Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
A 68-year-old man is admitted with acute decompensated heart failure. His BP is 82/54
mm Hg, HR 112 beats/min, and urine output 15 mL/hr for 3 hours. Which order will the
nurse question?
A. Start dobutamine 5 mcg/kg/min
B. Increase furosemide to 80 mg IV push
C. Restrict oral fluids to 1500 mL/day
1. D. Obtain daily weight each morning
Correct Answer: B
Rationale: In hypotensive, hypoperfused HF, aggressive diuresis will further reduce
preload and cardiac output. Dobutamine is appropriate to improve contractility and
perfusion. Fluid restriction and daily weights are standard. Increasing furosemide in this
hemodynamic profile risks cardiorenal syndrome and is therefore the order the nurse
should clarify first.
The nurse is caring for a client 4 hours post-CABG. Chest-tube drainage is 150 mL in the
last hour, and BP drops from 118/70 to 90/58 mm Hg. What is the priority action?
A. Increase the oxygen percentage on the ventilator
B. Milk the chest tube to ensure patency
C. Administer IV fluid bolus as ordered
2. D. Obtain a 12-lead ECG immediately
Correct Answer: C
Rationale: Acute mediastinal bleeding with hemodynamic instability indicates
hypovolemic shock; rapid fluid resuscitation is life-saving. Milking may be done after
,volume is addressed. O₂ will not correct hypovolemia. ECG is important but secondary to
restoring perfusion.
A client with COPD has an ABG of pH 7.28, PaCO₂ 65 mm Hg, HCO₃ 34 mEq/L, PaO₂
48 mm Hg. Which action is most appropriate?
A. Place on 6 L/min nasal cannula O₂
B. Encourage incentive spirometry q hour
C. Start BiPAP per protocol
3. D. Give IV normal-bolus 500 mL
Correct Answer: C
Rationale: Acute-on-chronic respiratory acidosis with severe hypoxemia requires
non-invasive ventilation to decrease work of breathing and improve oxygenation without
risking CO₂ narcosis from high-flow O₂. BiPAP reduces PaCO₂ and increases PaO₂
effectively. High-flow O₂ can abolish hypoxic drive in COPD.
A client with DKA receives an insulin infusion at 0.1 units/kg/hr. Which lab value is the
best indicator that the infusion is effective in the first 4 hours?
A. Glucose decrease by 50–75 mg/dL/hr
B. pH increase to > 7.30
C. Ketones negative in urine
4. D. Bicarbonate rise to > 18 mEq/L
Correct Answer: A
Rationale: A controlled glucose drop of 50–75 mg/dL/hr indicates insulin is suppressing
hepatic glucose output without precipitating cerebral edema. pH and bicarbonate improve
more slowly (over 6–8 h). Urine ketones lag behind serum clearance.
The nurse is assessing a client with acute pancreatitis. Which finding requires immediate
intervention?
A. Left upper-quadrain pain radiating to back
B. Serum amylase 800 units/L
C. HR 110 beats/min, BP 88/50 mm Hg
, 5. D. Temperature 38.1 °C (100.6 °F)
Correct Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemic shock from third-spacing
and hemorrhage—life-threatening complications. Pain and fever are expected; amylase
levels do not correlate with severity. Rapid fluid resuscitation is critical.
A client with a subtotal thyroidectomy develops tingling in fingers and facial muscle
spasms when the blood-pressure cuff is inflated. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hypermagnesemia
6. D. Hypernatremia
Correct Answer: B
Rationale: Tetany and Trousseau sign indicate hypocalcemia from inadvertent
parathyroid removal or injury. Calcium replacement is urgent to prevent laryngospasm.
Other electrolytes do not produce these neuromuscular signs.
A client with Guillain-Barré syndrome experiences progressive weakness and difficulty
swallowing. Which priority nursing intervention is essential?
A. Administer sedatives to decrease anxiety
B. Perform active-assist range-of-motion exercises
C. Monitor forced vital capacity q4h
7. D. Encourage clear-liquid diet to limit fatigue
Correct Answer: C
Rationale: Respiratory muscle weakness can precipitate acute respiratory failure; FVC <
20 mL/kg signals need for intubation. Sedatives depress respiration. Liquids increase
aspiration risk if swallowing is impaired. ROM is important but not life-saving.
, A post-operative cholecystectomy client suddenly becomes dyspneic and tachycardic.
SpO₂ is 86 % on 4 L NC. Which test will the provider order first?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
8. D. ABG
Correct Answer: A
Rationale: Chest X-ray is rapid, rules out pneumothorax, atelectasis, or pulmonary
edema, and guides further work-up. CT-PEA is definitive for PE but requires stable
patient and contrast. D-dimer is nonspecific post-op.
The nurse is caring for a client with a pulmonary embolism on heparin infusion. aPTT is
110 seconds (target 60–80). What is the priority action?
A. Stop the infusion for 1 hour and restart at lower dose
B. Obtain PT/INR stat
C. Give protamine sulfate
9. D. Increase rate to achieve therapeutic trough
Correct Answer: A
Rationale: A supratherapeutic aPTT increases bleeding risk; temporary holding and dose
reduction per protocol restore therapeutic range. Protamine is reserved for
life-threatening bleeding. PT/INR monitors warfarin, not heparin.
A client with liver cirrhosis develops abdominal distension and shortness of breath.
Paracentesis removes 6 L of fluid. Which post-procedure assessment is most critical?
A. Monitor BP and HR for hypotension
B. Check dressing for leakage
C. Encourage PO fluids to 3000 mL
10. D. Measure temperature q 4 h
Correct Answer: A
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
A 68-year-old man is admitted with acute decompensated heart failure. His BP is 82/54
mm Hg, HR 112 beats/min, and urine output 15 mL/hr for 3 hours. Which order will the
nurse question?
A. Start dobutamine 5 mcg/kg/min
B. Increase furosemide to 80 mg IV push
C. Restrict oral fluids to 1500 mL/day
1. D. Obtain daily weight each morning
Correct Answer: B
Rationale: In hypotensive, hypoperfused HF, aggressive diuresis will further reduce
preload and cardiac output. Dobutamine is appropriate to improve contractility and
perfusion. Fluid restriction and daily weights are standard. Increasing furosemide in this
hemodynamic profile risks cardiorenal syndrome and is therefore the order the nurse
should clarify first.
The nurse is caring for a client 4 hours post-CABG. Chest-tube drainage is 150 mL in the
last hour, and BP drops from 118/70 to 90/58 mm Hg. What is the priority action?
A. Increase the oxygen percentage on the ventilator
B. Milk the chest tube to ensure patency
C. Administer IV fluid bolus as ordered
2. D. Obtain a 12-lead ECG immediately
Correct Answer: C
Rationale: Acute mediastinal bleeding with hemodynamic instability indicates
hypovolemic shock; rapid fluid resuscitation is life-saving. Milking may be done after
,volume is addressed. O₂ will not correct hypovolemia. ECG is important but secondary to
restoring perfusion.
A client with COPD has an ABG of pH 7.28, PaCO₂ 65 mm Hg, HCO₃ 34 mEq/L, PaO₂
48 mm Hg. Which action is most appropriate?
A. Place on 6 L/min nasal cannula O₂
B. Encourage incentive spirometry q hour
C. Start BiPAP per protocol
3. D. Give IV normal-bolus 500 mL
Correct Answer: C
Rationale: Acute-on-chronic respiratory acidosis with severe hypoxemia requires
non-invasive ventilation to decrease work of breathing and improve oxygenation without
risking CO₂ narcosis from high-flow O₂. BiPAP reduces PaCO₂ and increases PaO₂
effectively. High-flow O₂ can abolish hypoxic drive in COPD.
A client with DKA receives an insulin infusion at 0.1 units/kg/hr. Which lab value is the
best indicator that the infusion is effective in the first 4 hours?
A. Glucose decrease by 50–75 mg/dL/hr
B. pH increase to > 7.30
C. Ketones negative in urine
4. D. Bicarbonate rise to > 18 mEq/L
Correct Answer: A
Rationale: A controlled glucose drop of 50–75 mg/dL/hr indicates insulin is suppressing
hepatic glucose output without precipitating cerebral edema. pH and bicarbonate improve
more slowly (over 6–8 h). Urine ketones lag behind serum clearance.
The nurse is assessing a client with acute pancreatitis. Which finding requires immediate
intervention?
A. Left upper-quadrain pain radiating to back
B. Serum amylase 800 units/L
C. HR 110 beats/min, BP 88/50 mm Hg
, 5. D. Temperature 38.1 °C (100.6 °F)
Correct Answer: C
Rationale: Tachycardia and hypotension suggest hypovolemic shock from third-spacing
and hemorrhage—life-threatening complications. Pain and fever are expected; amylase
levels do not correlate with severity. Rapid fluid resuscitation is critical.
A client with a subtotal thyroidectomy develops tingling in fingers and facial muscle
spasms when the blood-pressure cuff is inflated. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hypermagnesemia
6. D. Hypernatremia
Correct Answer: B
Rationale: Tetany and Trousseau sign indicate hypocalcemia from inadvertent
parathyroid removal or injury. Calcium replacement is urgent to prevent laryngospasm.
Other electrolytes do not produce these neuromuscular signs.
A client with Guillain-Barré syndrome experiences progressive weakness and difficulty
swallowing. Which priority nursing intervention is essential?
A. Administer sedatives to decrease anxiety
B. Perform active-assist range-of-motion exercises
C. Monitor forced vital capacity q4h
7. D. Encourage clear-liquid diet to limit fatigue
Correct Answer: C
Rationale: Respiratory muscle weakness can precipitate acute respiratory failure; FVC <
20 mL/kg signals need for intubation. Sedatives depress respiration. Liquids increase
aspiration risk if swallowing is impaired. ROM is important but not life-saving.
, A post-operative cholecystectomy client suddenly becomes dyspneic and tachycardic.
SpO₂ is 86 % on 4 L NC. Which test will the provider order first?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
8. D. ABG
Correct Answer: A
Rationale: Chest X-ray is rapid, rules out pneumothorax, atelectasis, or pulmonary
edema, and guides further work-up. CT-PEA is definitive for PE but requires stable
patient and contrast. D-dimer is nonspecific post-op.
The nurse is caring for a client with a pulmonary embolism on heparin infusion. aPTT is
110 seconds (target 60–80). What is the priority action?
A. Stop the infusion for 1 hour and restart at lower dose
B. Obtain PT/INR stat
C. Give protamine sulfate
9. D. Increase rate to achieve therapeutic trough
Correct Answer: A
Rationale: A supratherapeutic aPTT increases bleeding risk; temporary holding and dose
reduction per protocol restore therapeutic range. Protamine is reserved for
life-threatening bleeding. PT/INR monitors warfarin, not heparin.
A client with liver cirrhosis develops abdominal distension and shortness of breath.
Paracentesis removes 6 L of fluid. Which post-procedure assessment is most critical?
A. Monitor BP and HR for hypotension
B. Check dressing for leakage
C. Encourage PO fluids to 3000 mL
10. D. Measure temperature q 4 h
Correct Answer: A
