Evolve Elsevier HESI Medical-Surgical Examination 2026| A Review of 260 Comprehensive Practice Multichoice Questions with Verified Answers and Rationales| Guaranteed Pass | (Brand New!!)

HESI Medical-Surgical Examination : Comprehensive Practice Test Bank with Answers and Rationales | Nursing Exit Exam Prep This premium study resource provides nursing students with a comprehensive collection of 260 meticulously crafted multiple-choice questions designed to mirror the actual Evolve Elsevier HESI Medical-Surgical Examination format. Each question is accompanied by verified answers and evidence-based rationales that explain not only why the correct answer is right, but also why the other options are incorrect—reinforcing critical thinking and clinical reasoning skills essential for exam success. Evolve Elsevier HESI Medical-Surgical Examination 2026| A Review of 260 Comprehensive Practice Multichoice Questions with Verified Answers and Rationales| Guaranteed Pass | (Brand New!!) ________________________________________ TABLE OF CONTENTS 1. Cardiovascular System Disorders (Questions 1-45) 2. Respiratory System Disorders (Questions 46-75) 3. Gastrointestinal System Disorders (Questions 76-110) 4. Renal and Urinary System Disorders (Questions 111-135) 5. Endocrine System Disorders (Questions 136-165) 6. Neurological System Disorders (Questions 166-190) 7. Musculoskeletal System Disorders (Questions 191-215) 8. Integumentary System Disorders (Questions 216-235) 9. Oncology and Hematology (Questions 236-260) 10. Immunological and Infectious Diseases (Questions 261-280) 11. Reproductive and Genitourinary Disorders (Questions 281-300) ________________________________________ INTRODUCTION This comprehensive HESI Medical-Surgical Examination preparation guide contains 300 multiple-choice questions with verified answers and detailed rationales based on the latest Evolve Elsevier curriculum for 2025. Each question is designed to test critical thinking, clinical judgment, and application of nursing knowledge in various healthcare scenarios. The questions are organized by body systems and cover the most frequently tested content areas in the HESI Med-Surg examination. Each question includes the correct answer, detailed rationale explaining why the answer is correct, and explanations of why the other options are incorrect. This resource is ideal for nursing students preparing for the HESI exit exam, NCLEX-RN, or course-specific medical-surgical nursing examinations. ________________________________________ SECTION 1: CARDIOVASCULAR SYSTEM DISORDERS 1. A 68-year-old male client with a history of hypertension is admitted with acute chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads V1-V4. Which intervention should the nurse implement first? A) Administer sublingual nitroglycerin B) Obtain cardiac enzyme levels C) Administer oxygen via nasal cannula D) Prepare for emergent percutaneous coronary intervention Answer: C) Administer oxygen via nasal cannula Rationale: The priority intervention for a client with suspected acute myocardial infarction (AMI) is to administer supplemental oxygen to increase oxygen delivery to the myocardium and prevent further ischemic damage. The client's symptoms and ECG changes are consistent with an anterior wall MI. While nitroglycerin, cardiac enzymes, and PCI are all important interventions, oxygen administration is the immediate priority to address tissue hypoxia. Nitroglycerin may be administered after oxygen, but it can cause hypotension in clients with right ventricular infarction. Cardiac enzymes confirm diagnosis but do not provide immediate treatment. PCI is a definitive treatment but requires preparation time. 2. A client with chronic heart failure is prescribed digoxin. Which assessment finding indicates the client may be experiencing digoxin toxicity? A) Heart rate of 72 beats per minute B) Serum potassium level of 4.2 mEq/L C) Yellow-green halos around visual fields D) Blood pressure of 138/86 mmHg Answer: C) Yellow-green halos around visual fields Rationale: Visual disturbances, particularly seeing yellow-green halos around objects (xanthopsia), are classic signs of digoxin toxicity. Other manifestations include nausea, vomiting, anorexia, bradycardia, and cardiac dysrhythmias. A heart rate of 72 bpm is within normal limits. A serum potassium of 4.2 mEq/L is also normal; hypokalemia (below 3.5 mEq/L) increases the risk of digoxin toxicity. The blood pressure of 138/86 mmHg is slightly elevated but does not indicate digoxin toxicity. 3. Which dietary instruction should the nurse provide to a client with hypertension who is prescribed a low-sodium diet? A) "Use salt substitutes freely to enhance flavor" B) "Avoid canned soups and processed meats" C) "Increase intake of dairy products" D) "Consume at least 3 servings of red meat weekly" Answer: B) "Avoid canned soups and processed meats" Rationale: Canned soups and processed meats contain high amounts of sodium as preservatives and should be avoided on a low-sodium diet. Salt substitutes often contain potassium chloride, which may be contraindicated in clients taking potassium-sparing diuretics or those with renal impairment. Dairy products are often high in sodium and should be limited. Red meat consumption should be limited, not increased, for clients with hypertension. 4. A client with atrial fibrillation is receiving warfarin therapy. Which laboratory value should the nurse monitor to evaluate the effectiveness of this medication? A) Platelet count B) Prothrombin time (PT) and International Normalized Ratio (INR) C) Activated partial thromboplastin time (aPTT) D) Bleeding time Answer: B) Prothrombin time (PT) and International Normalized Ratio (INR) Rationale: Warfarin therapy is monitored using PT and INR, with a therapeutic INR typically between 2.0 and 3.0 for atrial fibrillation. Platelet count monitors for thrombocytopenia but does not assess warfarin effectiveness. aPTT monitors heparin therapy, not warfarin. Bleeding time assesses platelet function and is not specific to warfarin therapy. 5. A client with heart failure is prescribed furosemide. Which electrolyte imbalance should the nurse anticipate and monitor for? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hypocalcemia Answer: B) Hypokalemia Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle, leading to increased potassium excretion. This can result in hypokalemia, which increases the risk of cardiac dysrhythmias, especially in clients also taking digoxin. Hyperkalemia is not associated with furosemide use; potassium-sparing diuretics can cause this. Hypernatremia may occur with dehydration but is not a direct effect. Hypocalcemia is not a primary concern with furosemide. 6. The nurse is assessing a client with peripheral arterial disease (PAD). Which finding is most characteristic of this condition? A) Bilateral lower extremity edema B) Intermittent claudication C) Brownish discoloration of the ankles D) Thickened, leathery skin on the lower legs Answer: B) Intermittent claudication Rationale: Intermittent claudication, or pain in the calf muscles during exercise that is relieved by rest, is a hallmark symptom of PAD caused by decreased arterial blood flow. Bilateral lower extremity edema is more characteristic of venous insufficiency or heart failure. Brownish discoloration of the ankles (hemosiderin deposition) and thickened, leathery skin are characteristic of chronic venous insufficiency, not arterial disease. 7. Which position is most appropriate for a client experiencing acute pulmonary edema? A) Supine with legs elevated B) High Fowler's position with legs dependent C) Left lateral recumbent position D) Trendelenburg position Answer: B) High Fowler's position with legs dependent Rationale: High Fowler's position with legs dependent reduces venous return to the heart (preload), decreasing pulmonary congestion and improving breathing. Supine with legs elevated increases venous return and would worsen pulmonary edema. Left lateral recumbent position is used for clients with suspected pulmonary embolism. Trendelenburg position increases venous return and would exacerbate pulmonary edema. 8. A client with coronary artery disease asks the nurse about the purpose of taking aspirin daily. What is the best response by the nurse? A) "Aspirin reduces your blood pressure to prevent heart attacks" B) "Aspirin prevents blood clots from forming in your arteries" C) "Aspirin lowers your cholesterol levels" D) "Aspirin reduces inflammation in your heart muscle" Answer: B) "Aspirin prevents blood clots from forming in your arteries" Rationale: Low-dose aspirin inhibits platelet aggregation, preventing the formation of thrombi in coronary arteries and reducing the risk of myocardial infarction and stroke. Aspirin does not significantly lower blood pressure (A), reduce cholesterol (C), or act as an anti-inflammatory for the heart muscle (D) in the same way as other medications. 9. The nurse is caring for a client immediately after cardiac catheterization via the femoral artery. Which assessment finding requires immediate intervention? A) Heart rate of 78 beats per minute B) Blood pressure of 130/80 mmHg C) Diminished pedal pulse on the affected side D) Urinary output of 60 mL in the last hour Answer: C) Diminished pedal pulse on the affected side Rationale: Diminished or absent pedal pulses on the affected side after femoral artery catheterization indicate possible arterial occlusion or thrombus formation, requiring immediate intervention to prevent tissue ischemia. A heart rate of 78 bpm is within normal limits. Blood pressure of 130/80 mmHg is acceptable. Urinary output of 60 mL in one hour is adequate (at least 30 mL/hour). 10. A client with varicose veins asks the nurse what she can do to prevent the condition from worsening. Which instruction is most appropriate? A) "Elevate your legs above heart level for 20 minutes, 3-4 times daily" B) "Cross your legs when sitting to improve circulation" C) "Wear knee-high socks to improve venous return" D) "Apply cold compresses to your legs to constrict the veins" Answer: A) "Elevate your legs above heart level for 20 minutes, 3-4 times daily" Rationale: Elevating the legs above heart level for 20 minutes, 3-4 times daily promotes venous return, reduces venous stasis, and decreases edema. Crossing legs impedes circulation and should be avoided. Knee-high socks do not provide adequate compression for varicose veins; graduated compression stockings that extend above the knee are recommended. Cold compresses would constrict veins but do not address the underlying venous insufficiency. 11. The nurse is providing discharge teaching to a client with heart failure. Which statement by the client indicates a need for further teaching? A) "I should weigh myself at the same time every morning" B) "I can stop taking my diuretic if I feel better" C) "I need to limit my sodium intake to less than 2 grams per day" D) "I should report any weight gain of 2-3 pounds in a day" Answer: B) "I can stop taking my diuretic if I feel better" Rationale: Stopping a diuretic without healthcare provider guidance is dangerous and can lead to fluid overload and worsening heart failure. Daily weights, sodium restriction, and reporting sudden weight gain (2-3 pounds in a day or 5 pounds in a week) are all appropriate self-management strategies for heart failure. 12. A client with a history of deep vein thrombosis (DVT) is prescribed heparin therapy. Which adverse effect should the nurse monitor for most closely? A) Hypotension B) Tachycardia C) Bleeding D) Hyperglycemia Answer: C) Bleeding Rationale: Heparin is an anticoagulant that increases the risk of bleeding, which is the most significant adverse effect to monitor. Hypotension and tachycardia may occur with severe bleeding but are not the primary effects. Hyperglycemia is not associated with heparin therapy. 13. A client is diagnosed with infective endocarditis. Which assessment finding is most consistent with this diagnosis? A) Splinter hemorrhages under the fingernails B) Wheezing on expiration C) Weight loss with decreased appetite D) Hypotension with tachycardia Answer: A) Splinter hemorrhages under the fingernails Rationale: Splinter hemorrhages (red-brown linear streaks under the fingernails) are characteristic findings in infective endocarditis, along with Janeway lesions, Osler's nodes, and Roth's spots. Wheezing is more consistent with respiratory conditions. Weight loss and decreased appetite are nonspecific findings. Hypotension with tachycardia is associated with many conditions, including sepsis and heart failure. 14. Which laboratory test is most specific for diagnosing a myocardial infarction? A) Serum potassium level B) Total cholesterol C) Troponin I D) White blood cell count Answer: C) Troponin I Rationale: Troponin I is a cardiac-specific protein released when myocardial damage occurs. It is the most sensitive and specific marker for myocardial infarction. Serum potassium is not specific to cardiac injury. Total cholesterol is a risk factor for coronary artery disease but does not diagnose MI. White blood cell count may be elevated with MI but is nonspecific. 15. The nurse is caring for a client with pericarditis. Which position should the nurse encourage to help relieve the client's chest pain? A) Supine with head elevated 30 degrees B) Sitting upright and leaning forward C) Left side-lying with knees flexed D) Trendelenburg position Answer: B) Sitting upright and leaning forward Rationale: Sitting upright and leaning forward relieves chest pain in pericarditis by reducing pressure on the pericardium and decreasing friction between the pericardial layers. Supine position often worsens pain by increasing pericardial friction. Left side-lying and Trendelenburg positions do not provide the same relief.