EVOLVE ELSEVIER HESI Medical-Surgical Nursing Final Exam
Review 2026–2027 | 130 Original NCLEX-Style Practice Questions
& Answers with Rationales | Comprehensive Med-Surg Study
Guide
Overview & Coverage
Master essential Evolve Elsevier Hesi medical-surgical nursing concepts with this
comprehensive collection of 100 original NCLEX-style practice questions and detailed
answer rationales. Designed for nursing students preparing for a Medical-Surgical Nursing final
exam, ATI-style assessments, HESI-style review, NCLEX-RN preparation, and course
examinations, this study guide emphasizes clinical judgment, prioritization, patient safety, and
evidence-based nursing care. Every question is original and focuses on applying nursing
knowledge to realistic clinical scenarios.
Coverage Includes:
Cardiovascular disorders, heart failure, acute coronary syndrome, dysrhythmias, and
hypertension
Respiratory disorders including COPD, asthma, pneumonia, pulmonary embolism,
pneumothorax, and oxygen therapy
Endocrine disorders including diabetes mellitus, diabetic ketoacidosis (DKA), thyroid
disorders, and adrenal disorders
Renal disorders, acute kidney injury (AKI), chronic kidney disease (CKD), dialysis, and
electrolyte management
Gastrointestinal disorders including pancreatitis, cirrhosis, gastrointestinal bleeding, liver
disease, ileostomy care, and hepatic encephalopathy
Neurological disorders including stroke, seizures, meningitis, and increased intracranial
pressure
Fluid, electrolyte, and acid-base imbalances
Hematologic disorders, blood transfusion reactions, anticoagulant therapy, and anemia
Oncology, chemotherapy complications, neutropenia, and infection prevention
Musculoskeletal disorders, postoperative care, orthopedic complications, and deep vein
thrombosis prevention
Pharmacology for common medical-surgical medications, including insulin,
anticoagulants, opioids, diuretics, ACE inhibitors, digoxin, and antibiotics
Nursing assessment, laboratory interpretation, patient education, infection control,
delegation, prioritization, and emergency nursing interventions
Clinical judgment and Next Generation NCLEX (NGN)-style decision-making scenarios
with detailed rationales
Question 1
,A nurse is caring for a patient admitted with acute decompensated heart failure.
Which assessment finding requires immediate intervention?
A. Bilateral ankle edema
B. Weight gain of 2 pounds in 24 hours
C. Oxygen saturation of 84% on room air with severe dyspnea
D. Fatigue with activity
Answer: C. Oxygen saturation of 84% on room air with severe dyspnea
Explanation: Severe hypoxemia and respiratory distress indicate impaired oxygenation and
require immediate intervention to prevent respiratory failure.
Question 2
A client with type 1 diabetes mellitus becomes diaphoretic, confused, and shaky
before lunch. Which nursing action should be performed first?
A. Administer scheduled insulin.
B. Notify the healthcare provider.
C. Obtain a urine glucose specimen.
D. Check the client's blood glucose level immediately.
Answer: D. Check the client's blood glucose level immediately.
Explanation: These findings suggest hypoglycemia. Confirming the blood glucose allows
prompt treatment and prevents neurological deterioration.
Question 3
A patient receiving intravenous heparin suddenly reports severe abdominal pain and
develops hypotension. Which complication should the nurse suspect first?
A. Hyperglycemia
B. Pulmonary edema
C. Internal hemorrhage
D. Hypertensive crisis
Answer: C. Internal hemorrhage
,Explanation: Heparin significantly increases bleeding risk. Sudden pain with hypotension
may indicate life-threatening internal bleeding requiring immediate evaluation.
Question 4
Which assessment finding is most consistent with fluid volume overload?
A. Flat neck veins
B. Dry mucous membranes
C. Orthostatic hypotension
D. Jugular venous distention with crackles in both lungs
Answer: D. Jugular venous distention with crackles in both lungs
Explanation: Elevated venous pressure and pulmonary congestion are classic signs of fluid
volume excess.
Question 5
A nurse assesses a patient one hour after administration of intravenous morphine.
Which finding requires the most immediate action?
A. Respiratory rate of 8 breaths/minute
B. Pain rating decreased to 3/10
C. Mild nausea
D. Drowsiness
Answer: A. Respiratory rate of 8 breaths/minute
Explanation: Respiratory depression is the most serious adverse effect of opioid therapy
and requires immediate intervention.
Question 6
A patient with chronic kidney disease has a serum potassium level of 6.4 mEq/L.
Which assessment is the priority?
A. Skin integrity
B. Bowel sounds
, C. Cardiac rhythm
D. Peripheral pulses
Answer: C. Cardiac rhythm
Explanation: Severe hyperkalemia may produce life-threatening dysrhythmias that require
continuous cardiac monitoring.
Question 7
Which finding is most characteristic of left-sided heart failure?
A. Hepatomegaly
B. Ascites
C. Peripheral edema only
D. Pulmonary crackles and orthopnea
Answer: D. Pulmonary crackles and orthopnea
Explanation: Left ventricular failure causes pulmonary congestion, leading to dyspnea,
orthopnea, and crackles.
Question 8
A nurse is teaching a client taking warfarin. Which statement indicates correct
understanding?
A. I will stop taking the medication if I bruise easily.
B. I should avoid all vegetables.
C. I will have my INR checked as scheduled.
D. I can take aspirin for headaches whenever needed.
Answer: C. I will have my INR checked as scheduled.
Explanation: Regular INR monitoring ensures safe and effective anticoagulation while
minimizing bleeding risk.
Question 9
Which laboratory value should the nurse review before administering digoxin?
Review 2026–2027 | 130 Original NCLEX-Style Practice Questions
& Answers with Rationales | Comprehensive Med-Surg Study
Guide
Overview & Coverage
Master essential Evolve Elsevier Hesi medical-surgical nursing concepts with this
comprehensive collection of 100 original NCLEX-style practice questions and detailed
answer rationales. Designed for nursing students preparing for a Medical-Surgical Nursing final
exam, ATI-style assessments, HESI-style review, NCLEX-RN preparation, and course
examinations, this study guide emphasizes clinical judgment, prioritization, patient safety, and
evidence-based nursing care. Every question is original and focuses on applying nursing
knowledge to realistic clinical scenarios.
Coverage Includes:
Cardiovascular disorders, heart failure, acute coronary syndrome, dysrhythmias, and
hypertension
Respiratory disorders including COPD, asthma, pneumonia, pulmonary embolism,
pneumothorax, and oxygen therapy
Endocrine disorders including diabetes mellitus, diabetic ketoacidosis (DKA), thyroid
disorders, and adrenal disorders
Renal disorders, acute kidney injury (AKI), chronic kidney disease (CKD), dialysis, and
electrolyte management
Gastrointestinal disorders including pancreatitis, cirrhosis, gastrointestinal bleeding, liver
disease, ileostomy care, and hepatic encephalopathy
Neurological disorders including stroke, seizures, meningitis, and increased intracranial
pressure
Fluid, electrolyte, and acid-base imbalances
Hematologic disorders, blood transfusion reactions, anticoagulant therapy, and anemia
Oncology, chemotherapy complications, neutropenia, and infection prevention
Musculoskeletal disorders, postoperative care, orthopedic complications, and deep vein
thrombosis prevention
Pharmacology for common medical-surgical medications, including insulin,
anticoagulants, opioids, diuretics, ACE inhibitors, digoxin, and antibiotics
Nursing assessment, laboratory interpretation, patient education, infection control,
delegation, prioritization, and emergency nursing interventions
Clinical judgment and Next Generation NCLEX (NGN)-style decision-making scenarios
with detailed rationales
Question 1
,A nurse is caring for a patient admitted with acute decompensated heart failure.
Which assessment finding requires immediate intervention?
A. Bilateral ankle edema
B. Weight gain of 2 pounds in 24 hours
C. Oxygen saturation of 84% on room air with severe dyspnea
D. Fatigue with activity
Answer: C. Oxygen saturation of 84% on room air with severe dyspnea
Explanation: Severe hypoxemia and respiratory distress indicate impaired oxygenation and
require immediate intervention to prevent respiratory failure.
Question 2
A client with type 1 diabetes mellitus becomes diaphoretic, confused, and shaky
before lunch. Which nursing action should be performed first?
A. Administer scheduled insulin.
B. Notify the healthcare provider.
C. Obtain a urine glucose specimen.
D. Check the client's blood glucose level immediately.
Answer: D. Check the client's blood glucose level immediately.
Explanation: These findings suggest hypoglycemia. Confirming the blood glucose allows
prompt treatment and prevents neurological deterioration.
Question 3
A patient receiving intravenous heparin suddenly reports severe abdominal pain and
develops hypotension. Which complication should the nurse suspect first?
A. Hyperglycemia
B. Pulmonary edema
C. Internal hemorrhage
D. Hypertensive crisis
Answer: C. Internal hemorrhage
,Explanation: Heparin significantly increases bleeding risk. Sudden pain with hypotension
may indicate life-threatening internal bleeding requiring immediate evaluation.
Question 4
Which assessment finding is most consistent with fluid volume overload?
A. Flat neck veins
B. Dry mucous membranes
C. Orthostatic hypotension
D. Jugular venous distention with crackles in both lungs
Answer: D. Jugular venous distention with crackles in both lungs
Explanation: Elevated venous pressure and pulmonary congestion are classic signs of fluid
volume excess.
Question 5
A nurse assesses a patient one hour after administration of intravenous morphine.
Which finding requires the most immediate action?
A. Respiratory rate of 8 breaths/minute
B. Pain rating decreased to 3/10
C. Mild nausea
D. Drowsiness
Answer: A. Respiratory rate of 8 breaths/minute
Explanation: Respiratory depression is the most serious adverse effect of opioid therapy
and requires immediate intervention.
Question 6
A patient with chronic kidney disease has a serum potassium level of 6.4 mEq/L.
Which assessment is the priority?
A. Skin integrity
B. Bowel sounds
, C. Cardiac rhythm
D. Peripheral pulses
Answer: C. Cardiac rhythm
Explanation: Severe hyperkalemia may produce life-threatening dysrhythmias that require
continuous cardiac monitoring.
Question 7
Which finding is most characteristic of left-sided heart failure?
A. Hepatomegaly
B. Ascites
C. Peripheral edema only
D. Pulmonary crackles and orthopnea
Answer: D. Pulmonary crackles and orthopnea
Explanation: Left ventricular failure causes pulmonary congestion, leading to dyspnea,
orthopnea, and crackles.
Question 8
A nurse is teaching a client taking warfarin. Which statement indicates correct
understanding?
A. I will stop taking the medication if I bruise easily.
B. I should avoid all vegetables.
C. I will have my INR checked as scheduled.
D. I can take aspirin for headaches whenever needed.
Answer: C. I will have my INR checked as scheduled.
Explanation: Regular INR monitoring ensures safe and effective anticoagulation while
minimizing bleeding risk.
Question 9
Which laboratory value should the nurse review before administering digoxin?
