Evolve HESI Med-Surg 2025|2026 ACTUAL EXAM REVIEW 150
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES COVERING
MOST TESTED QUESTIONS PERFECT FOR A+ GRADE
1. A patient with chronic heart failure reports increased shortness of breath and swelling in
the legs. Which lab value should the nurse assess first?
A. Hemoglobin
B. Sodium
C. Potassium
D. ☑ B-type natriuretic peptide (BNP)
Rationale: BNP is elevated in heart failure and helps assess severity and fluid overload.
2. A patient with COPD is using a new inhaler. Which instruction is most important?
A. Use only once per week
B. ☑ Rinse mouth after use to prevent fungal infections
C. Take with food
D. Avoid walking for 1 hour after inhalation
Rationale: Inhaled corticosteroids can cause oral thrush if the mouth is not rinsed.
3. A patient with type 2 diabetes presents with hyperglycemia. Which oral antidiabetic drug
works by increasing insulin sensitivity?
A. Sulfonylureas
B. ☑ Metformin
C. Insulin
D. DPP-4 inhibitors
Rationale: Metformin improves insulin sensitivity in liver and muscle tissue, reducing glucose
production.
4. A patient with pneumonia has an oxygen saturation of 89%. What is the nurse’s priority
action?
A. Encourage deep breathing exercises
B. Start IV fluids
C. Administer antipyretics
D. ☑ Administer supplemental oxygen as prescribed
Rationale: Oxygen supplementation is immediately needed for hypoxemia to prevent tissue
hypoxia.
5. Which electrolyte imbalance is most concerning in a patient receiving furosemide?
A. Hypercalcemia
B. Hypermagnesemia
C. ☑ Hypokalemia
D. Hyperphosphatemia
,Rationale: Loop diuretics like furosemide increase potassium excretion, risking cardiac
dysrhythmias.
6. A patient with chronic kidney disease reports fatigue and pallor. Which lab value is most
relevant?
A. Sodium
B. ☑ Hemoglobin and hematocrit
C. Creatinine kinase
D. Platelet count
Rationale: CKD patients often develop anemia due to decreased erythropoietin production.
7. Which assessment finding is most consistent with hypoglycemia in a diabetic patient?
A. Polyuria
B. Fruity breath
C. ☑ Diaphoresis and confusion
D. Weight gain
Rationale: Hypoglycemia causes adrenergic and neuroglycopenic symptoms such as sweating,
shakiness, and confusion.
8. Which intervention is highest priority for a patient with a new diagnosis of deep vein
thrombosis (DVT)?
A. Encourage ambulation immediately
B. Administer analgesics
C. ☑ Administer anticoagulant therapy as prescribed
D. Apply ice packs
Rationale: Anticoagulation prevents clot extension and pulmonary embolism, the most urgent
risk.
9. A patient with acute pancreatitis reports severe abdominal pain and vomiting. Which lab
finding is expected?
A. Low amylase and lipase
B. Low WBC
C. ☑ Elevated serum amylase and lipase
D. Elevated hemoglobin
Rationale: Pancreatic inflammation causes leakage of digestive enzymes into the bloodstream.
10. A patient with cirrhosis is at risk for hepatic encephalopathy. Which assessment is most
critical?
A. Blood glucose levels
B. ☑ Mental status and orientation
C. Skin turgor
D. Vital signs only
, Rationale: Mental status changes are an early indicator of ammonia accumulation in hepatic
encephalopathy.
11. Which nursing intervention helps prevent pressure ulcers in an immobile patient?
A. Daily soap baths
B. ☑ Repositioning every 2 hours
C. Encourage caffeine intake
D. Restrict fluids
Rationale: Frequent repositioning relieves pressure on bony prominences to prevent skin
breakdown.
12. A patient with myocardial infarction reports chest pain radiating to the left arm. What is
the priority intervention?
A. Obtain a blood sample
B. Administer antacid
C. ☑ Administer oxygen and notify provider immediately
D. Encourage ambulation
Rationale: Immediate intervention is critical to reduce myocardial damage and prevent
complications.
13. Which type of heart failure is characterized by thickened, stiff ventricles?
A. Systolic
B. ☑ Diastolic (HFpEF)
C. Right-sided
D. Left-sided
Rationale: Diastolic heart failure involves impaired ventricular filling due to stiff ventricles.
14. Which assessment finding indicates worsening renal function?
A. Increased urine output
B. Decreased BUN and creatinine
C. ☑ Rising BUN and creatinine
D. Normal potassium
Rationale: Elevated BUN and creatinine indicate impaired kidney filtration.
15. A patient with chronic heart failure is prescribed digoxin. Which sign indicates toxicity?
A. Fever
B. ☑ Visual halos and nausea
C. Hypertension
D. Bradykinesia
Rationale: Digoxin toxicity presents with gastrointestinal and visual symptoms, as well as
dysrhythmias.
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES COVERING
MOST TESTED QUESTIONS PERFECT FOR A+ GRADE
1. A patient with chronic heart failure reports increased shortness of breath and swelling in
the legs. Which lab value should the nurse assess first?
A. Hemoglobin
B. Sodium
C. Potassium
D. ☑ B-type natriuretic peptide (BNP)
Rationale: BNP is elevated in heart failure and helps assess severity and fluid overload.
2. A patient with COPD is using a new inhaler. Which instruction is most important?
A. Use only once per week
B. ☑ Rinse mouth after use to prevent fungal infections
C. Take with food
D. Avoid walking for 1 hour after inhalation
Rationale: Inhaled corticosteroids can cause oral thrush if the mouth is not rinsed.
3. A patient with type 2 diabetes presents with hyperglycemia. Which oral antidiabetic drug
works by increasing insulin sensitivity?
A. Sulfonylureas
B. ☑ Metformin
C. Insulin
D. DPP-4 inhibitors
Rationale: Metformin improves insulin sensitivity in liver and muscle tissue, reducing glucose
production.
4. A patient with pneumonia has an oxygen saturation of 89%. What is the nurse’s priority
action?
A. Encourage deep breathing exercises
B. Start IV fluids
C. Administer antipyretics
D. ☑ Administer supplemental oxygen as prescribed
Rationale: Oxygen supplementation is immediately needed for hypoxemia to prevent tissue
hypoxia.
5. Which electrolyte imbalance is most concerning in a patient receiving furosemide?
A. Hypercalcemia
B. Hypermagnesemia
C. ☑ Hypokalemia
D. Hyperphosphatemia
,Rationale: Loop diuretics like furosemide increase potassium excretion, risking cardiac
dysrhythmias.
6. A patient with chronic kidney disease reports fatigue and pallor. Which lab value is most
relevant?
A. Sodium
B. ☑ Hemoglobin and hematocrit
C. Creatinine kinase
D. Platelet count
Rationale: CKD patients often develop anemia due to decreased erythropoietin production.
7. Which assessment finding is most consistent with hypoglycemia in a diabetic patient?
A. Polyuria
B. Fruity breath
C. ☑ Diaphoresis and confusion
D. Weight gain
Rationale: Hypoglycemia causes adrenergic and neuroglycopenic symptoms such as sweating,
shakiness, and confusion.
8. Which intervention is highest priority for a patient with a new diagnosis of deep vein
thrombosis (DVT)?
A. Encourage ambulation immediately
B. Administer analgesics
C. ☑ Administer anticoagulant therapy as prescribed
D. Apply ice packs
Rationale: Anticoagulation prevents clot extension and pulmonary embolism, the most urgent
risk.
9. A patient with acute pancreatitis reports severe abdominal pain and vomiting. Which lab
finding is expected?
A. Low amylase and lipase
B. Low WBC
C. ☑ Elevated serum amylase and lipase
D. Elevated hemoglobin
Rationale: Pancreatic inflammation causes leakage of digestive enzymes into the bloodstream.
10. A patient with cirrhosis is at risk for hepatic encephalopathy. Which assessment is most
critical?
A. Blood glucose levels
B. ☑ Mental status and orientation
C. Skin turgor
D. Vital signs only
, Rationale: Mental status changes are an early indicator of ammonia accumulation in hepatic
encephalopathy.
11. Which nursing intervention helps prevent pressure ulcers in an immobile patient?
A. Daily soap baths
B. ☑ Repositioning every 2 hours
C. Encourage caffeine intake
D. Restrict fluids
Rationale: Frequent repositioning relieves pressure on bony prominences to prevent skin
breakdown.
12. A patient with myocardial infarction reports chest pain radiating to the left arm. What is
the priority intervention?
A. Obtain a blood sample
B. Administer antacid
C. ☑ Administer oxygen and notify provider immediately
D. Encourage ambulation
Rationale: Immediate intervention is critical to reduce myocardial damage and prevent
complications.
13. Which type of heart failure is characterized by thickened, stiff ventricles?
A. Systolic
B. ☑ Diastolic (HFpEF)
C. Right-sided
D. Left-sided
Rationale: Diastolic heart failure involves impaired ventricular filling due to stiff ventricles.
14. Which assessment finding indicates worsening renal function?
A. Increased urine output
B. Decreased BUN and creatinine
C. ☑ Rising BUN and creatinine
D. Normal potassium
Rationale: Elevated BUN and creatinine indicate impaired kidney filtration.
15. A patient with chronic heart failure is prescribed digoxin. Which sign indicates toxicity?
A. Fever
B. ☑ Visual halos and nausea
C. Hypertension
D. Bradykinesia
Rationale: Digoxin toxicity presents with gastrointestinal and visual symptoms, as well as
dysrhythmias.
