Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing
Questions, Correct Answers & Full Rationales
1. A client with a history of heart failure is admitted with acute shortness of breath and
bilateral crackles. The nurse notes a new-onset irregular heart rate of 162 beats per
minute. Which action should the nurse take first?
A. Administer furosemide 40 mg IV push
B. Apply high-flow oxygen via non-rebreather
C. Obtain a 12-lead ECG immediately
D. Check the client’s last potassium level
Correct Answer: C
Rationale: A new-onset irregular tachycardia of 162 bpm suggests atrial fibrillation with rapid
ventricular response (AFib-RVR), which can precipitate acute decompensated HF. Obtaining a
12-lead ECG is the priority to confirm rhythm and guide further treatment such as rate/rhythm
control. High-flow oxygen (B) is appropriate but does not address the underlying rhythm;
furosemide (A) treats fluid overload but should follow ECG confirmation; checking potassium
(D) is important but not the immediate first step.
2. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who
is receiving oxygen at 5 L/min via nasal cannula. The client becomes increasingly
somnolent and his oxygen saturation is 96%. Which complication is the client most likely
experiencing?
,A. Acute hypercapnic respiratory failure
B. Oxygen toxicity
C. Pulmonary embolism
D. Acute respiratory distress syndrome (ARDS)
Correct Answer: A
Rationale: Clients with COPD often rely on hypoxic respiratory drive; high-flow oxygen can
blunt this drive, leading to hypercapnia and somnolence. The elevated saturation masks rising
PaCO₂. The nurse should decrease oxygen delivery and obtain an ABG. Oxygen toxicity (B)
develops over days; PE (C) presents with hypoxemia and chest pain; ARDS (D) causes severe
hypoxemia, not hyperoxia.
3. A postoperative client who underwent a total hip replacement reports sudden onset of
dyspnea and chest pain. The nurse notes petechiae over the chest and axilla. Which
finding would most strongly support a diagnosis of fat embolism syndrome?
A. Temperature 38.9 °C
B. PaO₂ 58 mmHg on room air
C. Platelet count 90,000/µL
D. Blood pressure 88/50 mmHg
Correct Answer: B
Rationale: Hypoxemia (PaO₂ < 60 mmHg) is an early and consistent sign of fat embolism due to
ventilation/perfusion mismatch from marrow fat globules in pulmonary capillaries. Petechiae,
altered mental status, and hypoxemia form the classic triad. Thrombocytopenia (C) may occur
but is nonspecific; hypotension (D) is a late sign; fever (A) is common post-op.
, 4. A client with diabetic ketoacidosis (DKA) is receiving an insulin infusion at 0.1
units/kg/hr. Which laboratory value is the best indicator that the insulin infusion is
effective?
A. Glucose decreasing 50 mg/dL/hr
B. pH increasing from 7.21 to 7.32
C. Potassium 3.0 mEq/L
D. Bicarbonate rising from 12 to 18 mEq/L
Correct Answer: B
Rationale: Closure of the anion gap and rising pH reflect resolution of ketoacidosis, the primary
goal of insulin therapy. Glucose falls faster than ketones; therefore, dextrose should be added
when glucose reaches 200–250 mg/dL to prevent hypoglycemia while continuing insulin to clear
ketones. Bicarbonate (D) is helpful but pH is more direct; hypokalemia (C) is a side effect, not
efficacy.
5. The nurse is assessing a client with acute pancreatitis. Which finding should be reported
to the provider immediately?
A. Grey Turner’s sign
B. Serum amylase 800 U/L
C. Pain rated 8/10
D. NPO status for 24 hours
Correct Answer: A
Rationale: Grey Turner’s sign (flank ecchymosis) indicates retroperitoneal bleeding and is a
marker of severe necrotizing pancreatitis, requiring possible surgical intervention and aggressive
, resuscitation. While pain (C) and elevated amylase (B) are expected, they are not immediately
life-threatening; NPO (D) is standard care.
6. A client with end-stage renal disease (ESRD) receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning, the client reports a metallic taste and
muscle cramping. Which electrolyte imbalance is most likely?
A. Hypernatremia
B. Hypokalemia
C. Hyperphosphatemia
D. Uremia with hyperkalemia
Correct Answer: D
Rationale: Metallic taste and muscle cramps are classic signs of uremia and hyperkalemia in the
interdialytic period. Hypokalemia (B) is rare in ESRD; hyperphosphatemia (C) causes itching
and bone pain but not acute cramps; hypernatremia (A) is uncommon due to thirst mechanism.
7. A client with a spinal cord injury at T4 is experiencing a pounding headache and
flushing. The nurse notes a blood pressure of 200/100 mmHg and bradycardia. Which
condition is the client experiencing?
A. Autonomic dysreflexia
B. Increased intracranial pressure
C. Parasympathetic overstimulation
D. Malignant hypertension
Correct Answer: A
(2025/2026) — 150 High-Level Nursing
Questions, Correct Answers & Full Rationales
1. A client with a history of heart failure is admitted with acute shortness of breath and
bilateral crackles. The nurse notes a new-onset irregular heart rate of 162 beats per
minute. Which action should the nurse take first?
A. Administer furosemide 40 mg IV push
B. Apply high-flow oxygen via non-rebreather
C. Obtain a 12-lead ECG immediately
D. Check the client’s last potassium level
Correct Answer: C
Rationale: A new-onset irregular tachycardia of 162 bpm suggests atrial fibrillation with rapid
ventricular response (AFib-RVR), which can precipitate acute decompensated HF. Obtaining a
12-lead ECG is the priority to confirm rhythm and guide further treatment such as rate/rhythm
control. High-flow oxygen (B) is appropriate but does not address the underlying rhythm;
furosemide (A) treats fluid overload but should follow ECG confirmation; checking potassium
(D) is important but not the immediate first step.
2. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who
is receiving oxygen at 5 L/min via nasal cannula. The client becomes increasingly
somnolent and his oxygen saturation is 96%. Which complication is the client most likely
experiencing?
,A. Acute hypercapnic respiratory failure
B. Oxygen toxicity
C. Pulmonary embolism
D. Acute respiratory distress syndrome (ARDS)
Correct Answer: A
Rationale: Clients with COPD often rely on hypoxic respiratory drive; high-flow oxygen can
blunt this drive, leading to hypercapnia and somnolence. The elevated saturation masks rising
PaCO₂. The nurse should decrease oxygen delivery and obtain an ABG. Oxygen toxicity (B)
develops over days; PE (C) presents with hypoxemia and chest pain; ARDS (D) causes severe
hypoxemia, not hyperoxia.
3. A postoperative client who underwent a total hip replacement reports sudden onset of
dyspnea and chest pain. The nurse notes petechiae over the chest and axilla. Which
finding would most strongly support a diagnosis of fat embolism syndrome?
A. Temperature 38.9 °C
B. PaO₂ 58 mmHg on room air
C. Platelet count 90,000/µL
D. Blood pressure 88/50 mmHg
Correct Answer: B
Rationale: Hypoxemia (PaO₂ < 60 mmHg) is an early and consistent sign of fat embolism due to
ventilation/perfusion mismatch from marrow fat globules in pulmonary capillaries. Petechiae,
altered mental status, and hypoxemia form the classic triad. Thrombocytopenia (C) may occur
but is nonspecific; hypotension (D) is a late sign; fever (A) is common post-op.
, 4. A client with diabetic ketoacidosis (DKA) is receiving an insulin infusion at 0.1
units/kg/hr. Which laboratory value is the best indicator that the insulin infusion is
effective?
A. Glucose decreasing 50 mg/dL/hr
B. pH increasing from 7.21 to 7.32
C. Potassium 3.0 mEq/L
D. Bicarbonate rising from 12 to 18 mEq/L
Correct Answer: B
Rationale: Closure of the anion gap and rising pH reflect resolution of ketoacidosis, the primary
goal of insulin therapy. Glucose falls faster than ketones; therefore, dextrose should be added
when glucose reaches 200–250 mg/dL to prevent hypoglycemia while continuing insulin to clear
ketones. Bicarbonate (D) is helpful but pH is more direct; hypokalemia (C) is a side effect, not
efficacy.
5. The nurse is assessing a client with acute pancreatitis. Which finding should be reported
to the provider immediately?
A. Grey Turner’s sign
B. Serum amylase 800 U/L
C. Pain rated 8/10
D. NPO status for 24 hours
Correct Answer: A
Rationale: Grey Turner’s sign (flank ecchymosis) indicates retroperitoneal bleeding and is a
marker of severe necrotizing pancreatitis, requiring possible surgical intervention and aggressive
, resuscitation. While pain (C) and elevated amylase (B) are expected, they are not immediately
life-threatening; NPO (D) is standard care.
6. A client with end-stage renal disease (ESRD) receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning, the client reports a metallic taste and
muscle cramping. Which electrolyte imbalance is most likely?
A. Hypernatremia
B. Hypokalemia
C. Hyperphosphatemia
D. Uremia with hyperkalemia
Correct Answer: D
Rationale: Metallic taste and muscle cramps are classic signs of uremia and hyperkalemia in the
interdialytic period. Hypokalemia (B) is rare in ESRD; hyperphosphatemia (C) causes itching
and bone pain but not acute cramps; hypernatremia (A) is uncommon due to thirst mechanism.
7. A client with a spinal cord injury at T4 is experiencing a pounding headache and
flushing. The nurse notes a blood pressure of 200/100 mmHg and bradycardia. Which
condition is the client experiencing?
A. Autonomic dysreflexia
B. Increased intracranial pressure
C. Parasympathetic overstimulation
D. Malignant hypertension
Correct Answer: A
