EVOLVE ELSEVIER HESI MED-SURG EXAM
QUESTION BANK 2026 ACTUAL EXAM
WITH QUESTIONS AND CORRECT
DETAILED ANSWERS
1. The nurse is teaching health promotion tips to the mother of a 2-year-old child. During
the follow-up visit, the nurse observes that the child has diarrhea and dental caries.
Which action is responsible for this condition?
• "I give my child 1 cup of fruit daily."
• "I give my child 8 oz of fruit juice daily."
• "I give my child vitamin C–rich foods daily."
• "I do not rinse my child’s mouth after brushing with fluoridated gels."
• "I give my child 8 oz of fruit juice daily."
· Providing 4 to 6 oz of 100% fruit juice per day is recommended for
toddlers. Consumption of high amounts of fruit juice can contribute to
diarrhea, overnutrition, and dental caries. One cup of fruit is sufficient
for good health in toddlers. Vitamin C enhances iron absorption in the
body. The mother should not rinse the child’s mouth after brushing with
fluoridated pastes and gels to maximize the action of the fluoridated
gels.
2. In which part of the cardiovascular system would the nurse expect an increase in
pressure in a toddler with pulmonic stenosis?
• Left atrium
• Right ventricle
• Pulmonary vein
• Pulmonary artery
• Right ventricle
· Pulmonic stenosis increases resistance to blood flow, causing right
ventricular hypertrophy; with right ventricular failure there is an
increase in pressure on the right side of the heart. Pressure in the left
side of the heart is decreased with pulmonic stenosis. Pressure in the
pulmonary vein is decreased with pulmonic stenosis. Pressure in the
pulmonary artery is decreased with pulmonic stenosis.
Page 1 of 49
,3. Which behavior would the nurse know is important to avoid in a 5-month-old child who
had heart surgery to repair the defects associated with tetralogy of Fallot?
• Crying
• Coughing
• Straining at stool
• Unnecessary movement
• Straining at stool
· Forceful evacuation involves taking a deep breath, holding it, and
straining (Valsalva maneuver). This increases intrathoracic pressure,
which puts excessive strain on the heart sutures. Crying is not a problem
after cardiac surgery; it may, in fact, help prevent respiratory
complications. Coughing and deep breathing are essential for the
prevention of postoperative respiratory complications. Activity is
gradually increased.
4. A critically ill 5-year-old child exhibits Kussmaul respirations. Which would the nurse
suspect may be causing an increasing acid-base imbalance?
• Metabolic alkalosis caused by an increase in base bicarbonate
• Respiratory alkalosis caused by excess carbon dioxide (CO2) output
• Respiratory acidosis caused by an accumulation of CO2
• Metabolic acidosis caused by a concentration of cations in body fluids
• Metabolic acidosis caused by a concentration of cations in body fluids
· Metabolic acidosis results from an excess concentration of hydrogen
cations. The kidneys cannot convert ammonium to ammonia, and there
is inadequate base bicarbonate to maintain an appropriate acid-base
balance. With Kussmaul respirations there is an excess of hydrogen ions,
the opposite of an excess of base bicarbonate. Carbonic acid blown off
as CO2 is a compensatory mechanism to counter the present metabolic
acidosis. There is an excess of hydrogen ions from a metabolic problem
rather than an excess of carbonic acid resulting from retained CO2.
5. Which intervention would the nurse recommend to the mother of a 6-month-old infant
who experiences injection site redness, swelling, and discomfort?
• Place a hot compress on the area.
• Administer a dose of acetaminophen.
• Give a cool sponge bath for 15 minutes.
• Apply an Ace bandage to the swollen site
• Administer a dose of acetaminophen.
Page 2 of 49
, · Acetaminophen will relieve any discomfort. A cold rather than a hot
compress will be soothing and help relieve the redness and swelling. A
sponge bath is likely to give the infant chills and is not indicated. An Ace
(compression) bandage is contraindicated and likely to restrict
circulation.
6. Which is the difference between the social contract orientation and the universal ethical
principle orientation stages?
• Social contract orientation involves following laws without question, whereas
universal ethical principle orientation involves civil disobedience.
• Social contract orientation is a part of conventional reasoning, whereas universal
ethical principle orientation is a part of postconventional reasoning.
• Social contract orientation focuses on expanded societal concerns in an
individual, whereas universal ethical principle orientation focuses on basic rights
and laws.
• Social contract orientation demonstrates moral decisions based on societal view,
whereas universal ethical principle orientation stage outlines an individual’s
response based on physical punishment.
• Social contract orientation involves following laws without question, whereas
universal ethical principle orientation involves civil disobedience.
· The social contract orientation stage relies on following laws without
question, whereas an individual under the universal ethical principle
orientation stage may show civil disobedience. Both the social contract
orientation stage and the universal ethical principle orientation stage
are part of postconventional reasoning. Both stages are related to basic
rights and laws. The society-maintaining orientation stage
demonstrates moral decisions based on societal laws, whereas the
punishment and obedience orientation stage outlines an individual’s
response based on the threat of physical punishment.
7. Which would the nurse emphasize when teaching insulin self-administration to a child
with recently diagnosed diabetes?
• The need to wash the hands before preparing the insulin injection
• The need to shake the bottle of insulin thoroughly before drawing up the dose
• The need to alternate the sites of the insulin injections among the four
extremities
• The need to rub the injection site briskly for half a minute after giving the
injection
• The need to wash the hands before preparing the insulin injection
Page 3 of 49
, · Thorough hand washing is the best infection-prevention technique and
should always precede preparation of an injection. Shaking insulin
causes air bubbles, which can interfere with preparation of an accurate
dose; the bottle should be rolled gently between the palms. Although
injection sites should be rotated, the abdomen, not the extremities, is
the preferred site for self-administration of insulin. The injection site
should not be rubbed, because this will affect absorption of the insulin
and cause a reaction at the site.
8. Which parental statement would the nurse determine indicates a need for further
education about development in a 15-month-old?
• "She’s always trying to get out of her car seat."
• "She cries when I leave her at the daycare center."
• "She gets into everything and scatters toys everywhere."
• "She has a temper tantrum every time I put her on the potty chair."
• "She has a temper tantrum every time I put her on the potty chair."
· Most 15-month-old toddlers are not ready for toilet training. Voluntary
sphincter control usually develops between 18 and 24 months of age. A
tantrum on being placed on the potty chair is autonomous behavior,
typical of a 15-month-old toddler. Crying when the mother leaves her at
the daycare center demonstrates separation anxiety, common in 15-
month-old toddlers. Scattering toys everywhere and trying to get out of
a car seat demonstrate autonomous behavior, typical of a 15-month-old
toddler.
9. Which action would the nurse take when an infant begins to cough and gag after a
nasogastric tube insertion?
• Auscultating for breath sounds
• Removing the tube, then reinserting it
• Administering the tube feeding slowly
• Observing the infant for circumoral cyanosis
• Removing the tube, then reinserting it
· The infant’s response indicates that the tube may be in the trachea
rather than the stomach. The tube should be removed, reinserted, and
verified for its placement before the feeding is started. Auscultating for
breath sounds does not provide information about the placement of the
tube. The tube should be removed immediately; it is unsafe to assess the
infant for additional signs of respiratory distress. It is unsafe to
Page 4 of 49
QUESTION BANK 2026 ACTUAL EXAM
WITH QUESTIONS AND CORRECT
DETAILED ANSWERS
1. The nurse is teaching health promotion tips to the mother of a 2-year-old child. During
the follow-up visit, the nurse observes that the child has diarrhea and dental caries.
Which action is responsible for this condition?
• "I give my child 1 cup of fruit daily."
• "I give my child 8 oz of fruit juice daily."
• "I give my child vitamin C–rich foods daily."
• "I do not rinse my child’s mouth after brushing with fluoridated gels."
• "I give my child 8 oz of fruit juice daily."
· Providing 4 to 6 oz of 100% fruit juice per day is recommended for
toddlers. Consumption of high amounts of fruit juice can contribute to
diarrhea, overnutrition, and dental caries. One cup of fruit is sufficient
for good health in toddlers. Vitamin C enhances iron absorption in the
body. The mother should not rinse the child’s mouth after brushing with
fluoridated pastes and gels to maximize the action of the fluoridated
gels.
2. In which part of the cardiovascular system would the nurse expect an increase in
pressure in a toddler with pulmonic stenosis?
• Left atrium
• Right ventricle
• Pulmonary vein
• Pulmonary artery
• Right ventricle
· Pulmonic stenosis increases resistance to blood flow, causing right
ventricular hypertrophy; with right ventricular failure there is an
increase in pressure on the right side of the heart. Pressure in the left
side of the heart is decreased with pulmonic stenosis. Pressure in the
pulmonary vein is decreased with pulmonic stenosis. Pressure in the
pulmonary artery is decreased with pulmonic stenosis.
Page 1 of 49
,3. Which behavior would the nurse know is important to avoid in a 5-month-old child who
had heart surgery to repair the defects associated with tetralogy of Fallot?
• Crying
• Coughing
• Straining at stool
• Unnecessary movement
• Straining at stool
· Forceful evacuation involves taking a deep breath, holding it, and
straining (Valsalva maneuver). This increases intrathoracic pressure,
which puts excessive strain on the heart sutures. Crying is not a problem
after cardiac surgery; it may, in fact, help prevent respiratory
complications. Coughing and deep breathing are essential for the
prevention of postoperative respiratory complications. Activity is
gradually increased.
4. A critically ill 5-year-old child exhibits Kussmaul respirations. Which would the nurse
suspect may be causing an increasing acid-base imbalance?
• Metabolic alkalosis caused by an increase in base bicarbonate
• Respiratory alkalosis caused by excess carbon dioxide (CO2) output
• Respiratory acidosis caused by an accumulation of CO2
• Metabolic acidosis caused by a concentration of cations in body fluids
• Metabolic acidosis caused by a concentration of cations in body fluids
· Metabolic acidosis results from an excess concentration of hydrogen
cations. The kidneys cannot convert ammonium to ammonia, and there
is inadequate base bicarbonate to maintain an appropriate acid-base
balance. With Kussmaul respirations there is an excess of hydrogen ions,
the opposite of an excess of base bicarbonate. Carbonic acid blown off
as CO2 is a compensatory mechanism to counter the present metabolic
acidosis. There is an excess of hydrogen ions from a metabolic problem
rather than an excess of carbonic acid resulting from retained CO2.
5. Which intervention would the nurse recommend to the mother of a 6-month-old infant
who experiences injection site redness, swelling, and discomfort?
• Place a hot compress on the area.
• Administer a dose of acetaminophen.
• Give a cool sponge bath for 15 minutes.
• Apply an Ace bandage to the swollen site
• Administer a dose of acetaminophen.
Page 2 of 49
, · Acetaminophen will relieve any discomfort. A cold rather than a hot
compress will be soothing and help relieve the redness and swelling. A
sponge bath is likely to give the infant chills and is not indicated. An Ace
(compression) bandage is contraindicated and likely to restrict
circulation.
6. Which is the difference between the social contract orientation and the universal ethical
principle orientation stages?
• Social contract orientation involves following laws without question, whereas
universal ethical principle orientation involves civil disobedience.
• Social contract orientation is a part of conventional reasoning, whereas universal
ethical principle orientation is a part of postconventional reasoning.
• Social contract orientation focuses on expanded societal concerns in an
individual, whereas universal ethical principle orientation focuses on basic rights
and laws.
• Social contract orientation demonstrates moral decisions based on societal view,
whereas universal ethical principle orientation stage outlines an individual’s
response based on physical punishment.
• Social contract orientation involves following laws without question, whereas
universal ethical principle orientation involves civil disobedience.
· The social contract orientation stage relies on following laws without
question, whereas an individual under the universal ethical principle
orientation stage may show civil disobedience. Both the social contract
orientation stage and the universal ethical principle orientation stage
are part of postconventional reasoning. Both stages are related to basic
rights and laws. The society-maintaining orientation stage
demonstrates moral decisions based on societal laws, whereas the
punishment and obedience orientation stage outlines an individual’s
response based on the threat of physical punishment.
7. Which would the nurse emphasize when teaching insulin self-administration to a child
with recently diagnosed diabetes?
• The need to wash the hands before preparing the insulin injection
• The need to shake the bottle of insulin thoroughly before drawing up the dose
• The need to alternate the sites of the insulin injections among the four
extremities
• The need to rub the injection site briskly for half a minute after giving the
injection
• The need to wash the hands before preparing the insulin injection
Page 3 of 49
, · Thorough hand washing is the best infection-prevention technique and
should always precede preparation of an injection. Shaking insulin
causes air bubbles, which can interfere with preparation of an accurate
dose; the bottle should be rolled gently between the palms. Although
injection sites should be rotated, the abdomen, not the extremities, is
the preferred site for self-administration of insulin. The injection site
should not be rubbed, because this will affect absorption of the insulin
and cause a reaction at the site.
8. Which parental statement would the nurse determine indicates a need for further
education about development in a 15-month-old?
• "She’s always trying to get out of her car seat."
• "She cries when I leave her at the daycare center."
• "She gets into everything and scatters toys everywhere."
• "She has a temper tantrum every time I put her on the potty chair."
• "She has a temper tantrum every time I put her on the potty chair."
· Most 15-month-old toddlers are not ready for toilet training. Voluntary
sphincter control usually develops between 18 and 24 months of age. A
tantrum on being placed on the potty chair is autonomous behavior,
typical of a 15-month-old toddler. Crying when the mother leaves her at
the daycare center demonstrates separation anxiety, common in 15-
month-old toddlers. Scattering toys everywhere and trying to get out of
a car seat demonstrate autonomous behavior, typical of a 15-month-old
toddler.
9. Which action would the nurse take when an infant begins to cough and gag after a
nasogastric tube insertion?
• Auscultating for breath sounds
• Removing the tube, then reinserting it
• Administering the tube feeding slowly
• Observing the infant for circumoral cyanosis
• Removing the tube, then reinserting it
· The infant’s response indicates that the tube may be in the trachea
rather than the stomach. The tube should be removed, reinserted, and
verified for its placement before the feeding is started. Auscultating for
breath sounds does not provide information about the placement of the
tube. The tube should be removed immediately; it is unsafe to assess the
infant for additional signs of respiratory distress. It is unsafe to
Page 4 of 49
