Elsevier Evolve HESI Med-Surg Practice Test Bank |
Verified Questions & Explanations) / HESI Medical-Surgical
Exam Study Guide: Real Exam Q&As & Rationales LATEST
UPDATE THIS YEAR.pdf
Overview & Coverage
Pass your Evolve Elsevier HESI Medical-Surgical Exam on your very first attempt!
The HESI Med-Surg exam is notorious for testing high-tier clinical reasoning,
prioritization, and safety delegation using tricky, NCLEX-style application questions.
This comprehensive, high-yield test bank contains 100 realistic practice questions
mapped directly to the actual test blueprint and core nursing frameworks (ABCs,
Maslow’s Hierarchy, and nursing process).
Stop wasting hours highlighting hundreds of pages of textbook chapters. This guide
trains your brain to break down complex medical-surgical scenarios, spot life-
threatening complications early, and select the correct option with absolute confidence.
Comprehensive Exam Coverage
This 100-question review leaves zero gaps in your preparation, testing you thoroughly
on:
Cardiovascular & Hematology: Myocardial Infarction, Angina vs. Acute Coronary
Syndrome, Left vs. Right Heart Failure, Atrial Fibrillation/Flutter, Pacemaker Safety,
DVT prophylaxis, and Blood Transfusion Reaction protocols.
Respiratory System: Pulmonary Embolism stabilization, acute COPD exacerbations,
precise oxygen delivery (Venturi masks), Pneumothorax management, and Chest Tube
Troubleshooting (tidaling vs. active air leaks).
Gastrointestinal & Hepatic: Acute Pancreatitis positioning, Cirrhosis/Hepatic
Encephalopathy (Ammonia tracking), Esophageal Varices emergency (Octreotide),
Appendicitis vs. Peritonitis (rigid, board-like abdomen), and tube feeding residuals.
Renal & Urinary: Chronic Kidney Disease (CKD), life-threatening Hyperkalemia
protocols, Hemodialysis AV Fistula assessments (bruit/thrill), Continuous Bladder
Irrigation (CBI) troubleshooting after a TURP, and post-renal biopsy hemorrhage
prevention.
, Endocrine & Metabolic: Diabetic Ketoacidosis (DKA) fluid resuscitation, hypoglycemia
rescue, SIADH vs. Diabetes Insipidus lab indicators, Addisonian Crisis avoidance,
Cushing's Syndrome hallmarks, and Hyperthyroidism vs. Hypothyroidism dosing.
Neurological System: Traumatic Brain Injury & Cushing's Triad (IICP), Meningitis
indicators (Kernig's and Brudzinski's signs), Tonic-Clonic Seizure interventions,
Autonomic Dysreflexia emergency protocols (T6 injuries), Stroke/tPA contraindications,
Guillain-Barré, and Myasthenia Gravis testing.
Musculoskeletal & Integumentary: Compartment Syndrome "6 Ps" emergency, Fat
Embolism Syndrome indicators, Skeletal Traction maintenance, total hip arthroplasty
positioning, Parkland Burn Formula calculations, and fluid shifting shock.
Acid-Base Balances & Electrolytes: Breaking down complex ABG values
(Metabolic/Respiratory Acidosis & Alkalosis), Hypocalcemia (Chvostek's sign after a
thyroidectomy), and hyperphosphatemia binders.
Disclaimer: This study guide is an independent student-created educational tool
designed to help you review medical-surgical nursing concepts. It is not officially
affiliated with, endorsed by, or a direct copy of Elsevier or proctored Evolve HESI testing
systems.
1. A nurse evaluates a client with a history of deep vein thrombosis (DVT) who
suddenly reports sharp chest pain and severe shortness of breath. Which action
should the nurse implement first?
o A) Obtain a 12-lead electrocardiogram (ECG)
o B) Administer high-flow supplemental oxygen therapy
o C) Initiate an intravenous heparin infusion line
o D) Prepare the client for a chest computed tomography (CT) scan
o Rationale: The client's symptoms indicate a life-threatening pulmonary
embolism (PE). Applying the ABCs (Airway, Breathing, Circulation), the
, immediate nursing priority is stabilizing oxygenation before initiating
diagnostic tests or secondary therapies.
2. A client is admitted to the emergency department in diabetic ketoacidosis (DKA). The
nurse establishes an intravenous line. Which fluid solution should the nurse expect
to infuse initially?
o A) 5% Dextrose in 0.45% Normal Saline
o B) 5% Dextrose in Water (D5W)
o C) 0.9% Sodium Chloride (Normal Saline)
o D) 3% Hypertonic Saline Solution
o Rationale: Severe dehydration occurs in DKA due to osmotic diuresis.
Initial fluid therapy focuses on expanding extracellular fluid volume and
restoring intravascular perfusion using an isotonic solution like 0.9% Normal
Saline.
3. While monitoring a client's electrocardiogram (ECG) monitor telemetry, the nurse
observes a sawtooth baseline pattern with a rapid atrial rate. The nurse identifies this
rhythm as:
o A) Ventricular Fibrillation
o B) Atrial Fibrillation
o C) Atrial Flutter
o D) Premature Ventricular Contractions
o Rationale: A distinctive "sawtooth" pattern of waves on an ECG strip is
the classic diagnostic indicator of atrial flutter.
, 4. A nurse assesses a client returning from a thyroidectomy. The client exhibits muscle
twitching, a positive Chvostek's sign, and reports tingling around the lips. Which
laboratory value requires immediate evaluation?
o A) Serum Potassium 3.2 mEq/L
o B) Serum Calcium 6.8 mg/dL
o C) Serum Sodium 132 mEq/L
o D) Serum Magnesium 1.2 mEq/L
o Rationale: Accidental damage or removal of the parathyroid glands during
a thyroidectomy can trigger severe hypocalcemia (normal: 9.0–10.5 mg/dL).
Signs include neuromusculoskeletal irritability, circumoral paresthesia, and
Chvostek's sign.
5. A client with chronic kidney disease (CKD) presents with an elevated serum
potassium level of 6.5 mEq/L. Which medication order should the nurse expect to
administer first to rapidly protect the myocardium?
o A) Oral Sodium Polystyrene Sulfonate
o B) Intravenous Calcium Gluconate
o C) Intravenous Regular Insulin and Dextrose
o D) Oral Furosemide Loop Diuretic
o Rationale: While insulin and sodium polystyrene sulfonate lower
potassium levels, intravenous calcium gluconate is given first in severe
hyperkalemia to stabilize the myocardial cell membrane and prevent lethal
arrhythmias.
Verified Questions & Explanations) / HESI Medical-Surgical
Exam Study Guide: Real Exam Q&As & Rationales LATEST
UPDATE THIS YEAR.pdf
Overview & Coverage
Pass your Evolve Elsevier HESI Medical-Surgical Exam on your very first attempt!
The HESI Med-Surg exam is notorious for testing high-tier clinical reasoning,
prioritization, and safety delegation using tricky, NCLEX-style application questions.
This comprehensive, high-yield test bank contains 100 realistic practice questions
mapped directly to the actual test blueprint and core nursing frameworks (ABCs,
Maslow’s Hierarchy, and nursing process).
Stop wasting hours highlighting hundreds of pages of textbook chapters. This guide
trains your brain to break down complex medical-surgical scenarios, spot life-
threatening complications early, and select the correct option with absolute confidence.
Comprehensive Exam Coverage
This 100-question review leaves zero gaps in your preparation, testing you thoroughly
on:
Cardiovascular & Hematology: Myocardial Infarction, Angina vs. Acute Coronary
Syndrome, Left vs. Right Heart Failure, Atrial Fibrillation/Flutter, Pacemaker Safety,
DVT prophylaxis, and Blood Transfusion Reaction protocols.
Respiratory System: Pulmonary Embolism stabilization, acute COPD exacerbations,
precise oxygen delivery (Venturi masks), Pneumothorax management, and Chest Tube
Troubleshooting (tidaling vs. active air leaks).
Gastrointestinal & Hepatic: Acute Pancreatitis positioning, Cirrhosis/Hepatic
Encephalopathy (Ammonia tracking), Esophageal Varices emergency (Octreotide),
Appendicitis vs. Peritonitis (rigid, board-like abdomen), and tube feeding residuals.
Renal & Urinary: Chronic Kidney Disease (CKD), life-threatening Hyperkalemia
protocols, Hemodialysis AV Fistula assessments (bruit/thrill), Continuous Bladder
Irrigation (CBI) troubleshooting after a TURP, and post-renal biopsy hemorrhage
prevention.
, Endocrine & Metabolic: Diabetic Ketoacidosis (DKA) fluid resuscitation, hypoglycemia
rescue, SIADH vs. Diabetes Insipidus lab indicators, Addisonian Crisis avoidance,
Cushing's Syndrome hallmarks, and Hyperthyroidism vs. Hypothyroidism dosing.
Neurological System: Traumatic Brain Injury & Cushing's Triad (IICP), Meningitis
indicators (Kernig's and Brudzinski's signs), Tonic-Clonic Seizure interventions,
Autonomic Dysreflexia emergency protocols (T6 injuries), Stroke/tPA contraindications,
Guillain-Barré, and Myasthenia Gravis testing.
Musculoskeletal & Integumentary: Compartment Syndrome "6 Ps" emergency, Fat
Embolism Syndrome indicators, Skeletal Traction maintenance, total hip arthroplasty
positioning, Parkland Burn Formula calculations, and fluid shifting shock.
Acid-Base Balances & Electrolytes: Breaking down complex ABG values
(Metabolic/Respiratory Acidosis & Alkalosis), Hypocalcemia (Chvostek's sign after a
thyroidectomy), and hyperphosphatemia binders.
Disclaimer: This study guide is an independent student-created educational tool
designed to help you review medical-surgical nursing concepts. It is not officially
affiliated with, endorsed by, or a direct copy of Elsevier or proctored Evolve HESI testing
systems.
1. A nurse evaluates a client with a history of deep vein thrombosis (DVT) who
suddenly reports sharp chest pain and severe shortness of breath. Which action
should the nurse implement first?
o A) Obtain a 12-lead electrocardiogram (ECG)
o B) Administer high-flow supplemental oxygen therapy
o C) Initiate an intravenous heparin infusion line
o D) Prepare the client for a chest computed tomography (CT) scan
o Rationale: The client's symptoms indicate a life-threatening pulmonary
embolism (PE). Applying the ABCs (Airway, Breathing, Circulation), the
, immediate nursing priority is stabilizing oxygenation before initiating
diagnostic tests or secondary therapies.
2. A client is admitted to the emergency department in diabetic ketoacidosis (DKA). The
nurse establishes an intravenous line. Which fluid solution should the nurse expect
to infuse initially?
o A) 5% Dextrose in 0.45% Normal Saline
o B) 5% Dextrose in Water (D5W)
o C) 0.9% Sodium Chloride (Normal Saline)
o D) 3% Hypertonic Saline Solution
o Rationale: Severe dehydration occurs in DKA due to osmotic diuresis.
Initial fluid therapy focuses on expanding extracellular fluid volume and
restoring intravascular perfusion using an isotonic solution like 0.9% Normal
Saline.
3. While monitoring a client's electrocardiogram (ECG) monitor telemetry, the nurse
observes a sawtooth baseline pattern with a rapid atrial rate. The nurse identifies this
rhythm as:
o A) Ventricular Fibrillation
o B) Atrial Fibrillation
o C) Atrial Flutter
o D) Premature Ventricular Contractions
o Rationale: A distinctive "sawtooth" pattern of waves on an ECG strip is
the classic diagnostic indicator of atrial flutter.
, 4. A nurse assesses a client returning from a thyroidectomy. The client exhibits muscle
twitching, a positive Chvostek's sign, and reports tingling around the lips. Which
laboratory value requires immediate evaluation?
o A) Serum Potassium 3.2 mEq/L
o B) Serum Calcium 6.8 mg/dL
o C) Serum Sodium 132 mEq/L
o D) Serum Magnesium 1.2 mEq/L
o Rationale: Accidental damage or removal of the parathyroid glands during
a thyroidectomy can trigger severe hypocalcemia (normal: 9.0–10.5 mg/dL).
Signs include neuromusculoskeletal irritability, circumoral paresthesia, and
Chvostek's sign.
5. A client with chronic kidney disease (CKD) presents with an elevated serum
potassium level of 6.5 mEq/L. Which medication order should the nurse expect to
administer first to rapidly protect the myocardium?
o A) Oral Sodium Polystyrene Sulfonate
o B) Intravenous Calcium Gluconate
o C) Intravenous Regular Insulin and Dextrose
o D) Oral Furosemide Loop Diuretic
o Rationale: While insulin and sodium polystyrene sulfonate lower
potassium levels, intravenous calcium gluconate is given first in severe
hyperkalemia to stabilize the myocardial cell membrane and prevent lethal
arrhythmias.
