Evolve Elsevier HESI Med-Surg Proctored Exam Test
Bank 2026 – Complete 150 Actual Exam Questions
with Detailed Verified Answers & Clinical Rationales
(Graded A+)
SECTION 1 — QUESTIONS 1–50
1. A client with heart failure reports a 2.5-kg weight gain over 3 days. Which interpretation is
most appropriate?
A. The weight gain indicates improved nutritional status.
B. The client is probably gaining muscle mass.
C. The finding suggests fluid retention.
D. The weight change is expected with aging.
Answer: C
Rationale: Rapid weight gain in heart failure usually reflects fluid accumulation rather than
tissue gain and may indicate worsening heart failure.
2. A client receiving digoxin has an apical pulse of 48 beats/minute and reports nausea and
yellow-green visual changes. What should the nurse do?
A. Administer the medication with food.
B. Hold the medication and notify the provider.
C. Give the next dose early.
D. Encourage increased potassium restriction.
Answer: B
,Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations of possible digoxin toxicity. The medication should be withheld and the provider
notified.
3. A client with myocardial infarction suddenly develops severe dyspnea, pink frothy sputum,
and diffuse crackles. Which complication should the nurse suspect?
A. Pulmonary edema
B. Pericarditis
C. Stable angina
D. Peripheral neuropathy
Answer: A
Rationale: Acute pulmonary edema can occur after myocardial infarction because impaired left
ventricular function causes pulmonary vascular congestion and fluid movement into the alveoli.
4. A client with acute pulmonary edema has severe dyspnea, crackles throughout both lung
fields, and an oxygen saturation of 82% on room air. Which intervention should the nurse
implement first?
A. Obtain the client's daily weight.
B. Administer the prescribed IV diuretic.
C. Place the client in high-Fowler position.
D. Restrict the client's oral fluid intake.
Answer: C
Rationale: Positioning the client upright immediately improves lung expansion and reduces
venous return. This is an immediate airway and breathing intervention while additional
treatments are prepared.
5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
by nasal cannula. The oxygen saturation is 91%, and the client reports less dyspnea. Which
action should the nurse take?
A. Increase oxygen to 10 L/min.
B. Discontinue oxygen therapy.
C. Maintain the prescribed oxygen flow rate.
D. Encourage the client to breathe rapidly.
,Answer: C
Rationale: Oxygen should be administered carefully in COPD and titrated according to the
prescribed target. An oxygen saturation around 88%–92% is commonly appropriate for clients
at risk of hypercapnic respiratory failure unless otherwise prescribed.
6. A client suddenly develops facial drooping, slurred speech, and weakness of the right arm.
What is the nurse's priority action?
A. Give the client oral fluids.
B. Determine the exact time symptoms began.
C. Place the client in Trendelenburg position.
D. Administer an antihypertensive medication immediately.
Answer: B
Rationale: Determining the last-known-well time is critical because eligibility for reperfusion
therapy in acute ischemic stroke depends heavily on symptom timing.
7. A client receiving IV heparin for a pulmonary embolism has a platelet count that decreases
from 220,000/mm³ to 88,000/mm³. Which action is most appropriate?
A. Continue the infusion and recheck the platelet count tomorrow.
B. Administer vitamin K.
C. Notify the provider immediately and anticipate discontinuation of heparin.
D. Administer another dose of heparin.
Answer: C
Rationale: A significant platelet decrease during heparin therapy raises concern for heparin-
induced thrombocytopenia (HIT), a potentially life-threatening complication requiring
immediate recognition and cessation of heparin.
8. A client taking warfarin is being discharged. Which statement indicates a need for additional
teaching?
A. "I will report unusual bleeding."
B. "I will keep my vitamin K intake relatively consistent."
C. "I can take aspirin whenever I have a headache."
D. "I will have my coagulation tests monitored as instructed."
, Answer: C
Rationale: Aspirin can increase bleeding risk when combined with warfarin. Clients should not
add aspirin or other medications without consulting the healthcare provider.
9. A client with asthma is experiencing wheezing and difficulty speaking. Which medication
should the nurse expect to administer for rapid bronchodilation?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Salmeterol alone
Answer: A
Rationale: Albuterol is a short-acting beta2-agonist used for rapid relief of acute bronchospasm.
10. A client with pneumonia has a respiratory rate of 32/minute, oxygen saturation of 86%, and
increasing confusion. Which finding requires immediate intervention?
A. Temperature of 38.1°C
B. Productive cough
C. Oxygen saturation of 86%
D. Decreased appetite
Answer: C
Rationale: Severe hypoxemia threatens tissue oxygenation and requires immediate intervention.
Confusion may also reflect inadequate oxygen delivery.
11. A client with suspected bacterial meningitis is admitted. Which infection-control precaution
is initially appropriate?
A. Contact precautions only
B. Droplet precautions
C. Protective isolation
D. Standard precautions only
Answer: B
Bank 2026 – Complete 150 Actual Exam Questions
with Detailed Verified Answers & Clinical Rationales
(Graded A+)
SECTION 1 — QUESTIONS 1–50
1. A client with heart failure reports a 2.5-kg weight gain over 3 days. Which interpretation is
most appropriate?
A. The weight gain indicates improved nutritional status.
B. The client is probably gaining muscle mass.
C. The finding suggests fluid retention.
D. The weight change is expected with aging.
Answer: C
Rationale: Rapid weight gain in heart failure usually reflects fluid accumulation rather than
tissue gain and may indicate worsening heart failure.
2. A client receiving digoxin has an apical pulse of 48 beats/minute and reports nausea and
yellow-green visual changes. What should the nurse do?
A. Administer the medication with food.
B. Hold the medication and notify the provider.
C. Give the next dose early.
D. Encourage increased potassium restriction.
Answer: B
,Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations of possible digoxin toxicity. The medication should be withheld and the provider
notified.
3. A client with myocardial infarction suddenly develops severe dyspnea, pink frothy sputum,
and diffuse crackles. Which complication should the nurse suspect?
A. Pulmonary edema
B. Pericarditis
C. Stable angina
D. Peripheral neuropathy
Answer: A
Rationale: Acute pulmonary edema can occur after myocardial infarction because impaired left
ventricular function causes pulmonary vascular congestion and fluid movement into the alveoli.
4. A client with acute pulmonary edema has severe dyspnea, crackles throughout both lung
fields, and an oxygen saturation of 82% on room air. Which intervention should the nurse
implement first?
A. Obtain the client's daily weight.
B. Administer the prescribed IV diuretic.
C. Place the client in high-Fowler position.
D. Restrict the client's oral fluid intake.
Answer: C
Rationale: Positioning the client upright immediately improves lung expansion and reduces
venous return. This is an immediate airway and breathing intervention while additional
treatments are prepared.
5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
by nasal cannula. The oxygen saturation is 91%, and the client reports less dyspnea. Which
action should the nurse take?
A. Increase oxygen to 10 L/min.
B. Discontinue oxygen therapy.
C. Maintain the prescribed oxygen flow rate.
D. Encourage the client to breathe rapidly.
,Answer: C
Rationale: Oxygen should be administered carefully in COPD and titrated according to the
prescribed target. An oxygen saturation around 88%–92% is commonly appropriate for clients
at risk of hypercapnic respiratory failure unless otherwise prescribed.
6. A client suddenly develops facial drooping, slurred speech, and weakness of the right arm.
What is the nurse's priority action?
A. Give the client oral fluids.
B. Determine the exact time symptoms began.
C. Place the client in Trendelenburg position.
D. Administer an antihypertensive medication immediately.
Answer: B
Rationale: Determining the last-known-well time is critical because eligibility for reperfusion
therapy in acute ischemic stroke depends heavily on symptom timing.
7. A client receiving IV heparin for a pulmonary embolism has a platelet count that decreases
from 220,000/mm³ to 88,000/mm³. Which action is most appropriate?
A. Continue the infusion and recheck the platelet count tomorrow.
B. Administer vitamin K.
C. Notify the provider immediately and anticipate discontinuation of heparin.
D. Administer another dose of heparin.
Answer: C
Rationale: A significant platelet decrease during heparin therapy raises concern for heparin-
induced thrombocytopenia (HIT), a potentially life-threatening complication requiring
immediate recognition and cessation of heparin.
8. A client taking warfarin is being discharged. Which statement indicates a need for additional
teaching?
A. "I will report unusual bleeding."
B. "I will keep my vitamin K intake relatively consistent."
C. "I can take aspirin whenever I have a headache."
D. "I will have my coagulation tests monitored as instructed."
, Answer: C
Rationale: Aspirin can increase bleeding risk when combined with warfarin. Clients should not
add aspirin or other medications without consulting the healthcare provider.
9. A client with asthma is experiencing wheezing and difficulty speaking. Which medication
should the nurse expect to administer for rapid bronchodilation?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Salmeterol alone
Answer: A
Rationale: Albuterol is a short-acting beta2-agonist used for rapid relief of acute bronchospasm.
10. A client with pneumonia has a respiratory rate of 32/minute, oxygen saturation of 86%, and
increasing confusion. Which finding requires immediate intervention?
A. Temperature of 38.1°C
B. Productive cough
C. Oxygen saturation of 86%
D. Decreased appetite
Answer: C
Rationale: Severe hypoxemia threatens tissue oxygenation and requires immediate intervention.
Confusion may also reflect inadequate oxygen delivery.
11. A client with suspected bacterial meningitis is admitted. Which infection-control precaution
is initially appropriate?
A. Contact precautions only
B. Droplet precautions
C. Protective isolation
D. Standard precautions only
Answer: B
