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 (HF) is admitted with 3+ pitting edema and reports
waking up gasping for breath the past three nights. Which assessment finding requires the
nurse’s immediate intervention?
A. Weight gain of 0.5 kg (1 lb) in 24 h
B. Oxygen saturation 88 % on 2 L/min nasal cannula
C. Bibasilar crackles that clear with cough
D. Urine output 40 mL/h for the past 4 h
Correct Answer: B
Rationale: An SpO₂ of 88 % indicates significant hypoxemia, a life-threatening
complication of acute decompensated HF. The nurse must immediately increase oxygen
delivery, obtain ABGs, and notify the provider. Option A is expected in fluid overload
but not emergent. Option C describes atelectatic crackles, not the persistent, fine crackles
of pulmonary edema. Option D is actually an adequate hourly output and does not signal
renal hypoperfusion at this time. Maintaining airway and oxygenation is the first priority
in the nursing process.
2
,The nurse is caring for a client 6 h after a coronary artery bypass graft (CABG) using the
left internal mammary artery. Which finding best indicates cardiac output is adequate?
A. Central venous pressure (CVP) 2 mmHg
B. Urine output 20 mL/h
C. Systemic vascular resistance (SVR) 1,600 dynes/sec/cm⁻⁵
D. Cardiac index 2.8 L/min/m²
Correct Answer: D
Rationale: Cardiac index (CI) normalizes cardiac output to body size; a CI ≥ 2.2
L/min/m² indicates sufficient tissue perfusion after CABG. Option A reflects
hypovolemia, Option B signals inadequate renal perfusion (<30 mL/h), and Option C
shows excessive afterload that can depress stroke volume. Continuous monitoring of CI
allows early detection of low-output states and guides titration of fluids, inotropes, and
vasodilators.
3
A client admitted with diabetic ketoacidosis (DKA) receives an IV insulin infusion at 8
units/h. Which serum value is most important for the nurse to verify before decreasing
the infusion rate?
A. Glucose 250 mg/dL
B. Potassium 3.0 mEq/L
C. Bicarbonate 18 mEq/L
D. Anion gap 20 mEq/L
,Correct Answer: B
Rationale: Insulin drives potassium intracellularly; hypokalemia (≤3.3 mEq/L) must be
corrected before insulin rate is lowered to prevent fatal dysrhythmias. Option A is still
above the target of 150–200 mg/dL but does not outweigh potassium concerns. Options C
and D show continued acidosis, yet safe potassium takes priority over closure of gap. The
nurse should collaborate with the provider to add potassium to fluids while maintaining
insulin until gap closes.
4
The nurse is assessing a client with Guillain-Barré syndrome (GBS). Which change
warrants immediate notification of the rapid-response team?
A. Bilateral facial weakness appearing over 12 h
B. Descending weakness now affecting the thighs
C. Shortness of breath with vital capacity 12 mL/kg
D. Reports of paresthesias in both hands
Correct Answer: C
Rationale: A vital capacity ≤15 mL/kg signals impending respiratory failure in GBS due
to diaphragmatic weakness, requiring emergent intubation. Option A is expected cranial
nerve involvement, Option B is classic ascending (not descending) weakness, and Option
D is an early sensory symptom that does not threaten airway. The nurse must perform
serial pulmonary function tests and have airway equipment at bedside.
5
, A postoperative client receiving morphine via patient-controlled analgesia (PCA) has a
respiratory rate of 8/min and is difficult to arouse. After stopping the PCA, which
medication should the nurse prepare to administer?
A. Naloxone 0.04 mg IV push, repeated PRN
B. Flumazenil 0.2 mg IV push
C. Protamine sulfate 10 mg IV push
D. Naltrexone 50 mg PO
Correct Answer: A
Rationale: Naloxone is the opioid-reversal agent of choice for respiratory depression;
giving small incremental doses (0.04 mg) reverses sedation without precipitating acute
pain or withdrawal. Option B reverses benzodiazepines, not opioids. Option C reverses
heparin, and Option D is an oral opioid blocker with slow onset, inappropriate for acute
overdose. The nurse stays with client, supports airway, and may repeat naloxone every
2–3 min.
6
A client with cirrhosis develops tense ascites and shortness of breath. Which nursing
intervention is most appropriate before administering the prescribed spironolactone?
A. Obtain baseline serum potassium
B. Insert indwelling urinary catheter
C. Measure abdominal girth daily
D. Weigh client at end of shift
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1
A client with a history of heart failure (HF) is admitted with 3+ pitting edema and reports
waking up gasping for breath the past three nights. Which assessment finding requires the
nurse’s immediate intervention?
A. Weight gain of 0.5 kg (1 lb) in 24 h
B. Oxygen saturation 88 % on 2 L/min nasal cannula
C. Bibasilar crackles that clear with cough
D. Urine output 40 mL/h for the past 4 h
Correct Answer: B
Rationale: An SpO₂ of 88 % indicates significant hypoxemia, a life-threatening
complication of acute decompensated HF. The nurse must immediately increase oxygen
delivery, obtain ABGs, and notify the provider. Option A is expected in fluid overload
but not emergent. Option C describes atelectatic crackles, not the persistent, fine crackles
of pulmonary edema. Option D is actually an adequate hourly output and does not signal
renal hypoperfusion at this time. Maintaining airway and oxygenation is the first priority
in the nursing process.
2
,The nurse is caring for a client 6 h after a coronary artery bypass graft (CABG) using the
left internal mammary artery. Which finding best indicates cardiac output is adequate?
A. Central venous pressure (CVP) 2 mmHg
B. Urine output 20 mL/h
C. Systemic vascular resistance (SVR) 1,600 dynes/sec/cm⁻⁵
D. Cardiac index 2.8 L/min/m²
Correct Answer: D
Rationale: Cardiac index (CI) normalizes cardiac output to body size; a CI ≥ 2.2
L/min/m² indicates sufficient tissue perfusion after CABG. Option A reflects
hypovolemia, Option B signals inadequate renal perfusion (<30 mL/h), and Option C
shows excessive afterload that can depress stroke volume. Continuous monitoring of CI
allows early detection of low-output states and guides titration of fluids, inotropes, and
vasodilators.
3
A client admitted with diabetic ketoacidosis (DKA) receives an IV insulin infusion at 8
units/h. Which serum value is most important for the nurse to verify before decreasing
the infusion rate?
A. Glucose 250 mg/dL
B. Potassium 3.0 mEq/L
C. Bicarbonate 18 mEq/L
D. Anion gap 20 mEq/L
,Correct Answer: B
Rationale: Insulin drives potassium intracellularly; hypokalemia (≤3.3 mEq/L) must be
corrected before insulin rate is lowered to prevent fatal dysrhythmias. Option A is still
above the target of 150–200 mg/dL but does not outweigh potassium concerns. Options C
and D show continued acidosis, yet safe potassium takes priority over closure of gap. The
nurse should collaborate with the provider to add potassium to fluids while maintaining
insulin until gap closes.
4
The nurse is assessing a client with Guillain-Barré syndrome (GBS). Which change
warrants immediate notification of the rapid-response team?
A. Bilateral facial weakness appearing over 12 h
B. Descending weakness now affecting the thighs
C. Shortness of breath with vital capacity 12 mL/kg
D. Reports of paresthesias in both hands
Correct Answer: C
Rationale: A vital capacity ≤15 mL/kg signals impending respiratory failure in GBS due
to diaphragmatic weakness, requiring emergent intubation. Option A is expected cranial
nerve involvement, Option B is classic ascending (not descending) weakness, and Option
D is an early sensory symptom that does not threaten airway. The nurse must perform
serial pulmonary function tests and have airway equipment at bedside.
5
, A postoperative client receiving morphine via patient-controlled analgesia (PCA) has a
respiratory rate of 8/min and is difficult to arouse. After stopping the PCA, which
medication should the nurse prepare to administer?
A. Naloxone 0.04 mg IV push, repeated PRN
B. Flumazenil 0.2 mg IV push
C. Protamine sulfate 10 mg IV push
D. Naltrexone 50 mg PO
Correct Answer: A
Rationale: Naloxone is the opioid-reversal agent of choice for respiratory depression;
giving small incremental doses (0.04 mg) reverses sedation without precipitating acute
pain or withdrawal. Option B reverses benzodiazepines, not opioids. Option C reverses
heparin, and Option D is an oral opioid blocker with slow onset, inappropriate for acute
overdose. The nurse stays with client, supports airway, and may repeat naloxone every
2–3 min.
6
A client with cirrhosis develops tense ascites and shortness of breath. Which nursing
intervention is most appropriate before administering the prescribed spironolactone?
A. Obtain baseline serum potassium
B. Insert indwelling urinary catheter
C. Measure abdominal girth daily
D. Weigh client at end of shift
