EVOLVE ELSEVIER HESI MEDICAL-SURGICAL EXAM
2025/2026
Question 1: The nurse is providing care to a client admitted to the emergency
room with a blood glucose level of 40 mg/dL and is semiconscious. What are the
nurse's next actions? (Select all that apply.)
A) Start an IV of Normal Saline.
B) Obtain a 50% dextrose solution.
C) Administer glucagon as per the standing order.
D) Turn the client to the side.
Correct Answer: A, B, C, D
Rationale: Oral carbohydrates should never be given to semiconscious or
unconscious clients due to the risk of aspiration. Glucagon can be administered
immediately. Starting an IV and preparing 50% dextrose are also crucial steps.
Placing the client in a side-lying position is important as there is a risk for vomiting
and aspiration .
Question 2: An 81-year-old client has emphysema. The client lives at home with a
cat and manages self-care with no difficulty. When making a home visit, the nurse
notices that this client's tongue is somewhat cracked and his eyeballs appear
sunken. Which nursing action is indicated?
A) Help the client determine ways to increase fluid intake.
B) Notify the healthcare provider immediately.
C) Instruct the client to get rid of the cat.
, D) Schedule a follow-up visit for next month.
Correct Answer: A
Rationale: Clients with COPD often have difficulty with fluid intake due to
shortness of breath and should ingest about 3 L of fluids daily. Cracked tongue
and sunken eyes are signs of dehydration. The nurse should suggest creative
methods to increase fluid intake .
Question 3: A 58-year-old client who has no health problems asks the nurse about
receiving the pneumococcal vaccine. Which statement given by the nurse would
offer the client accurate information about this vaccine?
A) "You will need a booster shot every year, just like the flu shot."
B) "It is usually recommended that persons older than 65 receive the
vaccine once in their lifetime."
C) "This vaccine is only given if you are traveling overseas."
D) "You will need this vaccine every 5 years to maintain immunity."
Correct Answer: B
Rationale: It is generally recommended that persons older than 65 years and
those with a history of chronic illness receive the pneumococcal vaccine once in
their lifetime. The influenza vaccine is given annually .
Question 4: The clinic nurse is teaching a client with osteoarthritis of the knees
bilaterally about self-care. Which teaching points will the nurse include? (Select all
that apply.)
A) Apply heat packs to your knees as needed for pain.
, B) Support your knees while you are in bed with a pillow or a rolled towel.
C) Get 7 to 8 hours of sleep every night.
D) Eat a balanced diet, including fish with Omega-3 fatty acids.
Correct Answer: A, B, C, D
Rationale: Heat application increases circulation and relieves pain. Supporting the
knees reduces joint strain. Adequate sleep helps with coping. A balanced diet with
Omega-3 fatty acids may help reduce inflammation .
Question 5: The nurse notes that the client's chest tube drainage has decreased
from 50 to 5 mL/hr 12 hours after insertion for hemothorax. What is the best
initial action for the nurse to take?
A) Notify the healthcare provider.
B) Document the finding as expected.
C) Assess for kinks or dependent loops in the tubing.
D) Prepare for chest tube removal.
Correct Answer: C
Rationale: The least invasive nursing action should be performed first to
determine why drainage has diminished. Kinks or dependent loops in the tubing
can obstruct drainage .
Question 6: During report, the nurse learns that a client with tumor lysis
syndrome is receiving an IV infusion containing insulin. Which action should the
nurse complete first?
, A) Monitor the client's serum potassium and blood glucose levels.
B) Assess the IV site for infiltration.
C) Review the client's allergy history.
D) Check the client's blood pressure.
Correct Answer: A
Rationale: Clients with tumor lysis syndrome may experience hyperkalemia.
Insulin is often added to the IV solution to help drive potassium into the cells. It is
most important to monitor serum potassium and blood glucose levels to ensure
they are not at dangerous levels .
Question 7: For the client undergoing hemodialysis, the nurse suspects the client
has an air embolism. What symptoms lead the nurse to this conclusion? (Select all
that apply.)
A) Dyspnea
B) Chest pain
C) Anxiety
D) Blue nail beds
Correct Answer: A, B, C, D
Rationale: Air embolism is a serious complication of hemodialysis. Symptoms
include dyspnea, chest pain, anxiety, and cyanosis (blue nail beds) .
2025/2026
Question 1: The nurse is providing care to a client admitted to the emergency
room with a blood glucose level of 40 mg/dL and is semiconscious. What are the
nurse's next actions? (Select all that apply.)
A) Start an IV of Normal Saline.
B) Obtain a 50% dextrose solution.
C) Administer glucagon as per the standing order.
D) Turn the client to the side.
Correct Answer: A, B, C, D
Rationale: Oral carbohydrates should never be given to semiconscious or
unconscious clients due to the risk of aspiration. Glucagon can be administered
immediately. Starting an IV and preparing 50% dextrose are also crucial steps.
Placing the client in a side-lying position is important as there is a risk for vomiting
and aspiration .
Question 2: An 81-year-old client has emphysema. The client lives at home with a
cat and manages self-care with no difficulty. When making a home visit, the nurse
notices that this client's tongue is somewhat cracked and his eyeballs appear
sunken. Which nursing action is indicated?
A) Help the client determine ways to increase fluid intake.
B) Notify the healthcare provider immediately.
C) Instruct the client to get rid of the cat.
, D) Schedule a follow-up visit for next month.
Correct Answer: A
Rationale: Clients with COPD often have difficulty with fluid intake due to
shortness of breath and should ingest about 3 L of fluids daily. Cracked tongue
and sunken eyes are signs of dehydration. The nurse should suggest creative
methods to increase fluid intake .
Question 3: A 58-year-old client who has no health problems asks the nurse about
receiving the pneumococcal vaccine. Which statement given by the nurse would
offer the client accurate information about this vaccine?
A) "You will need a booster shot every year, just like the flu shot."
B) "It is usually recommended that persons older than 65 receive the
vaccine once in their lifetime."
C) "This vaccine is only given if you are traveling overseas."
D) "You will need this vaccine every 5 years to maintain immunity."
Correct Answer: B
Rationale: It is generally recommended that persons older than 65 years and
those with a history of chronic illness receive the pneumococcal vaccine once in
their lifetime. The influenza vaccine is given annually .
Question 4: The clinic nurse is teaching a client with osteoarthritis of the knees
bilaterally about self-care. Which teaching points will the nurse include? (Select all
that apply.)
A) Apply heat packs to your knees as needed for pain.
, B) Support your knees while you are in bed with a pillow or a rolled towel.
C) Get 7 to 8 hours of sleep every night.
D) Eat a balanced diet, including fish with Omega-3 fatty acids.
Correct Answer: A, B, C, D
Rationale: Heat application increases circulation and relieves pain. Supporting the
knees reduces joint strain. Adequate sleep helps with coping. A balanced diet with
Omega-3 fatty acids may help reduce inflammation .
Question 5: The nurse notes that the client's chest tube drainage has decreased
from 50 to 5 mL/hr 12 hours after insertion for hemothorax. What is the best
initial action for the nurse to take?
A) Notify the healthcare provider.
B) Document the finding as expected.
C) Assess for kinks or dependent loops in the tubing.
D) Prepare for chest tube removal.
Correct Answer: C
Rationale: The least invasive nursing action should be performed first to
determine why drainage has diminished. Kinks or dependent loops in the tubing
can obstruct drainage .
Question 6: During report, the nurse learns that a client with tumor lysis
syndrome is receiving an IV infusion containing insulin. Which action should the
nurse complete first?
, A) Monitor the client's serum potassium and blood glucose levels.
B) Assess the IV site for infiltration.
C) Review the client's allergy history.
D) Check the client's blood pressure.
Correct Answer: A
Rationale: Clients with tumor lysis syndrome may experience hyperkalemia.
Insulin is often added to the IV solution to help drive potassium into the cells. It is
most important to monitor serum potassium and blood glucose levels to ensure
they are not at dangerous levels .
Question 7: For the client undergoing hemodialysis, the nurse suspects the client
has an air embolism. What symptoms lead the nurse to this conclusion? (Select all
that apply.)
A) Dyspnea
B) Chest pain
C) Anxiety
D) Blue nail beds
Correct Answer: A, B, C, D
Rationale: Air embolism is a serious complication of hemodialysis. Symptoms
include dyspnea, chest pain, anxiety, and cyanosis (blue nail beds) .
