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 decompensation.
Which assessment finding warrants immediate intervention?
A. Weight gain of 1 kg in 24 hours
B. Oxygen saturation 88% on 2 L nasal cannula
C. Bibasilar crackles
D. Jugular venous distention 4 cm above the sternal angle
Correct Answer: B
Rationale: An oxygen saturation below 90% indicates significant hypoxemia and requires
prompt intervention to prevent tissue hypoxia and organ dysfunction. While weight gain,
crackles, and JVD are all indicators of fluid overload, hypoxemia is the most immediate
threat to survival. Increasing oxygen delivery or support takes priority over diuresis in the
initial moments of care.
2. A postoperative client who underwent a right lower lobectomy reports sudden
chest pain and shortness of breath. The nurse notes tachycardia and a PaO₂ of 58
mmHg on room air. Which action should the nurse take first?
A. Administer morphine sulfate
B. Obtain a stat chest X-ray
C. Apply high-flow oxygen via non-rebreather mask
,D. Page the respiratory therapist for incentive spirometry coaching
Correct Answer: C
Rationale: The client is demonstrating signs of acute hypoxemic respiratory failure, most
likely from a pulmonary embolism or acute atelectasis. The immediate priority is to
maximize oxygen delivery with high-flow oxygen while preparing for further
diagnostics. Morphine would mask symptoms and depress respirations; a chest X-ray is
useful but not the first action; incentive spirometry is preventive, not therapeutic for acute
hypoxia.
3. A client with DKA is receiving an insulin infusion at 8 units/hour. The most recent
blood glucose is 180 mg/dL, down from 420 mg/dL two hours ago. Which
adjustment should the nurse anticipate?
A. Decrease insulin to 4 units/hour and add D5 to IV fluids
B. Continue current rate until glucose < 120 mg/dL
C. Stop insulin infusion and start subcutaneous NPH
D. Increase insulin to 12 units/hour
Correct Answer: A
Rationale: DKA protocols recommend reducing the insulin infusion to 2–5 units/hour
once glucose falls below 200–250 mg/dL and adding dextrose to prevent hypoglycemia
while continuing insulin to suppress ketone production. Stopping insulin abruptly allows
rebound ketosis; increasing the dose risks hypoglycemia; waiting for 120 mg/dL delays
necessary action.
, 4. A client with acute pancreatitis is complaining of severe epigastric pain that
radiates to the back. Which laboratory value should the nurse monitor as a
priority?
A. Serum calcium
B. Serum amylase
C. Serum glucose
D. Hematocrit
Correct Answer: A
Rationale: Severe pancreatitis can cause hypocalcemia due to saponification of fat by
lipase, and serum calcium < 8 mg/dL is a marker of severe disease and increased
mortality. While amylase and lipase are diagnostic, they do not correlate with severity.
Glucose and hematocrit are monitored, but calcium derangement is immediately
life-threatening and requires replacement.
5. A client with end-stage renal disease receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning, the client reports headache,
nausea, and a weight gain of 2.5 kg since yesterday. Which action is most
appropriate?
A. Restrict fluids to 1 L for the day
B. Administer an antiemetic and reschedule dialysis for Friday
C. Obtain a stat serum potassium and ECG
D. Encourage a high-protein snack
Correct Answer: C
, Rationale: The client is hypervolemic and at risk for hyperkalemia due to missed dialysis.
A stat potassium and ECG can detect peaked T waves or widening QRS, which require
immediate intervention such as IV calcium, insulin/glucose, or emergency dialysis. Fluid
restriction helps but does not address potential arrhythmia; waiting until Friday is unsafe;
protein intake does not correct electrolyte imbalance.
6. A client with a subarachnoid hemorrhage is being monitored in the neuro ICU.
The nurse notes a sudden increase in systolic BP from 130 to 190 mmHg and a
decrease in heart rate from 88 to 52 bpm. Which complication should the nurse
suspect?
A. Vasospasm
B. Cushing’s response to increased ICP
C. Neurogenic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: Hypertension with reflex bradycardia (Cushing’s triad) signals increased
intracranial pressure compromising cerebral perfusion. Immediate notification of the
provider and preparation for possible osmotic diuretics or surgical intervention is
required. Vasospasm typically occurs days later; neurogenic shock presents with
hypotension; PE causes tachycardia and hypoxemia.
7. A client with Guillain-Barré syndrome is experiencing ascending weakness.
Which change requires immediate notification of the provider?
A. Decreased grip strength from 4/5 to 3/5
B. Bilateral facial droop
(2025/2026) — 150 High-Level Nursing
Questions, Correct Answers & Full Rationales
1. A client with a history of heart failure is admitted with acute decompensation.
Which assessment finding warrants immediate intervention?
A. Weight gain of 1 kg in 24 hours
B. Oxygen saturation 88% on 2 L nasal cannula
C. Bibasilar crackles
D. Jugular venous distention 4 cm above the sternal angle
Correct Answer: B
Rationale: An oxygen saturation below 90% indicates significant hypoxemia and requires
prompt intervention to prevent tissue hypoxia and organ dysfunction. While weight gain,
crackles, and JVD are all indicators of fluid overload, hypoxemia is the most immediate
threat to survival. Increasing oxygen delivery or support takes priority over diuresis in the
initial moments of care.
2. A postoperative client who underwent a right lower lobectomy reports sudden
chest pain and shortness of breath. The nurse notes tachycardia and a PaO₂ of 58
mmHg on room air. Which action should the nurse take first?
A. Administer morphine sulfate
B. Obtain a stat chest X-ray
C. Apply high-flow oxygen via non-rebreather mask
,D. Page the respiratory therapist for incentive spirometry coaching
Correct Answer: C
Rationale: The client is demonstrating signs of acute hypoxemic respiratory failure, most
likely from a pulmonary embolism or acute atelectasis. The immediate priority is to
maximize oxygen delivery with high-flow oxygen while preparing for further
diagnostics. Morphine would mask symptoms and depress respirations; a chest X-ray is
useful but not the first action; incentive spirometry is preventive, not therapeutic for acute
hypoxia.
3. A client with DKA is receiving an insulin infusion at 8 units/hour. The most recent
blood glucose is 180 mg/dL, down from 420 mg/dL two hours ago. Which
adjustment should the nurse anticipate?
A. Decrease insulin to 4 units/hour and add D5 to IV fluids
B. Continue current rate until glucose < 120 mg/dL
C. Stop insulin infusion and start subcutaneous NPH
D. Increase insulin to 12 units/hour
Correct Answer: A
Rationale: DKA protocols recommend reducing the insulin infusion to 2–5 units/hour
once glucose falls below 200–250 mg/dL and adding dextrose to prevent hypoglycemia
while continuing insulin to suppress ketone production. Stopping insulin abruptly allows
rebound ketosis; increasing the dose risks hypoglycemia; waiting for 120 mg/dL delays
necessary action.
, 4. A client with acute pancreatitis is complaining of severe epigastric pain that
radiates to the back. Which laboratory value should the nurse monitor as a
priority?
A. Serum calcium
B. Serum amylase
C. Serum glucose
D. Hematocrit
Correct Answer: A
Rationale: Severe pancreatitis can cause hypocalcemia due to saponification of fat by
lipase, and serum calcium < 8 mg/dL is a marker of severe disease and increased
mortality. While amylase and lipase are diagnostic, they do not correlate with severity.
Glucose and hematocrit are monitored, but calcium derangement is immediately
life-threatening and requires replacement.
5. A client with end-stage renal disease receives hemodialysis on Monday,
Wednesday, and Friday. On Thursday morning, the client reports headache,
nausea, and a weight gain of 2.5 kg since yesterday. Which action is most
appropriate?
A. Restrict fluids to 1 L for the day
B. Administer an antiemetic and reschedule dialysis for Friday
C. Obtain a stat serum potassium and ECG
D. Encourage a high-protein snack
Correct Answer: C
, Rationale: The client is hypervolemic and at risk for hyperkalemia due to missed dialysis.
A stat potassium and ECG can detect peaked T waves or widening QRS, which require
immediate intervention such as IV calcium, insulin/glucose, or emergency dialysis. Fluid
restriction helps but does not address potential arrhythmia; waiting until Friday is unsafe;
protein intake does not correct electrolyte imbalance.
6. A client with a subarachnoid hemorrhage is being monitored in the neuro ICU.
The nurse notes a sudden increase in systolic BP from 130 to 190 mmHg and a
decrease in heart rate from 88 to 52 bpm. Which complication should the nurse
suspect?
A. Vasospasm
B. Cushing’s response to increased ICP
C. Neurogenic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: Hypertension with reflex bradycardia (Cushing’s triad) signals increased
intracranial pressure compromising cerebral perfusion. Immediate notification of the
provider and preparation for possible osmotic diuretics or surgical intervention is
required. Vasospasm typically occurs days later; neurogenic shock presents with
hypotension; PE causes tachycardia and hypoxemia.
7. A client with Guillain-Barré syndrome is experiencing ascending weakness.
Which change requires immediate notification of the provider?
A. Decreased grip strength from 4/5 to 3/5
B. Bilateral facial droop
