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EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM WITH 150+ REAL
EXAM QUESTIONS AND CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL SURGICAL LATEST EXAM 2026
(BRAND NEW!!)
1. A 68-year-old man with chronic heart failure is admitted with increasing
shortness of breath and peripheral edema. His weight has increased 4 kg in 5 days. He
takes lisinopril and furosemide at home. On assessment: BP 138/84 mm Hg, HR 96 bpm,
RR 24, JVD present, crackles halfway up the posterior lung fields, and 3+ pitting edema
to the knees. Which action should the nurse implement first?
A. Increase the oral furosemide dose at home.
B. Place the head of the bed at 45 degrees and apply supplemental oxygen.
C. Obtain a 12-lead ECG.
D. Call the provider to arrange urgent echocardiogram.
Answer: B. Place the head of the bed at 45 degrees and apply supplemental oxygen.
Rationale: The patient shows signs of pulmonary congestion and hypoxemia (dyspnea,
crackles, tachypnea, JVD). The immediate priority is to optimize oxygenation and
respiratory status (airway/breathing). Raising the head and giving O₂ relieves dyspnea
while further assessment/treatment is arranged. Diuretics and diagnostics are important
but secondary to stabilizing breathing.
2. A postoperative patient receiving PCA morphine reports respiratory rate 8
breaths/min and is difficult to arouse. Pulse ox 88% on room air. Which intervention
should the nurse perform first?
A. Stimulate the patient and raise head of bed.
B. Administer naloxone per protocol.
C. Stop the PCA infusion and call the provider.
D. Apply oxygen via nasal cannula at 2 L/min.
Answer: A. Stimulate the patient and raise head of bed.
Rationale: The immediate action for depressed respirations is to attempt to arouse and
stimulate the patient and open airway (raise head) to assess responsiveness. While
naloxone and stopping opioid are appropriate for opioid-induced respiratory depression,
brief stimulation and airway positioning are the first, fastest interventions. Apply O₂ after
stimulation if needed.
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3. A patient with chronic obstructive pulmonary disease (COPD) uses home oxygen
2 L/min at night. He presents with increased dyspnea and confusion. On arrival, RR 32,
O₂ sat 86% on 2 L. Which nursing action is most appropriate?
A. Increase oxygen to 6 L/min via nasal cannula.
B. Place the patient in high-Fowler’s position and administer bronchodilator via
nebulizer.
C. Encourage pursed-lip breathing and keep oxygen at 2 L.
D. Call respiratory therapy for immediate noninvasive ventilation (BiPAP).
Answer: B. Place the patient in high-Fowler’s position and administer
bronchodilator via nebulizer.
Rationale: For acute COPD exacerbation with hypoxemia, first support airway and
ventilation—upright position improves lung expansion; bronchodilator nebulizer helps
relieve bronchospasm. Oxygen should be titrated to maintain target saturation (usually
88–92% in COPD) — increasing to very high flows (A) risks CO₂ retention. BiPAP (D)
may be needed if respiratory failure progresses but initial steps include bronchodilator
and positioning.
4. A 54-year-old woman with type 2 diabetes is admitted with polyuria, polydipsia,
and fruity breath. Labs: glucose 520 mg/dL, serum sodium 136 mEq/L, potassium 5.6
mEq/L, arterial pH 7.28, bicarbonate 14 mEq/L. What is the nurse’s priority action?
A. Begin an IV infusion of regular insulin after obtaining an order.
B. Administer oral potassium to correct hyperkalemia.
C. Withhold IV fluids until potassium normalizes.
D. Start isotonic IV fluids (0.9% NS) as ordered.
Answer: D. Start isotonic IV fluids (0.9% NS) as ordered.
Rationale: In diabetic ketoacidosis (DKA), initial priority is IV fluid resuscitation to
restore perfusion and lower glucose. Insulin is important but fluids are started
immediately. Potassium is elevated but total body potassium is depleted; insulin will shift
potassium intracellularly—monitor closely. Oral potassium is inappropriate when patient
is vomiting/unstable.
5. A patient is receiving heparin infusion for DVT. Which lab result should the nurse
monitor to evaluate therapeutic effect?
A. Prothrombin time (PT) and INR.
B. Activated partial thromboplastin time (aPTT).
C. Platelet count only.
D. Fibrinogen level.
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Answer: B. Activated partial thromboplastin time (aPTT).
Rationale: Heparin's anticoagulant effect is monitored with aPTT (or anti-Xa levels when
available). PT/INR monitor warfarin therapy. Platelet count should be monitored for
heparin-induced thrombocytopenia (HIT) but not to titrate effect.
6. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of
6.0 mEq/L and peaked T waves on ECG. Which immediate intervention should the nurse
anticipate?
A. Administer IV calcium gluconate.
B. Administer oral potassium-binding resin only.
C. Give IV sodium bicarbonate and restrict fluids.
D. Prepare for urgent hemodialysis without other treatments.
Answer: A. Administer IV calcium gluconate.
Rationale: Hyperkalemia with ECG changes is life-threatening. IV calcium stabilizes
myocardial membrane rapidly (does not lower K⁺ but reduces arrhythmia risk) and is
first. Insulin with glucose, nebulized albuterol, and sodium bicarbonate (if acidotic) shift
potassium intracellularly; dialysis removes potassium but other temporizing measures are
started first.
7. A patient with community-acquired pneumonia is started on IV broad-spectrum
antibiotics. After the first dose, the patient reports itching and develops urticaria and
wheezing. What should the nurse do first?
A. Stop the antibiotic infusion and assess airway and breathing.
B. Administer diphenhydramine and continue infusion slowly.
C. Document as allergy and change the antibiotic tomorrow.
D. Continue infusion and notify provider after dose completion.
Answer: A. Stop the antibiotic infusion and assess airway and breathing.
Rationale: Signs of anaphylaxis/allergic reaction (wheezing, urticaria) require immediate
cessation of the offending medication and assessment of airway/breathing/circulation.
Initiate emergency measures (epinephrine, oxygen) as indicated. Antihistamines may
help but stopping infusion and assessing is first.
8. A 72-year-old post-op patient is on hydromorphone for pain. She is constipated
and hasn’t had a bowel movement in 4 days. Which order should the nurse question?
A. Start a bowel regimen with stool softener (docusate) and senna.
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B. Give PRN bisacodyl suppository if no BM in 48 hours.
C. Increase the hydromorphone dose for better pain control.
D. Encourage oral fluids, fiber, and ambulation as tolerated.
Answer: C. Increase the hydromorphone dose for better pain control.
Rationale: Opioids cause constipation; increasing opioid dose worsens constipation. Best
practice: implement bowel regimen (A), use stimulant laxative or suppository (B) as
needed, and encourage nonpharmacologic measures (D). Questioning additional opioid
dosing is appropriate until constipation addressed.
9. A patient with suspected acute mesenteric ischemia reports sudden severe
abdominal pain out of proportion to exam. Vital signs: BP 90/60, HR 120. Which action
is highest priority for the nurse?
A. Prepare the patient for immediate CT angiography with contrast.
B. Administer IV morphine for pain control.
C. Begin aggressive IV fluid resuscitation and notify provider urgently.
D. Obtain an abdominal x-ray.
Answer: C. Begin aggressive IV fluid resuscitation and notify provider urgently.
Rationale: The patient is hemodynamically unstable (hypotension, tachycardia) with
possible ischemia; immediate resuscitation with IV fluids and urgent notification for
emergent management/surgery is priority. Imaging such as CT angiography may be
indicated rapidly but stabilization comes first.
10. A patient is scheduled for a blood transfusion. Before starting, which action must
the nurse perform to ensure safety?
A. Verify the blood product with another licensed nurse at bedside.
B. Begin transfusion immediately because blood should not sit.
C. Warm the blood to body temperature prior to administration for all patients.
D. Obtain a urine sample to check for hematuria before starting.
Answer: A. Verify the blood product with another licensed nurse at bedside.
Rationale: Two-person verification (patient identity, blood type, unit number, expiration)
at bedside is required to prevent transfusion errors. Blood should be infused within the
specified time frame but not before verification. Warming blood is only for specific
indications. Urine sample is not required pretransfusion.
EVOLVE ELSEVIER HESI MED SURG ACTUAL EXAM WITH 150+ REAL
EXAM QUESTIONS AND CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL SURGICAL LATEST EXAM 2026
(BRAND NEW!!)
1. A 68-year-old man with chronic heart failure is admitted with increasing
shortness of breath and peripheral edema. His weight has increased 4 kg in 5 days. He
takes lisinopril and furosemide at home. On assessment: BP 138/84 mm Hg, HR 96 bpm,
RR 24, JVD present, crackles halfway up the posterior lung fields, and 3+ pitting edema
to the knees. Which action should the nurse implement first?
A. Increase the oral furosemide dose at home.
B. Place the head of the bed at 45 degrees and apply supplemental oxygen.
C. Obtain a 12-lead ECG.
D. Call the provider to arrange urgent echocardiogram.
Answer: B. Place the head of the bed at 45 degrees and apply supplemental oxygen.
Rationale: The patient shows signs of pulmonary congestion and hypoxemia (dyspnea,
crackles, tachypnea, JVD). The immediate priority is to optimize oxygenation and
respiratory status (airway/breathing). Raising the head and giving O₂ relieves dyspnea
while further assessment/treatment is arranged. Diuretics and diagnostics are important
but secondary to stabilizing breathing.
2. A postoperative patient receiving PCA morphine reports respiratory rate 8
breaths/min and is difficult to arouse. Pulse ox 88% on room air. Which intervention
should the nurse perform first?
A. Stimulate the patient and raise head of bed.
B. Administer naloxone per protocol.
C. Stop the PCA infusion and call the provider.
D. Apply oxygen via nasal cannula at 2 L/min.
Answer: A. Stimulate the patient and raise head of bed.
Rationale: The immediate action for depressed respirations is to attempt to arouse and
stimulate the patient and open airway (raise head) to assess responsiveness. While
naloxone and stopping opioid are appropriate for opioid-induced respiratory depression,
brief stimulation and airway positioning are the first, fastest interventions. Apply O₂ after
stimulation if needed.
,2|Page
3. A patient with chronic obstructive pulmonary disease (COPD) uses home oxygen
2 L/min at night. He presents with increased dyspnea and confusion. On arrival, RR 32,
O₂ sat 86% on 2 L. Which nursing action is most appropriate?
A. Increase oxygen to 6 L/min via nasal cannula.
B. Place the patient in high-Fowler’s position and administer bronchodilator via
nebulizer.
C. Encourage pursed-lip breathing and keep oxygen at 2 L.
D. Call respiratory therapy for immediate noninvasive ventilation (BiPAP).
Answer: B. Place the patient in high-Fowler’s position and administer
bronchodilator via nebulizer.
Rationale: For acute COPD exacerbation with hypoxemia, first support airway and
ventilation—upright position improves lung expansion; bronchodilator nebulizer helps
relieve bronchospasm. Oxygen should be titrated to maintain target saturation (usually
88–92% in COPD) — increasing to very high flows (A) risks CO₂ retention. BiPAP (D)
may be needed if respiratory failure progresses but initial steps include bronchodilator
and positioning.
4. A 54-year-old woman with type 2 diabetes is admitted with polyuria, polydipsia,
and fruity breath. Labs: glucose 520 mg/dL, serum sodium 136 mEq/L, potassium 5.6
mEq/L, arterial pH 7.28, bicarbonate 14 mEq/L. What is the nurse’s priority action?
A. Begin an IV infusion of regular insulin after obtaining an order.
B. Administer oral potassium to correct hyperkalemia.
C. Withhold IV fluids until potassium normalizes.
D. Start isotonic IV fluids (0.9% NS) as ordered.
Answer: D. Start isotonic IV fluids (0.9% NS) as ordered.
Rationale: In diabetic ketoacidosis (DKA), initial priority is IV fluid resuscitation to
restore perfusion and lower glucose. Insulin is important but fluids are started
immediately. Potassium is elevated but total body potassium is depleted; insulin will shift
potassium intracellularly—monitor closely. Oral potassium is inappropriate when patient
is vomiting/unstable.
5. A patient is receiving heparin infusion for DVT. Which lab result should the nurse
monitor to evaluate therapeutic effect?
A. Prothrombin time (PT) and INR.
B. Activated partial thromboplastin time (aPTT).
C. Platelet count only.
D. Fibrinogen level.
,3|Page
Answer: B. Activated partial thromboplastin time (aPTT).
Rationale: Heparin's anticoagulant effect is monitored with aPTT (or anti-Xa levels when
available). PT/INR monitor warfarin therapy. Platelet count should be monitored for
heparin-induced thrombocytopenia (HIT) but not to titrate effect.
6. A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of
6.0 mEq/L and peaked T waves on ECG. Which immediate intervention should the nurse
anticipate?
A. Administer IV calcium gluconate.
B. Administer oral potassium-binding resin only.
C. Give IV sodium bicarbonate and restrict fluids.
D. Prepare for urgent hemodialysis without other treatments.
Answer: A. Administer IV calcium gluconate.
Rationale: Hyperkalemia with ECG changes is life-threatening. IV calcium stabilizes
myocardial membrane rapidly (does not lower K⁺ but reduces arrhythmia risk) and is
first. Insulin with glucose, nebulized albuterol, and sodium bicarbonate (if acidotic) shift
potassium intracellularly; dialysis removes potassium but other temporizing measures are
started first.
7. A patient with community-acquired pneumonia is started on IV broad-spectrum
antibiotics. After the first dose, the patient reports itching and develops urticaria and
wheezing. What should the nurse do first?
A. Stop the antibiotic infusion and assess airway and breathing.
B. Administer diphenhydramine and continue infusion slowly.
C. Document as allergy and change the antibiotic tomorrow.
D. Continue infusion and notify provider after dose completion.
Answer: A. Stop the antibiotic infusion and assess airway and breathing.
Rationale: Signs of anaphylaxis/allergic reaction (wheezing, urticaria) require immediate
cessation of the offending medication and assessment of airway/breathing/circulation.
Initiate emergency measures (epinephrine, oxygen) as indicated. Antihistamines may
help but stopping infusion and assessing is first.
8. A 72-year-old post-op patient is on hydromorphone for pain. She is constipated
and hasn’t had a bowel movement in 4 days. Which order should the nurse question?
A. Start a bowel regimen with stool softener (docusate) and senna.
, 4|Page
B. Give PRN bisacodyl suppository if no BM in 48 hours.
C. Increase the hydromorphone dose for better pain control.
D. Encourage oral fluids, fiber, and ambulation as tolerated.
Answer: C. Increase the hydromorphone dose for better pain control.
Rationale: Opioids cause constipation; increasing opioid dose worsens constipation. Best
practice: implement bowel regimen (A), use stimulant laxative or suppository (B) as
needed, and encourage nonpharmacologic measures (D). Questioning additional opioid
dosing is appropriate until constipation addressed.
9. A patient with suspected acute mesenteric ischemia reports sudden severe
abdominal pain out of proportion to exam. Vital signs: BP 90/60, HR 120. Which action
is highest priority for the nurse?
A. Prepare the patient for immediate CT angiography with contrast.
B. Administer IV morphine for pain control.
C. Begin aggressive IV fluid resuscitation and notify provider urgently.
D. Obtain an abdominal x-ray.
Answer: C. Begin aggressive IV fluid resuscitation and notify provider urgently.
Rationale: The patient is hemodynamically unstable (hypotension, tachycardia) with
possible ischemia; immediate resuscitation with IV fluids and urgent notification for
emergent management/surgery is priority. Imaging such as CT angiography may be
indicated rapidly but stabilization comes first.
10. A patient is scheduled for a blood transfusion. Before starting, which action must
the nurse perform to ensure safety?
A. Verify the blood product with another licensed nurse at bedside.
B. Begin transfusion immediately because blood should not sit.
C. Warm the blood to body temperature prior to administration for all patients.
D. Obtain a urine sample to check for hematuria before starting.
Answer: A. Verify the blood product with another licensed nurse at bedside.
Rationale: Two-person verification (patient identity, blood type, unit number, expiration)
at bedside is required to prevent transfusion errors. Blood should be infused within the
specified time frame but not before verification. Warming blood is only for specific
indications. Urine sample is not required pretransfusion.
