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. The nurse notes
the client is dyspneic, with an SpO₂ of 86 % on room air, and bilateral crackles. Which
action should the nurse take first?
A. Administer IV furosemide 40 mg
B. Place the client in high-Fowler’s position and apply high-flow oxygen
C. Obtain a 12-lead ECG
D. Insert a Foley catheter
Correct Answer: B
Rationale: High-Fowler’s reduces venous return and diaphragmatic pressure, improving lung
expansion; high-flow oxygen corrects hypoxemia rapidly—both are immediate life-saving
measures. IV furosemide is next but only after oxygenation improves. ECG and Foley are
important assessments but do not address the ABC priority of oxygenation.
2. The nurse is caring for a client post-CABG. The client suddenly becomes anxious,
tachycardic, and the arterial line shows a 20 mmHg drop in systolic BP. The mediastinal
drainage has increased from 50 mL to 250 mL in 1 hour. Which complication should the
nurse suspect?
A. Cardiac tamponade
B. Acute graft closure
C. Pneumothorax
D. Hypovolemic shock
Correct Answer: A
Rationale: Rapid increase in mediastinal bleeding with hemodynamic instability suggests
tamponade—blood accumulates, compresses ventricles, and reduces stroke volume. Graft
closure presents with chest pain and ECG changes. Pneumothorax would show tracheal deviation
,or absent breath sounds. Hypovolemia is possible but the sudden large drainage points to
tamponade.
3. A client with DKA receives an insulin infusion at 0.1 unit/kg/hr. Which laboratory value
is the most reliable indicator that the insulin therapy is effective?
A. Blood glucose decreasing 50–75 mg/dL/hr
B. Serum bicarbonate rising toward normal
C. Urine ketones clearing
D. Serum potassium 4.0 mEq/L
Correct Answer: B
Rationale: Effective insulin suppresses ketone production, so rising bicarbonate reflects
resolution of acidosis—the primary life threat. Glucose falls first but can be influenced by fluids
alone. Urine ketones lag. Potassium is monitored but is unrelated to insulin’s anti-ketone effect.
4. The nurse is assessing a client with Guillain-Barré syndrome. Which finding requires
immediate intervention?
A. Bilateral lower-extremity weakness 4/5
B. Decreased deep tendon reflexes
C. Vital capacity 12 mL/kg
D. Paresthesias in hands
Correct Answer: C
Rationale: VC < 15–20 mL/kg signals impending respiratory failure—prepare for intubation.
Weakness and reflex loss are expected; paresthesias are sensory and not immediately
life-threatening.
5. A client with a pulmonary embolism is started on a heparin infusion. Twelve hours later,
platelet count drops from 250,000 to 90,000/mm³. What is the priority nursing action?
A. Stop the heparin infusion immediately
B. Increase the heparin rate to achieve therapeutic aPTT
C. Administer protamine sulfate
D. Notify the provider after shift report
Correct Answer: A
,Rationale: A > 50 % drop suggests heparin-induced thrombocytopenia; stopping heparin
prevents further antibody-mediated clotting. Protamine is for bleeding, not HIT. Increasing
heparin worsens thrombosis. Immediate notification is required.
6. A client with cirrhosis develops sudden severe abdominal pain and hypotension. The
nurse notes a rigid, board-like abdomen. Which complication is suspected?
A. Spontaneous bacterial peritonitis
B. Esophageal variceal rupture
C. Hepatorenal syndrome
D. Perforated viscus
Correct Answer: D
Rationale: Board-like rigidity and shock indicate peritonitis from perforation (e.g., ulcer). SBP
presents with fever and mild pain. Variceal bleed presents with hematemesis. Hepatorenal causes
oliguria, not acute abdomen.
7. A client returns from a subtotal thyroidectomy and reports tingling around the mouth and
fingertips. Which electrolyte imbalance should the nurse monitor?
A. Hypokalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Correct Answer: B
Rationale: Tingling and tetany signal hypocalcemia from inadvertent parathyroid removal or
suppression—check ionized calcium. Other electrolytes do not cause perioral numbness.
8. A client with acute pancreatitis has a nasogastric tube set to low intermittent suction.
Which finding best indicates that the inflammation is resolving?
A. Decrease in serum amylase
B. Absence of pain during palpation
C. Return of bowel sounds and flatus
D. Urine output > 30 mL/hr
Correct Answer: C
, Rationale: Return of bowel motility reflects decreased inflammation and edema—allows
progression to oral feeding. Amylase can normalize while pain persists. Pain is subjective. Urine
output reflects volume, not resolution.
9. A client with a fractured femur in Buck’s traction reports sudden dyspnea and chest pain.
Petechiae are noted over the chest and axilla. Which emergency intervention should the
nurse anticipate?
A. Administration of heparin
B. Application of an occlusive dressing
C. Oxygen and possible intubation
D. Morphine and cough encouragement
Correct Answer: C
Rationale: Fat embolism syndrome causes hypoxemia—high-flow oxygen, intubation if needed,
and respiratory support are priorities. Heparin is contraindicated (bleeding risk). Occlusive
dressing is for chest wall injury. Morphine masks symptoms.
10. A client with asthma receives albuterol via nebulizer and tremors develop. The heart rate
increases from 88 to 120 bpm. Which evaluation is most appropriate?
A. Discontinue albuterol immediately
B. Document as expected beta-2 side effect and continue if SaO₂ improves
C. Switch to ipratropium only
D. Obtain a chest X-ray
Correct Answer: B
Rationale: Tremor and mild tachycardia are common beta-2 agonist effects; benefits outweigh
risks if oxygenation improves. Discontinuation may worsen bronchospasm. Ipratropium can be
adjunct but not replacement during acute attack.
11. A client with Cushing’s syndrome is admitted for adrenalectomy. Which nursing
diagnosis is the priority?
A. Risk for infection
B. Disturbed body image
C. Excess fluid volume
D. Imbalanced nutrition: more than body requirements
(2025/2026) — 150 High-Level Nursing Questions,
Correct Answers & Full Rationales
1. A 68-year-old client is admitted with acute decompensated heart failure. The nurse notes
the client is dyspneic, with an SpO₂ of 86 % on room air, and bilateral crackles. Which
action should the nurse take first?
A. Administer IV furosemide 40 mg
B. Place the client in high-Fowler’s position and apply high-flow oxygen
C. Obtain a 12-lead ECG
D. Insert a Foley catheter
Correct Answer: B
Rationale: High-Fowler’s reduces venous return and diaphragmatic pressure, improving lung
expansion; high-flow oxygen corrects hypoxemia rapidly—both are immediate life-saving
measures. IV furosemide is next but only after oxygenation improves. ECG and Foley are
important assessments but do not address the ABC priority of oxygenation.
2. The nurse is caring for a client post-CABG. The client suddenly becomes anxious,
tachycardic, and the arterial line shows a 20 mmHg drop in systolic BP. The mediastinal
drainage has increased from 50 mL to 250 mL in 1 hour. Which complication should the
nurse suspect?
A. Cardiac tamponade
B. Acute graft closure
C. Pneumothorax
D. Hypovolemic shock
Correct Answer: A
Rationale: Rapid increase in mediastinal bleeding with hemodynamic instability suggests
tamponade—blood accumulates, compresses ventricles, and reduces stroke volume. Graft
closure presents with chest pain and ECG changes. Pneumothorax would show tracheal deviation
,or absent breath sounds. Hypovolemia is possible but the sudden large drainage points to
tamponade.
3. A client with DKA receives an insulin infusion at 0.1 unit/kg/hr. Which laboratory value
is the most reliable indicator that the insulin therapy is effective?
A. Blood glucose decreasing 50–75 mg/dL/hr
B. Serum bicarbonate rising toward normal
C. Urine ketones clearing
D. Serum potassium 4.0 mEq/L
Correct Answer: B
Rationale: Effective insulin suppresses ketone production, so rising bicarbonate reflects
resolution of acidosis—the primary life threat. Glucose falls first but can be influenced by fluids
alone. Urine ketones lag. Potassium is monitored but is unrelated to insulin’s anti-ketone effect.
4. The nurse is assessing a client with Guillain-Barré syndrome. Which finding requires
immediate intervention?
A. Bilateral lower-extremity weakness 4/5
B. Decreased deep tendon reflexes
C. Vital capacity 12 mL/kg
D. Paresthesias in hands
Correct Answer: C
Rationale: VC < 15–20 mL/kg signals impending respiratory failure—prepare for intubation.
Weakness and reflex loss are expected; paresthesias are sensory and not immediately
life-threatening.
5. A client with a pulmonary embolism is started on a heparin infusion. Twelve hours later,
platelet count drops from 250,000 to 90,000/mm³. What is the priority nursing action?
A. Stop the heparin infusion immediately
B. Increase the heparin rate to achieve therapeutic aPTT
C. Administer protamine sulfate
D. Notify the provider after shift report
Correct Answer: A
,Rationale: A > 50 % drop suggests heparin-induced thrombocytopenia; stopping heparin
prevents further antibody-mediated clotting. Protamine is for bleeding, not HIT. Increasing
heparin worsens thrombosis. Immediate notification is required.
6. A client with cirrhosis develops sudden severe abdominal pain and hypotension. The
nurse notes a rigid, board-like abdomen. Which complication is suspected?
A. Spontaneous bacterial peritonitis
B. Esophageal variceal rupture
C. Hepatorenal syndrome
D. Perforated viscus
Correct Answer: D
Rationale: Board-like rigidity and shock indicate peritonitis from perforation (e.g., ulcer). SBP
presents with fever and mild pain. Variceal bleed presents with hematemesis. Hepatorenal causes
oliguria, not acute abdomen.
7. A client returns from a subtotal thyroidectomy and reports tingling around the mouth and
fingertips. Which electrolyte imbalance should the nurse monitor?
A. Hypokalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Correct Answer: B
Rationale: Tingling and tetany signal hypocalcemia from inadvertent parathyroid removal or
suppression—check ionized calcium. Other electrolytes do not cause perioral numbness.
8. A client with acute pancreatitis has a nasogastric tube set to low intermittent suction.
Which finding best indicates that the inflammation is resolving?
A. Decrease in serum amylase
B. Absence of pain during palpation
C. Return of bowel sounds and flatus
D. Urine output > 30 mL/hr
Correct Answer: C
, Rationale: Return of bowel motility reflects decreased inflammation and edema—allows
progression to oral feeding. Amylase can normalize while pain persists. Pain is subjective. Urine
output reflects volume, not resolution.
9. A client with a fractured femur in Buck’s traction reports sudden dyspnea and chest pain.
Petechiae are noted over the chest and axilla. Which emergency intervention should the
nurse anticipate?
A. Administration of heparin
B. Application of an occlusive dressing
C. Oxygen and possible intubation
D. Morphine and cough encouragement
Correct Answer: C
Rationale: Fat embolism syndrome causes hypoxemia—high-flow oxygen, intubation if needed,
and respiratory support are priorities. Heparin is contraindicated (bleeding risk). Occlusive
dressing is for chest wall injury. Morphine masks symptoms.
10. A client with asthma receives albuterol via nebulizer and tremors develop. The heart rate
increases from 88 to 120 bpm. Which evaluation is most appropriate?
A. Discontinue albuterol immediately
B. Document as expected beta-2 side effect and continue if SaO₂ improves
C. Switch to ipratropium only
D. Obtain a chest X-ray
Correct Answer: B
Rationale: Tremor and mild tachycardia are common beta-2 agonist effects; benefits outweigh
risks if oxygenation improves. Discontinuation may worsen bronchospasm. Ipratropium can be
adjunct but not replacement during acute attack.
11. A client with Cushing’s syndrome is admitted for adrenalectomy. Which nursing
diagnosis is the priority?
A. Risk for infection
B. Disturbed body image
C. Excess fluid volume
D. Imbalanced nutrition: more than body requirements
