EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM 150 Real Exam Questions with Correct
Answers & Well-Elaborated Rationales HESI
Medical-Surgical Latest Exam 2025 (BRAND
NEW!!)
Question 1
A 68-year-old male with heart failure (HFrEF) is admitted with worsening dyspnea, orthopnea,
and 3+ pitting edema in both legs. He has crackles halfway up his lung fields. His current
medications include lisinopril, carvedilol, and furosemide. Which assessment finding is the best
indicator that his treatment is effective?
A) Daily weight decrease of 2 kg over 24 hours
B) Blood pressure 110/70 mmHg
C) Serum potassium 4.2 mEq/L
D) Urine output of 30 mL/hour
Correct Answer: A
Rationale: In acute decompensated heart failure, daily weight is the most accurate indicator of
fluid status. A weight loss of 1-2 kg/day safely reflects diuresis. Option B (BP) is important but
not the best indicator of decongestion. Option C (potassium) is within normal range but doesn't
reflect fluid removal. Option D (30 mL/hr) is minimal acceptable output but doesn't directly
indicate overall fluid loss.
Question 2
A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss,
and a persistent cough. Chest X-ray reveals a right hilar mass with mediastinal
lymphadenopathy. Which diagnostic test is most definitive for confirming the diagnosis?
A) CT scan of the chest
B) PET scan
C) Bronchoscopy with biopsy
,D) Sputum cytology
Correct Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic confirmation, which is the
gold standard for lung cancer diagnosis. CT and PET scans help with staging but are not
definitive. Sputum cytology has low sensitivity (especially for peripheral lesions).
Question 3
A nurse is caring for a patient with acute pancreatitis. Which laboratory finding is most specific
for this diagnosis?
A) Elevated WBC count
B) Elevated serum amylase
C) Elevated serum lipase
D) Elevated liver function tests
Correct Answer: C
Rationale: Serum lipase is more specific and remains elevated longer than amylase in acute
pancreatitis. Amylase can be elevated in other conditions (parotitis, intestinal obstruction). WBC
is nonspecific. LFT elevation may suggest biliary etiology but is not diagnostic for pancreatitis.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88%
on room air. The nurse administers oxygen via nasal cannula. Which target SpO2 range is
appropriate for this patient?
A) 94-98%
B) 90-92%
C) 88-92%
D) 85-89%
Correct Answer: C
Rationale: For COPD patients with chronic hypercapnia, the target SpO2 is 88-92% to avoid
suppressing the hypoxic respiratory drive and causing CO2 retention, respiratory acidosis, and
worsening hypercapnia.
Question 5
A 72-year-old female with a history of atrial fibrillation is started on warfarin. The INR result is
4.5. The patient has no signs of bleeding. What is the most appropriate nursing action?
A) Administer vitamin K immediately
,B) Hold the next dose of warfarin and notify the provider
C) Continue warfarin as prescribed
D) Administer fresh frozen plasma
Correct Answer: B
Rationale: For an asymptomatic patient with INR between 4.5 and 10 without bleeding, the
recommended action is to hold warfarin. Vitamin K is reserved for INR >10 or active bleeding.
FFP is for life-threatening bleeding or need for emergent reversal.
Question 6
A patient with type 1 diabetes mellitus is found unconscious. The nurse checks a bedside
glucose, which reads "LO" (less than 20 mg/dL). Which intervention should the nurse implement
FIRST?
A) Administer glucagon 1 mg IM
B) Start an IV and give 50 mL of D50W (dextrose 50%)
C) Give orange juice orally
D) Re-check glucose with a different meter
Correct Answer: B
Rationale: For an unconscious patient with severe hypoglycemia, IV dextrose (D50W) is the
fastest and most effective treatment. Glucagon IM is an alternative if IV access is not available.
Oral glucose is contraindicated in an unconscious patient due to aspiration risk.
Question 7
A patient is 6 hours post right total knee arthroplasty. Which finding requires immediate
intervention by the nurse?
A) Pain rated 6/10 on a 0-10 scale
B) Urine output of 40 mL in the last 2 hours
C) Oxygen saturation of 94% on room air
D) Sudden shortness of breath and chest pain
Correct Answer: D
Rationale: Sudden shortness of breath and chest pain after orthopedic surgery are classic signs
of pulmonary embolism (PE), a life-threatening complication requiring immediate intervention
(oxygen, assessment, notify provider, prepare for diagnostic testing).
Question 8
, A patient with cirrhosis has ascites and is receiving furosemide and spironolactone. Which
assessment finding is most concerning?
A) Weight loss of 1.5 kg in 24 hours
B) Serum potassium 3.8 mEq/L
C) Abdominal girth decreased by 3 cm
D) Patient complains of muscle cramps
Correct Answer: A
Rationale: Weight loss >1 kg/day in a patient with cirrhosis and ascites on diuretics suggests
excessive diuresis, which can lead to hypovolemia, prerenal azotemia, and hepatorenal
syndrome. Maximum safe weight loss is 0.5-1 kg/day (or up to 1 kg/day with peripheral edema).
Question 9
A 45-year-old male with a history of seizures is admitted after a generalized tonic-clonic seizure
that lasted 4 minutes. He is postictal but arousable. His vital signs are stable. Which medication
should the nurse anticipate administering?
A) IV lorazepam (Ativan)
B) IV fosphenytoin (Cerebyx)
C) Oral levetiracetam (Keppra)
D) No immediate medication unless seizure recurs
Correct Answer: D
Rationale: A single seizure lasting less than 5 minutes without status epilepticus typically does
not require acute benzodiazepine treatment if the patient is recovering. Antiepileptic loading
(fosphenytoin) is for status epilepticus or recurrent seizures. Observation and prevention of
injury are priorities.
Question 10
A patient with chronic kidney disease stage 4 (eGFR 25 mL/min) is prescribed metformin for
type 2 diabetes. What is the nurse's best action?
A) Administer the medication as ordered
B) Hold the medication and contact the provider
C) Give half the ordered dose
D) Give the medication with a full glass of water
Correct Answer: B
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min due to the risk of
lactic acidosis. The nurse should hold the medication and notify the provider for an alternative
antidiabetic agent (e.g., insulin or a medication not renally cleared).
EXAM 150 Real Exam Questions with Correct
Answers & Well-Elaborated Rationales HESI
Medical-Surgical Latest Exam 2025 (BRAND
NEW!!)
Question 1
A 68-year-old male with heart failure (HFrEF) is admitted with worsening dyspnea, orthopnea,
and 3+ pitting edema in both legs. He has crackles halfway up his lung fields. His current
medications include lisinopril, carvedilol, and furosemide. Which assessment finding is the best
indicator that his treatment is effective?
A) Daily weight decrease of 2 kg over 24 hours
B) Blood pressure 110/70 mmHg
C) Serum potassium 4.2 mEq/L
D) Urine output of 30 mL/hour
Correct Answer: A
Rationale: In acute decompensated heart failure, daily weight is the most accurate indicator of
fluid status. A weight loss of 1-2 kg/day safely reflects diuresis. Option B (BP) is important but
not the best indicator of decongestion. Option C (potassium) is within normal range but doesn't
reflect fluid removal. Option D (30 mL/hr) is minimal acceptable output but doesn't directly
indicate overall fluid loss.
Question 2
A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss,
and a persistent cough. Chest X-ray reveals a right hilar mass with mediastinal
lymphadenopathy. Which diagnostic test is most definitive for confirming the diagnosis?
A) CT scan of the chest
B) PET scan
C) Bronchoscopy with biopsy
,D) Sputum cytology
Correct Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic confirmation, which is the
gold standard for lung cancer diagnosis. CT and PET scans help with staging but are not
definitive. Sputum cytology has low sensitivity (especially for peripheral lesions).
Question 3
A nurse is caring for a patient with acute pancreatitis. Which laboratory finding is most specific
for this diagnosis?
A) Elevated WBC count
B) Elevated serum amylase
C) Elevated serum lipase
D) Elevated liver function tests
Correct Answer: C
Rationale: Serum lipase is more specific and remains elevated longer than amylase in acute
pancreatitis. Amylase can be elevated in other conditions (parotitis, intestinal obstruction). WBC
is nonspecific. LFT elevation may suggest biliary etiology but is not diagnostic for pancreatitis.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88%
on room air. The nurse administers oxygen via nasal cannula. Which target SpO2 range is
appropriate for this patient?
A) 94-98%
B) 90-92%
C) 88-92%
D) 85-89%
Correct Answer: C
Rationale: For COPD patients with chronic hypercapnia, the target SpO2 is 88-92% to avoid
suppressing the hypoxic respiratory drive and causing CO2 retention, respiratory acidosis, and
worsening hypercapnia.
Question 5
A 72-year-old female with a history of atrial fibrillation is started on warfarin. The INR result is
4.5. The patient has no signs of bleeding. What is the most appropriate nursing action?
A) Administer vitamin K immediately
,B) Hold the next dose of warfarin and notify the provider
C) Continue warfarin as prescribed
D) Administer fresh frozen plasma
Correct Answer: B
Rationale: For an asymptomatic patient with INR between 4.5 and 10 without bleeding, the
recommended action is to hold warfarin. Vitamin K is reserved for INR >10 or active bleeding.
FFP is for life-threatening bleeding or need for emergent reversal.
Question 6
A patient with type 1 diabetes mellitus is found unconscious. The nurse checks a bedside
glucose, which reads "LO" (less than 20 mg/dL). Which intervention should the nurse implement
FIRST?
A) Administer glucagon 1 mg IM
B) Start an IV and give 50 mL of D50W (dextrose 50%)
C) Give orange juice orally
D) Re-check glucose with a different meter
Correct Answer: B
Rationale: For an unconscious patient with severe hypoglycemia, IV dextrose (D50W) is the
fastest and most effective treatment. Glucagon IM is an alternative if IV access is not available.
Oral glucose is contraindicated in an unconscious patient due to aspiration risk.
Question 7
A patient is 6 hours post right total knee arthroplasty. Which finding requires immediate
intervention by the nurse?
A) Pain rated 6/10 on a 0-10 scale
B) Urine output of 40 mL in the last 2 hours
C) Oxygen saturation of 94% on room air
D) Sudden shortness of breath and chest pain
Correct Answer: D
Rationale: Sudden shortness of breath and chest pain after orthopedic surgery are classic signs
of pulmonary embolism (PE), a life-threatening complication requiring immediate intervention
(oxygen, assessment, notify provider, prepare for diagnostic testing).
Question 8
, A patient with cirrhosis has ascites and is receiving furosemide and spironolactone. Which
assessment finding is most concerning?
A) Weight loss of 1.5 kg in 24 hours
B) Serum potassium 3.8 mEq/L
C) Abdominal girth decreased by 3 cm
D) Patient complains of muscle cramps
Correct Answer: A
Rationale: Weight loss >1 kg/day in a patient with cirrhosis and ascites on diuretics suggests
excessive diuresis, which can lead to hypovolemia, prerenal azotemia, and hepatorenal
syndrome. Maximum safe weight loss is 0.5-1 kg/day (or up to 1 kg/day with peripheral edema).
Question 9
A 45-year-old male with a history of seizures is admitted after a generalized tonic-clonic seizure
that lasted 4 minutes. He is postictal but arousable. His vital signs are stable. Which medication
should the nurse anticipate administering?
A) IV lorazepam (Ativan)
B) IV fosphenytoin (Cerebyx)
C) Oral levetiracetam (Keppra)
D) No immediate medication unless seizure recurs
Correct Answer: D
Rationale: A single seizure lasting less than 5 minutes without status epilepticus typically does
not require acute benzodiazepine treatment if the patient is recovering. Antiepileptic loading
(fosphenytoin) is for status epilepticus or recurrent seizures. Observation and prevention of
injury are priorities.
Question 10
A patient with chronic kidney disease stage 4 (eGFR 25 mL/min) is prescribed metformin for
type 2 diabetes. What is the nurse's best action?
A) Administer the medication as ordered
B) Hold the medication and contact the provider
C) Give half the ordered dose
D) Give the medication with a full glass of water
Correct Answer: B
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min due to the risk of
lactic acidosis. The nurse should hold the medication and notify the provider for an alternative
antidiabetic agent (e.g., insulin or a medication not renally cleared).
