Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing
Questions, Correct Answers & Full Rationales
1. A 68-year-old male post-MI is receiving a continuous heparin infusion at 1200
units/hr. The most recent aPTT is 92 seconds (control 30 seconds). Which action
should the nurse take first?
A. Decrease the infusion rate by 200 units/hr
B. Stop the infusion for 1 hour and restart at a lower rate
C. Notify the physician immediately
D. Obtain a stat PT/INR
Correct Answer: B
Rationale: An aPTT more than three times the control indicates supra-therapeutic
anticoagulation and an increased bleeding risk; temporary discontinuation followed by a
reduced rate is the priority nursing action to quickly lower the anticoagulant effect.
Option A is too slow to reduce the level quickly. Option C is important but does not
address the immediate safety issue. Option D adds little because PT/INR is not used to
monitor heparin therapy.
2. The nurse is caring for a client with decompensated left-sided HF who suddenly
becomes very anxious and is coughing up pink, frothy sputum. Which position
should the nurse place the client in first?
A. High-Fowler’s with legs dependent
,B. Supine with head turned to the side
C. Right side-lying with knees flexed
D. Trendelenburg
Correct Answer: A
Rationale: High-Fowler’s decreases venous return (preload), reduces pulmonary
congestion, and improves ventilation. Frothy pink sputum signals acute pulmonary
edema, a medical emergency; legs dependent further reduces preload. Supine would
worsen pulmonary congestion. Side-lying is not optimal for ventilation. Trendelenburg
increases venous return and would worsen the condition.
3. A client with DKA receives an insulin infusion. Which laboratory value best
indicates to the nurse that the insulin therapy is effective?
A. Glucose decreasing 75 mg/dL/hr
B. pH increasing from 7.18 to 7.28
C. Serum K+ falling from 5.2 to 4.0 mEq/L
D. Bicarbonate rising from 12 to 18 mEq/L
Correct Answer: D
Rationale: Rising bicarbonate reflects correction of acidosis, the hallmark of DKA
resolution. Glucose drops first but does not indicate reversal of ketogenesis. pH lags
behind bicarbonate changes. Potassium shifts with insulin but is influenced by many
factors and is not the primary indicator of DKA resolution.
, 4. The nurse is assessing a client who returned from a craniotomy 2 hours ago and
notes a sudden increase in systolic BP from 128 to 190 mmHg with a decrease in
HR from 76 to 48 bpm. Which complication should the nurse suspect first?
A. Diabetes insipidus
B. Cushing’s triad indicating increased ICP
C. Pulmonary embolism
D. Hypovolemic shock
Correct Answer: B
Rationale: Hypertension with reflex bradycardia (Cushing’s response) reflects brain-stem
compression from rising ICP, a neurosurgical emergency. Diabetes insipidus presents
with polyuria and hypernatremia. PE presents with dyspnea and tachycardia. Shock
would cause hypotension and tachycardia, the opposite of this presentation.
5. A client with acute pancreatitis is complaining of severe epigastric pain that
radiates to the back. Which nursing intervention should be the priority?
A. Administer morphine 4 mg IV
B. Apply heat to the epigastrium
C. Offer a clear liquid diet
D. Encourage semi-Fowler’s position
Correct Answer: A
Rationale: Pain causes autonomic stress, vasoconstriction, and increased pancreatic
enzyme secretion; rapid IV opioid administration is priority. Heat may feel good but does
, not treat pain. Oral intake is held to rest the pancreas. Semi-Fowler’s does not relieve
pancreatic pain.
6. A client with COPD is receiving oxygen at 5 L/min via nasal cannula. He becomes
drowsy and his respirations decrease from 24 to 10/min. Which action should the
nurse take first?
A. Increase O2 to 6 L/min
B. Stimulate the patient verbally
C. Switch to a non-rebreather at 15 L/min
D. Place on a ventilator
Correct Answer: B
Rationale: Drowsiness and decreased respiratory rate signal CO2 narcosis; first ensure
airway and stimulate to assess responsiveness. Increasing oxygen would worsen
hypoventilation. Non-rebreather and ventilation may be needed later but initial rapid
assessment is key.
7. A client with end-stage renal disease receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning the nurse notes generalized edema,
2+ pitting, and a 4 kg weight gain since yesterday. Which action is most
appropriate?
A. Restrict fluids to 1000 mL/day
B. Administer IV furosemide 80 mg
C. Arrange for extra dialysis today
D. Obtain chest x-ray
(2025/2026) — 150 High-Level Nursing
Questions, Correct Answers & Full Rationales
1. A 68-year-old male post-MI is receiving a continuous heparin infusion at 1200
units/hr. The most recent aPTT is 92 seconds (control 30 seconds). Which action
should the nurse take first?
A. Decrease the infusion rate by 200 units/hr
B. Stop the infusion for 1 hour and restart at a lower rate
C. Notify the physician immediately
D. Obtain a stat PT/INR
Correct Answer: B
Rationale: An aPTT more than three times the control indicates supra-therapeutic
anticoagulation and an increased bleeding risk; temporary discontinuation followed by a
reduced rate is the priority nursing action to quickly lower the anticoagulant effect.
Option A is too slow to reduce the level quickly. Option C is important but does not
address the immediate safety issue. Option D adds little because PT/INR is not used to
monitor heparin therapy.
2. The nurse is caring for a client with decompensated left-sided HF who suddenly
becomes very anxious and is coughing up pink, frothy sputum. Which position
should the nurse place the client in first?
A. High-Fowler’s with legs dependent
,B. Supine with head turned to the side
C. Right side-lying with knees flexed
D. Trendelenburg
Correct Answer: A
Rationale: High-Fowler’s decreases venous return (preload), reduces pulmonary
congestion, and improves ventilation. Frothy pink sputum signals acute pulmonary
edema, a medical emergency; legs dependent further reduces preload. Supine would
worsen pulmonary congestion. Side-lying is not optimal for ventilation. Trendelenburg
increases venous return and would worsen the condition.
3. A client with DKA receives an insulin infusion. Which laboratory value best
indicates to the nurse that the insulin therapy is effective?
A. Glucose decreasing 75 mg/dL/hr
B. pH increasing from 7.18 to 7.28
C. Serum K+ falling from 5.2 to 4.0 mEq/L
D. Bicarbonate rising from 12 to 18 mEq/L
Correct Answer: D
Rationale: Rising bicarbonate reflects correction of acidosis, the hallmark of DKA
resolution. Glucose drops first but does not indicate reversal of ketogenesis. pH lags
behind bicarbonate changes. Potassium shifts with insulin but is influenced by many
factors and is not the primary indicator of DKA resolution.
, 4. The nurse is assessing a client who returned from a craniotomy 2 hours ago and
notes a sudden increase in systolic BP from 128 to 190 mmHg with a decrease in
HR from 76 to 48 bpm. Which complication should the nurse suspect first?
A. Diabetes insipidus
B. Cushing’s triad indicating increased ICP
C. Pulmonary embolism
D. Hypovolemic shock
Correct Answer: B
Rationale: Hypertension with reflex bradycardia (Cushing’s response) reflects brain-stem
compression from rising ICP, a neurosurgical emergency. Diabetes insipidus presents
with polyuria and hypernatremia. PE presents with dyspnea and tachycardia. Shock
would cause hypotension and tachycardia, the opposite of this presentation.
5. A client with acute pancreatitis is complaining of severe epigastric pain that
radiates to the back. Which nursing intervention should be the priority?
A. Administer morphine 4 mg IV
B. Apply heat to the epigastrium
C. Offer a clear liquid diet
D. Encourage semi-Fowler’s position
Correct Answer: A
Rationale: Pain causes autonomic stress, vasoconstriction, and increased pancreatic
enzyme secretion; rapid IV opioid administration is priority. Heat may feel good but does
, not treat pain. Oral intake is held to rest the pancreas. Semi-Fowler’s does not relieve
pancreatic pain.
6. A client with COPD is receiving oxygen at 5 L/min via nasal cannula. He becomes
drowsy and his respirations decrease from 24 to 10/min. Which action should the
nurse take first?
A. Increase O2 to 6 L/min
B. Stimulate the patient verbally
C. Switch to a non-rebreather at 15 L/min
D. Place on a ventilator
Correct Answer: B
Rationale: Drowsiness and decreased respiratory rate signal CO2 narcosis; first ensure
airway and stimulate to assess responsiveness. Increasing oxygen would worsen
hypoventilation. Non-rebreather and ventilation may be needed later but initial rapid
assessment is key.
7. A client with end-stage renal disease receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning the nurse notes generalized edema,
2+ pitting, and a 4 kg weight gain since yesterday. Which action is most
appropriate?
A. Restrict fluids to 1000 mL/day
B. Administer IV furosemide 80 mg
C. Arrange for extra dialysis today
D. Obtain chest x-ray
