Page 1 of 196
Evolve Elsevier Hesi Med Surg Actual Exam
With 100 Real Exam Questions And Correct
Answers With Rationales/ Evolve Hesi
Medical Surgical Latest Exam 2026/2027
||Complete A+ Guide
1. A client with heart failure is prescribed furosemide 40 mg
IV push. Which assessment finding requires immediate
action?
A. Weight increase of 1 lb in 24 hours
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Blood pressure 130/80 mmHg
Correct Answer: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia (normal 3.5–5.0) increases risk of
,Page 2 of 196
digoxin toxicity and cardiac dysrhythmias. Weight gain of 1
lb is minimal; 30 mL/hr urine output is adequate; BP is normal.
2. A client with unstable angina is started on IV heparin.
The aPTT level 6 hours later is 110 seconds. What should
the nurse do first?
A. Continue infusion as ordered
B. Stop the heparin infusion
C. Give protamine sulfate
D. Increase infusion rate
Correct Answer: B. Stop the heparin infusion
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times
control (approx 60–80 sec). 110 seconds indicates excessive
anticoagulation and bleeding risk. Stop infusion; notify
provider. Protamine is for severe bleeding, not first action.
3. A client post-MI develops crackles in both lung bases, S3
gallop, and BP 90/60 mmHg. Which condition does the
nurse suspect?
,Page 3 of 196
A. Cardiogenic shock
B. Pericarditis
C. Pulmonary embolism
D. Cardiac tamponade
Correct Answer: A. Cardiogenic shock
Rationale: S3 gallop + crackles indicate left ventricular
failure. Hypotension with these signs suggests cardiogenic
shock post-MI. Pericarditis causes chest pain relieved by
leaning forward. Tamponade shows muffled heart sounds,
distended neck veins, hypotension (Beck’s triad).
4. A client with hypertension is prescribed lisinopril. Which
finding indicates a therapeutic effect?
A. Heart rate 100 bpm
B. Urine output 20 mL/hr
C. Blood pressure 128/78 mmHg
D. Potassium 5.8 mEq/L
, Page 4 of 196
Correct Answer: C. Blood pressure 128/78 mmHg
no no no no no no
no Rationale: Lisinopril (ACE inhibitor) lowers BP by vasodilation
no no no no no no no
no and reducing aldosterone. Target BP for most hypertensives is
no no no no no no no no
<130/80. Hyperkalemia (>5.0) is an adverse effect, not
no no no no no no no
therapeutic.
no
5. A client with deep vein thrombosis (DVT) is on heparin
no no no no no no no no no
n o infusion. Which finding indicates the heparin is effective?
no no no no no no no
A. INR 2.5 no
B. aPTT 65 seconds no no
C. Platelets 150,000/mm³ n o
D. Bleeding time 8 minutes no no no
Correct Answer: B. aPTT 65 seconds
no no no no no
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times
no no no no no no no
no normal (normal ~30 sec → 45–75 sec). INR monitors warfarin.
no no no no no no no no no
no Platelets normal; bleeding time normal.
no no no no
6. A client with atrial fibrillation is on warfarin. INR is 4.5.
no no no no no no no no no no
no No bleeding. What should the nurse do?
no no no no no no
Evolve Elsevier Hesi Med Surg Actual Exam
With 100 Real Exam Questions And Correct
Answers With Rationales/ Evolve Hesi
Medical Surgical Latest Exam 2026/2027
||Complete A+ Guide
1. A client with heart failure is prescribed furosemide 40 mg
IV push. Which assessment finding requires immediate
action?
A. Weight increase of 1 lb in 24 hours
B. Serum potassium 3.2 mEq/L
C. Urine output 30 mL/hr
D. Blood pressure 130/80 mmHg
Correct Answer: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia (normal 3.5–5.0) increases risk of
,Page 2 of 196
digoxin toxicity and cardiac dysrhythmias. Weight gain of 1
lb is minimal; 30 mL/hr urine output is adequate; BP is normal.
2. A client with unstable angina is started on IV heparin.
The aPTT level 6 hours later is 110 seconds. What should
the nurse do first?
A. Continue infusion as ordered
B. Stop the heparin infusion
C. Give protamine sulfate
D. Increase infusion rate
Correct Answer: B. Stop the heparin infusion
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times
control (approx 60–80 sec). 110 seconds indicates excessive
anticoagulation and bleeding risk. Stop infusion; notify
provider. Protamine is for severe bleeding, not first action.
3. A client post-MI develops crackles in both lung bases, S3
gallop, and BP 90/60 mmHg. Which condition does the
nurse suspect?
,Page 3 of 196
A. Cardiogenic shock
B. Pericarditis
C. Pulmonary embolism
D. Cardiac tamponade
Correct Answer: A. Cardiogenic shock
Rationale: S3 gallop + crackles indicate left ventricular
failure. Hypotension with these signs suggests cardiogenic
shock post-MI. Pericarditis causes chest pain relieved by
leaning forward. Tamponade shows muffled heart sounds,
distended neck veins, hypotension (Beck’s triad).
4. A client with hypertension is prescribed lisinopril. Which
finding indicates a therapeutic effect?
A. Heart rate 100 bpm
B. Urine output 20 mL/hr
C. Blood pressure 128/78 mmHg
D. Potassium 5.8 mEq/L
, Page 4 of 196
Correct Answer: C. Blood pressure 128/78 mmHg
no no no no no no
no Rationale: Lisinopril (ACE inhibitor) lowers BP by vasodilation
no no no no no no no
no and reducing aldosterone. Target BP for most hypertensives is
no no no no no no no no
<130/80. Hyperkalemia (>5.0) is an adverse effect, not
no no no no no no no
therapeutic.
no
5. A client with deep vein thrombosis (DVT) is on heparin
no no no no no no no no no
n o infusion. Which finding indicates the heparin is effective?
no no no no no no no
A. INR 2.5 no
B. aPTT 65 seconds no no
C. Platelets 150,000/mm³ n o
D. Bleeding time 8 minutes no no no
Correct Answer: B. aPTT 65 seconds
no no no no no
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times
no no no no no no no
no normal (normal ~30 sec → 45–75 sec). INR monitors warfarin.
no no no no no no no no no
no Platelets normal; bleeding time normal.
no no no no
6. A client with atrial fibrillation is on warfarin. INR is 4.5.
no no no no no no no no no no
no No bleeding. What should the nurse do?
no no no no no no
