EVOLVE ELSEVIER
HESI MEDICAL
SURGICAL 2025/2026
TEST
BANKCOMPLETE
REAL EXAM |
GRADED A+ |
BRAND NEW
EDITION clinton njogu
[COMPANY NAME] [Company address]
, EVOLVE ELSEVIER HESI MEDICAL SURGICAL 2025/2026 TEST BANK
Complete Real Exam Questions & Correct Answers with Well-Elaborated Rationales | Graded
A+ | Brand New Edition
SECTION 1: RESPIRATORY SYSTEM
1. A client with COPD has an oxygen saturation of 88%. Which action should the nurse take
first?
• A. Increase oxygen to 4 L/min via nasal cannula
• B. Encourage deep breathing and coughing
• C. Apply a non-rebreather mask at 100% oxygen
• D. Auscultate lung sounds
Correct Answer: D
Rationale: Auscultation provides immediate assessment of breath sounds and guides
further intervention. Increasing oxygen without assessment could suppress the
hypoxic drive in COPD clients and lead to CO₂ retention. Assessment always
precedes intervention.
2. A nurse is caring for a client with a chest tube after a thoracotomy. Which finding requires
immediate intervention?
• A. Intermittent bubbling in the suction control chamber
• B. Tidaling in the water seal chamber
• C. Continuous bubbling in the water seal chamber
• D. Drainage of 50 mL in the first hour
Correct Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system, which can prevent lung re-expansion and lead to tension pneumothorax. The
nurse must assess connections, insertion site, and the chest tube itself to locate the
leak. Tidaling is normal and reflects pressure changes during respiration.
3. A client with tuberculosis is started on isoniazid and rifampin. Which instruction is most
important for the nurse to include?
• A. Take medications with antacids to prevent GI upset
Page 1 of 63
, • B. Expect orange discoloration of urine and tears
• C. Stop medications once symptoms resolve
• D. Avoid foods containing tyramine
Correct Answer: B
Rationale: Rifampin causes harmless orange-red discoloration of body fluids
including urine, sweat, and tears. Clients must be warned to prevent alarm and to
understand this is expected. Antacids interfere with absorption, medications must be
taken for the full course, and tyramine restriction applies to MAOIs, not anti-TB
drugs.
4. A client with pneumonia has a fever, productive cough, and pleuritic chest pain. Which
nursing intervention is most effective to mobilize secretions?
• A. Maintain bed rest
• B. Administer PRN antitussives
• C. Encourage fluid intake to 2–3 L/day
• D. Apply oxygen at 2 L/min
Correct Answer: C
Rationale: Adequate hydration thins pulmonary secretions, making them easier to
expectorate. Antitussives suppress the cough reflex and are avoided when secretion
mobilization is the goal. Bed rest and oxygen do not directly promote secretion
clearance.
5. The nurse is instructing a client with emphysema about positions that enhance breathing
during dyspneic periods. Which position should the nurse recommend?
• A. Sitting up in bed
• B. Side-lying in bed
• C. Sitting up and leaning on an overbed table
• D. Sitting up in a recliner chair
Correct Answer: C
Rationale: The tripod position (sitting upright, leaning forward with arms supported
on an overbed table) optimizes accessory muscle use and improves diaphragmatic
excursion. This position is most effective during acute dyspnea in COPD clients.
Page 2 of 63
, 6. The nurse has given instructions on pursed-lip breathing to a client with COPD. Which
statement by the client indicates effective teaching?
• A. "I should tighten my abdominal muscles with exhalation."
• B. "I should inhale through my mouth very deeply."
• C. "I should make inhalation twice as long as exhalation."
• D. "I should tighten my abdominal muscles with inhalation."
Correct Answer: A
Rationale: Pursed-lip breathing with abdominal tightening during exhalation helps
prevent airway collapse and promotes CO₂ elimination. Inhalation should occur
through the nose, and exhalation should be longer than inhalation, not the reverse.
7. Which assessment finding in a client with COPD indicates to the nurse that the respiratory
problem is chronic?
• A. Wheezing on exhalation
• B. Productive cough
• C. Generalized cyanosis
• D. Clubbing of the fingers
Correct Answer: D
Rationale: Clubbing of the fingers is a chronic sign of long-standing hypoxemia seen
in clients with prolonged respiratory disease. Wheezing, cough, and cyanosis can
occur acutely and do not necessarily indicate chronicity.
8. A client with COPD is receiving BiPAP for hypercapnic encephalopathy. Which assessment
findings indicate the BiPAP is effective? (Select all that apply.)
• A. pH improved from 7.25 to 7.38
• B. PaCO₂ decreased from 65 to 48 mm Hg
• C. Respiratory rate decreased from 32 to 22/min
• D. Accessory muscle use remains present
• E. Client reports dyspnea decreased from 8/10 to 3/10
Correct Answer: A, B, C, E
Rationale: Improvement in gas exchange (pH, PaCO₂), work of breathing (respiratory
rate), and subjective dyspnea confirm BiPAP efficacy. Accessory muscle use should
decrease, not remain present, if ventilation is improving.
Page 3 of 63
HESI MEDICAL
SURGICAL 2025/2026
TEST
BANKCOMPLETE
REAL EXAM |
GRADED A+ |
BRAND NEW
EDITION clinton njogu
[COMPANY NAME] [Company address]
, EVOLVE ELSEVIER HESI MEDICAL SURGICAL 2025/2026 TEST BANK
Complete Real Exam Questions & Correct Answers with Well-Elaborated Rationales | Graded
A+ | Brand New Edition
SECTION 1: RESPIRATORY SYSTEM
1. A client with COPD has an oxygen saturation of 88%. Which action should the nurse take
first?
• A. Increase oxygen to 4 L/min via nasal cannula
• B. Encourage deep breathing and coughing
• C. Apply a non-rebreather mask at 100% oxygen
• D. Auscultate lung sounds
Correct Answer: D
Rationale: Auscultation provides immediate assessment of breath sounds and guides
further intervention. Increasing oxygen without assessment could suppress the
hypoxic drive in COPD clients and lead to CO₂ retention. Assessment always
precedes intervention.
2. A nurse is caring for a client with a chest tube after a thoracotomy. Which finding requires
immediate intervention?
• A. Intermittent bubbling in the suction control chamber
• B. Tidaling in the water seal chamber
• C. Continuous bubbling in the water seal chamber
• D. Drainage of 50 mL in the first hour
Correct Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system, which can prevent lung re-expansion and lead to tension pneumothorax. The
nurse must assess connections, insertion site, and the chest tube itself to locate the
leak. Tidaling is normal and reflects pressure changes during respiration.
3. A client with tuberculosis is started on isoniazid and rifampin. Which instruction is most
important for the nurse to include?
• A. Take medications with antacids to prevent GI upset
Page 1 of 63
, • B. Expect orange discoloration of urine and tears
• C. Stop medications once symptoms resolve
• D. Avoid foods containing tyramine
Correct Answer: B
Rationale: Rifampin causes harmless orange-red discoloration of body fluids
including urine, sweat, and tears. Clients must be warned to prevent alarm and to
understand this is expected. Antacids interfere with absorption, medications must be
taken for the full course, and tyramine restriction applies to MAOIs, not anti-TB
drugs.
4. A client with pneumonia has a fever, productive cough, and pleuritic chest pain. Which
nursing intervention is most effective to mobilize secretions?
• A. Maintain bed rest
• B. Administer PRN antitussives
• C. Encourage fluid intake to 2–3 L/day
• D. Apply oxygen at 2 L/min
Correct Answer: C
Rationale: Adequate hydration thins pulmonary secretions, making them easier to
expectorate. Antitussives suppress the cough reflex and are avoided when secretion
mobilization is the goal. Bed rest and oxygen do not directly promote secretion
clearance.
5. The nurse is instructing a client with emphysema about positions that enhance breathing
during dyspneic periods. Which position should the nurse recommend?
• A. Sitting up in bed
• B. Side-lying in bed
• C. Sitting up and leaning on an overbed table
• D. Sitting up in a recliner chair
Correct Answer: C
Rationale: The tripod position (sitting upright, leaning forward with arms supported
on an overbed table) optimizes accessory muscle use and improves diaphragmatic
excursion. This position is most effective during acute dyspnea in COPD clients.
Page 2 of 63
, 6. The nurse has given instructions on pursed-lip breathing to a client with COPD. Which
statement by the client indicates effective teaching?
• A. "I should tighten my abdominal muscles with exhalation."
• B. "I should inhale through my mouth very deeply."
• C. "I should make inhalation twice as long as exhalation."
• D. "I should tighten my abdominal muscles with inhalation."
Correct Answer: A
Rationale: Pursed-lip breathing with abdominal tightening during exhalation helps
prevent airway collapse and promotes CO₂ elimination. Inhalation should occur
through the nose, and exhalation should be longer than inhalation, not the reverse.
7. Which assessment finding in a client with COPD indicates to the nurse that the respiratory
problem is chronic?
• A. Wheezing on exhalation
• B. Productive cough
• C. Generalized cyanosis
• D. Clubbing of the fingers
Correct Answer: D
Rationale: Clubbing of the fingers is a chronic sign of long-standing hypoxemia seen
in clients with prolonged respiratory disease. Wheezing, cough, and cyanosis can
occur acutely and do not necessarily indicate chronicity.
8. A client with COPD is receiving BiPAP for hypercapnic encephalopathy. Which assessment
findings indicate the BiPAP is effective? (Select all that apply.)
• A. pH improved from 7.25 to 7.38
• B. PaCO₂ decreased from 65 to 48 mm Hg
• C. Respiratory rate decreased from 32 to 22/min
• D. Accessory muscle use remains present
• E. Client reports dyspnea decreased from 8/10 to 3/10
Correct Answer: A, B, C, E
Rationale: Improvement in gas exchange (pH, PaCO₂), work of breathing (respiratory
rate), and subjective dyspnea confirm BiPAP efficacy. Accessory muscle use should
decrease, not remain present, if ventilation is improving.
Page 3 of 63
