hypotension, and compensatory vasoconstriction (increased SVR). Pulmonary artery wedge
pressure (PAWP) is elevated, indicating left ventricular failure. IV fluids are given cautiously
to avoid volume overload.
RESPIRATORY SYSTEM
11. A patient with chronic obstructive pulmonary disease (COPD) has a PaO₂ of 55
mmHg and a PaCO₂ of 60 mmHg. What is the significance of these values?
Answer: Hypoxemia with chronic hypercapnic respiratory failure
COPD patients often develop chronic respiratory acidosis with PaCO₂ >45 mmHg. A PaO₂
<60 mmHg indicates hypoxemic respiratory failure requiring supplemental oxygen.
However, oxygen should be titrated to target SpO₂ of 88-92% to avoid suppressing the
hypoxic drive.
12. A patient with pneumonia is admitted with a CURB-65 score of 3. What is the
recommended management?
