Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1. A 68-year-old man is admitted with acute decompensated heart failure. He reports
increasing dyspnea, orthopnea, and a 4 kg weight gain over 3 days. Which
assessment finding requires immediate intervention?
A. Bilateral crackles mid-lower lobes
B. Oxygen saturation 89 % on 2 L nasal cannula
C. Jugular venous distension to the angle of the jaw
D. 2+ pitting ankle edema
Correct Answer: C
Rationale: JVD to the angle of the jaw indicates marked volume overload and elevated
right-heart pressures, predisposing to pulmonary edema and respiratory failure. While all
options reflect fluid overload, severe JVD signals impending decompensation. Bilateral
crackles and low SpO₂ are concerning but not uniquely imminent; pedal edema is
chronic. Immediate IV diuretic administration and hemodynamic monitoring are
priorities.
2. The nurse is caring for a client 8 hours post-CABG. Chest tube drainage in the last
3 hours totals 180 mL/hr of bright-red blood. Which action is most appropriate?
A. Increase suction on the chest drainage system
B. Document the finding and continue to monitor
,C. Prepare for possible surgical exploration
D. Administer protamine sulfate per protocol
Correct Answer: C
Rationale: Postoperative bleeding >100–150 mL/hr of bright-red blood for 2–3
consecutive hours suggests surgical source (e.g., arterial bleed) requiring exploration.
Increasing suction does not address hemorrhage; documentation is insufficient; protamine
reverses heparin but bleeding this late is rarely coagulopathic. Notify surgeon, ensure
type & cross, and prepare OR.
3. A client with DKA receives an insulin infusion at 0.1 units/kg/hr. Which
laboratory value is the best indicator that the insulin dose is effective?
A. Serum glucose decreasing 50–75 mg/dL/hr
B. Serum bicarbonate rising to >18 mEq/L
C. Urine ketones becoming negative
D. Serum potassium 4.0 mEq/L
Correct Answer: B
Rationale: Resolution of acidemia (rising bicarbonate, pH >7.3) demonstrates insulin’s
suppression of ketogenesis—its primary goal. Glucose falls first due to volume
resuscitation and insulin, but ketone clearance lags; therefore bicarbonate is a better
efficacy marker. Urine ketones may remain positive for hours; potassium level reflects
repletion, not insulin action.
4. A client with Guillain-Barré syndrome experiences sudden difficulty speaking and
drooling. Vital signs are stable. What is the priority nursing action?
,A. Obtain a bedside spirometry
B. Elevate head of bed to 45°
C. Administer IV immunoglobulin
D. Call speech therapy for swallow evaluation
Correct Answer: A
Rationale: Bulbar dysfunction (dysphonia, drooling) heralds impending respiratory
failure; bedside spirometry (FVC, NIF) quantifies neuromuscular respiratory capacity and
guides intubation decisions. Elevating the head is supportive but secondary; IVIG is
disease-modifying, already initiated, and does not address acute airway compromise.
Speech evaluation is important but not the immediate priority.
5. The nurse is assessing a client 24 hours after a thyroidectomy. The client reports
tingling around the mouth and fingertips. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
Correct Answer: B
Rationale: Parathyroid injury or removal during thyroidectomy reduces PTH, causing
hypocalcemia with neuromuscular irritability (peri-oral tingling, Trousseau, Chvostek).
Hypokalemia presents with weakness or dysrhythmias; hypermagnesemia causes muscle
, weakness and hypotension; hyponatremia produces confusion and seizures. Check
ionized calcium and give IV calcium gluconate if low.
6. A client with liver cirrhosis develops sudden, massive hematemesis. Which
intervention should the nurse prepare to implement FIRST?
A. Insert a nasogastric tube for lavage
B. Establish two large-bore IV lines with normal saline
C. Administer vitamin K 10 mg IV push
D. Draw blood for type & crossmatch 4 units PRBC
Correct Answer: B
Rationale: Hemodynamic resuscitation is the immediate priority—large-bore IV access
permits rapid fluid and blood product administration. NG lavage aids diagnosis and
visualization but does not supersede circulatory support. Vitamin K takes 6–12 hours to
correct coagulopathy; labs are necessary but not life-saving.
7. A client with asthma receives albuterol and ipratropium nebulizers and IV
methylprednisolone. After 2 hours, peak flow improves from 150 to 200 L/min,
but the client is tremulous and HR 118 bpm. Which action is best?
A. Discontinue albuterol immediately
B. Switch to levalbuterol only
C. Reduce frequency of albuterol to every 4 hours
D. Continue current regimen and monitor closely
Correct Answer: D
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1. A 68-year-old man is admitted with acute decompensated heart failure. He reports
increasing dyspnea, orthopnea, and a 4 kg weight gain over 3 days. Which
assessment finding requires immediate intervention?
A. Bilateral crackles mid-lower lobes
B. Oxygen saturation 89 % on 2 L nasal cannula
C. Jugular venous distension to the angle of the jaw
D. 2+ pitting ankle edema
Correct Answer: C
Rationale: JVD to the angle of the jaw indicates marked volume overload and elevated
right-heart pressures, predisposing to pulmonary edema and respiratory failure. While all
options reflect fluid overload, severe JVD signals impending decompensation. Bilateral
crackles and low SpO₂ are concerning but not uniquely imminent; pedal edema is
chronic. Immediate IV diuretic administration and hemodynamic monitoring are
priorities.
2. The nurse is caring for a client 8 hours post-CABG. Chest tube drainage in the last
3 hours totals 180 mL/hr of bright-red blood. Which action is most appropriate?
A. Increase suction on the chest drainage system
B. Document the finding and continue to monitor
,C. Prepare for possible surgical exploration
D. Administer protamine sulfate per protocol
Correct Answer: C
Rationale: Postoperative bleeding >100–150 mL/hr of bright-red blood for 2–3
consecutive hours suggests surgical source (e.g., arterial bleed) requiring exploration.
Increasing suction does not address hemorrhage; documentation is insufficient; protamine
reverses heparin but bleeding this late is rarely coagulopathic. Notify surgeon, ensure
type & cross, and prepare OR.
3. A client with DKA receives an insulin infusion at 0.1 units/kg/hr. Which
laboratory value is the best indicator that the insulin dose is effective?
A. Serum glucose decreasing 50–75 mg/dL/hr
B. Serum bicarbonate rising to >18 mEq/L
C. Urine ketones becoming negative
D. Serum potassium 4.0 mEq/L
Correct Answer: B
Rationale: Resolution of acidemia (rising bicarbonate, pH >7.3) demonstrates insulin’s
suppression of ketogenesis—its primary goal. Glucose falls first due to volume
resuscitation and insulin, but ketone clearance lags; therefore bicarbonate is a better
efficacy marker. Urine ketones may remain positive for hours; potassium level reflects
repletion, not insulin action.
4. A client with Guillain-Barré syndrome experiences sudden difficulty speaking and
drooling. Vital signs are stable. What is the priority nursing action?
,A. Obtain a bedside spirometry
B. Elevate head of bed to 45°
C. Administer IV immunoglobulin
D. Call speech therapy for swallow evaluation
Correct Answer: A
Rationale: Bulbar dysfunction (dysphonia, drooling) heralds impending respiratory
failure; bedside spirometry (FVC, NIF) quantifies neuromuscular respiratory capacity and
guides intubation decisions. Elevating the head is supportive but secondary; IVIG is
disease-modifying, already initiated, and does not address acute airway compromise.
Speech evaluation is important but not the immediate priority.
5. The nurse is assessing a client 24 hours after a thyroidectomy. The client reports
tingling around the mouth and fingertips. Which electrolyte imbalance is
suspected?
A. Hypokalemia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyponatremia
Correct Answer: B
Rationale: Parathyroid injury or removal during thyroidectomy reduces PTH, causing
hypocalcemia with neuromuscular irritability (peri-oral tingling, Trousseau, Chvostek).
Hypokalemia presents with weakness or dysrhythmias; hypermagnesemia causes muscle
, weakness and hypotension; hyponatremia produces confusion and seizures. Check
ionized calcium and give IV calcium gluconate if low.
6. A client with liver cirrhosis develops sudden, massive hematemesis. Which
intervention should the nurse prepare to implement FIRST?
A. Insert a nasogastric tube for lavage
B. Establish two large-bore IV lines with normal saline
C. Administer vitamin K 10 mg IV push
D. Draw blood for type & crossmatch 4 units PRBC
Correct Answer: B
Rationale: Hemodynamic resuscitation is the immediate priority—large-bore IV access
permits rapid fluid and blood product administration. NG lavage aids diagnosis and
visualization but does not supersede circulatory support. Vitamin K takes 6–12 hours to
correct coagulopathy; labs are necessary but not life-saving.
7. A client with asthma receives albuterol and ipratropium nebulizers and IV
methylprednisolone. After 2 hours, peak flow improves from 150 to 200 L/min,
but the client is tremulous and HR 118 bpm. Which action is best?
A. Discontinue albuterol immediately
B. Switch to levalbuterol only
C. Reduce frequency of albuterol to every 4 hours
D. Continue current regimen and monitor closely
Correct Answer: D
