Evolve HESI Comprehensive Exit – Elsevier Evolve –
2026/2027 Academic Year
SECTION I: MEDICAL-SURGICAL NURSING (Questions 1–30)
Question 1
A 68-year-old male with a history of COPD is admitted with an acute
exacerbation. Which assessment finding requires immediate intervention?
A. Respiratory rate of 26 breaths per minute
B. Oxygen saturation of 89% on 2L nasal cannula
C. Use of accessory muscles and paradoxical breathing
D. Productive cough with greenish sputum
Correct Answer: C
Rationale: Use of accessory muscles and paradoxical breathing indicates
severe respiratory distress and impending respiratory failure. Paradoxical
breathing (chest moves inward during inspiration) suggests diaphragmatic fatigue
requiring immediate intervention such as non-invasive ventilation or intubation.
While a respiratory rate of 26 is elevated (normal 12-20), O₂ sat of 89% is below
target but may be expected in COPD patients with chronic hypoxemia. Productive
cough with green sputum indicates infection but is not immediately life-
threatening.
Question 2
The nurse is caring for a client with acute pancreatitis. Which laboratory finding is
most specific for this diagnosis?
A. Elevated ALT and AST
B. Elevated serum lipase
C. Elevated serum calcium
D. Elevated serum bilirubin
Correct Answer: B
, Rationale: Serum lipase is the most sensitive and specific laboratory marker
for acute pancreatitis. It rises within 4-8 hours of onset and remains elevated for
7-14 days. Amylase is also elevated but less specific. Elevated ALT/AST and
bilirubin suggest hepatobiliary disease. Hypocalcemia (not hypercalcemia) can
occur in pancreatitis due to fat necrosis binding calcium.
Question 3
A client with cirrhosis develops asterixis. Which assessment technique is used to
elicit this finding?
A. Ask the client to extend both arms and dorsiflex the wrists
B. Assess for pupillary response to light
C. Test for ankle clonus
D. Perform the Romberg test
Correct Answer: A
Rationale: Asterixis, or "liver flap," is a flapping tremor of the hands when the
wrists are extended. To elicit this sign, ask the client to extend both arms forward
with palms up and dorsiflex the wrists. A positive finding is a rapid, non-rhythmic
flexion-extension movement of the hands and wrists. This indicates hepatic
encephalopathy due to elevated ammonia levels.
Question 4
A client is 3 days post-hip hemiarthroplasty. Which instruction should the nurse
include in teaching about hip precautions?
A. "Cross your legs at the ankles when sitting"
B. "Place a pillow between your knees while lying in bed"
C. "Bend forward at the waist to pick up objects from the floor"
D. "Turn your operative leg inward when lying on your back"
Correct Answer: B
Rationale: Placing a pillow between the knees while lying in bed prevents hip
dislocation by maintaining the hip in a neutral position and preventing adduction
,past midline. Hip precautions following hemiarthroplasty include: no crossing
legs, no bending forward more than 90 degrees, and no turning the operative leg
inward (internal rotation). Crossing legs (A), bending forward (C), and internal
rotation (D) all violate hip precautions and increase dislocation risk.
Question 5
A client 3 days post-colostomy surgery sees the stoma for the first time and
becomes upset, stating it is much larger than expected. What is the best response
by the nurse?
A. "I understand you're upset. Would you like to talk about it?"
B. "The stoma will become smaller when the initial swelling diminishes"
C. "Most people feel that way at first. You'll get used to it"
D. "Let me get the ostomy nurse to come talk with you"
Correct Answer: B
Rationale: Postoperative swelling causes enlargement of the stoma. The
nurse can provide accurate information by teaching the client that the stoma will
become smaller when the swelling diminishes. This addresses the client's concern
directly with factual information while providing reassurance. Option A dismisses
the concern without addressing it; C minimizes the client's feelings; D may be
appropriate later but the nurse should first address the immediate concern.
Question 6
The healthcare provider prescribes morphine sulfate 4 mg IM STAT. The vial
contains 8 mg per mL. How many mL should the nurse administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: B
, Rationale: Using the formula: Desired dose ÷ Available dose × Volume = 4 mg
÷ 8 mg × 1 mL = 0.5 mL. Always double-check calculations and verify with another
nurse before administering high-alert medications like opioids.
Question 7
The healthcare provider prescribes 1,000 mL of Ringer's Lactate with 30 Units of
Pitocin to run over 4 hours for a client who has just delivered. What is the hourly
infusion rate?
A. 125 mL/hr
B. 200 mL/hr
C. 250 mL/hr
D. 500 mL/hr
Correct Answer: C
Rationale: 1,000 mL ÷ 4 hours = 250 mL/hr. The Pitocin dose is 30 Units in
1,000 mL, so the client receives 7.5 Units/hr (30 Units ÷ 4 hours). This is a typical
postpartum infusion rate for prevention of uterine atony.
Question 8
A client with heart failure is prescribed furosemide. Which assessment finding
indicates the medication is effective?
A. Increased blood pressure
B. Weight gain of 2 kg in 24 hours
C. Decreased peripheral edema
D. Increased heart rate
Correct Answer: C
Rationale: Furosemide is a loop diuretic that promotes excretion of fluid,
thereby reducing fluid overload manifestations including peripheral edema,
pulmonary congestion, and dyspnea. Effective diuresis is evidenced by decreased
edema, weight loss, and improved breath sounds. Increased blood pressure is not
2026/2027 Academic Year
SECTION I: MEDICAL-SURGICAL NURSING (Questions 1–30)
Question 1
A 68-year-old male with a history of COPD is admitted with an acute
exacerbation. Which assessment finding requires immediate intervention?
A. Respiratory rate of 26 breaths per minute
B. Oxygen saturation of 89% on 2L nasal cannula
C. Use of accessory muscles and paradoxical breathing
D. Productive cough with greenish sputum
Correct Answer: C
Rationale: Use of accessory muscles and paradoxical breathing indicates
severe respiratory distress and impending respiratory failure. Paradoxical
breathing (chest moves inward during inspiration) suggests diaphragmatic fatigue
requiring immediate intervention such as non-invasive ventilation or intubation.
While a respiratory rate of 26 is elevated (normal 12-20), O₂ sat of 89% is below
target but may be expected in COPD patients with chronic hypoxemia. Productive
cough with green sputum indicates infection but is not immediately life-
threatening.
Question 2
The nurse is caring for a client with acute pancreatitis. Which laboratory finding is
most specific for this diagnosis?
A. Elevated ALT and AST
B. Elevated serum lipase
C. Elevated serum calcium
D. Elevated serum bilirubin
Correct Answer: B
, Rationale: Serum lipase is the most sensitive and specific laboratory marker
for acute pancreatitis. It rises within 4-8 hours of onset and remains elevated for
7-14 days. Amylase is also elevated but less specific. Elevated ALT/AST and
bilirubin suggest hepatobiliary disease. Hypocalcemia (not hypercalcemia) can
occur in pancreatitis due to fat necrosis binding calcium.
Question 3
A client with cirrhosis develops asterixis. Which assessment technique is used to
elicit this finding?
A. Ask the client to extend both arms and dorsiflex the wrists
B. Assess for pupillary response to light
C. Test for ankle clonus
D. Perform the Romberg test
Correct Answer: A
Rationale: Asterixis, or "liver flap," is a flapping tremor of the hands when the
wrists are extended. To elicit this sign, ask the client to extend both arms forward
with palms up and dorsiflex the wrists. A positive finding is a rapid, non-rhythmic
flexion-extension movement of the hands and wrists. This indicates hepatic
encephalopathy due to elevated ammonia levels.
Question 4
A client is 3 days post-hip hemiarthroplasty. Which instruction should the nurse
include in teaching about hip precautions?
A. "Cross your legs at the ankles when sitting"
B. "Place a pillow between your knees while lying in bed"
C. "Bend forward at the waist to pick up objects from the floor"
D. "Turn your operative leg inward when lying on your back"
Correct Answer: B
Rationale: Placing a pillow between the knees while lying in bed prevents hip
dislocation by maintaining the hip in a neutral position and preventing adduction
,past midline. Hip precautions following hemiarthroplasty include: no crossing
legs, no bending forward more than 90 degrees, and no turning the operative leg
inward (internal rotation). Crossing legs (A), bending forward (C), and internal
rotation (D) all violate hip precautions and increase dislocation risk.
Question 5
A client 3 days post-colostomy surgery sees the stoma for the first time and
becomes upset, stating it is much larger than expected. What is the best response
by the nurse?
A. "I understand you're upset. Would you like to talk about it?"
B. "The stoma will become smaller when the initial swelling diminishes"
C. "Most people feel that way at first. You'll get used to it"
D. "Let me get the ostomy nurse to come talk with you"
Correct Answer: B
Rationale: Postoperative swelling causes enlargement of the stoma. The
nurse can provide accurate information by teaching the client that the stoma will
become smaller when the swelling diminishes. This addresses the client's concern
directly with factual information while providing reassurance. Option A dismisses
the concern without addressing it; C minimizes the client's feelings; D may be
appropriate later but the nurse should first address the immediate concern.
Question 6
The healthcare provider prescribes morphine sulfate 4 mg IM STAT. The vial
contains 8 mg per mL. How many mL should the nurse administer?
A. 0.25 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: B
, Rationale: Using the formula: Desired dose ÷ Available dose × Volume = 4 mg
÷ 8 mg × 1 mL = 0.5 mL. Always double-check calculations and verify with another
nurse before administering high-alert medications like opioids.
Question 7
The healthcare provider prescribes 1,000 mL of Ringer's Lactate with 30 Units of
Pitocin to run over 4 hours for a client who has just delivered. What is the hourly
infusion rate?
A. 125 mL/hr
B. 200 mL/hr
C. 250 mL/hr
D. 500 mL/hr
Correct Answer: C
Rationale: 1,000 mL ÷ 4 hours = 250 mL/hr. The Pitocin dose is 30 Units in
1,000 mL, so the client receives 7.5 Units/hr (30 Units ÷ 4 hours). This is a typical
postpartum infusion rate for prevention of uterine atony.
Question 8
A client with heart failure is prescribed furosemide. Which assessment finding
indicates the medication is effective?
A. Increased blood pressure
B. Weight gain of 2 kg in 24 hours
C. Decreased peripheral edema
D. Increased heart rate
Correct Answer: C
Rationale: Furosemide is a loop diuretic that promotes excretion of fluid,
thereby reducing fluid overload manifestations including peripheral edema,
pulmonary congestion, and dyspnea. Effective diuresis is evidenced by decreased
edema, weight loss, and improved breath sounds. Increased blood pressure is not
