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EVOLVE ELSEVIER HESI MED-SURG EXTENDED TEST
BANK - ACTUAL EXAM 2026/2027 | ELSEVIER/EVOLVE
| EXPERT VERIFIED | 300 VERIFIED Q&A | COMPLETE
RATIONALES | PASS GUARANTEED - A+ GRADED
EXAM OVERVIEW
Course: Evolve Elsevier HESI Med-Surg Extended Test Bank
Institution: Elsevier/Evolve
Exam Type: Extended Test Bank
Question Count: 300 Questions
Format: Multiple Choice with Verified Answers and Complete Rationales
Focus Areas: Comprehensive Med-Surg nursing content with extended application, clinical judgment,
prioritization, delegation, and advanced NGN-style integration across all body systems
QUESTION 1
A 68-year-old client with a history of hypertension, type 2 diabetes, and stage 3 chronic kidney disease is
admitted with acute decompensated heart failure. The client's vital signs are: BP 168/94 mmHg, HR 110 bpm,
RR 26/min, SpO2 91% on 2L NC, temperature 37.2°C. The client has 3+ pitting edema to the knees, jugular
venous distention, and crackles bilaterally at the lung bases. The healthcare provider orders furosemide 80 mg
IV push. Which assessment finding is most important to report to the healthcare provider before
administering this medication?
A) Serum potassium of 3.1 mEq/L
B) Serum creatinine of 2.8 mg/dL
C) Blood pressure of 168/94 mmHg
D) Weight gain of 2 kg in 24 hours
Correct Answer: A
Rationale: The serum potassium of 3.1 mEq/L is critically low (normal 3.5-5.0 mEq/L) and places this client at
high risk for cardiac arrhythmias, especially with underlying heart failure and potential digoxin use.
Furosemide is a loop diuretic that will further deplete potassium, worsening hypokalemia. The provider
should be notified before administration to consider potassium supplementation or an alternative diuretic.
The elevated creatinine (B) reflects the client's baseline CKD and should be monitored but is not the most
immediate concern before giving furosemide. The BP (C) indicates hypertension requiring treatment but is
not the priority. Weight gain (D) confirms fluid overload and indicates the need for diuresis, not a reason to
hold the medication.
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QUESTION 2
A 45-year-old client with a history of alcohol use disorder is admitted with acute pancreatitis. The client
reports severe epigastric pain radiating to the back, nausea, and vomiting. The client's vital signs are: BP 98/62
mmHg, HR 118 bpm, RR 22/min, temperature 38.1°C. Laboratory results show: serum lipase 1,200 U/L
(normal 0-160 U/L), serum amylase 850 U/L (normal 30-110 U/L), WBC 18,000/mm³, and glucose 180
mg/dL. Which prescribed intervention should the nurse implement first?
A) Administer morphine sulfate 4 mg IV push for pain
B) Initiate IV fluid resuscitation with normal saline at 200 mL/hr
C) Insert a nasogastric tube to low intermittent suction
D) Administer ondansetron 4 mg IV for nausea
Correct Answer: B
Rationale: The client is showing signs of hypovolemic shock from third-spacing of fluids in acute pancreatitis
(hypotension, tachycardia, elevated glucose). The priority intervention is aggressive IV fluid resuscitation to
restore intravascular volume and maintain tissue perfusion. Pain management (A) is important but secondary
to hemodynamic stabilization. NG tube (C) may be needed for persistent vomiting or ileus but is not the
priority. Ondansetron (D) addresses nausea but does not correct the underlying hemodynamic instability.
QUESTION 3
A 72-year-old client with a history of COPD and heart failure is admitted with worsening dyspnea, productive
cough with purulent sputum, and confusion. The client's vital signs are: BP 142/88 mmHg, HR 102 bpm, RR
30/min, temperature 38.5°C, SpO2 86% on room air. Arterial blood gas results: pH 7.28, PaCO2 58 mmHg,
PaO2 52 mmHg, HCO3 26 mEq/L. Which intervention should the nurse anticipate?
A) Bi-level positive airway pressure (BiPAP) ventilation
B) Immediate intubation and mechanical ventilation
C) Administration of sodium bicarbonate IV
D) Administration of albuterol nebulizer only
Correct Answer: A
Rationale: The client is in acute respiratory acidosis (pH 7.28, PaCO2 58) with hypoxemia, likely due to an
exacerbation of COPD. BiPAP is a non-invasive ventilation modality that can support ventilation, reduce
work of breathing, and improve gas exchange in COPD exacerbations, potentially avoiding intubation.
Immediate intubation (B) may be needed if BiPAP fails or the client deteriorates, but BiPAP is the less invasive
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first-line intervention. Sodium bicarbonate (C) is not indicated for respiratory acidosis; it is used for metabolic
acidosis. Albuterol alone (D) is insufficient to address the respiratory failure.
QUESTION 4
A 58-year-old client with a history of myocardial infarction and heart failure is prescribed carvedilol. The
client asks the nurse why this medication is being prescribed. Which response by the nurse is most accurate?
A) "This medication will help your heart pump more forcefully by increasing contractility."
B) "This medication will decrease your heart rate and blood pressure, reducing the workload on your heart."
C) "This medication will prevent blood clots from forming in your heart."
D) "This medication will remove excess fluid from your body."
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that works by decreasing heart rate, blood pressure, and myocardial
oxygen demand, thereby reducing the workload on the heart and improving outcomes in heart failure. It does
not increase contractility (A); that is the action of inotropes like digoxin. It does not prevent blood clots (C);
anticoagulants do that. It does not remove fluid (D); diuretics do that.
QUESTION 5
A 65-year-old client with end-stage renal disease (ESRD) on hemodialysis is admitted with a potassium level
of 6.8 mEq/L. The client is scheduled for emergent hemodialysis. Which interventions should the nurse
implement while awaiting dialysis? Select all that apply.
A) Administer calcium gluconate IV
B) Administer insulin and glucose IV
C) Administer sodium polystyrene sulfonate orally
D) Restrict all oral fluid intake
E) Administer potassium-sparing diuretics
Correct Answer: A, B, C
Rationale: Hyperkalemia (K+ >5.0 mEq/L) is a medical emergency requiring immediate intervention.
Calcium gluconate (A) stabilizes the cardiac membrane and prevents arrhythmias. Insulin and glucose (B)
drive potassium into cells, temporarily lowering serum levels. Sodium polystyrene sulfonate (C) binds
potassium in the GI tract for excretion. Fluid restriction (D) is appropriate for ESRD but does not directly
address hyperkalemia. Potassium-sparing diuretics (E) would worsen hyperkalemia and are contraindicated.
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QUESTION 6
A client with a history of deep vein thrombosis (DVT) is prescribed rivaroxaban. Which statement by the
client indicates a need for further teaching?
A) "I should take this medication with food to improve absorption."
B) "I should avoid taking this medication with aspirin or other blood thinners."
C) "I should stop taking this medication 2 days before my dental procedure."
D) "I should report any signs of bleeding, such as blood in my urine or stool."
Correct Answer: C
Rationale: Rivaroxaban is a direct oral anticoagulant (DOAC) that should not be stopped abruptly without
provider guidance. The duration of holding before a procedure depends on renal function and bleeding risk; 2
days may not be sufficient, and the provider should be consulted. Taking with food (A) improves absorption.
Avoiding aspirin (B) and reporting bleeding (D) are correct statements.
QUESTION 7
A 55-year-old client with cirrhosis is admitted with ascites and hepatic encephalopathy. The client is
confused, disoriented, and has a flapping tremor of the hands. The healthcare provider orders lactulose 30 mL
orally four times daily. Which finding indicates the lactulose is effective?
A) Decreased serum ammonia level
B) Increased serum bilirubin level
C) Increased serum albumin level
D) Decreased prothrombin time
Correct Answer: A
Rationale: Lactulose is used to treat hepatic encephalopathy by acidifying the colon, trapping ammonia, and
promoting its excretion in the stool. A decreased serum ammonia level indicates the medication is effective.
Increased bilirubin (B) suggests worsening liver function. Increased albumin (C) indicates improved liver
synthetic function but is not the primary effect of lactulose. Decreased PT (D) indicates improved clotting but
is not the primary effect.
QUESTION 8
A 42-year-old client with a history of asthma is prescribed fluticasone/salmeterol (Advair) inhaler. Which
statement by the client indicates understanding of the medication?
EVOLVE ELSEVIER HESI MED-SURG EXTENDED TEST
BANK - ACTUAL EXAM 2026/2027 | ELSEVIER/EVOLVE
| EXPERT VERIFIED | 300 VERIFIED Q&A | COMPLETE
RATIONALES | PASS GUARANTEED - A+ GRADED
EXAM OVERVIEW
Course: Evolve Elsevier HESI Med-Surg Extended Test Bank
Institution: Elsevier/Evolve
Exam Type: Extended Test Bank
Question Count: 300 Questions
Format: Multiple Choice with Verified Answers and Complete Rationales
Focus Areas: Comprehensive Med-Surg nursing content with extended application, clinical judgment,
prioritization, delegation, and advanced NGN-style integration across all body systems
QUESTION 1
A 68-year-old client with a history of hypertension, type 2 diabetes, and stage 3 chronic kidney disease is
admitted with acute decompensated heart failure. The client's vital signs are: BP 168/94 mmHg, HR 110 bpm,
RR 26/min, SpO2 91% on 2L NC, temperature 37.2°C. The client has 3+ pitting edema to the knees, jugular
venous distention, and crackles bilaterally at the lung bases. The healthcare provider orders furosemide 80 mg
IV push. Which assessment finding is most important to report to the healthcare provider before
administering this medication?
A) Serum potassium of 3.1 mEq/L
B) Serum creatinine of 2.8 mg/dL
C) Blood pressure of 168/94 mmHg
D) Weight gain of 2 kg in 24 hours
Correct Answer: A
Rationale: The serum potassium of 3.1 mEq/L is critically low (normal 3.5-5.0 mEq/L) and places this client at
high risk for cardiac arrhythmias, especially with underlying heart failure and potential digoxin use.
Furosemide is a loop diuretic that will further deplete potassium, worsening hypokalemia. The provider
should be notified before administration to consider potassium supplementation or an alternative diuretic.
The elevated creatinine (B) reflects the client's baseline CKD and should be monitored but is not the most
immediate concern before giving furosemide. The BP (C) indicates hypertension requiring treatment but is
not the priority. Weight gain (D) confirms fluid overload and indicates the need for diuresis, not a reason to
hold the medication.
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QUESTION 2
A 45-year-old client with a history of alcohol use disorder is admitted with acute pancreatitis. The client
reports severe epigastric pain radiating to the back, nausea, and vomiting. The client's vital signs are: BP 98/62
mmHg, HR 118 bpm, RR 22/min, temperature 38.1°C. Laboratory results show: serum lipase 1,200 U/L
(normal 0-160 U/L), serum amylase 850 U/L (normal 30-110 U/L), WBC 18,000/mm³, and glucose 180
mg/dL. Which prescribed intervention should the nurse implement first?
A) Administer morphine sulfate 4 mg IV push for pain
B) Initiate IV fluid resuscitation with normal saline at 200 mL/hr
C) Insert a nasogastric tube to low intermittent suction
D) Administer ondansetron 4 mg IV for nausea
Correct Answer: B
Rationale: The client is showing signs of hypovolemic shock from third-spacing of fluids in acute pancreatitis
(hypotension, tachycardia, elevated glucose). The priority intervention is aggressive IV fluid resuscitation to
restore intravascular volume and maintain tissue perfusion. Pain management (A) is important but secondary
to hemodynamic stabilization. NG tube (C) may be needed for persistent vomiting or ileus but is not the
priority. Ondansetron (D) addresses nausea but does not correct the underlying hemodynamic instability.
QUESTION 3
A 72-year-old client with a history of COPD and heart failure is admitted with worsening dyspnea, productive
cough with purulent sputum, and confusion. The client's vital signs are: BP 142/88 mmHg, HR 102 bpm, RR
30/min, temperature 38.5°C, SpO2 86% on room air. Arterial blood gas results: pH 7.28, PaCO2 58 mmHg,
PaO2 52 mmHg, HCO3 26 mEq/L. Which intervention should the nurse anticipate?
A) Bi-level positive airway pressure (BiPAP) ventilation
B) Immediate intubation and mechanical ventilation
C) Administration of sodium bicarbonate IV
D) Administration of albuterol nebulizer only
Correct Answer: A
Rationale: The client is in acute respiratory acidosis (pH 7.28, PaCO2 58) with hypoxemia, likely due to an
exacerbation of COPD. BiPAP is a non-invasive ventilation modality that can support ventilation, reduce
work of breathing, and improve gas exchange in COPD exacerbations, potentially avoiding intubation.
Immediate intubation (B) may be needed if BiPAP fails or the client deteriorates, but BiPAP is the less invasive
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first-line intervention. Sodium bicarbonate (C) is not indicated for respiratory acidosis; it is used for metabolic
acidosis. Albuterol alone (D) is insufficient to address the respiratory failure.
QUESTION 4
A 58-year-old client with a history of myocardial infarction and heart failure is prescribed carvedilol. The
client asks the nurse why this medication is being prescribed. Which response by the nurse is most accurate?
A) "This medication will help your heart pump more forcefully by increasing contractility."
B) "This medication will decrease your heart rate and blood pressure, reducing the workload on your heart."
C) "This medication will prevent blood clots from forming in your heart."
D) "This medication will remove excess fluid from your body."
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that works by decreasing heart rate, blood pressure, and myocardial
oxygen demand, thereby reducing the workload on the heart and improving outcomes in heart failure. It does
not increase contractility (A); that is the action of inotropes like digoxin. It does not prevent blood clots (C);
anticoagulants do that. It does not remove fluid (D); diuretics do that.
QUESTION 5
A 65-year-old client with end-stage renal disease (ESRD) on hemodialysis is admitted with a potassium level
of 6.8 mEq/L. The client is scheduled for emergent hemodialysis. Which interventions should the nurse
implement while awaiting dialysis? Select all that apply.
A) Administer calcium gluconate IV
B) Administer insulin and glucose IV
C) Administer sodium polystyrene sulfonate orally
D) Restrict all oral fluid intake
E) Administer potassium-sparing diuretics
Correct Answer: A, B, C
Rationale: Hyperkalemia (K+ >5.0 mEq/L) is a medical emergency requiring immediate intervention.
Calcium gluconate (A) stabilizes the cardiac membrane and prevents arrhythmias. Insulin and glucose (B)
drive potassium into cells, temporarily lowering serum levels. Sodium polystyrene sulfonate (C) binds
potassium in the GI tract for excretion. Fluid restriction (D) is appropriate for ESRD but does not directly
address hyperkalemia. Potassium-sparing diuretics (E) would worsen hyperkalemia and are contraindicated.
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QUESTION 6
A client with a history of deep vein thrombosis (DVT) is prescribed rivaroxaban. Which statement by the
client indicates a need for further teaching?
A) "I should take this medication with food to improve absorption."
B) "I should avoid taking this medication with aspirin or other blood thinners."
C) "I should stop taking this medication 2 days before my dental procedure."
D) "I should report any signs of bleeding, such as blood in my urine or stool."
Correct Answer: C
Rationale: Rivaroxaban is a direct oral anticoagulant (DOAC) that should not be stopped abruptly without
provider guidance. The duration of holding before a procedure depends on renal function and bleeding risk; 2
days may not be sufficient, and the provider should be consulted. Taking with food (A) improves absorption.
Avoiding aspirin (B) and reporting bleeding (D) are correct statements.
QUESTION 7
A 55-year-old client with cirrhosis is admitted with ascites and hepatic encephalopathy. The client is
confused, disoriented, and has a flapping tremor of the hands. The healthcare provider orders lactulose 30 mL
orally four times daily. Which finding indicates the lactulose is effective?
A) Decreased serum ammonia level
B) Increased serum bilirubin level
C) Increased serum albumin level
D) Decreased prothrombin time
Correct Answer: A
Rationale: Lactulose is used to treat hepatic encephalopathy by acidifying the colon, trapping ammonia, and
promoting its excretion in the stool. A decreased serum ammonia level indicates the medication is effective.
Increased bilirubin (B) suggests worsening liver function. Increased albumin (C) indicates improved liver
synthetic function but is not the primary effect of lactulose. Decreased PT (D) indicates improved clotting but
is not the primary effect.
QUESTION 8
A 42-year-old client with a history of asthma is prescribed fluticasone/salmeterol (Advair) inhaler. Which
statement by the client indicates understanding of the medication?
