A+ VERIFIED
MEDICAL-SURGICAL NURSING · OBJECTIVE ASSESSMENT
EVOLVE ELSEVIER HESI MED SURG
2026/2027 ACTUAL EXAM — Complete
Official Exam
150 Questions Full Rationales Verified Answers
A+ 6 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Cardiovascular & Hematologic Disorders
02 Respiratory & Oxygenation Disorders
03 Neurological & Sensory Disorders
04 Gastrointestinal, Renal & Endocrine Disorders
05 Perioperative, Musculoskeletal & Integumentary Care
06 Medication Administration, Safety & Prioritization
ABOUT THIS ASSESSMENT
Build mastery in medical-surgical nursing — from cardiovascular, hematologic,
respiratory, neurological, gastrointestinal, renal, and endocrine disorders to
perioperative, musculoskeletal, integumentary care, medication administration,
safety, and prioritization. This original study bank targets application and
analysis skills for the Evolve Elsevier HESI Med-Surg exam, with full rationales
for every answer. For review use only; not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
80% Advanced (Med-Surg) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Cardiovascular & Hematologic Disorders
Q1. A client with acute coronary syndrome reports sudden crushing chest pain radiating to the left arm. The monitor shows ST-segment
elevation in leads II, III, and aVF. The nurse’s priority action is to:
A. Administer oxygen, obtain a 12-lead ECG if not already done, and prepare for rapid reperfusion per protocol
B. Encourage the client to ambulate to relieve anxiety
C. Administer a full meal to prevent hypoglycemia
D. Discontinue all cardiac monitoring to reduce stimulation
Correct Answer: A
Rationale:
Inferior STEMI requires immediate reperfusion. Oxygen, ECG confirmation, and activation of the STEMI pathway are the priority. Ambulation or meals are
contraindicated during acute ischemia.
Q2. A client receiving continuous heparin infusion for a pulmonary embolism has an aPTT of 120 seconds (therapeutic range 60–80). The
nurse should first:
A. Increase the infusion rate by 200 units/hour
B. Administer an extra dose of oral warfarin
C. Hold the heparin infusion and notify the provider of the supra-therapeutic aPTT
D. Document the result and recheck in 24 hours
Correct Answer: C
Rationale:
aPTT well above the therapeutic window indicates excessive anticoagulation and bleeding risk. Holding the infusion and notifying the provider are required;
increasing the dose would worsen the problem.
Q3. A client with chronic heart failure has a weight gain of 2.5 kg in three days, increased dyspnea, and bilateral crackles. The nurse
anticipates which order as the most immediate intervention?
A. Encourage increased oral fluid intake to 3 L/day
B. Administer a loop diuretic and reassess respiratory status and weight
C. Schedule elective cardiac catheterization for next month
D. Start a high-sodium diet to improve appetite
Correct Answer: B
Rationale:
Rapid weight gain and pulmonary congestion indicate fluid overload. A loop diuretic reduces preload and pulmonary edema. Increased fluids or sodium would
exacerbate the problem.
Q4. A client post-cardiac catheterization via the right femoral artery has a firm, expanding hematoma at the puncture site and a drop in blood
pressure. The nurse’s first action is to:
A. Elevate the head of the bed to 90 degrees
B. Ambulate the client to improve circulation
C. Remove the pressure dressing completely to inspect the site
D. Apply firm manual pressure proximal to the puncture site and call for help
Correct Answer: D
Rationale:
An expanding hematoma with hypotension suggests active bleeding or retroperitoneal hemorrhage. Immediate firm pressure and rapid assistance are required to
control hemorrhage.
Q5. A client with atrial fibrillation is prescribed warfarin. The nurse teaches that the client should report which finding immediately?
A. Occasional skipped heartbeats that resolve spontaneously
B. Black, tarry stools or unusual bruising
C. Mild fatigue after starting the medication
D. A desire for more leafy green vegetables
Correct Answer: B
Rationale:
Black tarry stools and unusual bruising are signs of bleeding, a major warfarin adverse effect. Dietary vitamin K changes should be consistent but are not an
emergency; mild fatigue is common.
STUVIA ACTUAL EXAM · Page 2
, SECTION 1: Cardiovascular & Hematologic Disorders
Q6. A client with suspected pericarditis reports sharp chest pain that improves when leaning forward. The nurse auscultates a pericardial
friction rub. Which additional assessment finding would most concern the nurse for cardiac tamponade?
A. Pulsus paradoxus, muffled heart sounds, and jugular venous distention
B. Loud S1 and S2 with a regular rate
C. Warm, dry skin and bounding peripheral pulses
D. Clear lung sounds and normal blood pressure
Correct Answer: A
Rationale:
Beck’s triad (hypotension, muffled sounds, JVD) plus pulsus paradoxus indicate tamponade, a life-threatening complication of pericarditis requiring urgent
intervention.
Q7. A client with sickle cell disease is admitted in vaso-occlusive crisis with severe joint pain. The nurse prioritizes which intervention?
A. Restricting fluids to prevent overload
B. Applying ice packs directly to all joints for prolonged periods
C. Aggressive hydration and opioid analgesia per protocol
D. Withholding analgesia until diagnostic imaging is complete
Correct Answer: C
Rationale:
Hydration and adequate opioid pain control are first-line for vaso-occlusive crisis. Fluid restriction and delayed analgesia worsen ischemia; prolonged ice can
increase sickling.
Q8. A client receiving a unit of packed red blood cells develops chills, fever, and low-back pain 15 minutes after the transfusion starts. The
nurse’s immediate actions include:
A. Slow the rate and continue to observe for 30 more minutes
B. Add an antipyretic to the blood bag and resume
C. Flush the line with the remaining blood to clear the tubing
D. Stop the transfusion, maintain IV access with normal saline, and notify the provider
Correct Answer: D
Rationale:
Signs of acute hemolytic reaction require immediate cessation of the transfusion, preservation of IV access with saline, and notification of the provider and blood
bank.
Q9. A client with hypertension is started on lisinopril. The nurse teaches the client to report which potential adverse effect promptly?
A. Persistent dry cough or swelling of the lips and tongue
B. Temporary mild headache on the first day only
C. Increased appetite during the first week
D. Slight increase in energy level
Correct Answer: A
Rationale:
ACE-inhibitor cough and angioedema are important adverse effects; angioedema can be life-threatening. Mild transient headache is less urgent.
Q10. A client with deep-vein thrombosis is receiving enoxaparin. The nurse recognizes that the primary laboratory monitoring parameter for this
medication is:
A. Daily aPTT with dose adjustment for every result
B. Platelet count to detect heparin-induced thrombocytopenia; routine aPTT is not required for low-molecular-weight heparin at standard doses
C. Serum potassium every 4 hours
D. Arterial blood gas analysis twice daily
Correct Answer: B
Rationale:
LMWH does not require routine aPTT monitoring at prophylactic or standard therapeutic doses, but platelet counts are followed because HIT remains a risk.
Q11. A client post-MI develops new onset of a harsh holosystolic murmur and acute pulmonary edema. The nurse suspects which mechanical
complication?
A. Uncomplicated pericarditis without hemodynamic effect
B. Stable angina with no structural change
C. Ventricular septal rupture or papillary muscle rupture causing acute mitral regurgitation
D. Mild aortic stenosis that was previously undocumented
Correct Answer: C
Rationale:
New holosystolic murmur plus pulmonary edema after MI suggests VSR or papillary muscle rupture, both surgical emergencies.
STUVIA ACTUAL EXAM · Page 3
MEDICAL-SURGICAL NURSING · OBJECTIVE ASSESSMENT
EVOLVE ELSEVIER HESI MED SURG
2026/2027 ACTUAL EXAM — Complete
Official Exam
150 Questions Full Rationales Verified Answers
A+ 6 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Cardiovascular & Hematologic Disorders
02 Respiratory & Oxygenation Disorders
03 Neurological & Sensory Disorders
04 Gastrointestinal, Renal & Endocrine Disorders
05 Perioperative, Musculoskeletal & Integumentary Care
06 Medication Administration, Safety & Prioritization
ABOUT THIS ASSESSMENT
Build mastery in medical-surgical nursing — from cardiovascular, hematologic,
respiratory, neurological, gastrointestinal, renal, and endocrine disorders to
perioperative, musculoskeletal, integumentary care, medication administration,
safety, and prioritization. This original study bank targets application and
analysis skills for the Evolve Elsevier HESI Med-Surg exam, with full rationales
for every answer. For review use only; not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
80% Advanced (Med-Surg) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Cardiovascular & Hematologic Disorders
Q1. A client with acute coronary syndrome reports sudden crushing chest pain radiating to the left arm. The monitor shows ST-segment
elevation in leads II, III, and aVF. The nurse’s priority action is to:
A. Administer oxygen, obtain a 12-lead ECG if not already done, and prepare for rapid reperfusion per protocol
B. Encourage the client to ambulate to relieve anxiety
C. Administer a full meal to prevent hypoglycemia
D. Discontinue all cardiac monitoring to reduce stimulation
Correct Answer: A
Rationale:
Inferior STEMI requires immediate reperfusion. Oxygen, ECG confirmation, and activation of the STEMI pathway are the priority. Ambulation or meals are
contraindicated during acute ischemia.
Q2. A client receiving continuous heparin infusion for a pulmonary embolism has an aPTT of 120 seconds (therapeutic range 60–80). The
nurse should first:
A. Increase the infusion rate by 200 units/hour
B. Administer an extra dose of oral warfarin
C. Hold the heparin infusion and notify the provider of the supra-therapeutic aPTT
D. Document the result and recheck in 24 hours
Correct Answer: C
Rationale:
aPTT well above the therapeutic window indicates excessive anticoagulation and bleeding risk. Holding the infusion and notifying the provider are required;
increasing the dose would worsen the problem.
Q3. A client with chronic heart failure has a weight gain of 2.5 kg in three days, increased dyspnea, and bilateral crackles. The nurse
anticipates which order as the most immediate intervention?
A. Encourage increased oral fluid intake to 3 L/day
B. Administer a loop diuretic and reassess respiratory status and weight
C. Schedule elective cardiac catheterization for next month
D. Start a high-sodium diet to improve appetite
Correct Answer: B
Rationale:
Rapid weight gain and pulmonary congestion indicate fluid overload. A loop diuretic reduces preload and pulmonary edema. Increased fluids or sodium would
exacerbate the problem.
Q4. A client post-cardiac catheterization via the right femoral artery has a firm, expanding hematoma at the puncture site and a drop in blood
pressure. The nurse’s first action is to:
A. Elevate the head of the bed to 90 degrees
B. Ambulate the client to improve circulation
C. Remove the pressure dressing completely to inspect the site
D. Apply firm manual pressure proximal to the puncture site and call for help
Correct Answer: D
Rationale:
An expanding hematoma with hypotension suggests active bleeding or retroperitoneal hemorrhage. Immediate firm pressure and rapid assistance are required to
control hemorrhage.
Q5. A client with atrial fibrillation is prescribed warfarin. The nurse teaches that the client should report which finding immediately?
A. Occasional skipped heartbeats that resolve spontaneously
B. Black, tarry stools or unusual bruising
C. Mild fatigue after starting the medication
D. A desire for more leafy green vegetables
Correct Answer: B
Rationale:
Black tarry stools and unusual bruising are signs of bleeding, a major warfarin adverse effect. Dietary vitamin K changes should be consistent but are not an
emergency; mild fatigue is common.
STUVIA ACTUAL EXAM · Page 2
, SECTION 1: Cardiovascular & Hematologic Disorders
Q6. A client with suspected pericarditis reports sharp chest pain that improves when leaning forward. The nurse auscultates a pericardial
friction rub. Which additional assessment finding would most concern the nurse for cardiac tamponade?
A. Pulsus paradoxus, muffled heart sounds, and jugular venous distention
B. Loud S1 and S2 with a regular rate
C. Warm, dry skin and bounding peripheral pulses
D. Clear lung sounds and normal blood pressure
Correct Answer: A
Rationale:
Beck’s triad (hypotension, muffled sounds, JVD) plus pulsus paradoxus indicate tamponade, a life-threatening complication of pericarditis requiring urgent
intervention.
Q7. A client with sickle cell disease is admitted in vaso-occlusive crisis with severe joint pain. The nurse prioritizes which intervention?
A. Restricting fluids to prevent overload
B. Applying ice packs directly to all joints for prolonged periods
C. Aggressive hydration and opioid analgesia per protocol
D. Withholding analgesia until diagnostic imaging is complete
Correct Answer: C
Rationale:
Hydration and adequate opioid pain control are first-line for vaso-occlusive crisis. Fluid restriction and delayed analgesia worsen ischemia; prolonged ice can
increase sickling.
Q8. A client receiving a unit of packed red blood cells develops chills, fever, and low-back pain 15 minutes after the transfusion starts. The
nurse’s immediate actions include:
A. Slow the rate and continue to observe for 30 more minutes
B. Add an antipyretic to the blood bag and resume
C. Flush the line with the remaining blood to clear the tubing
D. Stop the transfusion, maintain IV access with normal saline, and notify the provider
Correct Answer: D
Rationale:
Signs of acute hemolytic reaction require immediate cessation of the transfusion, preservation of IV access with saline, and notification of the provider and blood
bank.
Q9. A client with hypertension is started on lisinopril. The nurse teaches the client to report which potential adverse effect promptly?
A. Persistent dry cough or swelling of the lips and tongue
B. Temporary mild headache on the first day only
C. Increased appetite during the first week
D. Slight increase in energy level
Correct Answer: A
Rationale:
ACE-inhibitor cough and angioedema are important adverse effects; angioedema can be life-threatening. Mild transient headache is less urgent.
Q10. A client with deep-vein thrombosis is receiving enoxaparin. The nurse recognizes that the primary laboratory monitoring parameter for this
medication is:
A. Daily aPTT with dose adjustment for every result
B. Platelet count to detect heparin-induced thrombocytopenia; routine aPTT is not required for low-molecular-weight heparin at standard doses
C. Serum potassium every 4 hours
D. Arterial blood gas analysis twice daily
Correct Answer: B
Rationale:
LMWH does not require routine aPTT monitoring at prophylactic or standard therapeutic doses, but platelet counts are followed because HIT remains a risk.
Q11. A client post-MI develops new onset of a harsh holosystolic murmur and acute pulmonary edema. The nurse suspects which mechanical
complication?
A. Uncomplicated pericarditis without hemodynamic effect
B. Stable angina with no structural change
C. Ventricular septal rupture or papillary muscle rupture causing acute mitral regurgitation
D. Mild aortic stenosis that was previously undocumented
Correct Answer: C
Rationale:
New holosystolic murmur plus pulmonary edema after MI suggests VSR or papillary muscle rupture, both surgical emergencies.
STUVIA ACTUAL EXAM · Page 3
