Page 1 of 132
EVOLVE ELSEVIER HESI MED SURG EXAM
QUESTIONS WITH DETAILED RATIONALES | NGN
CLINICAL JUDGMENT
ALIGNED**COMPREHENSIVE ADULT HEALTH
NURSING COMPETENCY ASSESSMENT FOR RN
LICENSURE READINESS **100% VERIFIED
GRADED A+ *ELSEVIER EVOLVE / NCSBN CJMM
TABLE OF CONTENTS
| Domain | Content Area | Questions |
|--------|-------------|-----------|------|
| **I** | **Cardiovascular Disorders** | 30 |
| **II** | **Respiratory Disorders** | 25 |
| **III** | **Gastrointestinal Disorders** | 22 |
| **IV** | **Endocrine & Metabolic Disorders** | 22 |
| **V** | **Renal & Genitourinary Disorders** | 20 |
| **VI** | **Neurological Disorders** | 20 |
| **VII** | **Musculoskeletal & Integumentary Disorders** | 18 |
| **VIII** | **Hematological & Oncological Disorders** | 18 |
| **IX** | **Perioperative & Emergency Nursing** | 15 |
| **X** | **Pharmacological & Parenteral Therapies** | 15 |
| **XI** | **Management of Care & Safety** | 15 |
,Page 2 of 132
DOMAIN I: CARDIOVASCULAR DISORDERS
### (Questions 1-30)
**1.** A client is admitted with acute decompensated heart failure (ADHF). Which assessment
finding will the nurse most likely identify as the priority concern?
A) 1+ pitting edema of bilateral ankles
B) Weight loss of 2 pounds since previous hospitalization
C) Bibasilar crackles and SpO₂ of 88% on room air
D) Blood pressure of 160/100 mm Hg
**Answer: C) Bibasilar crackles and SpO₂ of 88% on room air**
**Rationale:** Bibasilar crackles indicate pulmonary congestion and fluid accumulation in
the alveoli, while SpO₂ of 88% reflects inadequate oxygenation. These findings represent acute
respiratory compromise, which is the priority concern in ADHF. While hypertension (D) requires
management, oxygenation takes precedence. Edema (A) is a chronic manifestation, and weight
loss (B) suggests improvement rather than deterioration. Using the ABC (Airway, Breathing,
Circulation) priority framework, respiratory status is the immediate concern.
---
**2.** A client with atrial fibrillation is prescribed warfarin. The client's INR is 3.8. What is the
most appropriate nursing action?
A) Administer vitamin K as ordered
B) Hold the next dose of warfarin
C) Administer the warfarin as prescribed and notify the provider
D) Prepare for fresh frozen plasma transfusion
,Page 3 of 132
**Answer: C) Administer the warfarin as prescribed and notify the provider**
**Rationale:** For atrial fibrillation, the therapeutic INR goal is typically 2.0-3.0. An INR
of 3.8 is slightly above target but not critically high (critical is typically >4.5-5.0). The standard
protocol is to hold the dose only if INR >4.0 or if there is active bleeding. Since the question
does not indicate bleeding, the nurse should administer the dose and notify the provider for
possible dose adjustment. Vitamin K (A) would be appropriate for significant bleeding or INR
>5.0. Fresh frozen plasma (D) is reserved for life-threatening hemorrhage.
---
**3.** A 58-year-old male (WT 78 kg) is admitted with anterior STEMI. PCI is planned within
45 minutes. Which IV antiplatelet loading dose is evidence-based per 2026 AHA guidelines?
A) Clopidogrel 600 mg
B) Ticagrelor 180 mg
C) Prasugrel 60 mg
D) Abciximab 0.25 mg/kg
**Answer: B) Ticagrelor 180 mg**
**Rationale:** Ticagrelor 180 mg is a Class I recommendation for primary PCI in STEMI.
Prasugrel 60 mg is also acceptable but only if PCI is certain and there is no history of CVA/TIA.
Clopidogrel requires higher loading doses (600 mg) but is less preferred. Abciximab is a GP
IIb/IIIa inhibitor used in select cases but not first-line antiplatelet therapy. Ticagrelor provides
more rapid and consistent platelet inhibition compared to clopidogrel.
---
, Page 4 of 132
**4.** A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates that the medication is achieving its intended effect?
A) Blood pressure increases from 110/70 to 130/80 mmHg
B) Urine output decreases to 20 mL/hour
C) Jugular vein distension becomes more pronounced
D) Weight decreases by 2 kg in 24 hours
**Answer: D) Weight decreases by 2 kg in 24 hours**
**Rationale:** Furosemide is a loop diuretic used to reduce fluid overload. The primary
intended effect is diuresis, which should result in weight loss (each kilogram lost approximates 1
liter of fluid). Increased blood pressure (A) is not a therapeutic effect of furosemide. Decreased
urine output (B) would indicate the medication is ineffective. Increased JVD (C) indicates
worsening fluid overload.
---
**5.** A client presents to the emergency department with chest pain radiating to the left arm.
The ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery (LAD)
B) Left circumflex artery (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery
**Answer: C) Right coronary artery (RCA)**
EVOLVE ELSEVIER HESI MED SURG EXAM
QUESTIONS WITH DETAILED RATIONALES | NGN
CLINICAL JUDGMENT
ALIGNED**COMPREHENSIVE ADULT HEALTH
NURSING COMPETENCY ASSESSMENT FOR RN
LICENSURE READINESS **100% VERIFIED
GRADED A+ *ELSEVIER EVOLVE / NCSBN CJMM
TABLE OF CONTENTS
| Domain | Content Area | Questions |
|--------|-------------|-----------|------|
| **I** | **Cardiovascular Disorders** | 30 |
| **II** | **Respiratory Disorders** | 25 |
| **III** | **Gastrointestinal Disorders** | 22 |
| **IV** | **Endocrine & Metabolic Disorders** | 22 |
| **V** | **Renal & Genitourinary Disorders** | 20 |
| **VI** | **Neurological Disorders** | 20 |
| **VII** | **Musculoskeletal & Integumentary Disorders** | 18 |
| **VIII** | **Hematological & Oncological Disorders** | 18 |
| **IX** | **Perioperative & Emergency Nursing** | 15 |
| **X** | **Pharmacological & Parenteral Therapies** | 15 |
| **XI** | **Management of Care & Safety** | 15 |
,Page 2 of 132
DOMAIN I: CARDIOVASCULAR DISORDERS
### (Questions 1-30)
**1.** A client is admitted with acute decompensated heart failure (ADHF). Which assessment
finding will the nurse most likely identify as the priority concern?
A) 1+ pitting edema of bilateral ankles
B) Weight loss of 2 pounds since previous hospitalization
C) Bibasilar crackles and SpO₂ of 88% on room air
D) Blood pressure of 160/100 mm Hg
**Answer: C) Bibasilar crackles and SpO₂ of 88% on room air**
**Rationale:** Bibasilar crackles indicate pulmonary congestion and fluid accumulation in
the alveoli, while SpO₂ of 88% reflects inadequate oxygenation. These findings represent acute
respiratory compromise, which is the priority concern in ADHF. While hypertension (D) requires
management, oxygenation takes precedence. Edema (A) is a chronic manifestation, and weight
loss (B) suggests improvement rather than deterioration. Using the ABC (Airway, Breathing,
Circulation) priority framework, respiratory status is the immediate concern.
---
**2.** A client with atrial fibrillation is prescribed warfarin. The client's INR is 3.8. What is the
most appropriate nursing action?
A) Administer vitamin K as ordered
B) Hold the next dose of warfarin
C) Administer the warfarin as prescribed and notify the provider
D) Prepare for fresh frozen plasma transfusion
,Page 3 of 132
**Answer: C) Administer the warfarin as prescribed and notify the provider**
**Rationale:** For atrial fibrillation, the therapeutic INR goal is typically 2.0-3.0. An INR
of 3.8 is slightly above target but not critically high (critical is typically >4.5-5.0). The standard
protocol is to hold the dose only if INR >4.0 or if there is active bleeding. Since the question
does not indicate bleeding, the nurse should administer the dose and notify the provider for
possible dose adjustment. Vitamin K (A) would be appropriate for significant bleeding or INR
>5.0. Fresh frozen plasma (D) is reserved for life-threatening hemorrhage.
---
**3.** A 58-year-old male (WT 78 kg) is admitted with anterior STEMI. PCI is planned within
45 minutes. Which IV antiplatelet loading dose is evidence-based per 2026 AHA guidelines?
A) Clopidogrel 600 mg
B) Ticagrelor 180 mg
C) Prasugrel 60 mg
D) Abciximab 0.25 mg/kg
**Answer: B) Ticagrelor 180 mg**
**Rationale:** Ticagrelor 180 mg is a Class I recommendation for primary PCI in STEMI.
Prasugrel 60 mg is also acceptable but only if PCI is certain and there is no history of CVA/TIA.
Clopidogrel requires higher loading doses (600 mg) but is less preferred. Abciximab is a GP
IIb/IIIa inhibitor used in select cases but not first-line antiplatelet therapy. Ticagrelor provides
more rapid and consistent platelet inhibition compared to clopidogrel.
---
, Page 4 of 132
**4.** A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates that the medication is achieving its intended effect?
A) Blood pressure increases from 110/70 to 130/80 mmHg
B) Urine output decreases to 20 mL/hour
C) Jugular vein distension becomes more pronounced
D) Weight decreases by 2 kg in 24 hours
**Answer: D) Weight decreases by 2 kg in 24 hours**
**Rationale:** Furosemide is a loop diuretic used to reduce fluid overload. The primary
intended effect is diuresis, which should result in weight loss (each kilogram lost approximates 1
liter of fluid). Increased blood pressure (A) is not a therapeutic effect of furosemide. Decreased
urine output (B) would indicate the medication is ineffective. Increased JVD (C) indicates
worsening fluid overload.
---
**5.** A client presents to the emergency department with chest pain radiating to the left arm.
The ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery (LAD)
B) Left circumflex artery (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery
**Answer: C) Right coronary artery (RCA)**
