Evolve Elsevier HESI Med Surg Exam: (Latest
2026/2027 ) 70 Questions & Answers with Detailed
Rationales | Grade A
PREPARED FOR:
Evolve Elsevier HESI Medical-Surgical Examination
DOCUMENT INCLUDES:
● HESI-style exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Cardiovascular Disorders
● Respiratory Disorders
● Gastrointestinal Disorders
● Renal/Urinary Disorders
● Endocrine/Metabolic Disorders
● Neurological Disorders
● Musculoskeletal/Integumentary Disorders
● Hematological/Immunological Disorders
● Oncology
● Fluid & Electrolyte Imbalances
● Perioperative & Pain Management
● Infection Control & Emergency Care
SECTION 1: Cardiovascular Disorders
Question 1
,A patient with a history of heart failure is admitted with acute pulmonary edema. The
nurse auscultates loud, bubbly crackles bilaterally and notes pink, frothy sputum. Which
medication should the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Nitroglycerin
D. Dopamine
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts rapidly to reduce preload by promoting
venous dilation and diuresis, thereby relieving pulmonary congestion. In acute
pulmonary edema, reducing fluid overload is the immediate priority. Digoxin (option A)
is used for long-term heart rate control and contractility but does not act quickly enough
for acute pulmonary edema. Nitroglycerin (option C) reduces preload and afterload but
is typically used in conjunction with diuretics, not as the first-line agent for fluid
overload. Dopamine (option D) is a vasopressor used for hypotension and cardiogenic
shock, which is not the primary concern in this scenario.
Question 2
A patient with atrial fibrillation is started on warfarin therapy. The nurse knows that the
therapeutic international normalized ratio (INR) for this patient is:
A. 0.8 to 1.2
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.5 to 4.5
Correct Answer: C
,Rationale: For atrial fibrillation, the therapeutic INR range for warfarin therapy is 2.0 to
3.0. This range provides adequate anticoagulation to prevent thromboembolic stroke
while minimizing bleeding risk. An INR of 0.8 to 1.2 (option A) is within normal limits
and indicates no anticoagulant effect. An INR of 1.5 to 2.0 (option B) is subtherapeutic
for atrial fibrillation. An INR of 3.5 to 4.5 (option D) is supratherapeutic and increases
bleeding risk significantly.
Question 3
A patient is admitted with a myocardial infarction (MI) and is receiving tissue
plasminogen activator (tPA). Which nursing intervention is the highest priority during
tPA administration?
A. Monitor for reperfusion dysrhythmias
B. Assess neurologic status every 4 hours
C. Monitor blood pressure and watch for signs of bleeding
D. Obtain a 12-lead ECG every 30 minutes
Correct Answer: C
Rationale: tPA is a thrombolytic agent that carries a significant risk of bleeding,
including intracranial hemorrhage and systemic bleeding. The highest priority during
administration is vigilant monitoring of blood pressure and assessment for signs of
bleeding, such as gum bleeding, hematuria, or changes in neurologic status. While
reperfusion dysrhythmias (option A) and ECG monitoring (option D) are important,
bleeding is the most life-threatening complication. Neurologic assessment (option B) is
important but should be performed more frequently than every 4 hours during tPA
infusion.
Question 4
, A patient with hypertension is prescribed a beta-blocker. The nurse should teach the
patient to monitor for which adverse effect?
A. Dry cough
B. Hyperkalemia
C. Bradycardia
D. Gingival hyperplasia
Correct Answer: C
Rationale: Beta-blockers block beta-adrenergic receptors, which slows heart rate and
reduces myocardial oxygen demand. Bradycardia is a common and expected adverse
effect that patients should monitor for, along with fatigue, dizziness, and hypotension.
Dry cough (option A) is associated with ACE inhibitors. Hyperkalemia (option B) is more
commonly associated with ACE inhibitors, ARBs, and potassium-sparing diuretics.
Gingival hyperplasia (option D) is associated with calcium channel blockers such as
nifedipine.
Question 5
A patient with heart failure is receiving an angiotensin-converting enzyme (ACE)
inhibitor. The nurse should monitor for which potential complication?
A. Hypernatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
Correct Answer: B
Rationale: ACE inhibitors can cause hyperkalemia because they inhibit aldosterone
secretion, which normally promotes potassium excretion in the distal tubule. Patients
taking ACE inhibitors should have serum potassium levels monitored, especially if they
2026/2027 ) 70 Questions & Answers with Detailed
Rationales | Grade A
PREPARED FOR:
Evolve Elsevier HESI Medical-Surgical Examination
DOCUMENT INCLUDES:
● HESI-style exam questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Cardiovascular Disorders
● Respiratory Disorders
● Gastrointestinal Disorders
● Renal/Urinary Disorders
● Endocrine/Metabolic Disorders
● Neurological Disorders
● Musculoskeletal/Integumentary Disorders
● Hematological/Immunological Disorders
● Oncology
● Fluid & Electrolyte Imbalances
● Perioperative & Pain Management
● Infection Control & Emergency Care
SECTION 1: Cardiovascular Disorders
Question 1
,A patient with a history of heart failure is admitted with acute pulmonary edema. The
nurse auscultates loud, bubbly crackles bilaterally and notes pink, frothy sputum. Which
medication should the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Nitroglycerin
D. Dopamine
Correct Answer: B
Rationale: Furosemide is a loop diuretic that acts rapidly to reduce preload by promoting
venous dilation and diuresis, thereby relieving pulmonary congestion. In acute
pulmonary edema, reducing fluid overload is the immediate priority. Digoxin (option A)
is used for long-term heart rate control and contractility but does not act quickly enough
for acute pulmonary edema. Nitroglycerin (option C) reduces preload and afterload but
is typically used in conjunction with diuretics, not as the first-line agent for fluid
overload. Dopamine (option D) is a vasopressor used for hypotension and cardiogenic
shock, which is not the primary concern in this scenario.
Question 2
A patient with atrial fibrillation is started on warfarin therapy. The nurse knows that the
therapeutic international normalized ratio (INR) for this patient is:
A. 0.8 to 1.2
B. 1.5 to 2.0
C. 2.0 to 3.0
D. 3.5 to 4.5
Correct Answer: C
,Rationale: For atrial fibrillation, the therapeutic INR range for warfarin therapy is 2.0 to
3.0. This range provides adequate anticoagulation to prevent thromboembolic stroke
while minimizing bleeding risk. An INR of 0.8 to 1.2 (option A) is within normal limits
and indicates no anticoagulant effect. An INR of 1.5 to 2.0 (option B) is subtherapeutic
for atrial fibrillation. An INR of 3.5 to 4.5 (option D) is supratherapeutic and increases
bleeding risk significantly.
Question 3
A patient is admitted with a myocardial infarction (MI) and is receiving tissue
plasminogen activator (tPA). Which nursing intervention is the highest priority during
tPA administration?
A. Monitor for reperfusion dysrhythmias
B. Assess neurologic status every 4 hours
C. Monitor blood pressure and watch for signs of bleeding
D. Obtain a 12-lead ECG every 30 minutes
Correct Answer: C
Rationale: tPA is a thrombolytic agent that carries a significant risk of bleeding,
including intracranial hemorrhage and systemic bleeding. The highest priority during
administration is vigilant monitoring of blood pressure and assessment for signs of
bleeding, such as gum bleeding, hematuria, or changes in neurologic status. While
reperfusion dysrhythmias (option A) and ECG monitoring (option D) are important,
bleeding is the most life-threatening complication. Neurologic assessment (option B) is
important but should be performed more frequently than every 4 hours during tPA
infusion.
Question 4
, A patient with hypertension is prescribed a beta-blocker. The nurse should teach the
patient to monitor for which adverse effect?
A. Dry cough
B. Hyperkalemia
C. Bradycardia
D. Gingival hyperplasia
Correct Answer: C
Rationale: Beta-blockers block beta-adrenergic receptors, which slows heart rate and
reduces myocardial oxygen demand. Bradycardia is a common and expected adverse
effect that patients should monitor for, along with fatigue, dizziness, and hypotension.
Dry cough (option A) is associated with ACE inhibitors. Hyperkalemia (option B) is more
commonly associated with ACE inhibitors, ARBs, and potassium-sparing diuretics.
Gingival hyperplasia (option D) is associated with calcium channel blockers such as
nifedipine.
Question 5
A patient with heart failure is receiving an angiotensin-converting enzyme (ACE)
inhibitor. The nurse should monitor for which potential complication?
A. Hypernatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
Correct Answer: B
Rationale: ACE inhibitors can cause hyperkalemia because they inhibit aldosterone
secretion, which normally promotes potassium excretion in the distal tubule. Patients
taking ACE inhibitors should have serum potassium levels monitored, especially if they
