HESI MED SURG EVOLVE ELSEVIER EXAM VERSION 1- VERSION 8 QUESTIONS AND CORRECT SOLUTIONS
JUST RELEASED THIS YEAR………...
Core Domains:
- Cardiovascular and Hematological Disorders
- Respiratory and Pulmonary Disorders
- Gastrointestinal and Nutritional Disorders
- Neurological and Sensory Disorders
- Endocrine and Metabolic Disorders
- Renal and Genitourinary Disorders
- Musculoskeletal and Integumentary Disorders
- Immune and Infectious Disease Management
- Perioperative and Emergency Nursing Care
- Pharmacology and Fluid/Electrolyte Balance
Introduction
This comprehensive examination is designed to assess advanced knowledge and clinical judgment in medical-
surgical nursing. It covers a wide spectrum of disorders, integrating pathophysiology, pharmacology, and evidence-
based nursing interventions. The exam emphasizes real-world clinical scenarios to evaluate the nurse's ability to
prioritize care, manage complications, and make sound clinical decisions. Through a multiple-choice and scenario-
based format, candidates will demonstrate their proficiency in applying theoretical knowledge to complex patient
situations. This assessment is essential for validating readiness to provide safe, competent, and holistic care to
adult patients across diverse healthcare settings.
,SECTION ONE: QUESTIONS 1 – 100
1. A client with heart failure is prescribed digoxin. Which finding indicates a therapeutic effect of the
medication?
A. Heart rate of 52 beats per minute
B. Decreased shortness of breath and increased exercise tolerance
C. Serum potassium level of 3.0 mEq/L
D. Blood pressure of 90/60 mmHg
🟢 B. Decreased shortness of breath and increased exercise tolerance
🔴 RATIONALE: Digoxin is a cardiac glycoside that increases the force of myocardial contraction (positive
inotropy), which improves cardiac output and reduces symptoms of heart failure such as dyspnea and fatigue.
The therapeutic effect is measured by clinical improvement, not by achieving a specific heart rate, which may
indicate toxicity.
2. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which assessment
finding should the nurse report immediately?
A. A barrel-shaped chest
B. Prolonged expiratory phase
C. Use of accessory muscles to breathe
D. Oxygen saturation of 88% on room air
🟢 C. Use of accessory muscles to breathe
🔴 RATIONALE: The use of accessory muscles (e.g., sternocleidomastoid, intercostal muscles) indicates
respiratory distress and impending respiratory failure. This is a significant finding that requires immediate
intervention. While an O2 saturation of 88% is low and should be addressed, the use of accessory muscles is a
more urgent sign of respiratory fatigue and decompensation.
,3. A client is admitted with acute pancreatitis. Which laboratory value is most specific for this diagnosis?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated white blood cell count
D. Decreased serum calcium
🟢 B. Elevated serum lipase
🔴 RATIONALE: Serum lipase is more specific and sensitive for acute pancreatitis than serum amylase. While
both may be elevated, lipase remains elevated for a longer period and is a more reliable diagnostic indicator of
pancreatic inflammation. Amylase can also be elevated in other conditions like salivary gland disorders.
4. A client who had a gastrectomy is at risk for which vitamin deficiency?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin D
🟢 B. Vitamin B12
🔴 RATIONALE: The stomach produces intrinsic factor, which is essential for the absorption of vitamin B12 in
the ileum. Following a gastrectomy, the lack of intrinsic factor leads to pernicious anemia due to vitamin B12
deficiency. Lifelong vitamin B12 supplementation is typically required.
5. A client with type 1 diabetes mellitus is experiencing nausea, vomiting, and abdominal pain. Their breath
has a fruity odor. Which condition should the nurse suspect?
A. Hypoglycemia
B. Hyperosmolar hyperglycemic state (HHS)
C. Diabetic ketoacidosis (DKA)
D. Lactic acidosis
, 🟢 C. Diabetic ketoacidosis (DKA)
🔴 RATIONALE: The classic signs of DKA include hyperglycemia, ketosis, metabolic acidosis, dehydration, and a
fruity breath odor (acetone). Nausea, vomiting, and abdominal pain are also common symptoms. DKA is a life-
threatening complication of type 1 diabetes and requires immediate intervention.
6. A client is receiving IV heparin therapy for a deep vein thrombosis (DVT). Which laboratory test should the
nurse monitor to evaluate the therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🟢 C. Activated partial thromboplastin time (aPTT)
🔴 RATIONALE: The aPTT is the primary laboratory test used to monitor the therapeutic effect of unfractionated
heparin. The goal is typically 1.5 to 2.5 times the normal control value. PT and INR are used to monitor warfarin
therapy. Platelet count is monitored to detect heparin-induced thrombocytopenia (HIT).
7. A client with chronic kidney disease (CKD) is on a fluid restriction. Which assessment finding indicates that
the client is adhering to the restriction?
A. Moist mucous membranes
B. Absence of peripheral edema
C. Daily weight gain of 1 kg
D. Jugular vein distention
🟢 B. Absence of peripheral edema
🔴 RATIONALE: In CKD, fluid retention is a major concern. Adherence to fluid restriction should result in a lack
of fluid overload signs such as peripheral edema, pulmonary crackles, and jugular vein distention. A daily weight
JUST RELEASED THIS YEAR………...
Core Domains:
- Cardiovascular and Hematological Disorders
- Respiratory and Pulmonary Disorders
- Gastrointestinal and Nutritional Disorders
- Neurological and Sensory Disorders
- Endocrine and Metabolic Disorders
- Renal and Genitourinary Disorders
- Musculoskeletal and Integumentary Disorders
- Immune and Infectious Disease Management
- Perioperative and Emergency Nursing Care
- Pharmacology and Fluid/Electrolyte Balance
Introduction
This comprehensive examination is designed to assess advanced knowledge and clinical judgment in medical-
surgical nursing. It covers a wide spectrum of disorders, integrating pathophysiology, pharmacology, and evidence-
based nursing interventions. The exam emphasizes real-world clinical scenarios to evaluate the nurse's ability to
prioritize care, manage complications, and make sound clinical decisions. Through a multiple-choice and scenario-
based format, candidates will demonstrate their proficiency in applying theoretical knowledge to complex patient
situations. This assessment is essential for validating readiness to provide safe, competent, and holistic care to
adult patients across diverse healthcare settings.
,SECTION ONE: QUESTIONS 1 – 100
1. A client with heart failure is prescribed digoxin. Which finding indicates a therapeutic effect of the
medication?
A. Heart rate of 52 beats per minute
B. Decreased shortness of breath and increased exercise tolerance
C. Serum potassium level of 3.0 mEq/L
D. Blood pressure of 90/60 mmHg
🟢 B. Decreased shortness of breath and increased exercise tolerance
🔴 RATIONALE: Digoxin is a cardiac glycoside that increases the force of myocardial contraction (positive
inotropy), which improves cardiac output and reduces symptoms of heart failure such as dyspnea and fatigue.
The therapeutic effect is measured by clinical improvement, not by achieving a specific heart rate, which may
indicate toxicity.
2. A nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which assessment
finding should the nurse report immediately?
A. A barrel-shaped chest
B. Prolonged expiratory phase
C. Use of accessory muscles to breathe
D. Oxygen saturation of 88% on room air
🟢 C. Use of accessory muscles to breathe
🔴 RATIONALE: The use of accessory muscles (e.g., sternocleidomastoid, intercostal muscles) indicates
respiratory distress and impending respiratory failure. This is a significant finding that requires immediate
intervention. While an O2 saturation of 88% is low and should be addressed, the use of accessory muscles is a
more urgent sign of respiratory fatigue and decompensation.
,3. A client is admitted with acute pancreatitis. Which laboratory value is most specific for this diagnosis?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated white blood cell count
D. Decreased serum calcium
🟢 B. Elevated serum lipase
🔴 RATIONALE: Serum lipase is more specific and sensitive for acute pancreatitis than serum amylase. While
both may be elevated, lipase remains elevated for a longer period and is a more reliable diagnostic indicator of
pancreatic inflammation. Amylase can also be elevated in other conditions like salivary gland disorders.
4. A client who had a gastrectomy is at risk for which vitamin deficiency?
A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Vitamin D
🟢 B. Vitamin B12
🔴 RATIONALE: The stomach produces intrinsic factor, which is essential for the absorption of vitamin B12 in
the ileum. Following a gastrectomy, the lack of intrinsic factor leads to pernicious anemia due to vitamin B12
deficiency. Lifelong vitamin B12 supplementation is typically required.
5. A client with type 1 diabetes mellitus is experiencing nausea, vomiting, and abdominal pain. Their breath
has a fruity odor. Which condition should the nurse suspect?
A. Hypoglycemia
B. Hyperosmolar hyperglycemic state (HHS)
C. Diabetic ketoacidosis (DKA)
D. Lactic acidosis
, 🟢 C. Diabetic ketoacidosis (DKA)
🔴 RATIONALE: The classic signs of DKA include hyperglycemia, ketosis, metabolic acidosis, dehydration, and a
fruity breath odor (acetone). Nausea, vomiting, and abdominal pain are also common symptoms. DKA is a life-
threatening complication of type 1 diabetes and requires immediate intervention.
6. A client is receiving IV heparin therapy for a deep vein thrombosis (DVT). Which laboratory test should the
nurse monitor to evaluate the therapeutic effect?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🟢 C. Activated partial thromboplastin time (aPTT)
🔴 RATIONALE: The aPTT is the primary laboratory test used to monitor the therapeutic effect of unfractionated
heparin. The goal is typically 1.5 to 2.5 times the normal control value. PT and INR are used to monitor warfarin
therapy. Platelet count is monitored to detect heparin-induced thrombocytopenia (HIT).
7. A client with chronic kidney disease (CKD) is on a fluid restriction. Which assessment finding indicates that
the client is adhering to the restriction?
A. Moist mucous membranes
B. Absence of peripheral edema
C. Daily weight gain of 1 kg
D. Jugular vein distention
🟢 B. Absence of peripheral edema
🔴 RATIONALE: In CKD, fluid retention is a major concern. Adherence to fluid restriction should result in a lack
of fluid overload signs such as peripheral edema, pulmonary crackles, and jugular vein distention. A daily weight
