EVOLVE ELSEVIER HESI MED SURG 2025”2026 ACTUAL
EXAM 150 QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALE
1. A nurse is caring for a client admitted with acute pancreatitis who reports
severe epigastric pain radiating to the back. The client’s vomiting has increased,
and abdominal rigidity is noted. Which action is the nurse’s PRIORITY?
☑ A. Notify the provider immediately about signs of possible hemorrhagic pancreatitis
☐ B. Offer ice chips to decrease nausea
☐ C. Increase activity to reduce abdominal stiffness
☐ D. Administer oral opioids for pain
Rationale: Abdominal rigidity and worsening symptoms may indicate hemorrhage or peritonitis,
requiring urgent provider notification.
2. A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The
nurse notes increasing somnolence and a decreasing respiratory rate. What
should the nurse do FIRST?
☑ A. Lower the oxygen flow rate to maintain SpO₂ around the prescribed target
☐ B. Encourage coughing and deep breathing
☐ C. Stop oxygen therapy entirely
☐ D. Increase oxygen further
Rationale: Too much oxygen can suppress respiratory drive in clients with chronic CO₂
retention, causing hypoventilation.
3. A nurse assesses a client post-thyroidectomy who suddenly develops
inspiratory stridor. What is the immediate nursing action?
☑ A. Prepare for emergency airway management due to possible laryngeal edema
☐ B. Encourage rapid fluid intake
☐ C. Position the client supine
☐ D. Administer oral calcium supplements
Rationale: Stridor indicates airway obstruction; emergency airway intervention may be needed.
,4. A client with heart failure reports sudden weight gain and increasing dyspnea.
Which assessment is MOST important?
☑ A. Auscultate lung sounds for crackles
☐ B. Palpate pedal pulses
☐ C. Assess bowel sounds
☐ D. Review hemoglobin level
Rationale: Dyspnea and weight gain indicate fluid retention; crackles reveal pulmonary edema
risk.
5. A client receiving morphine develops respiratory depression with a rate of
8/min. What should the nurse do FIRST?
☑ A. Administer naloxone per protocol
☐ B. Give an additional dose of morphine
☐ C. Apply cool compresses
☐ D. Place the client supine without intervention
Rationale: Naloxone reverses opioid-induced respiratory depression and restores ventilation.
6. A diabetic client presents with confusion, dry mucous membranes, and blood
glucose of 588 mg/dL. ABGs indicate metabolic acidosis. What is the priority
intervention?
☑ A. Begin IV fluids to correct dehydration
☐ B. Restrict fluids until glucose decreases
☐ C. Give oral insulin
☐ D. Encourage food intake
Rationale: Fluid resuscitation is the first step in treating DKA to restore perfusion.
7. A client with possible stroke arrives with sudden facial droop and slurred
speech. The nurse’s PRIORITY is to:
☑ A. Determine the exact time the symptoms began
☐ B. Assess bowel pattern
☐ C. Schedule physical therapy
☐ D. Provide oral fluids immediately
Rationale: Thrombolytic therapy eligibility depends on the time of symptom onset.
,8. A nurse caring for a client with pneumonia notes increased restlessness and
agitation. What is the MOST likely cause?
☑ A. Hypoxemia
☐ B. Anxiety from hospitalization
☐ C. Vitamin deficiency
☐ D. Pain control issues
Rationale: Restlessness is an early sign of oxygen deprivation in respiratory conditions.
9. A client on warfarin reports black, tarry stools. What should the nurse do
FIRST?
☑ A. Notify the provider due to possible GI bleeding
☐ B. Increase warfarin dose
☐ C. Encourage high-fat diet
☐ D. Reassess stool in 72 hours
Rationale: Melena is a sign of GI bleeding, a serious warfarin complication.
10. A client with chronic kidney disease has a serum potassium of 6.4 mEq/L.
Which intervention is PRIORITY?
☑ A. Administer IV insulin with glucose as prescribed
☐ B. Give high-potassium foods
☐ C. Prepare for hemodialysis without ECG monitoring
☐ D. No action needed
Rationale: Insulin shifts potassium into cells, reducing life-threatening hyperkalemia quickly.
11. A nurse caring for a postoperative client notices a rigid, board-like abdomen
and no bowel sounds. What complication is suspected?
☑ A. Peritonitis
☐ B. Normal healing
☐ C. GERD
☐ D. C-diff infection
, Rationale: Abdominal rigidity and absent bowel sounds indicate inflammation of the
peritoneum.
12. A client with a new colostomy is distressed about body image. Which
response by the nurse is MOST therapeutic?
☑ A. “Tell me more about how this change is affecting you.”
☐ B. “You’ll get used to it eventually.”
☐ C. “This isn’t a big deal.”
☐ D. “At least your surgery went well.”
Rationale: Open-ended, empathetic communication supports emotional processing.
13. A nurse is administering IV furosemide. Which finding requires
IMMEDIATE intervention?
☑ A. Potassium level of 2.9 mEq/L
☐ B. Urine output of 1,500 mL/day
☐ C. Mild dizziness when standing
☐ D. Sodium 140 mEq/L
Rationale: Severe hypokalemia increases risk of arrhythmias.
14. A client with GI bleeding has BP 88/56 mmHg, HR 128/min, and cool,
clammy skin. What is the highest priority?
☑ A. Begin rapid IV fluid resuscitation
☐ B. Offer oral fluids
☐ C. Obtain stool sample
☐ D. Provide warm blankets only
Rationale: Hypovolemic shock requires immediate fluid replacement.
15. A client with multiple sclerosis reports new onset double vision. What is the
nurse’s PRIORITY?
☑ A. Ensure safety by implementing fall precautions
☐ B. Encourage watching TV
EXAM 150 QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALE
1. A nurse is caring for a client admitted with acute pancreatitis who reports
severe epigastric pain radiating to the back. The client’s vomiting has increased,
and abdominal rigidity is noted. Which action is the nurse’s PRIORITY?
☑ A. Notify the provider immediately about signs of possible hemorrhagic pancreatitis
☐ B. Offer ice chips to decrease nausea
☐ C. Increase activity to reduce abdominal stiffness
☐ D. Administer oral opioids for pain
Rationale: Abdominal rigidity and worsening symptoms may indicate hemorrhage or peritonitis,
requiring urgent provider notification.
2. A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The
nurse notes increasing somnolence and a decreasing respiratory rate. What
should the nurse do FIRST?
☑ A. Lower the oxygen flow rate to maintain SpO₂ around the prescribed target
☐ B. Encourage coughing and deep breathing
☐ C. Stop oxygen therapy entirely
☐ D. Increase oxygen further
Rationale: Too much oxygen can suppress respiratory drive in clients with chronic CO₂
retention, causing hypoventilation.
3. A nurse assesses a client post-thyroidectomy who suddenly develops
inspiratory stridor. What is the immediate nursing action?
☑ A. Prepare for emergency airway management due to possible laryngeal edema
☐ B. Encourage rapid fluid intake
☐ C. Position the client supine
☐ D. Administer oral calcium supplements
Rationale: Stridor indicates airway obstruction; emergency airway intervention may be needed.
,4. A client with heart failure reports sudden weight gain and increasing dyspnea.
Which assessment is MOST important?
☑ A. Auscultate lung sounds for crackles
☐ B. Palpate pedal pulses
☐ C. Assess bowel sounds
☐ D. Review hemoglobin level
Rationale: Dyspnea and weight gain indicate fluid retention; crackles reveal pulmonary edema
risk.
5. A client receiving morphine develops respiratory depression with a rate of
8/min. What should the nurse do FIRST?
☑ A. Administer naloxone per protocol
☐ B. Give an additional dose of morphine
☐ C. Apply cool compresses
☐ D. Place the client supine without intervention
Rationale: Naloxone reverses opioid-induced respiratory depression and restores ventilation.
6. A diabetic client presents with confusion, dry mucous membranes, and blood
glucose of 588 mg/dL. ABGs indicate metabolic acidosis. What is the priority
intervention?
☑ A. Begin IV fluids to correct dehydration
☐ B. Restrict fluids until glucose decreases
☐ C. Give oral insulin
☐ D. Encourage food intake
Rationale: Fluid resuscitation is the first step in treating DKA to restore perfusion.
7. A client with possible stroke arrives with sudden facial droop and slurred
speech. The nurse’s PRIORITY is to:
☑ A. Determine the exact time the symptoms began
☐ B. Assess bowel pattern
☐ C. Schedule physical therapy
☐ D. Provide oral fluids immediately
Rationale: Thrombolytic therapy eligibility depends on the time of symptom onset.
,8. A nurse caring for a client with pneumonia notes increased restlessness and
agitation. What is the MOST likely cause?
☑ A. Hypoxemia
☐ B. Anxiety from hospitalization
☐ C. Vitamin deficiency
☐ D. Pain control issues
Rationale: Restlessness is an early sign of oxygen deprivation in respiratory conditions.
9. A client on warfarin reports black, tarry stools. What should the nurse do
FIRST?
☑ A. Notify the provider due to possible GI bleeding
☐ B. Increase warfarin dose
☐ C. Encourage high-fat diet
☐ D. Reassess stool in 72 hours
Rationale: Melena is a sign of GI bleeding, a serious warfarin complication.
10. A client with chronic kidney disease has a serum potassium of 6.4 mEq/L.
Which intervention is PRIORITY?
☑ A. Administer IV insulin with glucose as prescribed
☐ B. Give high-potassium foods
☐ C. Prepare for hemodialysis without ECG monitoring
☐ D. No action needed
Rationale: Insulin shifts potassium into cells, reducing life-threatening hyperkalemia quickly.
11. A nurse caring for a postoperative client notices a rigid, board-like abdomen
and no bowel sounds. What complication is suspected?
☑ A. Peritonitis
☐ B. Normal healing
☐ C. GERD
☐ D. C-diff infection
, Rationale: Abdominal rigidity and absent bowel sounds indicate inflammation of the
peritoneum.
12. A client with a new colostomy is distressed about body image. Which
response by the nurse is MOST therapeutic?
☑ A. “Tell me more about how this change is affecting you.”
☐ B. “You’ll get used to it eventually.”
☐ C. “This isn’t a big deal.”
☐ D. “At least your surgery went well.”
Rationale: Open-ended, empathetic communication supports emotional processing.
13. A nurse is administering IV furosemide. Which finding requires
IMMEDIATE intervention?
☑ A. Potassium level of 2.9 mEq/L
☐ B. Urine output of 1,500 mL/day
☐ C. Mild dizziness when standing
☐ D. Sodium 140 mEq/L
Rationale: Severe hypokalemia increases risk of arrhythmias.
14. A client with GI bleeding has BP 88/56 mmHg, HR 128/min, and cool,
clammy skin. What is the highest priority?
☑ A. Begin rapid IV fluid resuscitation
☐ B. Offer oral fluids
☐ C. Obtain stool sample
☐ D. Provide warm blankets only
Rationale: Hypovolemic shock requires immediate fluid replacement.
15. A client with multiple sclerosis reports new onset double vision. What is the
nurse’s PRIORITY?
☑ A. Ensure safety by implementing fall precautions
☐ B. Encourage watching TV
