Evolve Elsevier HESI Med-Surg Practice Exam
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1. A 68-year-old client is admitted with acute decompensated heart failure. Vital
signs: BP 82/48 mm Hg, HR 110 beats/min, RR 28 breaths/min, SpO₂ 86 % on 4 L
nasal cannula. Bibasilar crackles are audible, and the client is alert but fatigued.
Which order should the nurse implement first?
A. Obtain a 12-lead ECG
B. Administer furosemide 80 mg IV push
C. Increase oxygen to 6 L via nasal cannula
D. Place the client in high-Fowler position
Correct Answer: D
Rationale: High-Fowler positioning reduces venous return (preload), decreases
ventricular filling pressures, and improves lung expansion, offering the fastest
improvement in oxygenation and dyspnea. Increasing oxygen alone (C) does not address
pulmonary congestion. While furosemide (B) is critical, positioning is performed during
the first 30–60 seconds and can be done simultaneously with calling for help. ECG (A) is
important but not the immediate life-saving action.
2. The nurse is caring for a client who had an anterior-wall STEMI 2 days ago. The
monitor suddenly shows sinus tachycardia at 120 beats/min with frequent
multifocal PVCs. Which assessment finding warrants immediate intervention?
A. Serum potassium 3.2 mEq/L
,B. Serum sodium 132 mEq/L
C. Blood glucose 190 mg/dL
D. Chest pain rated 2/10
Correct Answer: A
Rationale: Hypokalemia <3.5 mEq/L increases ventricular irritability and can precipitate
life-threatening ventricular tachycardia or fibrillation in the setting of recent MI.
Immediate replacement per protocol is required. Mild hyponatremia (B) and
hyperglycemia (C) are not acute arrhythmia triggers; low-level chest pain (D) should be
treated but is not the priority over lethal dysrhythmia risk.
3. A client with COPD is receiving mechanical ventilation. The ABG results are pH
7.48, PaCO₂ 32 mm Hg, PaO₂ 88 mm Hg, HCO₃⁻ 24 mEq/L. Which ventilator
change should the nurse anticipate?
A. Decrease FiO₂
B. Increase tidal volume
C. Decrease respiratory rate
D. Increase PEEP
Correct Answer: C
Rationale: The ABG shows acute respiratory alkalosis due to hyperventilation. Lowering
the respiratory rate allows PaCO₂ to rise toward the client’s chronic baseline (usually
50–60 mm Hg) and prevents alkalemia-induced arrhythmias and cerebral
vasoconstriction. Increasing tidal volume (B) would worsen hypocapnia; PEEP (D) and
FiO₂ (A) address oxygenation, not pH.
, 4. The nurse is assessing a client 4 hours after a right lower lobectomy. The
chest-tube chamber shows fluctuation with inspiration and expiration, and 50 mL
of serosanguineous drainage has occurred. Which action is most appropriate?
A. Strip the chest tube to maintain patency
B. Encourage the client to use the incentive spirometer hourly
C. Notify the provider immediately about the drainage amount
D. Milk the tubing toward the collection chamber
Correct Answer: B
Rationale: Gentle fluctuation (tidaling) and <100 mL of drainage in 4 hours are expected.
The priority is preventing atelectasis and promoting lung re-expansion through effective
incentive spirometry. Stripping or milking (A, D) is performed only if visible clots
obstruct the tube and is done with an order. Immediate notification (C) is unnecessary
unless drainage >200 mL/h or sudden cessation.
5. A client with DKA is receiving 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 5 mEq/L/hr
C. Urine ketones becoming negative
D. Serum potassium increasing 0.5 mEq/L/hr
Correct Answer: A
Rationale: A steady glucose drop of 50–75 mg/dL/hr indicates adequate insulin action
while preventing too-rapid decline that can cause cerebral edema. Bicarbonate (B) and
, ketones (C) correct more slowly (over 6–12 hours). Potassium shifts (D) occur early but
are influenced by fluids and supplementation, not solely insulin effectiveness.
6. The nurse is evaluating a client who returned from PACU after a transurethral
resection of the prostate (TURP). The continuous bladder irrigation (CBI) is
infusing at 100 mL/hr and draining dark pink. Which intervention is priority?
A. Increase the CBI inflow rate
B. Administer IV morphine for pain
C. Lower the CBI rate to 50 mL/hr
D. Obtain a stat hemoglobin and hematocrit
Correct Answer: A
Rationale: Dark pink output with possible clots signals bleeding that could obstruct the
catheter. Increasing irrigation rate dilutes blood, prevents clot formation, and maintains
catheter patency. Pain control (B) is secondary to preventing clot retention. Laboratory
values (D) are useful but do not address the immediate patency threat.
7. A client with Guillain-Barré syndrome in the progressive phase reports new onset
of shortness of breath and a weak cough. Vital capacity drops from 1,200 mL to
800 mL. Which action should the nurse take first?
A. Administer nebulized albuterol
B. Prepare for emergent intubation
C. Place the client in Trendelenburg position
D. Obtain an ABG
Correct Answer: B
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1. A 68-year-old client is admitted with acute decompensated heart failure. Vital
signs: BP 82/48 mm Hg, HR 110 beats/min, RR 28 breaths/min, SpO₂ 86 % on 4 L
nasal cannula. Bibasilar crackles are audible, and the client is alert but fatigued.
Which order should the nurse implement first?
A. Obtain a 12-lead ECG
B. Administer furosemide 80 mg IV push
C. Increase oxygen to 6 L via nasal cannula
D. Place the client in high-Fowler position
Correct Answer: D
Rationale: High-Fowler positioning reduces venous return (preload), decreases
ventricular filling pressures, and improves lung expansion, offering the fastest
improvement in oxygenation and dyspnea. Increasing oxygen alone (C) does not address
pulmonary congestion. While furosemide (B) is critical, positioning is performed during
the first 30–60 seconds and can be done simultaneously with calling for help. ECG (A) is
important but not the immediate life-saving action.
2. The nurse is caring for a client who had an anterior-wall STEMI 2 days ago. The
monitor suddenly shows sinus tachycardia at 120 beats/min with frequent
multifocal PVCs. Which assessment finding warrants immediate intervention?
A. Serum potassium 3.2 mEq/L
,B. Serum sodium 132 mEq/L
C. Blood glucose 190 mg/dL
D. Chest pain rated 2/10
Correct Answer: A
Rationale: Hypokalemia <3.5 mEq/L increases ventricular irritability and can precipitate
life-threatening ventricular tachycardia or fibrillation in the setting of recent MI.
Immediate replacement per protocol is required. Mild hyponatremia (B) and
hyperglycemia (C) are not acute arrhythmia triggers; low-level chest pain (D) should be
treated but is not the priority over lethal dysrhythmia risk.
3. A client with COPD is receiving mechanical ventilation. The ABG results are pH
7.48, PaCO₂ 32 mm Hg, PaO₂ 88 mm Hg, HCO₃⁻ 24 mEq/L. Which ventilator
change should the nurse anticipate?
A. Decrease FiO₂
B. Increase tidal volume
C. Decrease respiratory rate
D. Increase PEEP
Correct Answer: C
Rationale: The ABG shows acute respiratory alkalosis due to hyperventilation. Lowering
the respiratory rate allows PaCO₂ to rise toward the client’s chronic baseline (usually
50–60 mm Hg) and prevents alkalemia-induced arrhythmias and cerebral
vasoconstriction. Increasing tidal volume (B) would worsen hypocapnia; PEEP (D) and
FiO₂ (A) address oxygenation, not pH.
, 4. The nurse is assessing a client 4 hours after a right lower lobectomy. The
chest-tube chamber shows fluctuation with inspiration and expiration, and 50 mL
of serosanguineous drainage has occurred. Which action is most appropriate?
A. Strip the chest tube to maintain patency
B. Encourage the client to use the incentive spirometer hourly
C. Notify the provider immediately about the drainage amount
D. Milk the tubing toward the collection chamber
Correct Answer: B
Rationale: Gentle fluctuation (tidaling) and <100 mL of drainage in 4 hours are expected.
The priority is preventing atelectasis and promoting lung re-expansion through effective
incentive spirometry. Stripping or milking (A, D) is performed only if visible clots
obstruct the tube and is done with an order. Immediate notification (C) is unnecessary
unless drainage >200 mL/h or sudden cessation.
5. A client with DKA is receiving 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 5 mEq/L/hr
C. Urine ketones becoming negative
D. Serum potassium increasing 0.5 mEq/L/hr
Correct Answer: A
Rationale: A steady glucose drop of 50–75 mg/dL/hr indicates adequate insulin action
while preventing too-rapid decline that can cause cerebral edema. Bicarbonate (B) and
, ketones (C) correct more slowly (over 6–12 hours). Potassium shifts (D) occur early but
are influenced by fluids and supplementation, not solely insulin effectiveness.
6. The nurse is evaluating a client who returned from PACU after a transurethral
resection of the prostate (TURP). The continuous bladder irrigation (CBI) is
infusing at 100 mL/hr and draining dark pink. Which intervention is priority?
A. Increase the CBI inflow rate
B. Administer IV morphine for pain
C. Lower the CBI rate to 50 mL/hr
D. Obtain a stat hemoglobin and hematocrit
Correct Answer: A
Rationale: Dark pink output with possible clots signals bleeding that could obstruct the
catheter. Increasing irrigation rate dilutes blood, prevents clot formation, and maintains
catheter patency. Pain control (B) is secondary to preventing clot retention. Laboratory
values (D) are useful but do not address the immediate patency threat.
7. A client with Guillain-Barré syndrome in the progressive phase reports new onset
of shortness of breath and a weak cough. Vital capacity drops from 1,200 mL to
800 mL. Which action should the nurse take first?
A. Administer nebulized albuterol
B. Prepare for emergent intubation
C. Place the client in Trendelenburg position
D. Obtain an ABG
Correct Answer: B
