Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
A 68-year-old client is admitted with acute decompensated heart failure. The nurse
notes bibasilar crackles, SaO₂ 88 % on 2 L nasal cannula, and BP 160/90 mm Hg.
Which prescription should the nurse implement FIRST?
1. A. Increase O₂ to 4 L via nasal cannula
B. Administer IV furosemide 40 mg push
C. Obtain stat chest X-ray
D. Start nitroglycerin drip at 5 mcg/min
Correct Answer: B
Rationale: Acute decompensated HF with pulmonary edema manifests as hypoxia
and fluid overload; rapid diuresis is the priority to decrease preload and relieve
pulmonary congestion. IV furosemide produces venodilation within minutes and
diuresis within 30 min, improving oxygenation. While oxygen should be titrated to
SpO₂ ≥ 94 %, increasing flow without addressing fluid overload delays recovery.
Chest X-ray confirms congestion but does not treat it. Nitroglycerin is useful but
second-line after diuretics for volume removal.
Four hours after a subtotal thyroidectomy, the client reports “tightness in the
throat” and audible stridor. Which action will the nurse take FIRST?
2. A. Auscultate lungs for wheezes
B. Check for bleeding under the dressing
C. Administer 100 % O₂ by non-rebreather
D. Have tracheostomy tray brought to bedside
Correct Answer: B
,Rationale: Stridor within 6 h of thyroidectomy suggests expanding neck hematoma
compressing the trachea. The nurse must quickly inspect for hematoma, loosen
tight dressings, and notify surgeon for evacuation before airway obstruction occurs.
Oxygen is supportive but does not relieve compression. Tracheostomy is a backup
but bleeding control is definitive.
The nurse is caring for a client with DKA receiving an insulin infusion at 8 units/h.
Current labs: glucose 280 mg/dL, K⁺ 3.2 mEq/L, pH 7.18. Which prescription is
MOST urgent?
3. A. Decrease insulin to 4 units/h to prevent hypoglycemia
B. Start 20 mEq KCl in 500 mL NS at 150 mL/h
C. Switch IVF to D5½NS when glucose <250
D. Administer bicarbonate 1 amp IV push
Correct Answer: B
Rationale: Insulin drives potassium intracellularly; with K⁺ 3.2 mEq/L, further
drops can precipitate fatal arrhythmias. Replacing potassium before insulin
reduction is critical. Current guidelines begin KCl when K⁺ <3.3 despite acidosis.
Bicarbonate is reserved for pH <6.9. Insulin should continue until ketones clear;
dextrose is added to prevent hypoglycemia while insulin infuses.
A client with acute pancreatitis has severe epigastric pain, BP 80/50 mm Hg, HR
120, RR 28, and urine output 15 mL/h. Which finding alerts the nurse that the
client is entering the systemic inflammatory response phase?
4. A. Serum amylase 1,800 U/L
B. Serum calcium 7.2 mg/dL
C. PaO₂ 58 mm Hg on room air
D. WBC 18,000 mm³
Correct Answer: C
,Rationale: Hypoxemia (PaO₂ <60 mm Hg) signals acute lung injury, the earliest
systemic manifestation of severe pancreatitis. Hypocalcemia and leukocytosis
support severity but are not life-threatening as quickly as respiratory failure. Close
monitoring and possible intubation are priorities.
The nurse receives report on four clients. Which one requires IMMEDIATE
assessment?
5. A. Post-MI client with chest tube output 75 mL/h
B. Post-cholecystectomy client with BP 100/60 on PCA morphine
C. COPD client with PaCO₂ 52 mm Hg after bronchodilator
D. Craniotomy client whose urine output jumped from 40 mL/h to 250 mL/h
Correct Answer: D
Rationale: Sudden polyuria after craniotomy suggests diabetes insipidus from
posterior pituitary dysfunction, leading rapidly to hypernatremia and hypovolemic
shock. Early recognition allows vasopressin and fluid replacement. Chest tube
output 75 mL/h is borderline but not emergent; mild hypotension on PCA and
PaCO₂ 52 are expected.
A client with cirrhosis and ascites develops abdominal pain and fever 38.9 °C.
Paracentesis shows WBC 350 cells/mm³ with 80 % neutrophils. Which
intervention is PRIORITY?
6. A. Start ceftriaxone 2 g IV daily
B. Infuse 25 % albumin 1.5 g/kg
C. Restrict sodium to 2 g/day
D. Schedule large-volume paracentesis
Correct Answer: A
Rationale: Spontaneous bacterial peritonitis (SBP) is defined as ascitic neutrophil
count ≥250 cells/mm³ with ≥50 % PMNs; empiric third-generation cephalosporin
, reduces mortality. Albumin prevents hepatorenal syndrome but antibiotics are first.
Sodium restriction and paracentesis manage ascites but do not treat infection.
The nurse is preparing a client for discharge after a below-knee amputation. Which
statement by the client indicates a need for further teaching?
7. A. “I will elevate the residual limb on two pillows while lying down.”
B. “I will begin pushing myself up in bed using my hands, not the trapeze.”
C. “I should wrap the stump with an elastic bandage twice daily.”
D. “I will inspect the incision every day for redness or drainage.”
Correct Answer: A
Rationale: Elevating the residual limb on pillows can cause hip flexion
contractures; the limb should lie flat or in slight extension to maintain neutral hip
alignment. Stump wrapping, daily inspection, and proper transfer technique are
correct.
A client with Guillain-Barré syndrome experiences ascending weakness and
dysphagia. Which nursing assessment is MOST critical every 2 hours?
8. A. Deep tendon reflexes
B. Hand grip strength
C. Forced vital capacity
D. Level of consciousness
Correct Answer: C
Rationale: Respiratory muscle weakness can progress rapidly; measuring FVC
predicts need for intubation (threshold <20 mL/kg or <30 % predicted). Reflex loss
and hand strength are useful but do not prioritize airway. Mental status is usually
preserved in GBS.
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
A 68-year-old client is admitted with acute decompensated heart failure. The nurse
notes bibasilar crackles, SaO₂ 88 % on 2 L nasal cannula, and BP 160/90 mm Hg.
Which prescription should the nurse implement FIRST?
1. A. Increase O₂ to 4 L via nasal cannula
B. Administer IV furosemide 40 mg push
C. Obtain stat chest X-ray
D. Start nitroglycerin drip at 5 mcg/min
Correct Answer: B
Rationale: Acute decompensated HF with pulmonary edema manifests as hypoxia
and fluid overload; rapid diuresis is the priority to decrease preload and relieve
pulmonary congestion. IV furosemide produces venodilation within minutes and
diuresis within 30 min, improving oxygenation. While oxygen should be titrated to
SpO₂ ≥ 94 %, increasing flow without addressing fluid overload delays recovery.
Chest X-ray confirms congestion but does not treat it. Nitroglycerin is useful but
second-line after diuretics for volume removal.
Four hours after a subtotal thyroidectomy, the client reports “tightness in the
throat” and audible stridor. Which action will the nurse take FIRST?
2. A. Auscultate lungs for wheezes
B. Check for bleeding under the dressing
C. Administer 100 % O₂ by non-rebreather
D. Have tracheostomy tray brought to bedside
Correct Answer: B
,Rationale: Stridor within 6 h of thyroidectomy suggests expanding neck hematoma
compressing the trachea. The nurse must quickly inspect for hematoma, loosen
tight dressings, and notify surgeon for evacuation before airway obstruction occurs.
Oxygen is supportive but does not relieve compression. Tracheostomy is a backup
but bleeding control is definitive.
The nurse is caring for a client with DKA receiving an insulin infusion at 8 units/h.
Current labs: glucose 280 mg/dL, K⁺ 3.2 mEq/L, pH 7.18. Which prescription is
MOST urgent?
3. A. Decrease insulin to 4 units/h to prevent hypoglycemia
B. Start 20 mEq KCl in 500 mL NS at 150 mL/h
C. Switch IVF to D5½NS when glucose <250
D. Administer bicarbonate 1 amp IV push
Correct Answer: B
Rationale: Insulin drives potassium intracellularly; with K⁺ 3.2 mEq/L, further
drops can precipitate fatal arrhythmias. Replacing potassium before insulin
reduction is critical. Current guidelines begin KCl when K⁺ <3.3 despite acidosis.
Bicarbonate is reserved for pH <6.9. Insulin should continue until ketones clear;
dextrose is added to prevent hypoglycemia while insulin infuses.
A client with acute pancreatitis has severe epigastric pain, BP 80/50 mm Hg, HR
120, RR 28, and urine output 15 mL/h. Which finding alerts the nurse that the
client is entering the systemic inflammatory response phase?
4. A. Serum amylase 1,800 U/L
B. Serum calcium 7.2 mg/dL
C. PaO₂ 58 mm Hg on room air
D. WBC 18,000 mm³
Correct Answer: C
,Rationale: Hypoxemia (PaO₂ <60 mm Hg) signals acute lung injury, the earliest
systemic manifestation of severe pancreatitis. Hypocalcemia and leukocytosis
support severity but are not life-threatening as quickly as respiratory failure. Close
monitoring and possible intubation are priorities.
The nurse receives report on four clients. Which one requires IMMEDIATE
assessment?
5. A. Post-MI client with chest tube output 75 mL/h
B. Post-cholecystectomy client with BP 100/60 on PCA morphine
C. COPD client with PaCO₂ 52 mm Hg after bronchodilator
D. Craniotomy client whose urine output jumped from 40 mL/h to 250 mL/h
Correct Answer: D
Rationale: Sudden polyuria after craniotomy suggests diabetes insipidus from
posterior pituitary dysfunction, leading rapidly to hypernatremia and hypovolemic
shock. Early recognition allows vasopressin and fluid replacement. Chest tube
output 75 mL/h is borderline but not emergent; mild hypotension on PCA and
PaCO₂ 52 are expected.
A client with cirrhosis and ascites develops abdominal pain and fever 38.9 °C.
Paracentesis shows WBC 350 cells/mm³ with 80 % neutrophils. Which
intervention is PRIORITY?
6. A. Start ceftriaxone 2 g IV daily
B. Infuse 25 % albumin 1.5 g/kg
C. Restrict sodium to 2 g/day
D. Schedule large-volume paracentesis
Correct Answer: A
Rationale: Spontaneous bacterial peritonitis (SBP) is defined as ascitic neutrophil
count ≥250 cells/mm³ with ≥50 % PMNs; empiric third-generation cephalosporin
, reduces mortality. Albumin prevents hepatorenal syndrome but antibiotics are first.
Sodium restriction and paracentesis manage ascites but do not treat infection.
The nurse is preparing a client for discharge after a below-knee amputation. Which
statement by the client indicates a need for further teaching?
7. A. “I will elevate the residual limb on two pillows while lying down.”
B. “I will begin pushing myself up in bed using my hands, not the trapeze.”
C. “I should wrap the stump with an elastic bandage twice daily.”
D. “I will inspect the incision every day for redness or drainage.”
Correct Answer: A
Rationale: Elevating the residual limb on pillows can cause hip flexion
contractures; the limb should lie flat or in slight extension to maintain neutral hip
alignment. Stump wrapping, daily inspection, and proper transfer technique are
correct.
A client with Guillain-Barré syndrome experiences ascending weakness and
dysphagia. Which nursing assessment is MOST critical every 2 hours?
8. A. Deep tendon reflexes
B. Hand grip strength
C. Forced vital capacity
D. Level of consciousness
Correct Answer: C
Rationale: Respiratory muscle weakness can progress rapidly; measuring FVC
predicts need for intubation (threshold <20 mL/kg or <30 % predicted). Reflex loss
and hand strength are useful but do not prioritize airway. Mental status is usually
preserved in GBS.
