Evolve Elsevier HESI RN Medical-Surgical ACTUAL
EXAM [QUESTION 1-200] AND ANSWERS UPDATED
2026/2027 | ORIGINAL PRACTICE SET | DETAILED
RATIONALES | INSTANT DOWNLOAD
INTRODUCTION
The Evolve Elsevier HESI RN Medical-Surgical Examination is a standardized HESI RN
specialty assessment developed by Elsevier to evaluate nursing students' mastery of medical-
surgical concepts and their ability to apply clinical knowledge to patient-care situations. Elsevier
identifies Medical-Surgical as one of its advanced HESI RN Specialty Exams, which are used by
nursing programs to assess mastery of specific clinical content areas. (Evolve)
The examination is primarily intended for prelicensure RN nursing students completing
medical-surgical nursing coursework. It evaluates application of nursing knowledge across
physiological alterations, assessment, pharmacology, clinical judgment, prioritization, patient
safety, and nursing interventions. Elsevier's current HESI review resources emphasize clinical
judgment, real-life clinical situations, and alternate-item practice as preparation for HESI and
NCLEX-style testing. (Evolve)
Success on a medical-surgical specialty assessment is important because medical-surgical
nursing represents a major portion of professional RN practice and provides the foundation for
clinical judgment used across many healthcare settings. Strong preparation also supports
transition from classroom learning to safe patient care and reinforces knowledge needed for
subsequent NCLEX-RN preparation. HESI specialty examinations are standardized assessments
rather than professional licensure examinations themselves. (Evolve)
Elsevier's published evidence indicates that HESI RN Specialty Exams, including Medical-
Surgical, are scored from 50 scored items. A single universal testing duration is not publicly
specified by Elsevier; schools may configure administration conditions according to their testing
policies. Therefore, the 200-question resource below is an original expanded practice bank,
not a representation of 200 questions contained in a live HESI examination. (Evolve)
CORE DOMAINS TESTED IN EVOLVE ELSEVIER HESI
RN MEDICAL-SURGICAL
Cardiovascular and hemodynamic disorders
Respiratory disorders and oxygenation
Neurologic disorders
Endocrine and metabolic disorders
Renal and urinary disorders
Gastrointestinal and hepatobiliary disorders
Musculoskeletal, integumentary, and wound management
, Hematologic, immune, infectious, and oncologic disorders
Perioperative, emergency, critical-care, and multisystem management
Pharmacology, fluid/electrolyte balance, prioritization, and clinical judgment
CONTENT AREA TABLE
Elsevier publicly confirms 50 scored items for HESI RN Specialty Exams but does not publish a
universal percentage blueprint for the Medical-Surgical specialty exam. The following
distribution is therefore a practical study-content allocation, not an official Elsevier percentage
blueprint. (Evolve)
% of Approx. #
Content Domain Key Topics Covered
Exam of Questions
Heart failure, dysrhythmias,
Cardiovascular/Hemodynamic 15% 30 ACS, shock, hypertension,
vascular disorders
COPD, asthma, pneumonia,
Respiratory/Oxygenation 12% 24 PE, ARDS, mechanical
ventilation
Stroke, seizures, ICP, spinal
Neurologic 10% 20 cord injury, Parkinson
disease, MG
Diabetes, thyroid disorders,
Endocrine/Metabolic 10% 20
adrenal disorders, SIADH, DI
AKI, CKD, dialysis,
Renal/Urinary 10% 20 glomerulonephritis, urinary
disorders
GI bleeding, pancreatitis,
Gastrointestinal/Hepatobiliary 10% 20 cirrhosis, inflammatory bowel
disease
Anemia, transfusion reactions,
Hematologic/Immune/Infectious/Oncology 11% 22 HIV, sepsis, cancer,
immunosuppression
Fractures, burns, amputations,
Musculoskeletal/Integumentary 8% 16
pressure injuries, arthritis
Trauma, postoperative
Perioperative/Emergency/Critical Care 7% 14 complications, shock,
emergency stabilization
Prioritization, medication
Integrated Clinical
7% 14 safety, fluid/electrolytes,
Judgment/Pharmacology
delegation
Integrated medical-surgical
Total 100% 200
nursing practice
,QUESTIONS 1-200
Q1: A client with acute decompensated heart failure suddenly develops severe dyspnea,
bilateral crackles, pink frothy sputum, and an oxygen saturation of 82%. Which
intervention should the nurse implement first?
A) Obtain a 12-lead ECG
B) Place the client in high-Fowler position and administer prescribed oxygen
C) Encourage oral fluids to improve renal perfusion
D) Prepare the client for ambulation
Correct Answer: B
Rationale: The findings indicate acute pulmonary edema caused by left-sided heart failure. The
immediate priority is improving oxygenation and reducing venous return by positioning the
client upright and administering oxygen. An ECG is important but does not address the
immediate oxygenation problem. Additional fluids can worsen pulmonary edema, and
ambulation is contraindicated during acute respiratory compromise.
Q2: A client taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-
green halos around lights. The apical pulse is 52/min. What should the nurse do?
A) Administer the scheduled dose with food
B) Encourage increased potassium intake immediately
C) Hold digoxin and notify the healthcare provider
D) Administer an additional dose because the pulse is below 60/min
Correct Answer: C
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations of digoxin toxicity. The nurse should withhold the medication and notify the
provider. Digoxin is generally held when the adult apical pulse is below 60/min. Increasing
potassium without knowing the serum potassium level is inappropriate, although hypokalemia
can increase digoxin toxicity.
Q3: A client with an acute myocardial infarction develops hypotension, cool clammy skin,
oliguria, and pulmonary crackles. Which prescription should the nurse question?
A) Continuous cardiac monitoring
B) Oxygen therapy as indicated
C) Vasopressor support
D) Rapid administration of several liters of isotonic fluid without reassessment
Correct Answer: D
Rationale: The client is demonstrating cardiogenic shock with pulmonary congestion. Excessive
fluid administration can worsen pulmonary edema when the failing left ventricle cannot
effectively pump the increased preload. Hemodynamic monitoring, oxygenation, and carefully
titrated vasoactive medications may be appropriate.
Q4: A client with atrial fibrillation is prescribed warfarin. Which laboratory result is most
important for the nurse to monitor?
A) Serum sodium
B) Troponin
, C) INR
D) Serum amylase
Correct Answer: C
Rationale: Warfarin therapy is monitored using the international normalized ratio (INR), which
evaluates anticoagulant effect and bleeding risk. Sodium, troponin, and amylase do not measure
warfarin effectiveness.
Q5: A client with chest pressure receives sublingual nitroglycerin. Five minutes later the
pain remains severe and blood pressure is 86/54 mm Hg. What is the nurse's priority
action?
A) Administer another nitroglycerin tablet
B) Have the client walk to reduce anxiety
C) Withhold additional nitroglycerin and notify the healthcare provider/emergency
response team
D) Place the client in a flat supine position
Correct Answer: C
Rationale: Nitroglycerin can significantly lower blood pressure. Severe persistent chest pain
with hypotension requires urgent evaluation for ongoing myocardial ischemia and hemodynamic
instability. Additional nitroglycerin could worsen hypotension. The client should remain at rest
with appropriate positioning and monitoring.
Q6: A client receiving IV unfractionated heparin develops hematuria and a sudden
decrease in hemoglobin. Which action is most appropriate?
A) Increase the infusion rate
B) Administer aspirin
C) Stop the heparin infusion and notify the healthcare provider
D) Encourage ambulation
Correct Answer: C
Rationale: Hematuria and falling hemoglobin suggest significant bleeding while receiving
anticoagulation. The infusion should be stopped and the provider notified promptly. Increasing
anticoagulation or administering aspirin would increase bleeding risk.
Q7: A client with chronic heart failure has gained 2.5 kg in 3 days and reports increasing
orthopnea. Which finding most strongly indicates fluid retention?
A) Dry oral mucosa
B) Decreased jugular venous pressure
C) Bilateral dependent edema with elevated jugular venous pressure
D) Increased urine output
Correct Answer: C
Rationale: Rapid weight gain, peripheral edema, and elevated jugular venous pressure indicate
volume overload. Dry mucosa and increased urine output are inconsistent with fluid retention.
Q8: A client with peripheral arterial disease reports severe calf pain while walking that
resolves after resting. Which teaching is most appropriate?
A) Keep the legs elevated above the heart continuously
B) Participate in a prescribed walking program with rest periods
EXAM [QUESTION 1-200] AND ANSWERS UPDATED
2026/2027 | ORIGINAL PRACTICE SET | DETAILED
RATIONALES | INSTANT DOWNLOAD
INTRODUCTION
The Evolve Elsevier HESI RN Medical-Surgical Examination is a standardized HESI RN
specialty assessment developed by Elsevier to evaluate nursing students' mastery of medical-
surgical concepts and their ability to apply clinical knowledge to patient-care situations. Elsevier
identifies Medical-Surgical as one of its advanced HESI RN Specialty Exams, which are used by
nursing programs to assess mastery of specific clinical content areas. (Evolve)
The examination is primarily intended for prelicensure RN nursing students completing
medical-surgical nursing coursework. It evaluates application of nursing knowledge across
physiological alterations, assessment, pharmacology, clinical judgment, prioritization, patient
safety, and nursing interventions. Elsevier's current HESI review resources emphasize clinical
judgment, real-life clinical situations, and alternate-item practice as preparation for HESI and
NCLEX-style testing. (Evolve)
Success on a medical-surgical specialty assessment is important because medical-surgical
nursing represents a major portion of professional RN practice and provides the foundation for
clinical judgment used across many healthcare settings. Strong preparation also supports
transition from classroom learning to safe patient care and reinforces knowledge needed for
subsequent NCLEX-RN preparation. HESI specialty examinations are standardized assessments
rather than professional licensure examinations themselves. (Evolve)
Elsevier's published evidence indicates that HESI RN Specialty Exams, including Medical-
Surgical, are scored from 50 scored items. A single universal testing duration is not publicly
specified by Elsevier; schools may configure administration conditions according to their testing
policies. Therefore, the 200-question resource below is an original expanded practice bank,
not a representation of 200 questions contained in a live HESI examination. (Evolve)
CORE DOMAINS TESTED IN EVOLVE ELSEVIER HESI
RN MEDICAL-SURGICAL
Cardiovascular and hemodynamic disorders
Respiratory disorders and oxygenation
Neurologic disorders
Endocrine and metabolic disorders
Renal and urinary disorders
Gastrointestinal and hepatobiliary disorders
Musculoskeletal, integumentary, and wound management
, Hematologic, immune, infectious, and oncologic disorders
Perioperative, emergency, critical-care, and multisystem management
Pharmacology, fluid/electrolyte balance, prioritization, and clinical judgment
CONTENT AREA TABLE
Elsevier publicly confirms 50 scored items for HESI RN Specialty Exams but does not publish a
universal percentage blueprint for the Medical-Surgical specialty exam. The following
distribution is therefore a practical study-content allocation, not an official Elsevier percentage
blueprint. (Evolve)
% of Approx. #
Content Domain Key Topics Covered
Exam of Questions
Heart failure, dysrhythmias,
Cardiovascular/Hemodynamic 15% 30 ACS, shock, hypertension,
vascular disorders
COPD, asthma, pneumonia,
Respiratory/Oxygenation 12% 24 PE, ARDS, mechanical
ventilation
Stroke, seizures, ICP, spinal
Neurologic 10% 20 cord injury, Parkinson
disease, MG
Diabetes, thyroid disorders,
Endocrine/Metabolic 10% 20
adrenal disorders, SIADH, DI
AKI, CKD, dialysis,
Renal/Urinary 10% 20 glomerulonephritis, urinary
disorders
GI bleeding, pancreatitis,
Gastrointestinal/Hepatobiliary 10% 20 cirrhosis, inflammatory bowel
disease
Anemia, transfusion reactions,
Hematologic/Immune/Infectious/Oncology 11% 22 HIV, sepsis, cancer,
immunosuppression
Fractures, burns, amputations,
Musculoskeletal/Integumentary 8% 16
pressure injuries, arthritis
Trauma, postoperative
Perioperative/Emergency/Critical Care 7% 14 complications, shock,
emergency stabilization
Prioritization, medication
Integrated Clinical
7% 14 safety, fluid/electrolytes,
Judgment/Pharmacology
delegation
Integrated medical-surgical
Total 100% 200
nursing practice
,QUESTIONS 1-200
Q1: A client with acute decompensated heart failure suddenly develops severe dyspnea,
bilateral crackles, pink frothy sputum, and an oxygen saturation of 82%. Which
intervention should the nurse implement first?
A) Obtain a 12-lead ECG
B) Place the client in high-Fowler position and administer prescribed oxygen
C) Encourage oral fluids to improve renal perfusion
D) Prepare the client for ambulation
Correct Answer: B
Rationale: The findings indicate acute pulmonary edema caused by left-sided heart failure. The
immediate priority is improving oxygenation and reducing venous return by positioning the
client upright and administering oxygen. An ECG is important but does not address the
immediate oxygenation problem. Additional fluids can worsen pulmonary edema, and
ambulation is contraindicated during acute respiratory compromise.
Q2: A client taking digoxin for heart failure reports nausea, anorexia, and seeing yellow-
green halos around lights. The apical pulse is 52/min. What should the nurse do?
A) Administer the scheduled dose with food
B) Encourage increased potassium intake immediately
C) Hold digoxin and notify the healthcare provider
D) Administer an additional dose because the pulse is below 60/min
Correct Answer: C
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are classic
manifestations of digoxin toxicity. The nurse should withhold the medication and notify the
provider. Digoxin is generally held when the adult apical pulse is below 60/min. Increasing
potassium without knowing the serum potassium level is inappropriate, although hypokalemia
can increase digoxin toxicity.
Q3: A client with an acute myocardial infarction develops hypotension, cool clammy skin,
oliguria, and pulmonary crackles. Which prescription should the nurse question?
A) Continuous cardiac monitoring
B) Oxygen therapy as indicated
C) Vasopressor support
D) Rapid administration of several liters of isotonic fluid without reassessment
Correct Answer: D
Rationale: The client is demonstrating cardiogenic shock with pulmonary congestion. Excessive
fluid administration can worsen pulmonary edema when the failing left ventricle cannot
effectively pump the increased preload. Hemodynamic monitoring, oxygenation, and carefully
titrated vasoactive medications may be appropriate.
Q4: A client with atrial fibrillation is prescribed warfarin. Which laboratory result is most
important for the nurse to monitor?
A) Serum sodium
B) Troponin
, C) INR
D) Serum amylase
Correct Answer: C
Rationale: Warfarin therapy is monitored using the international normalized ratio (INR), which
evaluates anticoagulant effect and bleeding risk. Sodium, troponin, and amylase do not measure
warfarin effectiveness.
Q5: A client with chest pressure receives sublingual nitroglycerin. Five minutes later the
pain remains severe and blood pressure is 86/54 mm Hg. What is the nurse's priority
action?
A) Administer another nitroglycerin tablet
B) Have the client walk to reduce anxiety
C) Withhold additional nitroglycerin and notify the healthcare provider/emergency
response team
D) Place the client in a flat supine position
Correct Answer: C
Rationale: Nitroglycerin can significantly lower blood pressure. Severe persistent chest pain
with hypotension requires urgent evaluation for ongoing myocardial ischemia and hemodynamic
instability. Additional nitroglycerin could worsen hypotension. The client should remain at rest
with appropriate positioning and monitoring.
Q6: A client receiving IV unfractionated heparin develops hematuria and a sudden
decrease in hemoglobin. Which action is most appropriate?
A) Increase the infusion rate
B) Administer aspirin
C) Stop the heparin infusion and notify the healthcare provider
D) Encourage ambulation
Correct Answer: C
Rationale: Hematuria and falling hemoglobin suggest significant bleeding while receiving
anticoagulation. The infusion should be stopped and the provider notified promptly. Increasing
anticoagulation or administering aspirin would increase bleeding risk.
Q7: A client with chronic heart failure has gained 2.5 kg in 3 days and reports increasing
orthopnea. Which finding most strongly indicates fluid retention?
A) Dry oral mucosa
B) Decreased jugular venous pressure
C) Bilateral dependent edema with elevated jugular venous pressure
D) Increased urine output
Correct Answer: C
Rationale: Rapid weight gain, peripheral edema, and elevated jugular venous pressure indicate
volume overload. Dry mucosa and increased urine output are inconsistent with fluid retention.
Q8: A client with peripheral arterial disease reports severe calf pain while walking that
resolves after resting. Which teaching is most appropriate?
A) Keep the legs elevated above the heart continuously
B) Participate in a prescribed walking program with rest periods
