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PRRE
EMM II U
UMM SS TT U
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MAA TT E
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A LL SS S
STTU
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COOL
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T II O
ONN :: 2
2002
2 55
EVOLVE ELSEVIER HESI MED SURG (LATEST UPDATE
2025/2026) EXAM QUESTIONS WITH RATIONALIZED
ACCURATE ANSWERS
WHAT'S INSIDE:
Latest 2025/2026 Questions
Verified Correct Answers Highlighted for Easy Learning
Detailed Explanations & Rationales for Better Understanding
Proven to Boost Grades and Exam Confidence
Covers All Essential Topics and Core Concepts
Perfect for Quick Revision and Last-Minute Review
Question 1
A 68‑year‑old man underwent a total hip arthroplasty three days ago. He has been ambulating with assistance but
suddenly becomes short of breath while seated, reporting a sharp, pleuritic chest pain that worsens with deep
inspiration. His vital signs are: temperature 37.2°C (99°F), pulse 118/min, respirations 28/min, blood pressure
138/84 mmHg, and oxygen saturation 86% on room air. Physical examination reveals clear lung fields bilaterally,
mild calf tenderness on the left, and a faint, low‑grade murmur over the left lower sternal border. The surgical team
is on call, and a portable chest X‑ray is pending. Which of the following actions should the nurse take first?
A. Administer intravenous morphine for pain control.
B. Obtain a stat chest computed tomography angiography.
C. Initiate an intravenous heparin bolus.
D. Place the patient in the Trendelenburg position.
Correct Answer
Initiate an intravenous heparin bolus.
Rationale:
The presentation suggests a pulmonary embolism, a life‑threatening event requiring rapid anticoagulation to prevent clot propagation.
Administering a heparin bolus provides immediate therapeutic effect while diagnostic imaging is arranged. Morphine treats pain but
does not address the underlying obstruction, and Trendelenburg worsens ventilation‑perfusion mismatch.
,Question 2
A 45‑year‑old woman with a known history of Graves disease presents to the emergency department after missing
her scheduled dose of methimazole for two days. She reports fever, profuse sweating, palpitations, agitation, and a
new onset of atrial fibrillation with a ventricular rate of 140/min. Her temperature is 39.4°C (103°F), pulse 130/min,
blood pressure 110/70 mmHg, and respiratory rate 22/min. Physical exam shows a diffuse goiter, fine tremor, and
exophthalmos. Laboratory results are pending. Which nursing intervention should be performed immediately to
address the most life‑threatening aspect of her condition?
A. Administer the scheduled dose of propylthiouracil intravenously.
B. Prepare the patient for emergent thyroidectomy.
C. Initiate cooling measures and give intravenous propranolol.
D. Obtain a repeat thyroid function panel.
Correct Answer
Initiate cooling measures and give intravenous propranolol.
Rationale:
The patient is exhibiting signs of thyroid storm, a medical emergency characterized by hyperthermia, tachyarrhythmia, and
heightened adrenergic activity. Intravenous propranolol rapidly blunts the sympathetic response and allows temperature control, while
cooling measures further reduce the fever. Antithyroid drugs and labs are essential but not immediate priorities.
Question 3
A 30‑year‑old male firefighter suffers a 35% total body surface area scald injury involving the anterior trunk and
both upper extremities. He was admitted to the intensive care unit and has been receiving fluid resuscitation
according to the Parkland formula. On day three, his temperature rises to 39.2°C (102.5°F), heart rate increases to
128/min, blood pressure drops to 95/60 mmHg, and his urine output falls to 0.3 mL/kg/hr. The burn wounds appear
erythematous with yellowish purulent drainage, and there is a new onset of mental confusion. Which of the
following is the most likely diagnosis?
A. Sepsis secondary to wound infection.
B. Acute respiratory distress syndrome.
C. Hypermetabolic response to burn injury.
D. Fluid overload with pulmonary edema.
Correct Answer
Sepsis secondary to wound infection.
Rationale:
The sudden fever, tachycardia, hypotension, oliguria, and purulent wound drainage indicate a systemic inflammatory response
triggered by infection of the burn sites, consistent with sepsis. Early identification allows prompt broad‑spectrum antibiotics and
hemodynamic support, which are critical to prevent progression to septic shock. Other complications such as ARDS or fluid overload
present different clinical patterns.
,Question 4
A 70‑year‑old female recovering from an open abdominal hysterectomy on postoperative day two is receiving
patient‑controlled analgesia (PCA) with morphine. The PCA device is set to deliver a 1‑mg bolus with a 10‑minute
lockout interval, and a maximum dose of 6 mg per hour. At 02:00 a.m., the nurse notes the patient’s respiratory rate
has decreased to 8 breaths per minute, she is difficult to arouse, and her pupils are pinpoint. Her oxygen saturation
is 88% on room air. Which of the following actions should the nurse take first?
A. Decrease the PCA dosage settings.
B. Administer naloxone intravenously.
C. Encourage the patient to perform deep breathing exercises.
D. Increase the supplemental oxygen flow rate.
Correct Answer
Administer naloxone intravenously.
Rationale:
The patient’s respiratory depression, decreased consciousness, and pinpoint pupils are classic signs of opioid overdose from the PCA
device. Naloxone is a rapid‑acting opioid antagonist that reverses these effects and restores adequate ventilation. Adjusting the PCA
settings or providing supplemental oxygen does not address the life‑threatening overdose.
Question 5
During a laparoscopic cholecystectomy, a 55‑year‑old male with no prior cardiac history develops a rapid rise in
end‑tidal CO₂, muscle rigidity, and a core temperature of 41°C (105.8°F) despite a stable blood pressure of 130/78
mmHg. The anesthesiologist suspects malignant hyperthermia. Which of the following is the most appropriate
immediate pharmacologic intervention for the nurse to prepare and administer?
A. Intravenous dantrolene sodium.
B. Increase the concentration of the inhaled anesthetic agent.
C. Intravenous epinephrine bolus.
D. Apply ice packs to the patient’s skin.
Correct Answer
Intravenous dantrolene sodium.
Rationale:
Malignant hyperthermia is a hypermetabolic crisis caused by uncontrolled calcium release in skeletal muscle, and dantrolene directly
inhibits this release, halting the reaction. Immediate administration of intravenous dantrolene is the definitive treatment, while cooling
measures support temperature reduction. Increasing anesthetic depth or using epinephrine would not correct the underlying
pathophysiology.
, Question 6
A 55-year-old woman with a ten-year history of type 2 diabetes mellitus presents to the emergency department with
a sudden onset of severe epigastric pain that radiates to the back, accompanied by nausea and two episodes of
vomiting. On examination, she is afebrile, her abdomen is tender to palpation in the upper quadrants, and bowel
sounds are diminished. Laboratory studies reveal a serum amylase of 420 U/L (normal 30-110), serum lipase of 780
U/L (normal 13-60), a white blood cell count of 14,000/mm³, and a C‑reactive protein (CRP) level of 180 mg/L
(normal <10). An abdominal CT scan shows areas of pancreatic necrosis. Which laboratory finding is most specific
for the presence of necrotizing pancreatitis in this patient?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated C‑reactive protein
D. Elevated serum calcium
Correct Answer
Elevated C‑reactive protein
Rationale:
CRP rises markedly in severe inflammation and levels above 150 mg/L correlate strongly with necrotizing pancreatitis, making it the
most specific laboratory marker for this complication. Amylase and lipase are sensitive for pancreatitis but do not differentiate
severity. Hypercalcemia may predispose to pancreatitis but is not a severity indicator.
Question 7
A 62-year-old man is on postoperative day three after a total hip arthroplasty. He has been receiving subcutaneous
low‑molecular‑weight heparin for deep‑vein thrombosis prophylaxis. Suddenly, he becomes dyspneic, reports sharp
pleuritic chest pain, and his heart rate accelerates to 118 beats per minute while his oxygen saturation falls to 88%
on room air. Physical examination reveals clear lung fields and a mildly distended neck vein. The nurse suspects a
pulmonary embolism. Which diagnostic test should be performed first to obtain the most rapid and definitive
confirmation of the suspected embolus?
A. D‑dimer assay
B. Ventilation‑perfusion (V/Q) scan
C. Computed tomography pulmonary angiography (CTPA)
D. Lower‑extremity duplex ultrasound
Correct Answer
Computed tomography pulmonary angiography (CTPA)
Rationale:
CTPA directly visualizes intraluminal thrombus in the pulmonary arteries and provides the quickest definitive diagnosis, essential for
urgent anticoagulation. D‑dimer is nonspecific, V/Q scans are less accurate in postoperative patients, and duplex ultrasound evaluates
leg veins, not pulmonary vessels.
PRRE
EMM II U
UMM SS TT U
UDDY
Y M
MAA TT E
ERR II A
A LL SS S
STTU
UDDY
Y C
COOL
LLLE
ECCT
T II O
ONN :: 2
2002
2 55
EVOLVE ELSEVIER HESI MED SURG (LATEST UPDATE
2025/2026) EXAM QUESTIONS WITH RATIONALIZED
ACCURATE ANSWERS
WHAT'S INSIDE:
Latest 2025/2026 Questions
Verified Correct Answers Highlighted for Easy Learning
Detailed Explanations & Rationales for Better Understanding
Proven to Boost Grades and Exam Confidence
Covers All Essential Topics and Core Concepts
Perfect for Quick Revision and Last-Minute Review
Question 1
A 68‑year‑old man underwent a total hip arthroplasty three days ago. He has been ambulating with assistance but
suddenly becomes short of breath while seated, reporting a sharp, pleuritic chest pain that worsens with deep
inspiration. His vital signs are: temperature 37.2°C (99°F), pulse 118/min, respirations 28/min, blood pressure
138/84 mmHg, and oxygen saturation 86% on room air. Physical examination reveals clear lung fields bilaterally,
mild calf tenderness on the left, and a faint, low‑grade murmur over the left lower sternal border. The surgical team
is on call, and a portable chest X‑ray is pending. Which of the following actions should the nurse take first?
A. Administer intravenous morphine for pain control.
B. Obtain a stat chest computed tomography angiography.
C. Initiate an intravenous heparin bolus.
D. Place the patient in the Trendelenburg position.
Correct Answer
Initiate an intravenous heparin bolus.
Rationale:
The presentation suggests a pulmonary embolism, a life‑threatening event requiring rapid anticoagulation to prevent clot propagation.
Administering a heparin bolus provides immediate therapeutic effect while diagnostic imaging is arranged. Morphine treats pain but
does not address the underlying obstruction, and Trendelenburg worsens ventilation‑perfusion mismatch.
,Question 2
A 45‑year‑old woman with a known history of Graves disease presents to the emergency department after missing
her scheduled dose of methimazole for two days. She reports fever, profuse sweating, palpitations, agitation, and a
new onset of atrial fibrillation with a ventricular rate of 140/min. Her temperature is 39.4°C (103°F), pulse 130/min,
blood pressure 110/70 mmHg, and respiratory rate 22/min. Physical exam shows a diffuse goiter, fine tremor, and
exophthalmos. Laboratory results are pending. Which nursing intervention should be performed immediately to
address the most life‑threatening aspect of her condition?
A. Administer the scheduled dose of propylthiouracil intravenously.
B. Prepare the patient for emergent thyroidectomy.
C. Initiate cooling measures and give intravenous propranolol.
D. Obtain a repeat thyroid function panel.
Correct Answer
Initiate cooling measures and give intravenous propranolol.
Rationale:
The patient is exhibiting signs of thyroid storm, a medical emergency characterized by hyperthermia, tachyarrhythmia, and
heightened adrenergic activity. Intravenous propranolol rapidly blunts the sympathetic response and allows temperature control, while
cooling measures further reduce the fever. Antithyroid drugs and labs are essential but not immediate priorities.
Question 3
A 30‑year‑old male firefighter suffers a 35% total body surface area scald injury involving the anterior trunk and
both upper extremities. He was admitted to the intensive care unit and has been receiving fluid resuscitation
according to the Parkland formula. On day three, his temperature rises to 39.2°C (102.5°F), heart rate increases to
128/min, blood pressure drops to 95/60 mmHg, and his urine output falls to 0.3 mL/kg/hr. The burn wounds appear
erythematous with yellowish purulent drainage, and there is a new onset of mental confusion. Which of the
following is the most likely diagnosis?
A. Sepsis secondary to wound infection.
B. Acute respiratory distress syndrome.
C. Hypermetabolic response to burn injury.
D. Fluid overload with pulmonary edema.
Correct Answer
Sepsis secondary to wound infection.
Rationale:
The sudden fever, tachycardia, hypotension, oliguria, and purulent wound drainage indicate a systemic inflammatory response
triggered by infection of the burn sites, consistent with sepsis. Early identification allows prompt broad‑spectrum antibiotics and
hemodynamic support, which are critical to prevent progression to septic shock. Other complications such as ARDS or fluid overload
present different clinical patterns.
,Question 4
A 70‑year‑old female recovering from an open abdominal hysterectomy on postoperative day two is receiving
patient‑controlled analgesia (PCA) with morphine. The PCA device is set to deliver a 1‑mg bolus with a 10‑minute
lockout interval, and a maximum dose of 6 mg per hour. At 02:00 a.m., the nurse notes the patient’s respiratory rate
has decreased to 8 breaths per minute, she is difficult to arouse, and her pupils are pinpoint. Her oxygen saturation
is 88% on room air. Which of the following actions should the nurse take first?
A. Decrease the PCA dosage settings.
B. Administer naloxone intravenously.
C. Encourage the patient to perform deep breathing exercises.
D. Increase the supplemental oxygen flow rate.
Correct Answer
Administer naloxone intravenously.
Rationale:
The patient’s respiratory depression, decreased consciousness, and pinpoint pupils are classic signs of opioid overdose from the PCA
device. Naloxone is a rapid‑acting opioid antagonist that reverses these effects and restores adequate ventilation. Adjusting the PCA
settings or providing supplemental oxygen does not address the life‑threatening overdose.
Question 5
During a laparoscopic cholecystectomy, a 55‑year‑old male with no prior cardiac history develops a rapid rise in
end‑tidal CO₂, muscle rigidity, and a core temperature of 41°C (105.8°F) despite a stable blood pressure of 130/78
mmHg. The anesthesiologist suspects malignant hyperthermia. Which of the following is the most appropriate
immediate pharmacologic intervention for the nurse to prepare and administer?
A. Intravenous dantrolene sodium.
B. Increase the concentration of the inhaled anesthetic agent.
C. Intravenous epinephrine bolus.
D. Apply ice packs to the patient’s skin.
Correct Answer
Intravenous dantrolene sodium.
Rationale:
Malignant hyperthermia is a hypermetabolic crisis caused by uncontrolled calcium release in skeletal muscle, and dantrolene directly
inhibits this release, halting the reaction. Immediate administration of intravenous dantrolene is the definitive treatment, while cooling
measures support temperature reduction. Increasing anesthetic depth or using epinephrine would not correct the underlying
pathophysiology.
, Question 6
A 55-year-old woman with a ten-year history of type 2 diabetes mellitus presents to the emergency department with
a sudden onset of severe epigastric pain that radiates to the back, accompanied by nausea and two episodes of
vomiting. On examination, she is afebrile, her abdomen is tender to palpation in the upper quadrants, and bowel
sounds are diminished. Laboratory studies reveal a serum amylase of 420 U/L (normal 30-110), serum lipase of 780
U/L (normal 13-60), a white blood cell count of 14,000/mm³, and a C‑reactive protein (CRP) level of 180 mg/L
(normal <10). An abdominal CT scan shows areas of pancreatic necrosis. Which laboratory finding is most specific
for the presence of necrotizing pancreatitis in this patient?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated C‑reactive protein
D. Elevated serum calcium
Correct Answer
Elevated C‑reactive protein
Rationale:
CRP rises markedly in severe inflammation and levels above 150 mg/L correlate strongly with necrotizing pancreatitis, making it the
most specific laboratory marker for this complication. Amylase and lipase are sensitive for pancreatitis but do not differentiate
severity. Hypercalcemia may predispose to pancreatitis but is not a severity indicator.
Question 7
A 62-year-old man is on postoperative day three after a total hip arthroplasty. He has been receiving subcutaneous
low‑molecular‑weight heparin for deep‑vein thrombosis prophylaxis. Suddenly, he becomes dyspneic, reports sharp
pleuritic chest pain, and his heart rate accelerates to 118 beats per minute while his oxygen saturation falls to 88%
on room air. Physical examination reveals clear lung fields and a mildly distended neck vein. The nurse suspects a
pulmonary embolism. Which diagnostic test should be performed first to obtain the most rapid and definitive
confirmation of the suspected embolus?
A. D‑dimer assay
B. Ventilation‑perfusion (V/Q) scan
C. Computed tomography pulmonary angiography (CTPA)
D. Lower‑extremity duplex ultrasound
Correct Answer
Computed tomography pulmonary angiography (CTPA)
Rationale:
CTPA directly visualizes intraluminal thrombus in the pulmonary arteries and provides the quickest definitive diagnosis, essential for
urgent anticoagulation. D‑dimer is nonspecific, V/Q scans are less accurate in postoperative patients, and duplex ultrasound evaluates
leg veins, not pulmonary vessels.
