HESI Med Surg Exit Exam – EVOLVE/Elsevier
Style 2026/2027 Realistic Practice Questions 100
NCLEX-Style Items with Correct Answers +
Detailed Rationales Medical-Surgical Nursing
Comprehensive Test Bank | Pass Guarantee
Question 1 A client with a recent diagnosis of type 1 diabetes mellitus is being
discharged. Which statement by the client indicates the need for further teaching?
A. “I should eat more fiber and whole grains.” B. “I can have a piece of cake on special
occasions.” C. “I will check my blood sugar before every meal and at bedtime.” D. “I
should avoid all carbohydrates completely.”
Answer: D
Rationale: Complete carbohydrate avoidance is incorrect and dangerous in diabetes
management. Carbohydrates are essential when consumed in appropriate amounts and
types (complex preferred). Option D shows a fundamental misunderstanding.
Question 2 A client is admitted with acute exacerbation of heart failure. Which finding
should the nurse report immediately?
A. Bilateral 2+ pitting edema of the lower extremities B. Crackles in the lower lung fields
bilaterally C. Blood pressure 88/52 mmHg D. Pulse oximetry 92% on 2 L oxygen
Answer: C
Rationale: Hypotension (88/52 mmHg) in acute heart failure indicates possible
cardiogenic shock or severe decompensation and is the most urgent finding requiring
immediate intervention.
Question 3 The nurse is caring for a client receiving IV heparin for deep vein thrombosis.
The aPTT is 110 seconds (therapeutic range 60–80 seconds). What is the priority nursing
action?
A. Continue the infusion at the current rate B. Hold the heparin infusion C. Increase the
infusion rate D. Administer protamine sulfate
Answer: B
Rationale: aPTT >100 seconds is supratherapeutic → high bleeding risk. Priority is to
hold the infusion immediately and notify the provider.
Question 4 A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
client becomes increasingly lethargic. What is the priority action?
, A. Increase oxygen to 4 L/min immediately B. Obtain arterial blood gases C. Place the
client in high-Fowler’s position D. Encourage coughing and deep breathing
Answer: B
Rationale: Lethargy in a COPD client receiving oxygen may indicate CO₂ retention
(hypercapnic respiratory failure). ABGs are needed to evaluate oxygenation and
ventilation before changing oxygen therapy.
Question 5 A client with chronic kidney disease stage 4 is prescribed epoetin alfa. The
nurse should teach the client that the primary purpose of this medication is to:
A. Lower blood pressure B. Stimulate red blood cell production C. Reduce potassium
levels D. Bind dietary phosphate
Answer: B
Rationale: Epoetin alfa is synthetic erythropoietin used to treat anemia of chronic kidney
disease by stimulating bone marrow production of red blood cells.
Question 6 Which of the following is the most common cause of acute pancreatitis in the
United States?
A. Alcohol abuse B. Gallstones C. Hypertriglyceridemia D. Medications
Answer: B
Rationale: Gallstones remain the leading cause of acute pancreatitis in the United
States, followed closely by alcohol.
Question 7 A client with suspected pulmonary embolism has high pretest probability.
What is the most appropriate diagnostic test?
A. D-dimer B. Ventilation-perfusion (V/Q) scan C. CT pulmonary angiography D. Lower
extremity Doppler ultrasound
Answer: C
Rationale: CT pulmonary angiography (CTPA) is the gold-standard diagnostic test for
pulmonary embolism in patients with high clinical probability.
Question 8 A client with rheumatoid arthritis is prescribed methotrexate. Which
laboratory value should the nurse monitor most closely?
A. Serum potassium B. Complete blood count (CBC) and liver function tests C. Serum
creatinine D. Blood glucose
Answer: B
Rationale: Methotrexate can cause bone marrow suppression (anemia, leukopenia,
thrombocytopenia) and hepatotoxicity; regular CBC and LFT monitoring is required.
Question 9 A client receiving packed red blood cells reports chills and low back pain 15
minutes after the transfusion begins. What is the priority action?
A. Slow the transfusion rate B. Stop the transfusion immediately C. Administer
diphenhydramine D. Continue the transfusion and monitor
Style 2026/2027 Realistic Practice Questions 100
NCLEX-Style Items with Correct Answers +
Detailed Rationales Medical-Surgical Nursing
Comprehensive Test Bank | Pass Guarantee
Question 1 A client with a recent diagnosis of type 1 diabetes mellitus is being
discharged. Which statement by the client indicates the need for further teaching?
A. “I should eat more fiber and whole grains.” B. “I can have a piece of cake on special
occasions.” C. “I will check my blood sugar before every meal and at bedtime.” D. “I
should avoid all carbohydrates completely.”
Answer: D
Rationale: Complete carbohydrate avoidance is incorrect and dangerous in diabetes
management. Carbohydrates are essential when consumed in appropriate amounts and
types (complex preferred). Option D shows a fundamental misunderstanding.
Question 2 A client is admitted with acute exacerbation of heart failure. Which finding
should the nurse report immediately?
A. Bilateral 2+ pitting edema of the lower extremities B. Crackles in the lower lung fields
bilaterally C. Blood pressure 88/52 mmHg D. Pulse oximetry 92% on 2 L oxygen
Answer: C
Rationale: Hypotension (88/52 mmHg) in acute heart failure indicates possible
cardiogenic shock or severe decompensation and is the most urgent finding requiring
immediate intervention.
Question 3 The nurse is caring for a client receiving IV heparin for deep vein thrombosis.
The aPTT is 110 seconds (therapeutic range 60–80 seconds). What is the priority nursing
action?
A. Continue the infusion at the current rate B. Hold the heparin infusion C. Increase the
infusion rate D. Administer protamine sulfate
Answer: B
Rationale: aPTT >100 seconds is supratherapeutic → high bleeding risk. Priority is to
hold the infusion immediately and notify the provider.
Question 4 A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
client becomes increasingly lethargic. What is the priority action?
, A. Increase oxygen to 4 L/min immediately B. Obtain arterial blood gases C. Place the
client in high-Fowler’s position D. Encourage coughing and deep breathing
Answer: B
Rationale: Lethargy in a COPD client receiving oxygen may indicate CO₂ retention
(hypercapnic respiratory failure). ABGs are needed to evaluate oxygenation and
ventilation before changing oxygen therapy.
Question 5 A client with chronic kidney disease stage 4 is prescribed epoetin alfa. The
nurse should teach the client that the primary purpose of this medication is to:
A. Lower blood pressure B. Stimulate red blood cell production C. Reduce potassium
levels D. Bind dietary phosphate
Answer: B
Rationale: Epoetin alfa is synthetic erythropoietin used to treat anemia of chronic kidney
disease by stimulating bone marrow production of red blood cells.
Question 6 Which of the following is the most common cause of acute pancreatitis in the
United States?
A. Alcohol abuse B. Gallstones C. Hypertriglyceridemia D. Medications
Answer: B
Rationale: Gallstones remain the leading cause of acute pancreatitis in the United
States, followed closely by alcohol.
Question 7 A client with suspected pulmonary embolism has high pretest probability.
What is the most appropriate diagnostic test?
A. D-dimer B. Ventilation-perfusion (V/Q) scan C. CT pulmonary angiography D. Lower
extremity Doppler ultrasound
Answer: C
Rationale: CT pulmonary angiography (CTPA) is the gold-standard diagnostic test for
pulmonary embolism in patients with high clinical probability.
Question 8 A client with rheumatoid arthritis is prescribed methotrexate. Which
laboratory value should the nurse monitor most closely?
A. Serum potassium B. Complete blood count (CBC) and liver function tests C. Serum
creatinine D. Blood glucose
Answer: B
Rationale: Methotrexate can cause bone marrow suppression (anemia, leukopenia,
thrombocytopenia) and hepatotoxicity; regular CBC and LFT monitoring is required.
Question 9 A client receiving packed red blood cells reports chills and low back pain 15
minutes after the transfusion begins. What is the priority action?
A. Slow the transfusion rate B. Stop the transfusion immediately C. Administer
diphenhydramine D. Continue the transfusion and monitor
