EVOLVE ELSEVIER HESI MED SURG
FINAL EXAM ACTUAL TEST BANK
Questions And Well Graded Solutions
With Rationales Updated 2026 2027
Ace your Evolve Elsevier HESI Medical-Surgical Final Exam with this
actual exam study guide and test bank. Features 200 high-yield,
authentic exam questions, comprehensive answer keys, and explicit
clinical rationales—focusing heavily on high-stakes "Select All That
Apply" (SATA) items. Master core concepts across cardiovascular, renal,
respiratory, and endocrine systems. Maximize your score using verified
NCLEX-style priority frameworks. Perfect for nursing student
remediation.
Cardiovascular System
1. A nurse is assessing a client with left-sided heart failure. Which clinical
manifestations should the nurse expect to find? (Select all that apply.)
A) Dyspnea on exertion
B) Bilateral pedal edema
C) Dry, nonproductive cough
D) Jugular vein distension
E) Basilar crackles
F) Orthopnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary lungs,
leading to pulmonary congestion (crackles, cough) and respiratory distress
(dyspnea, orthopnea). Pedal edema and jugular vein distension are signs of
systemic congestion seen in right-sided heart failure.
2. A client is admitted with an acute exacerbation of right-sided heart failure. Which
assessment findings should the nurse document? (Select all that apply.)
A) Jugular venous distention
B) Pulmonary edema
C) Hepatomegaly
D) Dependent bilateral edema
E) Hemoptysis
F) Ascites
Rationale: Right-sided heart failure causes systemic venous congestion. Blood
1|Page
, backs up into the vena cava, causing fluid accumulation in the liver (hepatomegaly),
abdomen (ascites), lower extremities (dependent edema), and neck veins.
Pulmonary edema and hemoptysis are signs of left-sided heart failure.
3. A nurse is reviewing the lab results of a client suspected of having an acute
myocardial infarction (MI). Which cardiac biomarkers support this diagnosis? (Select
all that apply.)
A) Troponin I
B) B-type natriuretic peptide (BNP)
C) Troponin T
D) CK-MB
E) C-reactive protein (CRP)
Rationale: Troponin I, Troponin T, and CK-MB are highly specific enzymes released
into the bloodstream following cardiac muscle injury. BNP is a marker for heart
failure/fluid stretch, and CRP is a general marker of systemic inflammation.
4. A client with a history of deep vein thrombosis (DVT) is being discharged on
warfarin. Which discharge instructions should the nurse include? (Select all that
apply.)
A) Use a soft-bristled toothbrush.
B) Increase intake of dark green leafy vegetables.
C) Shave with an electric razor rather than a straight blade.
D) Avoid taking aspirin or NSAIDs without consulting the provider.
E) Report dark, tarry stools immediately.
Rationale: Warfarin increases bleeding risks; soft toothbrushes, electric razors, and
avoiding aspirin minimize trauma and concurrent bleeding risks. Dark, tarry stools
indicate GI bleeding. Green leafy vegetables are rich in Vitamin K (the antidote) and
must be kept consistent in the diet, not increased.
5. A nurse is caring for a client immediately following a cardiac catheterization via the
right femoral artery. Which nursing interventions are priorities? (Select all that apply.)
A) Ambulate the client within 30 minutes.
B) Maintain the right leg in a straight position.
C) Assess the pedal pulses in the right foot every 15 minutes.
D) Keep the head of the bed elevated at 45 degrees.
E) Monitor the femoral insertion site for hematoma formation.
Rationale: Femoral access requires strict bed rest with the affected leg straight to
prevent arterial bleeding. Frequent distal pulse checks ensure arterial patency, and
checking the site catches bleeding/hematomas early. The head of the bed should be
kept low (under 30 degrees).
6. A client presents with a hypertensive crisis (blood pressure 210/120 mmHg). Which
clinical findings indicate target organ damage? (Select all that apply.)
A) Chest pain
B) Blurry vision
C) Hyperactivity
D) Altered mental status
E) Oliguria
Rationale: Hypertensive crises damage vulnerable organs. Chest pain indicates
myocardial ischemia; blurry vision indicates retinal hemorrhage; altered mental
status indicates hypertensive encephalopathy; oliguria indicates acute kidney injury.
7. A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
findings would cause the nurse to hold the medication? (Select all that apply.)
A) Blood pressure 140/90 mmHg
2|Page
, B) Apical heart rate of 52 beats per minute
C) Serum potassium level of 3.1 mEq/L
D) Client reports seeing yellow-green halos
E) Serum digoxin level of 1.2 ng/mL
Rationale: Digoxin should be held if the apical heart rate is below 60 bpm.
Hypokalemia (3.1 mEq/L) potentiates digoxin toxicity. Yellow-green halos are a
classic sign of active toxicity. Digoxin level 1.2 is within the normal therapeutic range
(0.5–2.0 ng/mL).
8. A client has been diagnosed with peripheral arterial disease (PAD). Which
assessment findings are consistent with this diagnosis? (Select all that apply.)
A) Brown pigmentation around the ankles
B) Intermittent claudication
C) Cool skin temperature to the lower extremities
D) Dependent rubor
E) Thick, edematous ankles
F) Diminished pedal pulses
Rationale: PAD limits arterial blood flow to the extremities, leading to ischemic
muscle pain during exercise (intermittent claudication), cold skin, and weak pulses.
Dependent rubor (redness when dangling) is also a classic sign, while brown
pigmentation and thick edema are hallmarks of venous disease.
9. A nurse is caring for a client with infective endocarditis. Which assessment findings
should the nurse expect? (Select all that apply.)
A) Fever and chills
B) Splinter hemorrhages under the fingernails
C) New onset heart murmur
D) Absent peripheral pulses
E) Osler's nodes on the fingers
Rationale: Infective endocarditis is an infection of the heart valves characterized by
systemic infection signs (fever), micro-emboli signs (splinter hemorrhages, Osler's
nodes), and changing valve structures causing murmurs. Complete absence of
peripheral pulses is not standard unless a major occlusion occurs.
10. A client with chronic venous insufficiency is being evaluated. Which assessment
findings should the nurse anticipate? (Select all that apply.)
A) Pale, shiny legs
B) Leathery, brown-pigmented skin on lower legs
C) Minimal, non-pitting edema
D) Edema around the ankles
E) Ulcers on the medial malleolus
Rationale: Chronic venous insufficiency causes blood pooling, leading to high
hydrostatic pressure, noticeable ankle edema, and RBC breakdown that stains the
skin brown. Venous ulcers typically form near the inner ankle (medial malleolus).
Respiratory System
3|Page
, 11. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which clinical findings should the nurse expect? (Select all that apply.)
A) Barrel chest
B) Clubbing of fingers
C) PaO2 of 95 mmHg
D) Productive morning cough
E) Use of accessory muscles
F) Hypercapnia
Rationale: COPD causes air trapping leading to a barrel chest. Chronic hypoxia
triggers finger clubbing. Chronic inflammation leads to a productive cough and
accessory muscle use. Hypercapnia (retaining CO2) is expected, and PaO2 is
typically low (<80 mmHg).
12. A nurse is planning care for a client with a newly placed chest tube for a
pneumothorax. Which interventions should be included? (Select all that apply.)
A) Strip or milk the chest tube tubing hourly.
B) Keep the drainage system below the level of the client's chest.
C) Monitor for continuous bubbling in the water-seal chamber as a sign of an
air leak.
D) Clamp the chest tube when the client ambulates.
E) Tape all connections securely.
Rationale: The drainage system must always remain below the chest to prevent
backflow. Continuous bubbling in the water seal indicates an air leak. Connections
must be taped to prevent disconnection. Stripping/milking increases negative
pressure dangerously, and clamping during ambulation can cause a tension
pneumothorax.
13. A client is admitted with severe acute respiratory distress syndrome (ARDS). Which
clinical manifestations should the nurse expect? (Select all that apply.)
A) Hypoxemia refractory to high concentrations of oxygen
B) Increased lung compliance
C) Severe dyspnea and tachypnea
D) Intercostal retractions
E) White-out appearance on chest X-ray
Rationale: ARDS is characterized by profound, stubborn hypoxemia that does not
improve with oxygen (refractory hypoxemia), severe dyspnea, retractions, and
diffuse bilateral infiltrates ("white-out") on an X-ray. Lung compliance decreases
drastically as lungs stiffen.
14. A nurse is caring for a client with active pulmonary tuberculosis (TB). Which infection
control measures must be implemented? (Select all that apply.)
A) Place the client in a negative-pressure airflow room.
B) Wear a standard surgical mask when entering the room.
C) Wear an N95 respirator mask when providing care.
D) Keep the client's room door open for ventilation.
E) Have the client wear a surgical mask if transport outside the room is
necessary.
Rationale: Active TB requires airborne precautions. This includes a negative-
pressure isolation room, keeping the door closed, and healthcare staff wearing an
N95 mask. If the client must travel, they wear a surgical mask to capture respiratory
droplets.
15. A client returns to the medical-surgical unit after a bronchoscopy. Which actions
should the nurse perform? (Select all that apply.)
4|Page
FINAL EXAM ACTUAL TEST BANK
Questions And Well Graded Solutions
With Rationales Updated 2026 2027
Ace your Evolve Elsevier HESI Medical-Surgical Final Exam with this
actual exam study guide and test bank. Features 200 high-yield,
authentic exam questions, comprehensive answer keys, and explicit
clinical rationales—focusing heavily on high-stakes "Select All That
Apply" (SATA) items. Master core concepts across cardiovascular, renal,
respiratory, and endocrine systems. Maximize your score using verified
NCLEX-style priority frameworks. Perfect for nursing student
remediation.
Cardiovascular System
1. A nurse is assessing a client with left-sided heart failure. Which clinical
manifestations should the nurse expect to find? (Select all that apply.)
A) Dyspnea on exertion
B) Bilateral pedal edema
C) Dry, nonproductive cough
D) Jugular vein distension
E) Basilar crackles
F) Orthopnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary lungs,
leading to pulmonary congestion (crackles, cough) and respiratory distress
(dyspnea, orthopnea). Pedal edema and jugular vein distension are signs of
systemic congestion seen in right-sided heart failure.
2. A client is admitted with an acute exacerbation of right-sided heart failure. Which
assessment findings should the nurse document? (Select all that apply.)
A) Jugular venous distention
B) Pulmonary edema
C) Hepatomegaly
D) Dependent bilateral edema
E) Hemoptysis
F) Ascites
Rationale: Right-sided heart failure causes systemic venous congestion. Blood
1|Page
, backs up into the vena cava, causing fluid accumulation in the liver (hepatomegaly),
abdomen (ascites), lower extremities (dependent edema), and neck veins.
Pulmonary edema and hemoptysis are signs of left-sided heart failure.
3. A nurse is reviewing the lab results of a client suspected of having an acute
myocardial infarction (MI). Which cardiac biomarkers support this diagnosis? (Select
all that apply.)
A) Troponin I
B) B-type natriuretic peptide (BNP)
C) Troponin T
D) CK-MB
E) C-reactive protein (CRP)
Rationale: Troponin I, Troponin T, and CK-MB are highly specific enzymes released
into the bloodstream following cardiac muscle injury. BNP is a marker for heart
failure/fluid stretch, and CRP is a general marker of systemic inflammation.
4. A client with a history of deep vein thrombosis (DVT) is being discharged on
warfarin. Which discharge instructions should the nurse include? (Select all that
apply.)
A) Use a soft-bristled toothbrush.
B) Increase intake of dark green leafy vegetables.
C) Shave with an electric razor rather than a straight blade.
D) Avoid taking aspirin or NSAIDs without consulting the provider.
E) Report dark, tarry stools immediately.
Rationale: Warfarin increases bleeding risks; soft toothbrushes, electric razors, and
avoiding aspirin minimize trauma and concurrent bleeding risks. Dark, tarry stools
indicate GI bleeding. Green leafy vegetables are rich in Vitamin K (the antidote) and
must be kept consistent in the diet, not increased.
5. A nurse is caring for a client immediately following a cardiac catheterization via the
right femoral artery. Which nursing interventions are priorities? (Select all that apply.)
A) Ambulate the client within 30 minutes.
B) Maintain the right leg in a straight position.
C) Assess the pedal pulses in the right foot every 15 minutes.
D) Keep the head of the bed elevated at 45 degrees.
E) Monitor the femoral insertion site for hematoma formation.
Rationale: Femoral access requires strict bed rest with the affected leg straight to
prevent arterial bleeding. Frequent distal pulse checks ensure arterial patency, and
checking the site catches bleeding/hematomas early. The head of the bed should be
kept low (under 30 degrees).
6. A client presents with a hypertensive crisis (blood pressure 210/120 mmHg). Which
clinical findings indicate target organ damage? (Select all that apply.)
A) Chest pain
B) Blurry vision
C) Hyperactivity
D) Altered mental status
E) Oliguria
Rationale: Hypertensive crises damage vulnerable organs. Chest pain indicates
myocardial ischemia; blurry vision indicates retinal hemorrhage; altered mental
status indicates hypertensive encephalopathy; oliguria indicates acute kidney injury.
7. A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
findings would cause the nurse to hold the medication? (Select all that apply.)
A) Blood pressure 140/90 mmHg
2|Page
, B) Apical heart rate of 52 beats per minute
C) Serum potassium level of 3.1 mEq/L
D) Client reports seeing yellow-green halos
E) Serum digoxin level of 1.2 ng/mL
Rationale: Digoxin should be held if the apical heart rate is below 60 bpm.
Hypokalemia (3.1 mEq/L) potentiates digoxin toxicity. Yellow-green halos are a
classic sign of active toxicity. Digoxin level 1.2 is within the normal therapeutic range
(0.5–2.0 ng/mL).
8. A client has been diagnosed with peripheral arterial disease (PAD). Which
assessment findings are consistent with this diagnosis? (Select all that apply.)
A) Brown pigmentation around the ankles
B) Intermittent claudication
C) Cool skin temperature to the lower extremities
D) Dependent rubor
E) Thick, edematous ankles
F) Diminished pedal pulses
Rationale: PAD limits arterial blood flow to the extremities, leading to ischemic
muscle pain during exercise (intermittent claudication), cold skin, and weak pulses.
Dependent rubor (redness when dangling) is also a classic sign, while brown
pigmentation and thick edema are hallmarks of venous disease.
9. A nurse is caring for a client with infective endocarditis. Which assessment findings
should the nurse expect? (Select all that apply.)
A) Fever and chills
B) Splinter hemorrhages under the fingernails
C) New onset heart murmur
D) Absent peripheral pulses
E) Osler's nodes on the fingers
Rationale: Infective endocarditis is an infection of the heart valves characterized by
systemic infection signs (fever), micro-emboli signs (splinter hemorrhages, Osler's
nodes), and changing valve structures causing murmurs. Complete absence of
peripheral pulses is not standard unless a major occlusion occurs.
10. A client with chronic venous insufficiency is being evaluated. Which assessment
findings should the nurse anticipate? (Select all that apply.)
A) Pale, shiny legs
B) Leathery, brown-pigmented skin on lower legs
C) Minimal, non-pitting edema
D) Edema around the ankles
E) Ulcers on the medial malleolus
Rationale: Chronic venous insufficiency causes blood pooling, leading to high
hydrostatic pressure, noticeable ankle edema, and RBC breakdown that stains the
skin brown. Venous ulcers typically form near the inner ankle (medial malleolus).
Respiratory System
3|Page
, 11. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which clinical findings should the nurse expect? (Select all that apply.)
A) Barrel chest
B) Clubbing of fingers
C) PaO2 of 95 mmHg
D) Productive morning cough
E) Use of accessory muscles
F) Hypercapnia
Rationale: COPD causes air trapping leading to a barrel chest. Chronic hypoxia
triggers finger clubbing. Chronic inflammation leads to a productive cough and
accessory muscle use. Hypercapnia (retaining CO2) is expected, and PaO2 is
typically low (<80 mmHg).
12. A nurse is planning care for a client with a newly placed chest tube for a
pneumothorax. Which interventions should be included? (Select all that apply.)
A) Strip or milk the chest tube tubing hourly.
B) Keep the drainage system below the level of the client's chest.
C) Monitor for continuous bubbling in the water-seal chamber as a sign of an
air leak.
D) Clamp the chest tube when the client ambulates.
E) Tape all connections securely.
Rationale: The drainage system must always remain below the chest to prevent
backflow. Continuous bubbling in the water seal indicates an air leak. Connections
must be taped to prevent disconnection. Stripping/milking increases negative
pressure dangerously, and clamping during ambulation can cause a tension
pneumothorax.
13. A client is admitted with severe acute respiratory distress syndrome (ARDS). Which
clinical manifestations should the nurse expect? (Select all that apply.)
A) Hypoxemia refractory to high concentrations of oxygen
B) Increased lung compliance
C) Severe dyspnea and tachypnea
D) Intercostal retractions
E) White-out appearance on chest X-ray
Rationale: ARDS is characterized by profound, stubborn hypoxemia that does not
improve with oxygen (refractory hypoxemia), severe dyspnea, retractions, and
diffuse bilateral infiltrates ("white-out") on an X-ray. Lung compliance decreases
drastically as lungs stiffen.
14. A nurse is caring for a client with active pulmonary tuberculosis (TB). Which infection
control measures must be implemented? (Select all that apply.)
A) Place the client in a negative-pressure airflow room.
B) Wear a standard surgical mask when entering the room.
C) Wear an N95 respirator mask when providing care.
D) Keep the client's room door open for ventilation.
E) Have the client wear a surgical mask if transport outside the room is
necessary.
Rationale: Active TB requires airborne precautions. This includes a negative-
pressure isolation room, keeping the door closed, and healthcare staff wearing an
N95 mask. If the client must travel, they wear a surgical mask to capture respiratory
droplets.
15. A client returns to the medical-surgical unit after a bronchoscopy. Which actions
should the nurse perform? (Select all that apply.)
4|Page
