Evolve Elsevier HESI Med Surg Exam Study Guide |
Complete Actual Exam Questions with Verified
Correct Answers and Detailed Rationales | Latest
Update 2026/2027 – Already Graded A+
SECTION 1: MANAGEMENT OF CARE & PRIORITIZATION
Q1. The charge nurse receives handoff on four med-surg clients. Which client
should the nurse assess FIRST?
A. 65-year-old post-op day 1 abdominal hysterectomy, reports 6/10 incisional
pain, vital signs stable, SpO₂ 98% on 2L NC
B. 50-year-old with heart failure on IV furosemide 40 mg q8h, reports dizziness
upon standing, HR 118, BP 92/58, last voided 8 hours ago
C. 30-year-old with new-onset type 1 diabetes, 1 hour post-breakfast glucose 180
mg/dL, denies symptoms
D. 72-year-old with Alzheimer's disease, bed alarm sounding, attempting to climb
over side rails, vital signs stable
Correct Answer: B
Rationale: Hypotension (92/58) with tachycardia (118) and oliguria (no void for 8
hours) signals volume depletion from diuretic therapy—an unstable
cardiopulmonary/renal issue requiring immediate intervention. Orthostatic
changes predispose to falls and acute kidney injury. Client A has stable pain, Client
C has an expected glucose elevation, and Client D can be managed with safety
measures.
Q2. The RN is delegating morning care tasks. Which task is appropriate to assign
to the UAP?
,A. Reposition a 2-hour post-craniotomy patient whose ICP monitor reads 14
mmHg
B. Measure Accu-Chek for a diabetic patient who is diaphoretic and tremulous
C. Assist a 90 kg stroke patient with left neglect to transfer bed → chair using a
gait belt
D. Perform a sterile dressing change on a central-line site that is erythematous
Correct Answer: C
Rationale: Transfer assistance with a gait belt is a standard mobility task within
UAP scope. Accu-Chek on a symptomatic hypoglycemic patient (B) requires RN
assessment and judgment. Sterile central-line dressing changes (D) and
repositioning fresh craniotomy patients (A) require RN-level assessment.
Q3. A provider writes the following order: "Insulin aspart 8 units + NPH 14 units
– now and qAM." What is the nurse's best action?
A. Draw both insulins into the same syringe and administer immediately
B. Clarify if the doses should be given as two separate injections
C. Give aspart now, hold NPH until breakfast tray arrives
D. Use an insulin pen loaded with 70/30 mix for convenience
Correct Answer: B
Rationale: Combining two insulins requires confirmation of compatibility and
timing (NPH is typically given with breakfast; aspart is rapid-acting given with
meals). The nurse must clarify timing and confirm the correct mixing sequence
(aspart clear → NPH cloudy). A 70/30 pen (D) is a different concentration and
formulation.
Q4. A nurse discovers an insulin dose of 40 units was given instead of 4 units.
The patient is now diaphoretic with glucose 48 mg/dL. After treating the
hypoglycemia, the nurse must:
,A. Complete an incident report before end of shift
B. Document only the corrected glucose value in the chart
C. Notify the provider during next rounds
D. Add "insulin-sensitive" to the allergy list
Correct Answer: A
Rationale: Incident reports are mandatory for medication errors to initiate quality
review and prevent recurrence. Immediate provider notification is also required
(not waiting for rounds). Documenting only the corrected value (B) is falsification.
Incident reports should be completed as soon as possible after the error.
Q5. A nurse is caring for four clients. Which situation represents the greatest
safety threat?
A. Post-MI patient on heparin drip, aPTT 90 sec (goal 60–80)
B. New chest tube, bubbling in water-seal chamber, tidaling present
C. TPN infusion, patient complains of chills 30 minutes after bag change
D. Post-thyroidectomy patient, voice hoarse but speaking in full sentences
Correct Answer: C
Rationale: Chills after TPN change indicate possible catheter-related bloodstream
infection (CRBSI)—a life-threatening complication requiring immediate line
discontinuation and culture. A slightly elevated aPTT (A) requires dose adjustment.
Bubbling with tidaling (B) is normal chest tube function. Hoarseness (D) is
expected after thyroidectomy but requires monitoring for worsening.
Q6. A patient with a femur fracture suddenly becomes confused and develops a
petechial rash across the chest. What is the nurse's priority action?
A. Notify the Rapid Response Team
B. Apply supplemental oxygen via mask
, C. Prepare for an emergency head CT
D. Perform a complete skin assessment
Correct Answer: B
Rationale: These are classic signs of Fat Embolism Syndrome (FES). Fat globules
cause acute respiratory distress and pulmonary obstruction. The priority is to
support oxygenation with supplemental oxygen. Rapid response notification
should follow immediately.
Q7. A postoperative client has skin that is cool, pale, and moist, with scant urine
output. Oxygen is being administered at 2 L/min, and a saline lock is in place.
Which intervention should the nurse implement first?
A. Measure the urine specific gravity
B. Obtain IV fluids for infusion per protocol
C. Prepare for insertion of a central venous catheter
D. Auscultate the client's breath sounds
Correct Answer: B
Rationale: The client is exhibiting early signs of hypovolemic shock. The priority is
to restore intravascular volume by obtaining IV fluids. Assessment and preparation
for other interventions follow after initial volume resuscitation.
Q8. The nurse is caring for a client who is 3 hours post-operative laryngectomy.
Which is the priority in the assessment?
A. Patient comfort
B. Incisional drainage
C. Blood pressure and heart rate
D. Airway patency
Correct Answer: D
Complete Actual Exam Questions with Verified
Correct Answers and Detailed Rationales | Latest
Update 2026/2027 – Already Graded A+
SECTION 1: MANAGEMENT OF CARE & PRIORITIZATION
Q1. The charge nurse receives handoff on four med-surg clients. Which client
should the nurse assess FIRST?
A. 65-year-old post-op day 1 abdominal hysterectomy, reports 6/10 incisional
pain, vital signs stable, SpO₂ 98% on 2L NC
B. 50-year-old with heart failure on IV furosemide 40 mg q8h, reports dizziness
upon standing, HR 118, BP 92/58, last voided 8 hours ago
C. 30-year-old with new-onset type 1 diabetes, 1 hour post-breakfast glucose 180
mg/dL, denies symptoms
D. 72-year-old with Alzheimer's disease, bed alarm sounding, attempting to climb
over side rails, vital signs stable
Correct Answer: B
Rationale: Hypotension (92/58) with tachycardia (118) and oliguria (no void for 8
hours) signals volume depletion from diuretic therapy—an unstable
cardiopulmonary/renal issue requiring immediate intervention. Orthostatic
changes predispose to falls and acute kidney injury. Client A has stable pain, Client
C has an expected glucose elevation, and Client D can be managed with safety
measures.
Q2. The RN is delegating morning care tasks. Which task is appropriate to assign
to the UAP?
,A. Reposition a 2-hour post-craniotomy patient whose ICP monitor reads 14
mmHg
B. Measure Accu-Chek for a diabetic patient who is diaphoretic and tremulous
C. Assist a 90 kg stroke patient with left neglect to transfer bed → chair using a
gait belt
D. Perform a sterile dressing change on a central-line site that is erythematous
Correct Answer: C
Rationale: Transfer assistance with a gait belt is a standard mobility task within
UAP scope. Accu-Chek on a symptomatic hypoglycemic patient (B) requires RN
assessment and judgment. Sterile central-line dressing changes (D) and
repositioning fresh craniotomy patients (A) require RN-level assessment.
Q3. A provider writes the following order: "Insulin aspart 8 units + NPH 14 units
– now and qAM." What is the nurse's best action?
A. Draw both insulins into the same syringe and administer immediately
B. Clarify if the doses should be given as two separate injections
C. Give aspart now, hold NPH until breakfast tray arrives
D. Use an insulin pen loaded with 70/30 mix for convenience
Correct Answer: B
Rationale: Combining two insulins requires confirmation of compatibility and
timing (NPH is typically given with breakfast; aspart is rapid-acting given with
meals). The nurse must clarify timing and confirm the correct mixing sequence
(aspart clear → NPH cloudy). A 70/30 pen (D) is a different concentration and
formulation.
Q4. A nurse discovers an insulin dose of 40 units was given instead of 4 units.
The patient is now diaphoretic with glucose 48 mg/dL. After treating the
hypoglycemia, the nurse must:
,A. Complete an incident report before end of shift
B. Document only the corrected glucose value in the chart
C. Notify the provider during next rounds
D. Add "insulin-sensitive" to the allergy list
Correct Answer: A
Rationale: Incident reports are mandatory for medication errors to initiate quality
review and prevent recurrence. Immediate provider notification is also required
(not waiting for rounds). Documenting only the corrected value (B) is falsification.
Incident reports should be completed as soon as possible after the error.
Q5. A nurse is caring for four clients. Which situation represents the greatest
safety threat?
A. Post-MI patient on heparin drip, aPTT 90 sec (goal 60–80)
B. New chest tube, bubbling in water-seal chamber, tidaling present
C. TPN infusion, patient complains of chills 30 minutes after bag change
D. Post-thyroidectomy patient, voice hoarse but speaking in full sentences
Correct Answer: C
Rationale: Chills after TPN change indicate possible catheter-related bloodstream
infection (CRBSI)—a life-threatening complication requiring immediate line
discontinuation and culture. A slightly elevated aPTT (A) requires dose adjustment.
Bubbling with tidaling (B) is normal chest tube function. Hoarseness (D) is
expected after thyroidectomy but requires monitoring for worsening.
Q6. A patient with a femur fracture suddenly becomes confused and develops a
petechial rash across the chest. What is the nurse's priority action?
A. Notify the Rapid Response Team
B. Apply supplemental oxygen via mask
, C. Prepare for an emergency head CT
D. Perform a complete skin assessment
Correct Answer: B
Rationale: These are classic signs of Fat Embolism Syndrome (FES). Fat globules
cause acute respiratory distress and pulmonary obstruction. The priority is to
support oxygenation with supplemental oxygen. Rapid response notification
should follow immediately.
Q7. A postoperative client has skin that is cool, pale, and moist, with scant urine
output. Oxygen is being administered at 2 L/min, and a saline lock is in place.
Which intervention should the nurse implement first?
A. Measure the urine specific gravity
B. Obtain IV fluids for infusion per protocol
C. Prepare for insertion of a central venous catheter
D. Auscultate the client's breath sounds
Correct Answer: B
Rationale: The client is exhibiting early signs of hypovolemic shock. The priority is
to restore intravascular volume by obtaining IV fluids. Assessment and preparation
for other interventions follow after initial volume resuscitation.
Q8. The nurse is caring for a client who is 3 hours post-operative laryngectomy.
Which is the priority in the assessment?
A. Patient comfort
B. Incisional drainage
C. Blood pressure and heart rate
D. Airway patency
Correct Answer: D
