2026 UPDATED QUESTIONS DOWNLOAD
Evolve Elsevier HESI Med-Surg Specialty Exam 300
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 300 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A nurse is caring for a patient with an Acute Myocardial Infarction. Which rhythm is the
most common cause of death within the first few hours after an MI?
A) Atrial Fibrillation
B) Ventricular Fibrillation
C) Sinus Bradycardia
D) First-degree Heart Block
Answer: B
Rationale: Ventricular fibrillation (VF) is the most lethal arrhythmia following an MI due to
myocardial irritability and is the leading cause of pre-hospital cardiac arrest.
Which assessment finding in a patient with a chest tube requires immediate
intervention?
A) 50 mL of serosanguinous drainage in 2 hours
B) Vigorous bubbling in the suction control chamber
C) Tracheal deviation toward the unaffected side
D) Tidaling (fluctuation) in the water-seal chamber
Answer: C
Rationale: Tracheal deviation indicates a tension pneumothorax, a life-threatening emergency
where pressure buildup shifts the mediastinum.
, 2026 UPDATED QUESTIONS DOWNLOAD
A patient with a history of heart failure is prescribed Spironolactone. Which food should
the nurse instruct the patient to avoid?
A) White bread
B) Bananas
C) Apples
D) Green beans
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. Consuming high-potassium foods
like bananas increases the risk of dangerous hyperkalemia.
What is the primary nursing priority for a patient experiencing an Anaphylactic
Reaction?
A) Administering IV Diphenhydramine
B) Starting a large-bore IV line
C) Administering Epinephrine IM
D) Documenting the trigger of the reaction
Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis to reverse bronchoconstriction
and vasodilation; all other treatments are secondary.
A patient with a suspected Stroke is arriving at the ED. Which diagnostic test must be
completed first?
A) 12-lead EKG
B) Non-contrast CT scan of the head
C) Lumbar puncture
D) Carotid ultrasound
Answer: B
Rationale: A CT scan is the priority to rule out a hemorrhagic stroke before fibrinolytic therapy
(tPA) can be safely administered for an ischemic stroke.
Which finding is a hallmark of "Diabetes Insipidus"?
A) High urine specific gravity (>1.030)
B) Low serum sodium (<135)
C) Massive polyuria and low urine specific gravity (<1.005)
D) Weight gain and edema
Answer: C
Rationale: DI is characterized by a deficiency of ADH, leading to the inability to concentrate
urine, resulting in massive fluid loss and very dilute urine.
A nurse is assessing a patient 4 hours post-Abdominal Aortic Aneurysm (AAA) repair.
Which finding suggests a graft occlusion?
, 2026 UPDATED QUESTIONS DOWNLOAD
A) Increased bowel sounds
B) Absent pedal pulses
C) Serosanguinous drainage on the dressing
D) Temperature of 99.1°F
Answer: B
Rationale: Loss of pulses distal to the surgical site is a classic sign of graft occlusion or
embolization and requires immediate surgical consultation.
Which electrolyte abnormality is most commonly associated with a "Widened QRS" and
"Tall Peaked T-waves"?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
Answer: B
Rationale: Hyperkalemia alters myocardial conduction; peaked T-waves are the earliest sign,
followed by QRS widening as levels rise.
A patient is diagnosed with Pheochromocytoma. What is the priority nursing
assessment?
A) Daily weights
B) Blood pressure monitoring
C) Urine output
D) Skin turgor
Answer: B
Rationale: Pheochromocytoma is a catecholamine-secreting tumor that causes severe,
episodic hypertension. A hypertensive crisis is the greatest risk.
A patient is prescribed Warfarin. Which lab value indicates the medication is in the
therapeutic range?
A) PTT of 60 seconds
B) INR of 2.5
C) Platelets of 150,000
D) Hemoglobin of 14 g/dL
Answer: B
Rationale: The therapeutic INR for a patient on Warfarin is typically between 2.0 and 3.0.
Which position is most appropriate for a patient following a Liver Biopsy?
A) Left side-lying
B) Right side-lying
C) High-Fowler's
, 2026 UPDATED QUESTIONS DOWNLOAD
D) Supine with head flat
Answer: B
Rationale: Placing the patient on their right side applies pressure to the biopsy site to prevent
hemorrhage, as the liver is highly vascular.
A patient with Guillain-Barré Syndrome (GBS) is being monitored. Which assessment is
the priority?
A) Deep tendon reflexes
B) Skin integrity
C) Vital capacity and respiratory effort
D) Nutritional intake
Answer: C
Rationale: GBS causes ascending paralysis. The most life-threatening complication is
respiratory failure when the paralysis reaches the diaphragm.
What is the "Rule of Nines" estimate for a patient with burns on the entire chest and the
entire right arm?
A) 18%
B) 27%
C) 36%
D) 9%
Answer: B
Rationale: The anterior trunk (chest/abdomen) is 18% and one entire arm is 9%. Total = 27%.
A patient with a fractured hip is in "Buck’s Traction." What is the primary purpose of
this traction?
A) To realign the bone
B) To reduce muscle spasms and maintain immobilization
C) To prevent wound infection
D) To allow for early ambulation
Answer: B
Rationale: Buck's traction is a temporary skin traction used to decrease painful muscle spasms
before surgical repair.
Which medication is the treatment of choice for "Ventricular Tachycardia" with a pulse?
A) Atropine
B) Amiodarone
C) Adenosine
D) Digoxin
Answer: B
Evolve Elsevier HESI Med-Surg Specialty Exam 300
Questions on Hematology, Cardiac, GI, and Renal
Care
This comprehensive study resource is specifically designed for nursing students preparing
for the Evolve Elsevier HESI Med-Surg Specialty Exam. It contains 300 high-yield
practice questions covering essential topics such as fluid & electrolytes, advanced
cardiac rhythms, acid-base balance, and neurological emergencies. Each question
features an italicized rationale to help you master the clinical judgment required to
pass the HESI and excel in NCLEX-style testing.
A nurse is caring for a patient with an Acute Myocardial Infarction. Which rhythm is the
most common cause of death within the first few hours after an MI?
A) Atrial Fibrillation
B) Ventricular Fibrillation
C) Sinus Bradycardia
D) First-degree Heart Block
Answer: B
Rationale: Ventricular fibrillation (VF) is the most lethal arrhythmia following an MI due to
myocardial irritability and is the leading cause of pre-hospital cardiac arrest.
Which assessment finding in a patient with a chest tube requires immediate
intervention?
A) 50 mL of serosanguinous drainage in 2 hours
B) Vigorous bubbling in the suction control chamber
C) Tracheal deviation toward the unaffected side
D) Tidaling (fluctuation) in the water-seal chamber
Answer: C
Rationale: Tracheal deviation indicates a tension pneumothorax, a life-threatening emergency
where pressure buildup shifts the mediastinum.
, 2026 UPDATED QUESTIONS DOWNLOAD
A patient with a history of heart failure is prescribed Spironolactone. Which food should
the nurse instruct the patient to avoid?
A) White bread
B) Bananas
C) Apples
D) Green beans
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. Consuming high-potassium foods
like bananas increases the risk of dangerous hyperkalemia.
What is the primary nursing priority for a patient experiencing an Anaphylactic
Reaction?
A) Administering IV Diphenhydramine
B) Starting a large-bore IV line
C) Administering Epinephrine IM
D) Documenting the trigger of the reaction
Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis to reverse bronchoconstriction
and vasodilation; all other treatments are secondary.
A patient with a suspected Stroke is arriving at the ED. Which diagnostic test must be
completed first?
A) 12-lead EKG
B) Non-contrast CT scan of the head
C) Lumbar puncture
D) Carotid ultrasound
Answer: B
Rationale: A CT scan is the priority to rule out a hemorrhagic stroke before fibrinolytic therapy
(tPA) can be safely administered for an ischemic stroke.
Which finding is a hallmark of "Diabetes Insipidus"?
A) High urine specific gravity (>1.030)
B) Low serum sodium (<135)
C) Massive polyuria and low urine specific gravity (<1.005)
D) Weight gain and edema
Answer: C
Rationale: DI is characterized by a deficiency of ADH, leading to the inability to concentrate
urine, resulting in massive fluid loss and very dilute urine.
A nurse is assessing a patient 4 hours post-Abdominal Aortic Aneurysm (AAA) repair.
Which finding suggests a graft occlusion?
, 2026 UPDATED QUESTIONS DOWNLOAD
A) Increased bowel sounds
B) Absent pedal pulses
C) Serosanguinous drainage on the dressing
D) Temperature of 99.1°F
Answer: B
Rationale: Loss of pulses distal to the surgical site is a classic sign of graft occlusion or
embolization and requires immediate surgical consultation.
Which electrolyte abnormality is most commonly associated with a "Widened QRS" and
"Tall Peaked T-waves"?
A) Hypocalcemia
B) Hyperkalemia
C) Hyponatremia
D) Hypomagnesemia
Answer: B
Rationale: Hyperkalemia alters myocardial conduction; peaked T-waves are the earliest sign,
followed by QRS widening as levels rise.
A patient is diagnosed with Pheochromocytoma. What is the priority nursing
assessment?
A) Daily weights
B) Blood pressure monitoring
C) Urine output
D) Skin turgor
Answer: B
Rationale: Pheochromocytoma is a catecholamine-secreting tumor that causes severe,
episodic hypertension. A hypertensive crisis is the greatest risk.
A patient is prescribed Warfarin. Which lab value indicates the medication is in the
therapeutic range?
A) PTT of 60 seconds
B) INR of 2.5
C) Platelets of 150,000
D) Hemoglobin of 14 g/dL
Answer: B
Rationale: The therapeutic INR for a patient on Warfarin is typically between 2.0 and 3.0.
Which position is most appropriate for a patient following a Liver Biopsy?
A) Left side-lying
B) Right side-lying
C) High-Fowler's
, 2026 UPDATED QUESTIONS DOWNLOAD
D) Supine with head flat
Answer: B
Rationale: Placing the patient on their right side applies pressure to the biopsy site to prevent
hemorrhage, as the liver is highly vascular.
A patient with Guillain-Barré Syndrome (GBS) is being monitored. Which assessment is
the priority?
A) Deep tendon reflexes
B) Skin integrity
C) Vital capacity and respiratory effort
D) Nutritional intake
Answer: C
Rationale: GBS causes ascending paralysis. The most life-threatening complication is
respiratory failure when the paralysis reaches the diaphragm.
What is the "Rule of Nines" estimate for a patient with burns on the entire chest and the
entire right arm?
A) 18%
B) 27%
C) 36%
D) 9%
Answer: B
Rationale: The anterior trunk (chest/abdomen) is 18% and one entire arm is 9%. Total = 27%.
A patient with a fractured hip is in "Buck’s Traction." What is the primary purpose of
this traction?
A) To realign the bone
B) To reduce muscle spasms and maintain immobilization
C) To prevent wound infection
D) To allow for early ambulation
Answer: B
Rationale: Buck's traction is a temporary skin traction used to decrease painful muscle spasms
before surgical repair.
Which medication is the treatment of choice for "Ventricular Tachycardia" with a pulse?
A) Atropine
B) Amiodarone
C) Adenosine
D) Digoxin
Answer: B
