EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
EVOLVE MED-SURG HESI
With Verified Correct Answers & Rationales
125 Questions | Redesigned Study Edition
HOW TO USE THIS GUIDE | Correct answer(s) are highlighted in gold with a checkmark. Each question includes a rationale
directly below to reinforce understanding.
MED-SURG HESI — 125 Questions with Rationales
The nurse is concerned about infection for a client after an esophagogastrostomy for
Q1 esophageal cancer. Which actions should the nurse include in the client's plan of care?
(Select all that apply.)
A ✔ Frequent oral care every 2 hours while awake
B ✔ Use incentive spirometer every 2 hours
C ✔ Empty contents from NG tube every 8 hours
D Ambulate within 1 hour of return from the PACU
E Limit visitors until postoperative day 2
ANSWER: A, B, C
Rationale: One hour post-op is too soon to ambulate for this client. Visitors help support the patient and are encouraged. Oral care is
necessary as the client will be NPO. Pulmonary exercises decrease infection risk. The NG tube will be on intermittent suction to
decompress the stomach.
The client is return demonstrating wrapping of the left limb amputated above the knee. The
Q2 nurse evaluates the client is starting the wrapping method correctly when the client places the
end of the bandage at which point?
A ✔ Around the waist
B At the inner aspect of the left stump
C At the outer aspect of the left stump
D At the left groin area
ANSWER: A
Rationale: The waist is the anchor point for the bandage for an above-the-knee amputation.
A nurse is assisting an 82-year-old client with ambulation and is concerned that the client may
Q3 fall. Which area contains the older person's center of gravity?
A Head and neck
B ✔ Upper torso
C Bilateral arms
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,EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
D Feet and legs
ANSWER: B
Rationale: Stooped posture results in the upper torso becoming the center of gravity for older persons. In younger adults, the hips are
the center of gravity, but osteoporosis and bone degeneration shift this upward with age.
A client with hypertension receiving ramipril 5 mg PO daily is scheduled for a dose at 0900. At
Q4 0830, the client's blood pressure is 120/70 mm Hg. Which action should the nurse take?
A ✔ Administer the prescribed dose at the scheduled time
B Hold the dose and contact the health care provider
C Hold the dose and recheck the blood pressure in 1 hour
D Check the health care provider's prescription to clarify the dose
ANSWER: A
Rationale: The client's blood pressure is within normal limits, indicating the ramipril is having the desired effect and should be
administered. Holding would be appropriate only if systolic BP were below 100 mm Hg or signs of hypotension were present.
The nurse is providing care for a client diagnosed with trigeminal neuralgia (tic douloureux).
Q5 Which symptoms will the nurse be looking for in the focused assessment? (Select all that
apply.)
A ✔ Facial muscle spasms
B ✔ Sudden facial pain
C Unilateral facial weakness
D Difficulty in chewing
E Tinnitus
F Hearing difficulties
ANSWER: A, B
Rationale: Trigeminal neuralgia is characterized by paroxysms of pain similar to an electric shock in the area innervated by one or more
branches of the trigeminal nerve (CN V). The remaining symptoms are not related to this condition.
In caring for a client with acute diverticulitis, which assessment data warrants an immediate
Q6 nursing action?
A ✔ The client has a rigid hard abdomen and elevated WBC
B The client has left lower quadrant pain and an elevated temperature
C The client is refusing to eat and is complaining of nausea
D The client has not had a bowel movement in 2 days and has a soft abdomen
ANSWER: A
Rationale: A hard rigid abdomen and elevated WBC indicates peritonitis, a medical emergency requiring immediate provider notification.
Options B and C are expected manifestations of diverticulitis. Option D does not warrant immediate intervention.
The nurse is caring for a client with a fractured right elbow. Which assessment finding has the
Q7 highest priority and requires immediate intervention?
A Ecchymosis over the right elbow area
B ✔ Deep unrelenting pain in the right arm
C An edematous right elbow
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,EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
D The presence of crepitus in the right elbow
ANSWER: B
Rationale: Compartment syndrome causes pain uncontrolled by opioids and neurovascular compromise. Options A, C, and D are
expected findings related to the injury.
The nurse notes that a client scheduled for surgery has an elevated BUN level. Which
Q8 condition most likely contributed to this finding?
A Myocardial infarction 2 months ago
B ✔ Anorexia and vomiting for the past 2 days
C Recently diagnosed type 2 diabetes mellitus
D Skeletal traction for a right hip fracture
ANSWER: B
Rationale: Dehydration caused by vomiting would cause an increased BUN level. Option A affects serum enzymes. Option C primarily
affects blood glucose. Option D may affect CBC but would not directly increase BUN.
Which instruction is best for the nurse to provide to a client with emphysema and chronic
Q9 fatigue?
A ✔ Pace your activities and schedule rest periods
B Increase the amount of oxygen you use at night
C Obtain medical evaluation for antibiotic therapy
D Reduce your intake of fluids containing caffeine
ANSWER: A
Rationale: Energy management through pacing activities and scheduling rest periods is the priority instruction. Increasing oxygen at
night may decrease the drive to breathe. No signs of infection are present. Reducing caffeine is less beneficial than energy conservation.
Which nursing action would be appropriate for a client who is newly diagnosed with Cushing
Q10 syndrome?
A ✔ Monitor blood glucose levels daily
B Increase intake of fluids high in potassium
C Encourage adequate rest between activities
D Offer the client a sodium-enriched menu
ANSWER: A
Rationale: Cushing syndrome results from hypersecretion of glucocorticoids; clients often develop diabetes mellitus. Monitoring blood
glucose allows early treatment. A low-calorie, low-carbohydrate, low-sodium diet is recommended — not sodium enrichment.
During the change of shift report, the charge nurse reviews infusions being received by clients
Q11 on the oncology unit. The client receiving which infusion should be assessed first?
A Continuous IV infusion of magnesium
B One-time infusion of albumin
C ✔ Continuous epidural infusion of morphine
D Intermittent infusion of IV vancomycin
ANSWER: C
Rationale: The client with the morphine epidural infusion is at highest risk for respiratory depression and should be assessed first.
Page 3 | For Study Purposes Only
, EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
Magnesium can cause hypotension; albumin carries the lowest risk; vancomycin can cause nephrotoxicity but is less immediately life-
threatening.
A client with acute renal failure from a nephrotoxic drug asks if dialysis will always be needed.
Q12 Which pathophysiologic consequence supports the need for temporary dialysis until acute
tubular necrosis subsides?
A Azotemia
B Oliguria
C Hyperkalemia
D ✔ Nephron obstruction
ANSWER: D
Rationale: Nephrotoxins cause acute tubular necrosis, a reversible acute renal failure, creating renal tubular obstruction from sloughed
or edematous endothelial cells. The obstruction resolves with return of adequate GFR, after which dialysis is no longer needed.
The client returns to the unit after abdominal surgery with a 5x9 inch absorbent dressing in
Q13 place. The nurse notes a spot of red staining centrally on the dressing. What is the nurse's
next action?
A Note the size of the stain in the chart
B ✔ Circle the stain with an ink pen
C Remove the dressing to assess the source of the bleeding
D Place a pressure dressing on the existing dressing
ANSWER: B
Rationale: Circling the existing stain allows the nurse to assess any subtle increase in drainage over time. The size is charted afterward.
The nurse removes the dressing only under provider prescription or in an emergency.
While at a home game, the mother of a 6-year-old is screaming that her child is having an
Q14 asthma attack. The nurse finds the child gasping for breath with circumoral cyanosis. What
are the nurse's next actions? (Select all that apply.)
A ✔ Yell, 'Call 911'
B ✔ Ask the mother if she has the child's bronchodilator
C Start cardiopulmonary respirations
D Ask the mother if the child is allergic to bee stings
E ✔ Stay with the child and mother until the ambulance arrives
F ✔ Sit the child straight up in Fowler's position
ANSWER: A, B, E, F
Rationale: CPR is not needed as the child is still moving air. Bee sting allergy relates to anaphylaxis, not asthma. Calling for help, using
a bronchodilator, staying with the patient, and upright positioning are all correct for an acute asthma emergency.
The nurse is providing care to a client after a percutaneous transluminal coronary angioplasty
Q15 (PTCA). What actions will the nurse include in the client's plan of care? (Select all that apply.)
A ✔ Frequent vital signs
B ✔ Determine if the client is allergic to aspirin
C Assist out of bed 2 hours after return from the procedure
Page 4 | For Study Purposes Only
EVOLVE MED-SURG HESI
With Verified Correct Answers & Rationales
125 Questions | Redesigned Study Edition
HOW TO USE THIS GUIDE | Correct answer(s) are highlighted in gold with a checkmark. Each question includes a rationale
directly below to reinforce understanding.
MED-SURG HESI — 125 Questions with Rationales
The nurse is concerned about infection for a client after an esophagogastrostomy for
Q1 esophageal cancer. Which actions should the nurse include in the client's plan of care?
(Select all that apply.)
A ✔ Frequent oral care every 2 hours while awake
B ✔ Use incentive spirometer every 2 hours
C ✔ Empty contents from NG tube every 8 hours
D Ambulate within 1 hour of return from the PACU
E Limit visitors until postoperative day 2
ANSWER: A, B, C
Rationale: One hour post-op is too soon to ambulate for this client. Visitors help support the patient and are encouraged. Oral care is
necessary as the client will be NPO. Pulmonary exercises decrease infection risk. The NG tube will be on intermittent suction to
decompress the stomach.
The client is return demonstrating wrapping of the left limb amputated above the knee. The
Q2 nurse evaluates the client is starting the wrapping method correctly when the client places the
end of the bandage at which point?
A ✔ Around the waist
B At the inner aspect of the left stump
C At the outer aspect of the left stump
D At the left groin area
ANSWER: A
Rationale: The waist is the anchor point for the bandage for an above-the-knee amputation.
A nurse is assisting an 82-year-old client with ambulation and is concerned that the client may
Q3 fall. Which area contains the older person's center of gravity?
A Head and neck
B ✔ Upper torso
C Bilateral arms
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,EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
D Feet and legs
ANSWER: B
Rationale: Stooped posture results in the upper torso becoming the center of gravity for older persons. In younger adults, the hips are
the center of gravity, but osteoporosis and bone degeneration shift this upward with age.
A client with hypertension receiving ramipril 5 mg PO daily is scheduled for a dose at 0900. At
Q4 0830, the client's blood pressure is 120/70 mm Hg. Which action should the nurse take?
A ✔ Administer the prescribed dose at the scheduled time
B Hold the dose and contact the health care provider
C Hold the dose and recheck the blood pressure in 1 hour
D Check the health care provider's prescription to clarify the dose
ANSWER: A
Rationale: The client's blood pressure is within normal limits, indicating the ramipril is having the desired effect and should be
administered. Holding would be appropriate only if systolic BP were below 100 mm Hg or signs of hypotension were present.
The nurse is providing care for a client diagnosed with trigeminal neuralgia (tic douloureux).
Q5 Which symptoms will the nurse be looking for in the focused assessment? (Select all that
apply.)
A ✔ Facial muscle spasms
B ✔ Sudden facial pain
C Unilateral facial weakness
D Difficulty in chewing
E Tinnitus
F Hearing difficulties
ANSWER: A, B
Rationale: Trigeminal neuralgia is characterized by paroxysms of pain similar to an electric shock in the area innervated by one or more
branches of the trigeminal nerve (CN V). The remaining symptoms are not related to this condition.
In caring for a client with acute diverticulitis, which assessment data warrants an immediate
Q6 nursing action?
A ✔ The client has a rigid hard abdomen and elevated WBC
B The client has left lower quadrant pain and an elevated temperature
C The client is refusing to eat and is complaining of nausea
D The client has not had a bowel movement in 2 days and has a soft abdomen
ANSWER: A
Rationale: A hard rigid abdomen and elevated WBC indicates peritonitis, a medical emergency requiring immediate provider notification.
Options B and C are expected manifestations of diverticulitis. Option D does not warrant immediate intervention.
The nurse is caring for a client with a fractured right elbow. Which assessment finding has the
Q7 highest priority and requires immediate intervention?
A Ecchymosis over the right elbow area
B ✔ Deep unrelenting pain in the right arm
C An edematous right elbow
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,EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
D The presence of crepitus in the right elbow
ANSWER: B
Rationale: Compartment syndrome causes pain uncontrolled by opioids and neurovascular compromise. Options A, C, and D are
expected findings related to the injury.
The nurse notes that a client scheduled for surgery has an elevated BUN level. Which
Q8 condition most likely contributed to this finding?
A Myocardial infarction 2 months ago
B ✔ Anorexia and vomiting for the past 2 days
C Recently diagnosed type 2 diabetes mellitus
D Skeletal traction for a right hip fracture
ANSWER: B
Rationale: Dehydration caused by vomiting would cause an increased BUN level. Option A affects serum enzymes. Option C primarily
affects blood glucose. Option D may affect CBC but would not directly increase BUN.
Which instruction is best for the nurse to provide to a client with emphysema and chronic
Q9 fatigue?
A ✔ Pace your activities and schedule rest periods
B Increase the amount of oxygen you use at night
C Obtain medical evaluation for antibiotic therapy
D Reduce your intake of fluids containing caffeine
ANSWER: A
Rationale: Energy management through pacing activities and scheduling rest periods is the priority instruction. Increasing oxygen at
night may decrease the drive to breathe. No signs of infection are present. Reducing caffeine is less beneficial than energy conservation.
Which nursing action would be appropriate for a client who is newly diagnosed with Cushing
Q10 syndrome?
A ✔ Monitor blood glucose levels daily
B Increase intake of fluids high in potassium
C Encourage adequate rest between activities
D Offer the client a sodium-enriched menu
ANSWER: A
Rationale: Cushing syndrome results from hypersecretion of glucocorticoids; clients often develop diabetes mellitus. Monitoring blood
glucose allows early treatment. A low-calorie, low-carbohydrate, low-sodium diet is recommended — not sodium enrichment.
During the change of shift report, the charge nurse reviews infusions being received by clients
Q11 on the oncology unit. The client receiving which infusion should be assessed first?
A Continuous IV infusion of magnesium
B One-time infusion of albumin
C ✔ Continuous epidural infusion of morphine
D Intermittent infusion of IV vancomycin
ANSWER: C
Rationale: The client with the morphine epidural infusion is at highest risk for respiratory depression and should be assessed first.
Page 3 | For Study Purposes Only
, EVOLVE MED-SURG HESI | Study Edition 125 Questions with Rationales
Magnesium can cause hypotension; albumin carries the lowest risk; vancomycin can cause nephrotoxicity but is less immediately life-
threatening.
A client with acute renal failure from a nephrotoxic drug asks if dialysis will always be needed.
Q12 Which pathophysiologic consequence supports the need for temporary dialysis until acute
tubular necrosis subsides?
A Azotemia
B Oliguria
C Hyperkalemia
D ✔ Nephron obstruction
ANSWER: D
Rationale: Nephrotoxins cause acute tubular necrosis, a reversible acute renal failure, creating renal tubular obstruction from sloughed
or edematous endothelial cells. The obstruction resolves with return of adequate GFR, after which dialysis is no longer needed.
The client returns to the unit after abdominal surgery with a 5x9 inch absorbent dressing in
Q13 place. The nurse notes a spot of red staining centrally on the dressing. What is the nurse's
next action?
A Note the size of the stain in the chart
B ✔ Circle the stain with an ink pen
C Remove the dressing to assess the source of the bleeding
D Place a pressure dressing on the existing dressing
ANSWER: B
Rationale: Circling the existing stain allows the nurse to assess any subtle increase in drainage over time. The size is charted afterward.
The nurse removes the dressing only under provider prescription or in an emergency.
While at a home game, the mother of a 6-year-old is screaming that her child is having an
Q14 asthma attack. The nurse finds the child gasping for breath with circumoral cyanosis. What
are the nurse's next actions? (Select all that apply.)
A ✔ Yell, 'Call 911'
B ✔ Ask the mother if she has the child's bronchodilator
C Start cardiopulmonary respirations
D Ask the mother if the child is allergic to bee stings
E ✔ Stay with the child and mother until the ambulance arrives
F ✔ Sit the child straight up in Fowler's position
ANSWER: A, B, E, F
Rationale: CPR is not needed as the child is still moving air. Bee sting allergy relates to anaphylaxis, not asthma. Calling for help, using
a bronchodilator, staying with the patient, and upright positioning are all correct for an acute asthma emergency.
The nurse is providing care to a client after a percutaneous transluminal coronary angioplasty
Q15 (PTCA). What actions will the nurse include in the client's plan of care? (Select all that apply.)
A ✔ Frequent vital signs
B ✔ Determine if the client is allergic to aspirin
C Assist out of bed 2 hours after return from the procedure
Page 4 | For Study Purposes Only
