EVOLVE ELSEVIER HESI MEDICAL-SURGICAL
EXAM 2026 – COMPLETE PRACTICE TEST
BANK Ultimate HESI Med-Surg Study Guide | Latest
Edition | High-Yield, Exam-Ready Format
1. A 67-year-old client with a history of COPD and chronic bronchitis is admitted
with increasing dyspnea, productive cough, and audible expiratory wheezing.
The nurse notes the client is on 6 L/min oxygen via nasal cannula, has a
respiratory rate of 10/min, and is difficult to arouse. ABG reveals: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 80 mmHg. What is the nurse’s PRIORITY action?
A. Encourage the client to take slow deep breaths
B. Decrease the oxygen flow rate immediately
C. Call the rapid response team
D. Position the client in high Fowler’s position
Correct Answer: C
Rationale: The client is showing signs of acute CO₂ retention and impending respiratory
failure (low pH, very high CO₂, decreased mental status). High oxygen can worsen CO₂
retention in COPD, but the lethargy and hypoventilation are emergent and require immediate
advanced airway assessment. After calling rapid response, the oxygen and ventilation strategy
can be corrected.
2. A 48-year-old postoperative client (6 hours after abdominal surgery) suddenly
reports severe shortness of breath, sharp chest pain on inspiration, and a feeling
of impending doom. Their O₂ saturation drops from 96% to 88% despite 2 L/min
oxygen. The nurse notes tachycardia (HR 128), hypotension (BP 90/60), and clear
lung sounds. What is the priority intervention?
A. Increase oxygen to 6 L/min
B. Place the client in high Fowler’s position
C. Notify the healthcare provider immediately
D. Administer PRN morphine to reduce anxiety
,Correct Answer: B
Rationale: These symptoms strongly indicate a pulmonary embolism (sudden dyspnea, sharp
chest pain, tachycardia, low BP). Before notifications or medications, the nurse must maximize
oxygenation by elevating the head of the bed. This is the FIRST immediate action to stabilize
breathing.
3. A client hospitalized for heart failure has gained 3.5 kg (7.7 lb) in two days,
has crackles in all lung fields, severe orthopnea, and is coughing up frothy pink
sputum. The nurse auscultates an S3 gallop and notes a respiratory rate of
32/min. What is the MOST urgent nursing action?
A. Prepare for IV furosemide administration
B. Obtain a STAT chest x-ray
C. Apply high-flow oxygen via non-rebreather mask
D. Insert a Foley catheter for strict I&O
Correct Answer: C
Rationale: Frothy pink sputum = acute pulmonary edema, a life-threatening emergency.
Oxygenation must be addressed immediately before medications or diagnostics. High-flow
oxygen helps stabilize the client while preparing for diuretics.
4. A 59-year-old client with type 2 diabetes becomes diaphoretic, anxious,
lightheaded, and confused during morning rounds. Their blood glucose is 48
mg/dL. They are awake but unable to state their name clearly. What is the
nurse’s FIRST action?
A. Give 4–6 oz of rapid-acting oral carbohydrates
B. Administer 1 mg glucagon IM
C. Notify the healthcare provider
D. Start an IV line for 50% dextrose
Correct Answer: A
Rationale: The client is conscious enough to swallow safely → oral glucose is the fastest and
safest first option. Glucagon and IV dextrose are used if the client becomes unconscious or
cannot swallow.
5. A patient receiving IV furosemide for fluid overload suddenly reports
weakness and palpitations. Telemetry reveals frequent PVCs. Which lab value
requires IMMEDIATE intervention?
,A. Potassium 2.8 mEq/L
B. Sodium 142 mEq/L
C. Magnesium 1.7 mg/dL
D. BUN 16 mg/dL
Correct Answer: A
Rationale: Hypokalemia (<3.5) can rapidly lead to dangerous arrhythmias. A potassium of 2.8
with PVCs is a medical emergency requiring immediate replacement.
6. A client with suspected pneumonia is instructed in the use of an incentive
spirometer. Which statement by the client indicates CORRECT understanding?
A. “I should exhale quickly into the device to raise the ball.”
B. “I inhale slowly and deeply to raise the piston, then hold my breath briefly.”
C. “I only need to use this if I start coughing a lot.”
D. “I should blow into the device before every use.”
Correct Answer: B
Rationale: Proper technique: slow, deep inhalation → hold for 2–3 seconds → repeat 10
times hourly. This improves lung expansion and prevents atelectasis.
7. A 42-year-old client with acute pancreatitis complains of increasing abdominal
pain radiating to the back. The nurse notes bluish discoloration on the flanks and
abdomen. What is the nurse’s interpretation of this finding?
A. Expected bruising from IV therapy
B. Bowel obstruction symptoms
C. Retroperitoneal hemorrhage requiring urgent attention
D. Poor skin perfusion from dehydration
Correct Answer: C
Rationale: Grey-Turner’s sign (flank bruising) and Cullen’s sign indicate retroperitoneal
bleeding. This is a serious, potentially fatal complication of pancreatitis.
8. A client with chronic kidney disease presents with extreme fatigue, pallor, and
exertional shortness of breath. Labs show Hgb 6.9 g/dL, Hct 21%, K⁺ 4.8, and
creatinine 7.1 mg/dL. What is the PRIORITY intervention?
, A. Restrict potassium-rich foods
B. Prepare for blood transfusion as ordered
C. Start a high-calorie diet
D. Encourage oral fluids
Correct Answer: B
Rationale: Hgb < 7 with symptomatic anemia → urgent transfusion to improve oxygen
delivery.
9. A client admitted with DKA has been receiving IV insulin therapy for 2 hours.
Which finding indicates that the condition is IMPROVING?
A. Kussmaul respirations persist
B. Serum glucose decreases from 560 to 250 mg/dL
C. pH increases from 7.12 to 7.30
D. Urine output decreases
Correct Answer: C
Rationale: The hallmark of improvement in DKA is correction of metabolic acidosis,
represented by rising pH. Glucose changes alone don’t confirm improvement.
10. A client with cirrhosis and massive ascites is prescribed spironolactone, a
low-sodium diet, and acetaminophen 4 g/day for pain. Which prescription should
the nurse question?
A. Spironolactone
B. Low-sodium diet
C. Acetaminophen 4 g/day
D. Daily weights
Correct Answer: C
Rationale: Clients with liver disease cannot safely metabolize acetaminophen. The maximum
safe dose is ≤ 2 g/day, often avoided entirely.
11. A 32-year-old client with 35% total body surface area (TBSA) burns to the
chest, abdomen, and both arms becomes suddenly restless and anxious. The
nurse notes tachycardia, a respiratory rate of 30/min, and oxygen saturation that
dropped from 97% to 91% within 10 minutes. Lung sounds are clear, and pain
medication was given 30 minutes ago. What is the nurse’s priority action?
EXAM 2026 – COMPLETE PRACTICE TEST
BANK Ultimate HESI Med-Surg Study Guide | Latest
Edition | High-Yield, Exam-Ready Format
1. A 67-year-old client with a history of COPD and chronic bronchitis is admitted
with increasing dyspnea, productive cough, and audible expiratory wheezing.
The nurse notes the client is on 6 L/min oxygen via nasal cannula, has a
respiratory rate of 10/min, and is difficult to arouse. ABG reveals: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 80 mmHg. What is the nurse’s PRIORITY action?
A. Encourage the client to take slow deep breaths
B. Decrease the oxygen flow rate immediately
C. Call the rapid response team
D. Position the client in high Fowler’s position
Correct Answer: C
Rationale: The client is showing signs of acute CO₂ retention and impending respiratory
failure (low pH, very high CO₂, decreased mental status). High oxygen can worsen CO₂
retention in COPD, but the lethargy and hypoventilation are emergent and require immediate
advanced airway assessment. After calling rapid response, the oxygen and ventilation strategy
can be corrected.
2. A 48-year-old postoperative client (6 hours after abdominal surgery) suddenly
reports severe shortness of breath, sharp chest pain on inspiration, and a feeling
of impending doom. Their O₂ saturation drops from 96% to 88% despite 2 L/min
oxygen. The nurse notes tachycardia (HR 128), hypotension (BP 90/60), and clear
lung sounds. What is the priority intervention?
A. Increase oxygen to 6 L/min
B. Place the client in high Fowler’s position
C. Notify the healthcare provider immediately
D. Administer PRN morphine to reduce anxiety
,Correct Answer: B
Rationale: These symptoms strongly indicate a pulmonary embolism (sudden dyspnea, sharp
chest pain, tachycardia, low BP). Before notifications or medications, the nurse must maximize
oxygenation by elevating the head of the bed. This is the FIRST immediate action to stabilize
breathing.
3. A client hospitalized for heart failure has gained 3.5 kg (7.7 lb) in two days,
has crackles in all lung fields, severe orthopnea, and is coughing up frothy pink
sputum. The nurse auscultates an S3 gallop and notes a respiratory rate of
32/min. What is the MOST urgent nursing action?
A. Prepare for IV furosemide administration
B. Obtain a STAT chest x-ray
C. Apply high-flow oxygen via non-rebreather mask
D. Insert a Foley catheter for strict I&O
Correct Answer: C
Rationale: Frothy pink sputum = acute pulmonary edema, a life-threatening emergency.
Oxygenation must be addressed immediately before medications or diagnostics. High-flow
oxygen helps stabilize the client while preparing for diuretics.
4. A 59-year-old client with type 2 diabetes becomes diaphoretic, anxious,
lightheaded, and confused during morning rounds. Their blood glucose is 48
mg/dL. They are awake but unable to state their name clearly. What is the
nurse’s FIRST action?
A. Give 4–6 oz of rapid-acting oral carbohydrates
B. Administer 1 mg glucagon IM
C. Notify the healthcare provider
D. Start an IV line for 50% dextrose
Correct Answer: A
Rationale: The client is conscious enough to swallow safely → oral glucose is the fastest and
safest first option. Glucagon and IV dextrose are used if the client becomes unconscious or
cannot swallow.
5. A patient receiving IV furosemide for fluid overload suddenly reports
weakness and palpitations. Telemetry reveals frequent PVCs. Which lab value
requires IMMEDIATE intervention?
,A. Potassium 2.8 mEq/L
B. Sodium 142 mEq/L
C. Magnesium 1.7 mg/dL
D. BUN 16 mg/dL
Correct Answer: A
Rationale: Hypokalemia (<3.5) can rapidly lead to dangerous arrhythmias. A potassium of 2.8
with PVCs is a medical emergency requiring immediate replacement.
6. A client with suspected pneumonia is instructed in the use of an incentive
spirometer. Which statement by the client indicates CORRECT understanding?
A. “I should exhale quickly into the device to raise the ball.”
B. “I inhale slowly and deeply to raise the piston, then hold my breath briefly.”
C. “I only need to use this if I start coughing a lot.”
D. “I should blow into the device before every use.”
Correct Answer: B
Rationale: Proper technique: slow, deep inhalation → hold for 2–3 seconds → repeat 10
times hourly. This improves lung expansion and prevents atelectasis.
7. A 42-year-old client with acute pancreatitis complains of increasing abdominal
pain radiating to the back. The nurse notes bluish discoloration on the flanks and
abdomen. What is the nurse’s interpretation of this finding?
A. Expected bruising from IV therapy
B. Bowel obstruction symptoms
C. Retroperitoneal hemorrhage requiring urgent attention
D. Poor skin perfusion from dehydration
Correct Answer: C
Rationale: Grey-Turner’s sign (flank bruising) and Cullen’s sign indicate retroperitoneal
bleeding. This is a serious, potentially fatal complication of pancreatitis.
8. A client with chronic kidney disease presents with extreme fatigue, pallor, and
exertional shortness of breath. Labs show Hgb 6.9 g/dL, Hct 21%, K⁺ 4.8, and
creatinine 7.1 mg/dL. What is the PRIORITY intervention?
, A. Restrict potassium-rich foods
B. Prepare for blood transfusion as ordered
C. Start a high-calorie diet
D. Encourage oral fluids
Correct Answer: B
Rationale: Hgb < 7 with symptomatic anemia → urgent transfusion to improve oxygen
delivery.
9. A client admitted with DKA has been receiving IV insulin therapy for 2 hours.
Which finding indicates that the condition is IMPROVING?
A. Kussmaul respirations persist
B. Serum glucose decreases from 560 to 250 mg/dL
C. pH increases from 7.12 to 7.30
D. Urine output decreases
Correct Answer: C
Rationale: The hallmark of improvement in DKA is correction of metabolic acidosis,
represented by rising pH. Glucose changes alone don’t confirm improvement.
10. A client with cirrhosis and massive ascites is prescribed spironolactone, a
low-sodium diet, and acetaminophen 4 g/day for pain. Which prescription should
the nurse question?
A. Spironolactone
B. Low-sodium diet
C. Acetaminophen 4 g/day
D. Daily weights
Correct Answer: C
Rationale: Clients with liver disease cannot safely metabolize acetaminophen. The maximum
safe dose is ≤ 2 g/day, often avoided entirely.
11. A 32-year-old client with 35% total body surface area (TBSA) burns to the
chest, abdomen, and both arms becomes suddenly restless and anxious. The
nurse notes tachycardia, a respiratory rate of 30/min, and oxygen saturation that
dropped from 97% to 91% within 10 minutes. Lung sounds are clear, and pain
medication was given 30 minutes ago. What is the nurse’s priority action?
