EVOLVE ELSEVIER HESI MED SURG
EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM WITH 350 REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL
SURGICAL LATEST EXAM 2025-2026 (latest) ACE
YOUR TEST GRADED A+ -PDF
1. The arterial blood gas (ABG) readings that indicate compensated respiratory acidosis are a PaCO2 of
A. 30 mm Hg and bicarbonate level of 24 mEq/L.
B. 30 mm Hg and bicarbonate level of 30 mEq/L.
C. 50 mm Hg and bicarbonate level of 20 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L. –
ANS :D. 50 mm Hg and bicarbonate level of 30 mEq/L. If compensation is present, carbon dioxide and
bicarbonate are abnormal (or nearly so) in opposite directions (e.g., one is acidotic and the other alkalotic).
ADMIN 1
, EVOLVE ELSEVIER HESI MED SURG
2. A patient admitted to the emergency department with tension pneumothorax and mediastinal shift
following an automobile crash is most likely to exhibit A. bradycardia.
B. severe hypotension.
C. mediastinal flutter.
D. a sucking chest wound. –
ANS :B. severe hypotension. Mediastinal shift may cause compression of the lung in the direction of the shift
and compression, traction, torsion, or kinking of the great vessels. Blood return to the heart is dangerously
impaired and causes a subsequent decrease in cardiac output and blood pressure. Tachycardia is a clinical
manifestation of tension pneumothorax. An uncovered opened pneumothorax is associated with a sucking chest
wound and mediastinal flutter.
3. In preparing the preoperative teaching plan for a patient who is to undergo a total laryngectomy, a nurse
should give highest priority to the
A. tracheostomy being in place for 2 to 3 days.
B. patient's not being able to speak normally again.
C. insertion of a gastrostomy feeding tube during surgery.
D. patient's not being able to perform deep-breathing exercises.
- ANS :B. patient's not being able to speak normally again. Patients who have a total laryngectomy have a
permanent tracheostomy and will need to learn how to speak using alternative methods, such as an artificial
larynx. The tracheostomy will be permanent to allow normal breathing patterns and air exchange. After surgery,
the patient's nutrition is supplemented with enteral feedings, and when the patient can swallow secretions, oral
feedings can begin. Deep-breathing exercises should be performed with the patient at least every 2 hours to
prevent further pulmonary complications.
4. After a posterior nasal pack is inserted by a physician, the patient is very anxious and states, "I don't feel
like I'm breathing right." The immediate intervention the nurse should initiate is to
A. monitor ABGs.
B. reassure the patient that this is normal discomfort.
C. cut the pack strings and pull the packing out with a hemostat.
D. direct a flashlight into the patient's mouth and inspect the oral cavity. –
ADMIN 2
, EVOLVE ELSEVIER HESI MED SURG
ANS :D. direct a flashlight into the patient's mouth and inspect the oral cavity. The nurse should inspect the oral
cavity for the presence of blood, soft palate necrosis, and proper placement of the posterior plug. If the posterior
plug is visible, the physician should be notified for readjustment of the packing. Reassurance, cutting the strings,
and ABGs are not top priority interventions. The nurse needs further data before intervening.
5. A nurse is performing assessment for a patient diagnosed with chronic obstructive pulmonary disease
(COPD). Which of the following findings should the nurse expect to observe?
A. Nonproductive cough
B. Prolonged inspiration
C. Vesicular breath sounds
D. Increased anterior-posterior chest diameter –
ANS :D. Increased anterior-posterior chest diameter An increased anterior-posterior diameter is a compensatory
mechanism experienced by patients with COPD and is caused by air-trapping. Patients with COPD have a
productive cough, often expectorating copious amounts of sputum. Because of air-trapping, patients with COPD
experience a prolonged expiration because the rate of gas on exhalation takes longer to escape. Chest
auscultation for patients with COPD often reveals wheezing, crackles, and other adventitious breath sounds.
6. A nurse is working on a respiratory care unit where many of the patients are affected by asthma. Which of
the following actions by the nurse would most likely increase respiratory difficulty for the patients?
A. Wearing perfume to work
B. Encouraging patients to ambulate daily C. Allowing the patients to eat green leafy vegetables
D. Withholding antibiotic therapy until cultures are obtained –
ANS :A. Wearing perfume to work People with asthma should avoid extrinsic allergens and irritants (e.g., dust,
pollen, smoke, certain foods, colognes and perfumes, certain types of medications) because their airways become
inflamed, producing shortness of breath, chest tightness, and wheezing. Many green leafy vegetables are rich in
vitamins, minerals, and proteins, which incorporate healthy lifestyle patterns into the patients' daily living
routines. Routine exercise is a part of a prudent lifestyle, and for patients with asthma the physical and
psychosocial effects of ambulation can incorporate feelings of well-being, strength, and enhancement of physical
endurance. Antibiotic therapy is always initiated after cultures are obtained so that the sensitivity to the organism
can be readily identified.
7. The most appropriate position to assist a patient with chronic obstructive pulmonary disease (COPD) who
is having difficulty breathing would be a
A. high Fowler's position without a pillow behind the head.
ADMIN 3
, EVOLVE ELSEVIER HESI MED SURG
B. semi-Fowler's position with a single pillow behind the head.
C. right side-lying position with the head of the bed at 45 degrees' elevation.
D. sitting upright and forward position with arms supported on an over-the-bed table. –
ANS :D. sitting upright and forward position with arms supported on an over-the-bed table.Sitting upright and
leaning forward with arms supported on an over-the-bed table would be of most help to this patient, because it
allows for expansion of the thoracic cage in all four directions (front, back, and two sides).
8. A person complains of fatigue and malaise and has a slight temperature elevation for 2 days before
symptoms of influenza (fever, chest congestion, and productive cough) become noticeable. During the time
immediately before the illness is diagnosed, the patient
A. could avoid contracting the disease if treatment is begun with antibiotics.
B. is unable to spread the disease because it is still in the incubation period. C. is in the prodromal stage and is
highly contagious and able to spread the disease.
D. has a nosocomial infection, which affects approximately two million individuals a year. –
ANS :C. is in the prodromal stage and is highly contagious and able to spread the disease. The prodromal stage is
a short period of time (hours to several days) immediately preceding the onset of an illness during which the
patient is very contagious. Antibiotics are not effective against viral illnesses. The incubation period is the time
from entry of the organism to the onset of symptoms and, in some viral illnesses, may be contagious. Nosocomial
infections are those acquired in a hospital, and this scenario does not suggest the source of the infection.
9. In older adults, infection after exposure to respiratory illness is most likely to
A. result in similar rates of infection as in the younger adult.
B. be easily prevented with the use of antibiotics after being exposed.
C. result in serious lower respiratory infection related to weakened respiratory muscles and fewer cilia.
D. be less serious because the older adult has less contact with younger children who are most likely to carry
serious infections. –
ANS :C. result in serious lower respiratory infection related to weakened respiratory muscles and fewer cilia.
Changes in the older adult respiratory system make older adults more susceptible to infections that can be very
serious and life threatening. Use of antibiotics to "prevent" lung infections is not recommended and is ineffective
for viral infections.
ADMIN 4
EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM WITH 350 REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL
SURGICAL LATEST EXAM 2025-2026 (latest) ACE
YOUR TEST GRADED A+ -PDF
1. The arterial blood gas (ABG) readings that indicate compensated respiratory acidosis are a PaCO2 of
A. 30 mm Hg and bicarbonate level of 24 mEq/L.
B. 30 mm Hg and bicarbonate level of 30 mEq/L.
C. 50 mm Hg and bicarbonate level of 20 mEq/L.
D. 50 mm Hg and bicarbonate level of 30 mEq/L. –
ANS :D. 50 mm Hg and bicarbonate level of 30 mEq/L. If compensation is present, carbon dioxide and
bicarbonate are abnormal (or nearly so) in opposite directions (e.g., one is acidotic and the other alkalotic).
ADMIN 1
, EVOLVE ELSEVIER HESI MED SURG
2. A patient admitted to the emergency department with tension pneumothorax and mediastinal shift
following an automobile crash is most likely to exhibit A. bradycardia.
B. severe hypotension.
C. mediastinal flutter.
D. a sucking chest wound. –
ANS :B. severe hypotension. Mediastinal shift may cause compression of the lung in the direction of the shift
and compression, traction, torsion, or kinking of the great vessels. Blood return to the heart is dangerously
impaired and causes a subsequent decrease in cardiac output and blood pressure. Tachycardia is a clinical
manifestation of tension pneumothorax. An uncovered opened pneumothorax is associated with a sucking chest
wound and mediastinal flutter.
3. In preparing the preoperative teaching plan for a patient who is to undergo a total laryngectomy, a nurse
should give highest priority to the
A. tracheostomy being in place for 2 to 3 days.
B. patient's not being able to speak normally again.
C. insertion of a gastrostomy feeding tube during surgery.
D. patient's not being able to perform deep-breathing exercises.
- ANS :B. patient's not being able to speak normally again. Patients who have a total laryngectomy have a
permanent tracheostomy and will need to learn how to speak using alternative methods, such as an artificial
larynx. The tracheostomy will be permanent to allow normal breathing patterns and air exchange. After surgery,
the patient's nutrition is supplemented with enteral feedings, and when the patient can swallow secretions, oral
feedings can begin. Deep-breathing exercises should be performed with the patient at least every 2 hours to
prevent further pulmonary complications.
4. After a posterior nasal pack is inserted by a physician, the patient is very anxious and states, "I don't feel
like I'm breathing right." The immediate intervention the nurse should initiate is to
A. monitor ABGs.
B. reassure the patient that this is normal discomfort.
C. cut the pack strings and pull the packing out with a hemostat.
D. direct a flashlight into the patient's mouth and inspect the oral cavity. –
ADMIN 2
, EVOLVE ELSEVIER HESI MED SURG
ANS :D. direct a flashlight into the patient's mouth and inspect the oral cavity. The nurse should inspect the oral
cavity for the presence of blood, soft palate necrosis, and proper placement of the posterior plug. If the posterior
plug is visible, the physician should be notified for readjustment of the packing. Reassurance, cutting the strings,
and ABGs are not top priority interventions. The nurse needs further data before intervening.
5. A nurse is performing assessment for a patient diagnosed with chronic obstructive pulmonary disease
(COPD). Which of the following findings should the nurse expect to observe?
A. Nonproductive cough
B. Prolonged inspiration
C. Vesicular breath sounds
D. Increased anterior-posterior chest diameter –
ANS :D. Increased anterior-posterior chest diameter An increased anterior-posterior diameter is a compensatory
mechanism experienced by patients with COPD and is caused by air-trapping. Patients with COPD have a
productive cough, often expectorating copious amounts of sputum. Because of air-trapping, patients with COPD
experience a prolonged expiration because the rate of gas on exhalation takes longer to escape. Chest
auscultation for patients with COPD often reveals wheezing, crackles, and other adventitious breath sounds.
6. A nurse is working on a respiratory care unit where many of the patients are affected by asthma. Which of
the following actions by the nurse would most likely increase respiratory difficulty for the patients?
A. Wearing perfume to work
B. Encouraging patients to ambulate daily C. Allowing the patients to eat green leafy vegetables
D. Withholding antibiotic therapy until cultures are obtained –
ANS :A. Wearing perfume to work People with asthma should avoid extrinsic allergens and irritants (e.g., dust,
pollen, smoke, certain foods, colognes and perfumes, certain types of medications) because their airways become
inflamed, producing shortness of breath, chest tightness, and wheezing. Many green leafy vegetables are rich in
vitamins, minerals, and proteins, which incorporate healthy lifestyle patterns into the patients' daily living
routines. Routine exercise is a part of a prudent lifestyle, and for patients with asthma the physical and
psychosocial effects of ambulation can incorporate feelings of well-being, strength, and enhancement of physical
endurance. Antibiotic therapy is always initiated after cultures are obtained so that the sensitivity to the organism
can be readily identified.
7. The most appropriate position to assist a patient with chronic obstructive pulmonary disease (COPD) who
is having difficulty breathing would be a
A. high Fowler's position without a pillow behind the head.
ADMIN 3
, EVOLVE ELSEVIER HESI MED SURG
B. semi-Fowler's position with a single pillow behind the head.
C. right side-lying position with the head of the bed at 45 degrees' elevation.
D. sitting upright and forward position with arms supported on an over-the-bed table. –
ANS :D. sitting upright and forward position with arms supported on an over-the-bed table.Sitting upright and
leaning forward with arms supported on an over-the-bed table would be of most help to this patient, because it
allows for expansion of the thoracic cage in all four directions (front, back, and two sides).
8. A person complains of fatigue and malaise and has a slight temperature elevation for 2 days before
symptoms of influenza (fever, chest congestion, and productive cough) become noticeable. During the time
immediately before the illness is diagnosed, the patient
A. could avoid contracting the disease if treatment is begun with antibiotics.
B. is unable to spread the disease because it is still in the incubation period. C. is in the prodromal stage and is
highly contagious and able to spread the disease.
D. has a nosocomial infection, which affects approximately two million individuals a year. –
ANS :C. is in the prodromal stage and is highly contagious and able to spread the disease. The prodromal stage is
a short period of time (hours to several days) immediately preceding the onset of an illness during which the
patient is very contagious. Antibiotics are not effective against viral illnesses. The incubation period is the time
from entry of the organism to the onset of symptoms and, in some viral illnesses, may be contagious. Nosocomial
infections are those acquired in a hospital, and this scenario does not suggest the source of the infection.
9. In older adults, infection after exposure to respiratory illness is most likely to
A. result in similar rates of infection as in the younger adult.
B. be easily prevented with the use of antibiotics after being exposed.
C. result in serious lower respiratory infection related to weakened respiratory muscles and fewer cilia.
D. be less serious because the older adult has less contact with younger children who are most likely to carry
serious infections. –
ANS :C. result in serious lower respiratory infection related to weakened respiratory muscles and fewer cilia.
Changes in the older adult respiratory system make older adults more susceptible to infections that can be very
serious and life threatening. Use of antibiotics to "prevent" lung infections is not recommended and is ineffective
for viral infections.
ADMIN 4
