HESI Med Surg Exit Exam 2025/2026 - EVOLVE
Elsevier - 100+ NCLEX-Style Practice Questions
with ANSWERs & Rationales - Medical Surgical
Nursing Test Bank
Question 1
A 68-year-old client with heart failure is receiving digoxin 0.25 mg PO daily. Which morning serum result
requires the nurse to hold the dose?
A. K+ 3.8 mEq/L
B. Mg2+ 1.9 mg/dL
C. Ca2+ 9.2 mg/dL
D. Digoxin level 2.8 ng/mL
ANSWER: D
Rationale for Option A: Potassium level of 3.8 mEq/L is within normal range (3.5-5.0 mEq/L) and does
not require holding digoxin. While hypokalemia can increase digoxin toxicity risk, this level is acceptable.
Rationale for Option B: Magnesium level of 1.9 mg/dL is within normal range (1.7-2.2 mg/dL) and does
not contraindicate digoxin administration.
Rationale for Option C: Calcium level of 9.2 mg/dL is within normal range (8.5-10.5 mg/dL) and is not a
reason to hold digoxin.
Rationale for Option D: Digoxin level of 2.8 ng/mL exceeds the therapeutic range (0.5-0.8 ng/mL or up to
2.0 ng/mL in some labs). Levels >2 ng/mL indicate toxicity, requiring the nurse to hold the dose and
notify the provider immediately.
Question 2
Two hours after starting a unit of packed RBCs, a client reports flank pain and chills. What is the nurse's
first action?
A. Stop the transfusion
B. Take temperature
,C. Send remaining blood to lab
D. Start normal saline at KVO
ANSWER: A
Rationale for Option A: Stopping the transfusion immediately is the priority action when an acute
hemolytic reaction is suspected. This limits the antigen-antibody response and prevents further
complications.
Rationale for Option B: Taking temperature is important but not the first action. Assessment follows
intervention in emergency situations.
Rationale for Option C: Sending blood to the lab is necessary but occurs after stopping the transfusion
and maintaining patient safety.
Rationale for Option D: Starting normal saline is important to maintain IV access and blood pressure, but
stopping the offending agent (blood transfusion) must occur first.
Question 3
A client with COPD has the following arterial blood gas results: pH 7.32, PaCO2 58 mmHg, PaO2 60
mmHg, HCO3 28 mEq/L. How should the nurse interpret these results?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with full compensation
C. Respiratory alkalosis with no compensation
D. Metabolic alkalosis with partial compensation
ANSWER: A
Rationale for Option A: The pH is low (acidotic), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (compensation). This indicates respiratory acidosis with partial compensation, common in
COPD.
Rationale for Option B: Metabolic acidosis would show low HCO3, not elevated. The primary problem
here is respiratory (elevated PaCO2).
Rationale for Option C: Respiratory alkalosis would show low PaCO2 and elevated pH, opposite of these
findings.
Rationale for Option D: Metabolic alkalosis would show elevated HCO3 as the primary problem with
elevated pH, not the pattern seen here.
Question 4
The nurse is caring for a client 24 hours postoperative following abdominal surgery. Which assessment
finding requires immediate intervention?
A. Temperature 100.4°F (38°C)
,B. Absent bowel sounds
C. Urine output 25 mL/hr
D. Pain rating 6/10
ANSWER: C
Rationale for Option A: A temperature of 100.4°F in the first 24 hours post-op is common due to the
inflammatory response and does not require immediate intervention.
Rationale for Option B: Absent bowel sounds are expected within 24 hours after abdominal surgery.
Bowel function typically returns in 24-72 hours.
Rationale for Option C: Urine output of 25 mL/hr is below the minimum acceptable level of 30 mL/hr,
indicating possible hypovolemia, decreased cardiac output, or renal impairment requiring immediate
intervention.
Rationale for Option D: Pain rating of 6/10 requires intervention but is not immediately life-threatening.
Adequate pain management is important but urine output takes priority.
Question 5
A client with diabetes mellitus type 1 has a blood glucose level of 52 mg/dL. Which symptom would the
nurse expect to assess?
A. Polyuria and polydipsia
B. Diaphoresis and tremors
C. Kussmaul respirations
D. Fruity breath odor
ANSWER: B
Rationale for Option A: Polyuria and polydipsia are symptoms of hyperglycemia, not hypoglycemia.
These occur when blood glucose is elevated.
Rationale for Option B: Diaphoresis (sweating) and tremors are classic adrenergic symptoms of
hypoglycemia (blood glucose <70 mg/dL), caused by sympathetic nervous system activation.
Rationale for Option C: Kussmaul respirations (deep, rapid breathing) occur in diabetic ketoacidosis
(DKA), a complication of severe hyperglycemia, not hypoglycemia.
Rationale for Option D: Fruity breath odor is associated with DKA and hyperglycemia due to acetone
production, not hypoglycemia.
Question 6
The nurse is preparing to administer furosemide 40 mg IV push to a client with heart failure. Which
assessment is the priority before administration?
A. Lung sounds
, B. Blood pressure
C. Weight
D. Potassium level
ANSWER: B
Rationale for Option A: Assessing lung sounds is important for evaluating heart failure status but is not
the priority before giving furosemide.
Rationale for Option B: Blood pressure is the priority assessment before administering furosemide
because it can cause significant hypotension, especially with IV administration. The nurse must ensure
the BP is adequate before giving this potent diuretic.
Rationale for Option C: Weight is important for monitoring fluid status and diuretic effectiveness but is
not the priority before administration.
Rationale for Option D: Potassium level is important because furosemide causes potassium loss, but
checking BP takes priority for immediate safety before administration.
Question 7
A client is receiving heparin IV for deep vein thrombosis. The aPTT result is 98 seconds (control 30
seconds). What action should the nurse take?
A. Increase the heparin infusion rate
B. Continue the infusion as prescribed
C. Hold the heparin and notify the provider
D. Administer vitamin K
ANSWER: C
Rationale for Option A: Increasing the infusion would be dangerous as the aPTT is already
supratherapeutic, increasing bleeding risk.
Rationale for Option B: Continuing the infusion is unsafe because the aPTT is significantly elevated.
Therapeutic range is typically 1.5-2.5 times control (45-75 seconds for this client).
Rationale for Option C: The aPTT of 98 seconds is above therapeutic range (control 30 × 2.5 = 75 seconds
maximum), indicating excessive anticoagulation. The nurse should hold heparin and notify the provider
to prevent bleeding complications.
Rationale for Option D: Vitamin K is the antidote for warfarin, not heparin. Protamine sulfate is the
antidote for heparin.
Question 8
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates the chest tube is functioning properly?
Elsevier - 100+ NCLEX-Style Practice Questions
with ANSWERs & Rationales - Medical Surgical
Nursing Test Bank
Question 1
A 68-year-old client with heart failure is receiving digoxin 0.25 mg PO daily. Which morning serum result
requires the nurse to hold the dose?
A. K+ 3.8 mEq/L
B. Mg2+ 1.9 mg/dL
C. Ca2+ 9.2 mg/dL
D. Digoxin level 2.8 ng/mL
ANSWER: D
Rationale for Option A: Potassium level of 3.8 mEq/L is within normal range (3.5-5.0 mEq/L) and does
not require holding digoxin. While hypokalemia can increase digoxin toxicity risk, this level is acceptable.
Rationale for Option B: Magnesium level of 1.9 mg/dL is within normal range (1.7-2.2 mg/dL) and does
not contraindicate digoxin administration.
Rationale for Option C: Calcium level of 9.2 mg/dL is within normal range (8.5-10.5 mg/dL) and is not a
reason to hold digoxin.
Rationale for Option D: Digoxin level of 2.8 ng/mL exceeds the therapeutic range (0.5-0.8 ng/mL or up to
2.0 ng/mL in some labs). Levels >2 ng/mL indicate toxicity, requiring the nurse to hold the dose and
notify the provider immediately.
Question 2
Two hours after starting a unit of packed RBCs, a client reports flank pain and chills. What is the nurse's
first action?
A. Stop the transfusion
B. Take temperature
,C. Send remaining blood to lab
D. Start normal saline at KVO
ANSWER: A
Rationale for Option A: Stopping the transfusion immediately is the priority action when an acute
hemolytic reaction is suspected. This limits the antigen-antibody response and prevents further
complications.
Rationale for Option B: Taking temperature is important but not the first action. Assessment follows
intervention in emergency situations.
Rationale for Option C: Sending blood to the lab is necessary but occurs after stopping the transfusion
and maintaining patient safety.
Rationale for Option D: Starting normal saline is important to maintain IV access and blood pressure, but
stopping the offending agent (blood transfusion) must occur first.
Question 3
A client with COPD has the following arterial blood gas results: pH 7.32, PaCO2 58 mmHg, PaO2 60
mmHg, HCO3 28 mEq/L. How should the nurse interpret these results?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with full compensation
C. Respiratory alkalosis with no compensation
D. Metabolic alkalosis with partial compensation
ANSWER: A
Rationale for Option A: The pH is low (acidotic), PaCO2 is elevated (respiratory cause), and HCO3 is
elevated (compensation). This indicates respiratory acidosis with partial compensation, common in
COPD.
Rationale for Option B: Metabolic acidosis would show low HCO3, not elevated. The primary problem
here is respiratory (elevated PaCO2).
Rationale for Option C: Respiratory alkalosis would show low PaCO2 and elevated pH, opposite of these
findings.
Rationale for Option D: Metabolic alkalosis would show elevated HCO3 as the primary problem with
elevated pH, not the pattern seen here.
Question 4
The nurse is caring for a client 24 hours postoperative following abdominal surgery. Which assessment
finding requires immediate intervention?
A. Temperature 100.4°F (38°C)
,B. Absent bowel sounds
C. Urine output 25 mL/hr
D. Pain rating 6/10
ANSWER: C
Rationale for Option A: A temperature of 100.4°F in the first 24 hours post-op is common due to the
inflammatory response and does not require immediate intervention.
Rationale for Option B: Absent bowel sounds are expected within 24 hours after abdominal surgery.
Bowel function typically returns in 24-72 hours.
Rationale for Option C: Urine output of 25 mL/hr is below the minimum acceptable level of 30 mL/hr,
indicating possible hypovolemia, decreased cardiac output, or renal impairment requiring immediate
intervention.
Rationale for Option D: Pain rating of 6/10 requires intervention but is not immediately life-threatening.
Adequate pain management is important but urine output takes priority.
Question 5
A client with diabetes mellitus type 1 has a blood glucose level of 52 mg/dL. Which symptom would the
nurse expect to assess?
A. Polyuria and polydipsia
B. Diaphoresis and tremors
C. Kussmaul respirations
D. Fruity breath odor
ANSWER: B
Rationale for Option A: Polyuria and polydipsia are symptoms of hyperglycemia, not hypoglycemia.
These occur when blood glucose is elevated.
Rationale for Option B: Diaphoresis (sweating) and tremors are classic adrenergic symptoms of
hypoglycemia (blood glucose <70 mg/dL), caused by sympathetic nervous system activation.
Rationale for Option C: Kussmaul respirations (deep, rapid breathing) occur in diabetic ketoacidosis
(DKA), a complication of severe hyperglycemia, not hypoglycemia.
Rationale for Option D: Fruity breath odor is associated with DKA and hyperglycemia due to acetone
production, not hypoglycemia.
Question 6
The nurse is preparing to administer furosemide 40 mg IV push to a client with heart failure. Which
assessment is the priority before administration?
A. Lung sounds
, B. Blood pressure
C. Weight
D. Potassium level
ANSWER: B
Rationale for Option A: Assessing lung sounds is important for evaluating heart failure status but is not
the priority before giving furosemide.
Rationale for Option B: Blood pressure is the priority assessment before administering furosemide
because it can cause significant hypotension, especially with IV administration. The nurse must ensure
the BP is adequate before giving this potent diuretic.
Rationale for Option C: Weight is important for monitoring fluid status and diuretic effectiveness but is
not the priority before administration.
Rationale for Option D: Potassium level is important because furosemide causes potassium loss, but
checking BP takes priority for immediate safety before administration.
Question 7
A client is receiving heparin IV for deep vein thrombosis. The aPTT result is 98 seconds (control 30
seconds). What action should the nurse take?
A. Increase the heparin infusion rate
B. Continue the infusion as prescribed
C. Hold the heparin and notify the provider
D. Administer vitamin K
ANSWER: C
Rationale for Option A: Increasing the infusion would be dangerous as the aPTT is already
supratherapeutic, increasing bleeding risk.
Rationale for Option B: Continuing the infusion is unsafe because the aPTT is significantly elevated.
Therapeutic range is typically 1.5-2.5 times control (45-75 seconds for this client).
Rationale for Option C: The aPTT of 98 seconds is above therapeutic range (control 30 × 2.5 = 75 seconds
maximum), indicating excessive anticoagulation. The nurse should hold heparin and notify the provider
to prevent bleeding complications.
Rationale for Option D: Vitamin K is the antidote for warfarin, not heparin. Protamine sulfate is the
antidote for heparin.
Question 8
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates the chest tube is functioning properly?
