EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM
2026/2027 | 150 Real Questions and Correct Answers with
Well-Elaborated Rationales | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular (20 Questions)
Q1: A client with chronic heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding requires immediate nursing intervention?
A. Weight gain of 2 pounds over 3 days
B. Potassium level of 3.2 mEq/L
C. Blood pressure of 142/88 mmHg
D. Crackles in bilateral lung bases
Correct Answer: B
Rationale: A potassium level of 3.2 mEq/L indicates moderate hypokalemia (normal
3.5-5.0 mEq/L) and requires immediate intervention. Furosemide is a loop diuretic that
causes potassium wasting in the kidneys, leading to hypokalemia. Severe hypokalemia
can precipitate life-threatening cardiac dysrhythmias, including ventricular tachycardia
and fibrillation. The nurse should notify the provider immediately for potassium
replacement therapy.
Why other options are incorrect: Weight gain of 2 pounds (A) indicates fluid retention
but is not immediately life-threatening; it requires monitoring and possible diuretic
adjustment. Blood pressure 142/88 mmHg (C) is elevated but stable for a heart failure
client; immediate intervention isn't required unless systolic exceeds 180 or diastolic
exceeds 110. Crackles in lung bases (D) indicate pulmonary congestion common in
heart failure; while requiring documentation and monitoring, this chronic finding doesn't
demand immediate action like critical electrolyte imbalance. Priority framework: Use
,ABCs and safety—electrolyte imbalances threatening cardiac stability take precedence
over chronic condition management.
Q2: A client with atrial fibrillation is prescribed warfarin 5 mg daily. Which laboratory
value indicates the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT) of 35 seconds
B. International Normalized Ratio (INR) of 2.5
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 250,000/mm³
Correct Answer: B
Rationale: An INR of 2.5 is within the therapeutic range of 2.0-3.0 for atrial fibrillation.
Warfarin is a vitamin K antagonist that inhibits synthesis of clotting factors II, VII, IX, and
X. The INR standardizes PT results across laboratories, providing consistent monitoring.
This level indicates adequate anticoagulation to prevent thromboembolic stroke while
minimizing bleeding risk.
Why other options are incorrect: aPTT (A) monitors heparin therapy, not warfarin. PT of
12 seconds (C) is within normal range (11-13.5 seconds) and indicates subtherapeutic
warfarin effect—clients with a-fib require prolonged PT/elevated INR. Platelet count (D)
monitors platelet production and isn't affected by warfarin; warfarin affects clotting
factor synthesis, not platelet quantity. Clinical pearl: Always verify INR before
administering warfarin; hold dose and notify provider if INR >4.0 due to bleeding risk.
Q3: A client with acute myocardial infarction receives tissue plasminogen activator
(tPA). Which finding indicates a potential complication requiring immediate action?
A. Resolution of chest pain after 45 minutes
B. Bleeding from the IV insertion site
C. ST-segment elevation returning to baseline
D. Reperfusion dysrhythmias
,Correct Answer: B
Rationale: Bleeding from the IV site indicates potential hemorrhagic complication of
thrombolytic therapy. tPA converts plasminogen to plasmin, which lyses fibrin
clots—including not only the coronary thrombus but also hemostatic clots throughout
the body. Nurses must monitor for bleeding at all invasive sites, gums, urine, stool, and
neurological changes suggesting intracranial hemorrhage. Immediate pressure
application, protocol notification, and preparation to discontinue infusion are required.
Why other options are incorrect: Resolution of chest pain (A) and ST-segment return to
baseline (C) are desired therapeutic effects indicating successful reperfusion.
Reperfusion dysrhythmias (D)—accelerated idioventricular rhythm, PVCs—are common
and expected when blood flow returns to ischemic myocardium; these require
monitoring but not immediate intervention unless hemodynamically unstable. Safety
priority: Bleeding is the most dangerous complication of thrombolytics; intracranial
hemorrhage can be fatal.
Q4: A client with heart failure has a brain natriuretic peptide (BNP) level of 850 pg/mL.
How should the nurse interpret this result?
A. Within normal limits; no heart failure present
B. Mild elevation indicating compensated heart failure
C. Moderate elevation consistent with decompensated heart failure
D. Severe elevation requiring immediate intubation
Correct Answer: C
Rationale: BNP 850 pg/mL indicates moderate to severe decompensated heart failure
(normal <100 pg/mL; 100-400 mild; 400-1000 moderate; >1000 severe). BNP is released
by ventricular myocardium in response to stretch from volume overload. Elevated levels
correlate with ventricular dysfunction severity and prognosis. This client requires
aggressive diuretic therapy, hemodynamic monitoring, and possible hospitalization.
, Why other options are incorrect: Normal BNP (A) excludes heart failure with high
negative predictive value. Mild elevation (B) would show 100-400 pg/mL. While 850
pg/mL is serious, it doesn't automatically require intubation (D)—that decision depends
on respiratory status, oxygenation, and acid-base balance, not BNP alone. Clinical
correlation: BNP guides severity assessment and treatment intensity but must be
interpreted with clinical presentation; renal failure can falsely elevate BNP without heart
failure.
Q5: A nurse is caring for a client 2 hours post-cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Blood pressure 138/84 mmHg
B. Absent pedal pulse on the right foot
C. Small hematoma at insertion site measuring 2 cm
D. Client reports mild discomfort at insertion site (pain 2/10)
Correct Answer: B
Rationale: Absent pedal pulse on the catheterized limb indicates potential arterial
occlusion from thrombus formation, dissection, or hematoma compression. This is a
vascular emergency requiring immediate notification of the interventional cardiologist,
preparation for possible angiography, and assessment of the 6 Ps (pain, pallor,
pulselessness, paresthesia, paralysis, poikilothermia). Limb viability is at risk; delayed
intervention can cause permanent ischemic damage.
Why other options are incorrect: BP 138/84 (A) is acceptable post-procedure. Small 2
cm hematoma (C) is common and managed with pressure and observation unless
expanding. Mild discomfort (D) is expected; severe pain would indicate complications.
Priority framework: Circulation takes precedence—absent pulse represents acute limb
ischemia, a time-sensitive emergency.
2026/2027 | 150 Real Questions and Correct Answers with
Well-Elaborated Rationales | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular (20 Questions)
Q1: A client with chronic heart failure is receiving furosemide 40 mg IV daily. Which
assessment finding requires immediate nursing intervention?
A. Weight gain of 2 pounds over 3 days
B. Potassium level of 3.2 mEq/L
C. Blood pressure of 142/88 mmHg
D. Crackles in bilateral lung bases
Correct Answer: B
Rationale: A potassium level of 3.2 mEq/L indicates moderate hypokalemia (normal
3.5-5.0 mEq/L) and requires immediate intervention. Furosemide is a loop diuretic that
causes potassium wasting in the kidneys, leading to hypokalemia. Severe hypokalemia
can precipitate life-threatening cardiac dysrhythmias, including ventricular tachycardia
and fibrillation. The nurse should notify the provider immediately for potassium
replacement therapy.
Why other options are incorrect: Weight gain of 2 pounds (A) indicates fluid retention
but is not immediately life-threatening; it requires monitoring and possible diuretic
adjustment. Blood pressure 142/88 mmHg (C) is elevated but stable for a heart failure
client; immediate intervention isn't required unless systolic exceeds 180 or diastolic
exceeds 110. Crackles in lung bases (D) indicate pulmonary congestion common in
heart failure; while requiring documentation and monitoring, this chronic finding doesn't
demand immediate action like critical electrolyte imbalance. Priority framework: Use
,ABCs and safety—electrolyte imbalances threatening cardiac stability take precedence
over chronic condition management.
Q2: A client with atrial fibrillation is prescribed warfarin 5 mg daily. Which laboratory
value indicates the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT) of 35 seconds
B. International Normalized Ratio (INR) of 2.5
C. Prothrombin time (PT) of 12 seconds
D. Platelet count of 250,000/mm³
Correct Answer: B
Rationale: An INR of 2.5 is within the therapeutic range of 2.0-3.0 for atrial fibrillation.
Warfarin is a vitamin K antagonist that inhibits synthesis of clotting factors II, VII, IX, and
X. The INR standardizes PT results across laboratories, providing consistent monitoring.
This level indicates adequate anticoagulation to prevent thromboembolic stroke while
minimizing bleeding risk.
Why other options are incorrect: aPTT (A) monitors heparin therapy, not warfarin. PT of
12 seconds (C) is within normal range (11-13.5 seconds) and indicates subtherapeutic
warfarin effect—clients with a-fib require prolonged PT/elevated INR. Platelet count (D)
monitors platelet production and isn't affected by warfarin; warfarin affects clotting
factor synthesis, not platelet quantity. Clinical pearl: Always verify INR before
administering warfarin; hold dose and notify provider if INR >4.0 due to bleeding risk.
Q3: A client with acute myocardial infarction receives tissue plasminogen activator
(tPA). Which finding indicates a potential complication requiring immediate action?
A. Resolution of chest pain after 45 minutes
B. Bleeding from the IV insertion site
C. ST-segment elevation returning to baseline
D. Reperfusion dysrhythmias
,Correct Answer: B
Rationale: Bleeding from the IV site indicates potential hemorrhagic complication of
thrombolytic therapy. tPA converts plasminogen to plasmin, which lyses fibrin
clots—including not only the coronary thrombus but also hemostatic clots throughout
the body. Nurses must monitor for bleeding at all invasive sites, gums, urine, stool, and
neurological changes suggesting intracranial hemorrhage. Immediate pressure
application, protocol notification, and preparation to discontinue infusion are required.
Why other options are incorrect: Resolution of chest pain (A) and ST-segment return to
baseline (C) are desired therapeutic effects indicating successful reperfusion.
Reperfusion dysrhythmias (D)—accelerated idioventricular rhythm, PVCs—are common
and expected when blood flow returns to ischemic myocardium; these require
monitoring but not immediate intervention unless hemodynamically unstable. Safety
priority: Bleeding is the most dangerous complication of thrombolytics; intracranial
hemorrhage can be fatal.
Q4: A client with heart failure has a brain natriuretic peptide (BNP) level of 850 pg/mL.
How should the nurse interpret this result?
A. Within normal limits; no heart failure present
B. Mild elevation indicating compensated heart failure
C. Moderate elevation consistent with decompensated heart failure
D. Severe elevation requiring immediate intubation
Correct Answer: C
Rationale: BNP 850 pg/mL indicates moderate to severe decompensated heart failure
(normal <100 pg/mL; 100-400 mild; 400-1000 moderate; >1000 severe). BNP is released
by ventricular myocardium in response to stretch from volume overload. Elevated levels
correlate with ventricular dysfunction severity and prognosis. This client requires
aggressive diuretic therapy, hemodynamic monitoring, and possible hospitalization.
, Why other options are incorrect: Normal BNP (A) excludes heart failure with high
negative predictive value. Mild elevation (B) would show 100-400 pg/mL. While 850
pg/mL is serious, it doesn't automatically require intubation (D)—that decision depends
on respiratory status, oxygenation, and acid-base balance, not BNP alone. Clinical
correlation: BNP guides severity assessment and treatment intensity but must be
interpreted with clinical presentation; renal failure can falsely elevate BNP without heart
failure.
Q5: A nurse is caring for a client 2 hours post-cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Blood pressure 138/84 mmHg
B. Absent pedal pulse on the right foot
C. Small hematoma at insertion site measuring 2 cm
D. Client reports mild discomfort at insertion site (pain 2/10)
Correct Answer: B
Rationale: Absent pedal pulse on the catheterized limb indicates potential arterial
occlusion from thrombus formation, dissection, or hematoma compression. This is a
vascular emergency requiring immediate notification of the interventional cardiologist,
preparation for possible angiography, and assessment of the 6 Ps (pain, pallor,
pulselessness, paresthesia, paralysis, poikilothermia). Limb viability is at risk; delayed
intervention can cause permanent ischemic damage.
Why other options are incorrect: BP 138/84 (A) is acceptable post-procedure. Small 2
cm hematoma (C) is common and managed with pressure and observation unless
expanding. Mild discomfort (D) is expected; severe pain would indicate complications.
Priority framework: Circulation takes precedence—absent pulse represents acute limb
ischemia, a time-sensitive emergency.
