© BestSellerStuvia
INDEPENDENT RN STUDY RESOURCE / 2026/2027
HESI EVOLVE ELSEVIER MED SURG
2026/2027 | Verified Questions
Elsevier Evolve | HESI RN Med-Surg | Professional Registered Nursing Candidates
© BestSellerStuvia
SCOPE AUDIENCE ACADEMIC YEAR
200 QUESTIONS RN CANDIDATES 2026/2027
CLINICAL JUDGMENT
Recognize what matters. Act for safety. Reassess the response.
This independently authored collection contains 200 questions. Each item has four choices, one keyed response, and a
concise clinical rationale. The eight-part distribution is an editorial study structure, not an Elsevier-issued HESI specialty
blueprint.
Management of Care · Safety and Infection Control · Basic Care and Comfort · Pharmacological and Parenteral Therapies ·
Reduction of Risk Potential · Physiological Adaptation · Cardiovascular & Respiratory Disorders · GI, Endocrine, Neuro,
Musculoskeletal Disorders
SCORING CONTEXT / Elsevier describes 850 as an acceptable HESI score benchmark. Its scaled scoring is not a fixed percentage of
items correct; institutions set their own requirements.
Independent educational material; not issued, sponsored, or endorsed by Elsevier. No secured HESI items are reproduced.
01 Management of Care 30 ITEMS
Question 1. After neck surgery, which patient requires the RN's immediate assessment?
A. A patient requesting an extra blanket.
B. A patient waiting for routine discharge paperwork.
C. A patient reporting incisional pain rated 4 of 10.
D. A patient with inspiratory stridor and visible neck swelling.
Correct Answer: D — A patient with inspiratory stridor and visible neck swelling.
Rationale Stridor and expanding swelling may signal rapidly worsening airway obstruction; circulation and
comfort concerns are secondary to a threatened airway.
Question 2. A stable patient has continuous bladder irrigation. Which task may the RN
delegate to trained assistive personnel under unit policy?
A. Determine whether clots require an increase in irrigation rate.
B. Decide whether the catheter is obstructed.
C. Measure and record the amount of drainage collected from the urinary bag.
D. Interpret the true urine output and revise the care plan.
Correct Answer: C — Measure and record the amount of drainage collected from the urinary bag.
Rationale Measuring and recording output is a routine task; the RN retains assessment of catheter function,
irrigation balance, and decisions about treatment.
© BestSellerStuvia | PAGE 1
,© BestSellerStuvia
Question 3. Which patient is most suitable for assignment to a licensed practical nurse under
RN supervision and local scope?
A. A stable patient two days after appendectomy who needs routine oral pain medication.
B. A patient needing initial instruction on home insulin injection.
C. A patient admitted minutes ago with undifferentiated chest pain.
D. A patient with a rapidly falling blood pressure after surgery.
Correct Answer: A — A stable patient two days after appendectomy who needs routine oral pain
medication.
Rationale A stable patient needing predictable care is suitable for LPN/VN assignment; initial assessment, unstable
changes, and initial teaching remain RN responsibilities.
Question 4. A patient arrives from the emergency department with a possible bowel
obstruction. Which responsibility should the RN retain?
A. Ask assistive personnel to decide the principal nursing concern.
B. Delay assessment until the next scheduled vital-sign round.
C. Assign the initial clinical assessment to an unlicensed transporter.
D. Perform the initial nursing assessment and establish priorities.
Correct Answer: D — Perform the initial nursing assessment and establish priorities.
Rationale Initial assessment requires licensed clinical judgment to recognize obstruction complications and plan
immediate care.
Question 5. A patient is beginning self-injection of insulin at discharge. Which assignment is
appropriate?
A. The RN provides initial instruction and checks the patient's demonstration.
B. The nurse presumes a signature proves the patient can use the medication.
C. The transporter gives the written instructions without RN involvement.
D. Assistive personnel select the dose and teach injection sites.
Correct Answer: A — The RN provides initial instruction and checks the patient's demonstration.
Rationale Initial medication teaching and assessment of understanding require RN judgment and direct patient
engagement.
Question 6. An assistant records that a postoperative patient walked only three steps before
dizziness. What should the RN do?
A. Chart that ambulation was tolerated because the patient stood up.
B. Assess the patient's symptoms and vital signs before planning further mobility.
C. Ask the assistant to diagnose the cause of dizziness.
D. Schedule the next walk without seeing the patient.
Correct Answer: B — Assess the patient's symptoms and vital signs before planning further
mobility.
Rationale The RN must interpret unexpected findings after delegated tasks; dizziness may signal hypotension or
another condition requiring a change in the care plan.
Question 7. A transfer report includes potassium 2.7 mmol/L and frequent ventricular ectopy.
Which handoff content has highest priority?
A. State the low potassium and rhythm change clearly to the receiving RN and confirm acknowledgment.
B. Wait to discuss the rhythm until routine rounds.
C. Mention only the room number and transport time.
D. Leave the laboratory result in a chart without verbal communication.
Correct Answer: A — State the low potassium and rhythm change clearly to the receiving RN and
confirm acknowledgment.
Rationale A low potassium level with ectopy threatens dysrhythmia; direct acknowledgment in the handoff
supports timely monitoring and treatment.
© BestSellerStuvia | PAGE 2
,© BestSellerStuvia
Question 8. A patient asks the RN to explain surgical risks that the surgeon has not discussed.
What should the RN do?
A. Describe risks from memory and obtain the signature in place of the surgeon.
B. Ask a family member to sign without discussing the patient's question.
C. Pause the signing process and ask the procedural clinician to provide the required explanation.
D. Witness the signature even though the patient says the procedure is unclear.
Correct Answer: C — Pause the signing process and ask the procedural clinician to provide the
required explanation.
Rationale The procedural clinician explains risks, benefits, and alternatives; the RN protects voluntariness and
alerts that clinician when understanding is incomplete.
Question 9. An oriented adult declines a recommended blood transfusion after discussing the
risks. What is the RN's best action?
A. Mark the blood as infused because it was prescribed.
B. Respect the decision, notify the team, and document the informed refusal and discussion.
C. Administer blood while the patient sleeps.
D. Ask a relative to overrule the capable patient's decision.
Correct Answer: B — Respect the decision, notify the team, and document the informed refusal and
discussion.
Rationale A capable adult may refuse treatment; nursing care includes verifying understanding, supporting
autonomy, and accurately documenting the decision.
Question 10. A patient with decision-making capacity states a care preference that differs
from an older directive. Which instruction guides care now?
A. Use the patient's current informed wishes and clarify the plan with the team.
B. Apply the older directive without speaking to the patient.
C. Ask assistive personnel to decide which document controls.
D. Follow the family's preference over the capable patient's choice.
Correct Answer: A — Use the patient's current informed wishes and clarify the plan with the team.
Rationale A capable patient's current decision directs present care; the directive principally guides care when the
patient cannot express a decision.
Question 11. A patient with limited English proficiency must decide about a complex
procedure. What should the RN arrange?
A. An available child to interpret the risk information.
B. A signature before the consent discussion starts.
C. A qualified medical interpreter for the clinical discussion.
D. A yes-or-no question in English as proof of understanding.
Correct Answer: C — A qualified medical interpreter for the clinical discussion.
Rationale A qualified interpreter supports accurate information exchange and informed decisions while reducing
errors and conflicts of interest.
Question 12. An RN leaves a shared workstation to respond to a call bell. What protects
patient information?
A. Leave the record open so colleagues can finish it.
B. Write the password on the desk for the next shift.
C. Copy the patient's chart to a personal device.
D. Lock or sign out of the session before leaving the station.
Correct Answer: D — Lock or sign out of the session before leaving the station.
Rationale Securing an unattended session prevents unauthorized access to health information while allowing the
RN to respond to the patient.
© BestSellerStuvia | PAGE 3
, © BestSellerStuvia
Question 13. The RN catches an incorrect heparin dose before it reaches the patient. What is
the appropriate system action?
A. Erase the order without informing anyone of the risk.
B. Correct the order discrepancy and submit a safety event report under policy.
C. Record an adverse drug reaction even though no dose was given.
D. Administer the dose because no harm has occurred yet.
Correct Answer: B — Correct the order discrepancy and submit a safety event report under policy.
Rationale Reporting a near miss helps identify unsafe processes; the patient should not receive the incorrect dose.
Question 14. A patient is found sitting on the floor after an unwitnessed fall. What should the
RN do first?
A. Lift the patient into bed before checking for injury.
B. Ask the patient to walk to prove there is no fracture.
C. Assess responsiveness, injury, and vital signs before moving the patient unless immediate danger requires it.
D. Finish routine medication rounds and return later.
Correct Answer: C — Assess responsiveness, injury, and vital signs before moving the patient unless
immediate danger requires it.
Rationale Assessment before movement identifies head injury, bleeding, or fracture and guides safe escalation and
documentation.
Question 15. A patient with platelets of 18,000 per microliter has an order for an
intramuscular injection. What should the RN do?
A. Inject into the largest muscle to prevent bleeding.
B. Clarify the order and seek a safer route before giving the medication.
C. Ask assistive personnel to administer it.
D. Give the injection and apply no pressure afterward.
Correct Answer: B — Clarify the order and seek a safer route before giving the medication.
Rationale Severe thrombocytopenia raises bleeding risk from intramuscular injection; the RN should address the
hazard before administration.
Question 16. A patient moves from intensive care to the ward with two different insulin lists.
What is the RN's priority?
A. Assume a copied home list replaces all active orders.
B. Choose the higher dose to avoid hyperglycemia.
C. Give both regimens until the next physician round.
D. Reconcile the current orders with the recent regimen and clarify discrepancies before administering insulin.
Correct Answer: D — Reconcile the current orders with the recent regimen and clarify
discrepancies before administering insulin.
Rationale Transitions can duplicate or omit medications; reconciliation and clarification prevent dosing errors.
Question 17. A frail patient cannot safely reach the bathroom after surgery. Which action best
coordinates ongoing care?
A. Wait for a fall before requesting equipment.
B. Prohibit all movement for the remainder of hospitalization.
C. Request therapy and mobility input while arranging a safe bedside toileting plan.
D. Let untrained relatives decide how to lift the patient.
Correct Answer: C — Request therapy and mobility input while arranging a safe bedside toileting
plan.
Rationale An interdisciplinary plan addresses current toileting needs and evaluates strength, equipment, and
assistance required for safer movement.
© BestSellerStuvia | PAGE 4
INDEPENDENT RN STUDY RESOURCE / 2026/2027
HESI EVOLVE ELSEVIER MED SURG
2026/2027 | Verified Questions
Elsevier Evolve | HESI RN Med-Surg | Professional Registered Nursing Candidates
© BestSellerStuvia
SCOPE AUDIENCE ACADEMIC YEAR
200 QUESTIONS RN CANDIDATES 2026/2027
CLINICAL JUDGMENT
Recognize what matters. Act for safety. Reassess the response.
This independently authored collection contains 200 questions. Each item has four choices, one keyed response, and a
concise clinical rationale. The eight-part distribution is an editorial study structure, not an Elsevier-issued HESI specialty
blueprint.
Management of Care · Safety and Infection Control · Basic Care and Comfort · Pharmacological and Parenteral Therapies ·
Reduction of Risk Potential · Physiological Adaptation · Cardiovascular & Respiratory Disorders · GI, Endocrine, Neuro,
Musculoskeletal Disorders
SCORING CONTEXT / Elsevier describes 850 as an acceptable HESI score benchmark. Its scaled scoring is not a fixed percentage of
items correct; institutions set their own requirements.
Independent educational material; not issued, sponsored, or endorsed by Elsevier. No secured HESI items are reproduced.
01 Management of Care 30 ITEMS
Question 1. After neck surgery, which patient requires the RN's immediate assessment?
A. A patient requesting an extra blanket.
B. A patient waiting for routine discharge paperwork.
C. A patient reporting incisional pain rated 4 of 10.
D. A patient with inspiratory stridor and visible neck swelling.
Correct Answer: D — A patient with inspiratory stridor and visible neck swelling.
Rationale Stridor and expanding swelling may signal rapidly worsening airway obstruction; circulation and
comfort concerns are secondary to a threatened airway.
Question 2. A stable patient has continuous bladder irrigation. Which task may the RN
delegate to trained assistive personnel under unit policy?
A. Determine whether clots require an increase in irrigation rate.
B. Decide whether the catheter is obstructed.
C. Measure and record the amount of drainage collected from the urinary bag.
D. Interpret the true urine output and revise the care plan.
Correct Answer: C — Measure and record the amount of drainage collected from the urinary bag.
Rationale Measuring and recording output is a routine task; the RN retains assessment of catheter function,
irrigation balance, and decisions about treatment.
© BestSellerStuvia | PAGE 1
,© BestSellerStuvia
Question 3. Which patient is most suitable for assignment to a licensed practical nurse under
RN supervision and local scope?
A. A stable patient two days after appendectomy who needs routine oral pain medication.
B. A patient needing initial instruction on home insulin injection.
C. A patient admitted minutes ago with undifferentiated chest pain.
D. A patient with a rapidly falling blood pressure after surgery.
Correct Answer: A — A stable patient two days after appendectomy who needs routine oral pain
medication.
Rationale A stable patient needing predictable care is suitable for LPN/VN assignment; initial assessment, unstable
changes, and initial teaching remain RN responsibilities.
Question 4. A patient arrives from the emergency department with a possible bowel
obstruction. Which responsibility should the RN retain?
A. Ask assistive personnel to decide the principal nursing concern.
B. Delay assessment until the next scheduled vital-sign round.
C. Assign the initial clinical assessment to an unlicensed transporter.
D. Perform the initial nursing assessment and establish priorities.
Correct Answer: D — Perform the initial nursing assessment and establish priorities.
Rationale Initial assessment requires licensed clinical judgment to recognize obstruction complications and plan
immediate care.
Question 5. A patient is beginning self-injection of insulin at discharge. Which assignment is
appropriate?
A. The RN provides initial instruction and checks the patient's demonstration.
B. The nurse presumes a signature proves the patient can use the medication.
C. The transporter gives the written instructions without RN involvement.
D. Assistive personnel select the dose and teach injection sites.
Correct Answer: A — The RN provides initial instruction and checks the patient's demonstration.
Rationale Initial medication teaching and assessment of understanding require RN judgment and direct patient
engagement.
Question 6. An assistant records that a postoperative patient walked only three steps before
dizziness. What should the RN do?
A. Chart that ambulation was tolerated because the patient stood up.
B. Assess the patient's symptoms and vital signs before planning further mobility.
C. Ask the assistant to diagnose the cause of dizziness.
D. Schedule the next walk without seeing the patient.
Correct Answer: B — Assess the patient's symptoms and vital signs before planning further
mobility.
Rationale The RN must interpret unexpected findings after delegated tasks; dizziness may signal hypotension or
another condition requiring a change in the care plan.
Question 7. A transfer report includes potassium 2.7 mmol/L and frequent ventricular ectopy.
Which handoff content has highest priority?
A. State the low potassium and rhythm change clearly to the receiving RN and confirm acknowledgment.
B. Wait to discuss the rhythm until routine rounds.
C. Mention only the room number and transport time.
D. Leave the laboratory result in a chart without verbal communication.
Correct Answer: A — State the low potassium and rhythm change clearly to the receiving RN and
confirm acknowledgment.
Rationale A low potassium level with ectopy threatens dysrhythmia; direct acknowledgment in the handoff
supports timely monitoring and treatment.
© BestSellerStuvia | PAGE 2
,© BestSellerStuvia
Question 8. A patient asks the RN to explain surgical risks that the surgeon has not discussed.
What should the RN do?
A. Describe risks from memory and obtain the signature in place of the surgeon.
B. Ask a family member to sign without discussing the patient's question.
C. Pause the signing process and ask the procedural clinician to provide the required explanation.
D. Witness the signature even though the patient says the procedure is unclear.
Correct Answer: C — Pause the signing process and ask the procedural clinician to provide the
required explanation.
Rationale The procedural clinician explains risks, benefits, and alternatives; the RN protects voluntariness and
alerts that clinician when understanding is incomplete.
Question 9. An oriented adult declines a recommended blood transfusion after discussing the
risks. What is the RN's best action?
A. Mark the blood as infused because it was prescribed.
B. Respect the decision, notify the team, and document the informed refusal and discussion.
C. Administer blood while the patient sleeps.
D. Ask a relative to overrule the capable patient's decision.
Correct Answer: B — Respect the decision, notify the team, and document the informed refusal and
discussion.
Rationale A capable adult may refuse treatment; nursing care includes verifying understanding, supporting
autonomy, and accurately documenting the decision.
Question 10. A patient with decision-making capacity states a care preference that differs
from an older directive. Which instruction guides care now?
A. Use the patient's current informed wishes and clarify the plan with the team.
B. Apply the older directive without speaking to the patient.
C. Ask assistive personnel to decide which document controls.
D. Follow the family's preference over the capable patient's choice.
Correct Answer: A — Use the patient's current informed wishes and clarify the plan with the team.
Rationale A capable patient's current decision directs present care; the directive principally guides care when the
patient cannot express a decision.
Question 11. A patient with limited English proficiency must decide about a complex
procedure. What should the RN arrange?
A. An available child to interpret the risk information.
B. A signature before the consent discussion starts.
C. A qualified medical interpreter for the clinical discussion.
D. A yes-or-no question in English as proof of understanding.
Correct Answer: C — A qualified medical interpreter for the clinical discussion.
Rationale A qualified interpreter supports accurate information exchange and informed decisions while reducing
errors and conflicts of interest.
Question 12. An RN leaves a shared workstation to respond to a call bell. What protects
patient information?
A. Leave the record open so colleagues can finish it.
B. Write the password on the desk for the next shift.
C. Copy the patient's chart to a personal device.
D. Lock or sign out of the session before leaving the station.
Correct Answer: D — Lock or sign out of the session before leaving the station.
Rationale Securing an unattended session prevents unauthorized access to health information while allowing the
RN to respond to the patient.
© BestSellerStuvia | PAGE 3
, © BestSellerStuvia
Question 13. The RN catches an incorrect heparin dose before it reaches the patient. What is
the appropriate system action?
A. Erase the order without informing anyone of the risk.
B. Correct the order discrepancy and submit a safety event report under policy.
C. Record an adverse drug reaction even though no dose was given.
D. Administer the dose because no harm has occurred yet.
Correct Answer: B — Correct the order discrepancy and submit a safety event report under policy.
Rationale Reporting a near miss helps identify unsafe processes; the patient should not receive the incorrect dose.
Question 14. A patient is found sitting on the floor after an unwitnessed fall. What should the
RN do first?
A. Lift the patient into bed before checking for injury.
B. Ask the patient to walk to prove there is no fracture.
C. Assess responsiveness, injury, and vital signs before moving the patient unless immediate danger requires it.
D. Finish routine medication rounds and return later.
Correct Answer: C — Assess responsiveness, injury, and vital signs before moving the patient unless
immediate danger requires it.
Rationale Assessment before movement identifies head injury, bleeding, or fracture and guides safe escalation and
documentation.
Question 15. A patient with platelets of 18,000 per microliter has an order for an
intramuscular injection. What should the RN do?
A. Inject into the largest muscle to prevent bleeding.
B. Clarify the order and seek a safer route before giving the medication.
C. Ask assistive personnel to administer it.
D. Give the injection and apply no pressure afterward.
Correct Answer: B — Clarify the order and seek a safer route before giving the medication.
Rationale Severe thrombocytopenia raises bleeding risk from intramuscular injection; the RN should address the
hazard before administration.
Question 16. A patient moves from intensive care to the ward with two different insulin lists.
What is the RN's priority?
A. Assume a copied home list replaces all active orders.
B. Choose the higher dose to avoid hyperglycemia.
C. Give both regimens until the next physician round.
D. Reconcile the current orders with the recent regimen and clarify discrepancies before administering insulin.
Correct Answer: D — Reconcile the current orders with the recent regimen and clarify
discrepancies before administering insulin.
Rationale Transitions can duplicate or omit medications; reconciliation and clarification prevent dosing errors.
Question 17. A frail patient cannot safely reach the bathroom after surgery. Which action best
coordinates ongoing care?
A. Wait for a fall before requesting equipment.
B. Prohibit all movement for the remainder of hospitalization.
C. Request therapy and mobility input while arranging a safe bedside toileting plan.
D. Let untrained relatives decide how to lift the patient.
Correct Answer: C — Request therapy and mobility input while arranging a safe bedside toileting
plan.
Rationale An interdisciplinary plan addresses current toileting needs and evaluates strength, equipment, and
assistance required for safer movement.
© BestSellerStuvia | PAGE 4
