2026 UPDATED QUESTIONS DOWNLOAD
Evolve Elsevier HESI Med-Surg Specialty Exam: 250+
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 250 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A patient is admitted with a potassium level of 6.2 mEq/L. Which peaked wave on the
ECG monitor should the nurse prioritize?
A. P wave
B. T wave
C. QRS complex
D. U wave
Correct Answer: B
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves. This is a critical indicator of potential ventricular arrhythmias.
Which assessment finding is most indicative of left-sided heart failure?
A. Jugular venous distension
B. Dependent edema
C. Orthopnea and crackles
D. Right upper quadrant pain
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary veins,
leading to pulmonary congestion, shortness of breath when lying flat (orthopnea), and
crackles on lung auscultation.
A patient with a history of COPD is receiving oxygen at 2L/min via nasal cannula.
The nurse notes the SpO2 is 89%. What is the most appropriate action?
A. Increase the oxygen to 6L/min
B. Continue to monitor the patient
C. Change to a non-rebreather mask
,2026 UPDATED QUESTIONS DOWNLOAD
D. Notify the physician immediately
Correct Answer: B
Rationale: For patients with chronic obstructive pulmonary disease (COPD), an oxygen
saturation (SpO2) between 88-92% is often the therapeutic goal to prevent the
suppression of their hypoxic drive to breathe.
Which laboratory result is the most sensitive indicator of renal failure?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Urine Specific Gravity
D. Creatine Kinase (CK)
Correct Answer: B
Rationale: Serum creatinine is the most reliable indicator of kidney function because it is
a metabolic byproduct of muscle that is exclusively excreted by the kidneys and is not
affected by diet or fluid intake like BUN.
A patient has a suspected Deep Vein Thrombosis (DVT) in the right calf. Which
nursing action is contraindicated?
A. Elevating the right leg
B. Applying a warm compress
C. Massaging the affected area
D. Measuring calf circumference daily
Correct Answer: C
Rationale: Massaging an area with a suspected DVT is strictly contraindicated as it can
dislodge the thrombus, causing it to travel to the lungs as a pulmonary embolism.
Which sign is a classic clinical manifestation of hypoglycemia?
A. Increased thirst and urination
B. Fruity breath odor
C. Diaphoresis and shakiness
D. Abdominal pain
Correct Answer: C
Rationale: Hypoglycemia triggers the sympathetic nervous system, resulting in "cold
and clammy" skin (diaphoresis), tremors, tachycardia, and irritability.
A patient post-thyroidectomy develops tingling in the fingers and a positive
Chvostek's sign. Which medication should the nurse have available?
A. Potassium chloride
B. Calcium gluconate
C. Sodium bicarbonate
D. Magnesium sulfate
,2026 UPDATED QUESTIONS DOWNLOAD
Correct Answer: B
Rationale: These are signs of hypocalcemia, which can occur if the parathyroid glands
are accidentally damaged or removed during a thyroidectomy. Calcium gluconate is the
emergency treatment.
A patient is diagnosed with an acute Myocardial Infarction (MI). Which cardiac
biomarker rises earliest?
A. Troponin I
B. CK-MB
C. Myoglobin
D. LDH
Correct Answer: C
Rationale: Myoglobin is the earliest marker to rise (within 1-3 hours) after myocardial
injury, though it is less specific than Troponin.
In a patient with Cirrhosis, which lab value is most likely responsible for hepatic
encephalopathy?
A. Elevated Bilirubin
B. Elevated Ammonia
C. Decreased Albumin
D. Elevated ALT/AST
Correct Answer: B
Rationale: Ammonia is a byproduct of protein metabolism. When the liver cannot
convert it to urea, high levels cross the blood-brain barrier, causing altered mental
status and confusion.
A patient with a chest tube has continuous bubbling in the water-seal chamber. What
does this indicate?
A. The system is working correctly
B. There is a leak in the system
C. The lung has fully re-expanded
D. The suction is too high
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Intermittent bubbling is normal during expiration or coughing until the lung re-expands.
Which position is most appropriate for a patient immediately following a Liver
Biopsy?
A. High-Fowler's
B. Left lateral
C. Right lateral
, 2026 UPDATED QUESTIONS DOWNLOAD
D. Supine
Correct Answer: C
Rationale: The patient should be positioned on their right side (affected side) for at least
2 hours to apply pressure to the biopsy site and prevent hemorrhage.
A patient presents with "the worst headache of my life" and nuchal rigidity. The
nurse suspects:
A. Migraine
B. Ischemic Stroke
C. Subarachnoid Hemorrhage
D. TIA
Correct Answer: C
Rationale: A "thunderclap" headache followed by neck stiffness (nuchal rigidity) is a
classic sign of a ruptured cerebral aneurysm or subarachnoid hemorrhage.
Which assessment finding is a priority for a patient with a newly applied cast?
A. Complaints of itching
B. Diminished distal pulses and paresthesia
C. Warm skin under the cast
D. Small amount of swelling
Correct Answer: B
Rationale: These are early signs of Compartment Syndrome, a surgical emergency
where increased pressure within a confined space compromises blood flow.
Which food choice is most appropriate for a patient on a Low-Purine diet for Gout?
A. Sardines
B. Organ meats (liver)
C. Whole grain bread
D. Asparagus
Correct Answer: C
Rationale: Patients with gout must avoid high-purine foods like organ meats, certain
seafood, and aged cheeses. Grains and most vegetables are safe choices.
What is the primary goal of using a Spacer with a Metered-Dose Inhaler (MDI)?
A. To make the inhaler easier to hold
B. To increase the amount of medication reaching the lungs
C. To prevent the medication from tasting bad
D. To reduce the cost of the medication
Correct Answer: B
Rationale: Spacers hold the medication in suspension, allowing the patient to inhale
Evolve Elsevier HESI Med-Surg Specialty Exam: 250+
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 250 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A patient is admitted with a potassium level of 6.2 mEq/L. Which peaked wave on the
ECG monitor should the nurse prioritize?
A. P wave
B. T wave
C. QRS complex
D. U wave
Correct Answer: B
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves. This is a critical indicator of potential ventricular arrhythmias.
Which assessment finding is most indicative of left-sided heart failure?
A. Jugular venous distension
B. Dependent edema
C. Orthopnea and crackles
D. Right upper quadrant pain
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary veins,
leading to pulmonary congestion, shortness of breath when lying flat (orthopnea), and
crackles on lung auscultation.
A patient with a history of COPD is receiving oxygen at 2L/min via nasal cannula.
The nurse notes the SpO2 is 89%. What is the most appropriate action?
A. Increase the oxygen to 6L/min
B. Continue to monitor the patient
C. Change to a non-rebreather mask
,2026 UPDATED QUESTIONS DOWNLOAD
D. Notify the physician immediately
Correct Answer: B
Rationale: For patients with chronic obstructive pulmonary disease (COPD), an oxygen
saturation (SpO2) between 88-92% is often the therapeutic goal to prevent the
suppression of their hypoxic drive to breathe.
Which laboratory result is the most sensitive indicator of renal failure?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Urine Specific Gravity
D. Creatine Kinase (CK)
Correct Answer: B
Rationale: Serum creatinine is the most reliable indicator of kidney function because it is
a metabolic byproduct of muscle that is exclusively excreted by the kidneys and is not
affected by diet or fluid intake like BUN.
A patient has a suspected Deep Vein Thrombosis (DVT) in the right calf. Which
nursing action is contraindicated?
A. Elevating the right leg
B. Applying a warm compress
C. Massaging the affected area
D. Measuring calf circumference daily
Correct Answer: C
Rationale: Massaging an area with a suspected DVT is strictly contraindicated as it can
dislodge the thrombus, causing it to travel to the lungs as a pulmonary embolism.
Which sign is a classic clinical manifestation of hypoglycemia?
A. Increased thirst and urination
B. Fruity breath odor
C. Diaphoresis and shakiness
D. Abdominal pain
Correct Answer: C
Rationale: Hypoglycemia triggers the sympathetic nervous system, resulting in "cold
and clammy" skin (diaphoresis), tremors, tachycardia, and irritability.
A patient post-thyroidectomy develops tingling in the fingers and a positive
Chvostek's sign. Which medication should the nurse have available?
A. Potassium chloride
B. Calcium gluconate
C. Sodium bicarbonate
D. Magnesium sulfate
,2026 UPDATED QUESTIONS DOWNLOAD
Correct Answer: B
Rationale: These are signs of hypocalcemia, which can occur if the parathyroid glands
are accidentally damaged or removed during a thyroidectomy. Calcium gluconate is the
emergency treatment.
A patient is diagnosed with an acute Myocardial Infarction (MI). Which cardiac
biomarker rises earliest?
A. Troponin I
B. CK-MB
C. Myoglobin
D. LDH
Correct Answer: C
Rationale: Myoglobin is the earliest marker to rise (within 1-3 hours) after myocardial
injury, though it is less specific than Troponin.
In a patient with Cirrhosis, which lab value is most likely responsible for hepatic
encephalopathy?
A. Elevated Bilirubin
B. Elevated Ammonia
C. Decreased Albumin
D. Elevated ALT/AST
Correct Answer: B
Rationale: Ammonia is a byproduct of protein metabolism. When the liver cannot
convert it to urea, high levels cross the blood-brain barrier, causing altered mental
status and confusion.
A patient with a chest tube has continuous bubbling in the water-seal chamber. What
does this indicate?
A. The system is working correctly
B. There is a leak in the system
C. The lung has fully re-expanded
D. The suction is too high
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
Intermittent bubbling is normal during expiration or coughing until the lung re-expands.
Which position is most appropriate for a patient immediately following a Liver
Biopsy?
A. High-Fowler's
B. Left lateral
C. Right lateral
, 2026 UPDATED QUESTIONS DOWNLOAD
D. Supine
Correct Answer: C
Rationale: The patient should be positioned on their right side (affected side) for at least
2 hours to apply pressure to the biopsy site and prevent hemorrhage.
A patient presents with "the worst headache of my life" and nuchal rigidity. The
nurse suspects:
A. Migraine
B. Ischemic Stroke
C. Subarachnoid Hemorrhage
D. TIA
Correct Answer: C
Rationale: A "thunderclap" headache followed by neck stiffness (nuchal rigidity) is a
classic sign of a ruptured cerebral aneurysm or subarachnoid hemorrhage.
Which assessment finding is a priority for a patient with a newly applied cast?
A. Complaints of itching
B. Diminished distal pulses and paresthesia
C. Warm skin under the cast
D. Small amount of swelling
Correct Answer: B
Rationale: These are early signs of Compartment Syndrome, a surgical emergency
where increased pressure within a confined space compromises blood flow.
Which food choice is most appropriate for a patient on a Low-Purine diet for Gout?
A. Sardines
B. Organ meats (liver)
C. Whole grain bread
D. Asparagus
Correct Answer: C
Rationale: Patients with gout must avoid high-purine foods like organ meats, certain
seafood, and aged cheeses. Grains and most vegetables are safe choices.
What is the primary goal of using a Spacer with a Metered-Dose Inhaler (MDI)?
A. To make the inhaler easier to hold
B. To increase the amount of medication reaching the lungs
C. To prevent the medication from tasting bad
D. To reduce the cost of the medication
Correct Answer: B
Rationale: Spacers hold the medication in suspension, allowing the patient to inhale
