EVOLVE ELSEVIER HESI MED SURG
EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM WITH 450 REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL
SURGICAL LATEST EXAM 2026-2027 (latest) ACE
YOUR TEST GRADED A+ -PDF
A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of
102°F/38.9°C. What other assessments should the nurse include in the client's focused assessment? (Select all
that apply.)
A.Nausea and vomiting
B.Loss of appetite
C.Abdominal cramping
D.Guarding with abdominal palpation
E.Low urine output
F.Cool, clammy skin - ANS :Correct Answer: A,B,C,D
Rationale:The client is showing signs of peritonitis with the sudden spike in temperature. Low urine output and
cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the health care provider
must be notified immediately.
ADMIN 1
, EVOLVE ELSEVIER HESI MED SURG
Which nursing action is necessary for the client with a flail chest?
A.Withhold prescribed analgesic medications.
B.Percuss the fractured rib area with light taps.
C.Avoid implementing pulmonary suctioning.
D.Encourage coughing and deep breathing. - ANS :Correct Answer: D
Rationale:Treatment of flail chest is focused on preventing atelectasis and related complications of compromised
ventilation by encouraging coughing and deep breathing. This condition is typically diagnosed in clients with
three or more rib fractures, resulting in paradoxic movement of a segment of the chest wall. Option C should not
be avoided because suctioning is necessary to maintain pulmonary toilet in clients who require mechanical
ventilation. Option A should not be withheld. Option B should not be applied because the fractures are clearly
visible on the chest radiograph.
One day after a Billroth II surgery, the client suddenly grabs his right chest and becomes pale and
diaphoretic. Vital signs are assessed as blood pressure 100/80 mm Hg, pulse 110 beats/min, and respirations
36 breaths/min. Which action is most important for the nurse to take?
A.Provide a paper bag for his hyperventilation.
B.Administer a prescribed PRN analgesic.
C.Have the client drink a glass of sweetened fruit juice.
D.Apply oxygen at 2 L via nasal cannula. - ANS :Correct Answer: D
Rationale:Pulmonary embolism and pneumothorax are risks associated with major abdominal surgery. The
nurse should immediately provide oxygen while performing further assessment. A rapid respiratory rate should
not be treated as hyperventilation. Option B should not be administered until more ominous causes are ruled out
or treated. There is no evidence that the client is hypoglycemic.
Which instruction should the nurse teach a female client about the prevention of toxic shock syndrome?
A."Get immunization against human papillomavirus (HPV)."
B."Change your tampon frequently."
C."Empty your bladder after intercourse."
D."Obtain a yearly flu vaccination." - ANS :Correct Answer: B
Rationale:Certain strains of Staphylococcus aureus produce a toxin that can enter the bloodstream through the
vaginal mucosa. Changing the tampon frequently reduces the exposure to these toxins, which are the primary
cause of toxic shock syndrome. Option A helps prevent cervical cancer, not toxic shock syndrome. Option C can
ADMIN 2
, EVOLVE ELSEVIER HESI MED SURG
lessen the incidence of urinary tract infection. Option D can help prevent some individuals from contracting the
flu and pneumonia, but no relationship to toxic shock syndrome has been proven.
The nurse observes the chest tube drainage has exceeded 300 mL of bright red bloody fluid for the past 30
minutes in the client after a coronary artery bypass graft. What is the nurse's next action?
A.Notify the healthcare provider.
B.Assess for restlessness.
C.Assess for pallor.
D.Tell the charge nurse. - ANS :Correct Answer: A
Rationale:This client is showing signs of hemorrhage, and must be evaluated by a health care provider. Pallor
and restlessness indicate decreased oxygenation, and support the finding of a possible hemorrhage. The
charge nurse will need to be notified, in the event that this client needs to return to the operating room
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day. The
nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the best
immediate action for the charge nurse to take?
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
D.Inform the nurse that her behavior is disruptive to the rest of the staff. - ANS :Correct Answer: A
Rationale:Continuing with the shift report is the best immediate action because it allows the nurse who was
floated some cooling off time. At a later time (after the nurse has cooled off) the charge nurse should discuss the
conduct of the nurse in private. Option B encourages the nurse to shirk the float assignment. Option C is
disruptive. Reprimanding the nurse in front of the staff would increase the nurse's hostility, so the nurse should
be counseled in private.
A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the
best for the nurse to provide?
A) Check it again in one month, and if it is still there schedule an appointment.
B) Most lumps are benign, but it is always best to come in for an examination.
C) Try not to worry too much about it, because usually, most lumps are benign.
D) If you are in your menstrual period it is not a good time to check for lumps. - ANS :B) Most lumps are
benign, but it is always best to come in for an examination.
ADMIN 3
, EVOLVE ELSEVIER HESI MED SURG
(B) provides the best response because it addresses the client's anxiety most effectively and encourages prompt
and immediate action for a potential problem. (A) postpones treatment if the lump is malignant, and does not
relieve the client's anxiety. (C and D) provide false reassurance and do not help relieve anxiety.
The nurse should be correct in withholding a dose of digoxin in a client with congestive heart failure without
specific instruction from the healthcare provider if the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min. - ANS :C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of
dangerous dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). The therapeutic range for digoxin is 0.8 to
2 ng/ml (toxic levels= >2 ng/ml); (A) is within this range. (B) would not warrant the nurse withholding the
digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min (D).
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory test results
to indicate a decreased serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose. - ANS :C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium (C)
(hypokalemia)--hypertension is the most prominent and universal sign. (A) is normal or elevated, depending on
the amount of water reabsorbed with the sodium. (B) is decreased with diabetes insipidus. (D) is not affected by
primary aldosteronism.
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for which treatment
protocol?
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
ADMIN 4
EVOLVE ELSEVIER HESI MED SURG ACTUAL
EXAM WITH 450 REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH WELL-ELABORATED
RATIONALES/ EVOLVE HESI MEDICAL
SURGICAL LATEST EXAM 2026-2027 (latest) ACE
YOUR TEST GRADED A+ -PDF
A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of
102°F/38.9°C. What other assessments should the nurse include in the client's focused assessment? (Select all
that apply.)
A.Nausea and vomiting
B.Loss of appetite
C.Abdominal cramping
D.Guarding with abdominal palpation
E.Low urine output
F.Cool, clammy skin - ANS :Correct Answer: A,B,C,D
Rationale:The client is showing signs of peritonitis with the sudden spike in temperature. Low urine output and
cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the health care provider
must be notified immediately.
ADMIN 1
, EVOLVE ELSEVIER HESI MED SURG
Which nursing action is necessary for the client with a flail chest?
A.Withhold prescribed analgesic medications.
B.Percuss the fractured rib area with light taps.
C.Avoid implementing pulmonary suctioning.
D.Encourage coughing and deep breathing. - ANS :Correct Answer: D
Rationale:Treatment of flail chest is focused on preventing atelectasis and related complications of compromised
ventilation by encouraging coughing and deep breathing. This condition is typically diagnosed in clients with
three or more rib fractures, resulting in paradoxic movement of a segment of the chest wall. Option C should not
be avoided because suctioning is necessary to maintain pulmonary toilet in clients who require mechanical
ventilation. Option A should not be withheld. Option B should not be applied because the fractures are clearly
visible on the chest radiograph.
One day after a Billroth II surgery, the client suddenly grabs his right chest and becomes pale and
diaphoretic. Vital signs are assessed as blood pressure 100/80 mm Hg, pulse 110 beats/min, and respirations
36 breaths/min. Which action is most important for the nurse to take?
A.Provide a paper bag for his hyperventilation.
B.Administer a prescribed PRN analgesic.
C.Have the client drink a glass of sweetened fruit juice.
D.Apply oxygen at 2 L via nasal cannula. - ANS :Correct Answer: D
Rationale:Pulmonary embolism and pneumothorax are risks associated with major abdominal surgery. The
nurse should immediately provide oxygen while performing further assessment. A rapid respiratory rate should
not be treated as hyperventilation. Option B should not be administered until more ominous causes are ruled out
or treated. There is no evidence that the client is hypoglycemic.
Which instruction should the nurse teach a female client about the prevention of toxic shock syndrome?
A."Get immunization against human papillomavirus (HPV)."
B."Change your tampon frequently."
C."Empty your bladder after intercourse."
D."Obtain a yearly flu vaccination." - ANS :Correct Answer: B
Rationale:Certain strains of Staphylococcus aureus produce a toxin that can enter the bloodstream through the
vaginal mucosa. Changing the tampon frequently reduces the exposure to these toxins, which are the primary
cause of toxic shock syndrome. Option A helps prevent cervical cancer, not toxic shock syndrome. Option C can
ADMIN 2
, EVOLVE ELSEVIER HESI MED SURG
lessen the incidence of urinary tract infection. Option D can help prevent some individuals from contracting the
flu and pneumonia, but no relationship to toxic shock syndrome has been proven.
The nurse observes the chest tube drainage has exceeded 300 mL of bright red bloody fluid for the past 30
minutes in the client after a coronary artery bypass graft. What is the nurse's next action?
A.Notify the healthcare provider.
B.Assess for restlessness.
C.Assess for pallor.
D.Tell the charge nurse. - ANS :Correct Answer: A
Rationale:This client is showing signs of hemorrhage, and must be evaluated by a health care provider. Pallor
and restlessness indicate decreased oxygenation, and support the finding of a possible hemorrhage. The
charge nurse will need to be notified, in the event that this client needs to return to the operating room
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day. The
nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the best
immediate action for the charge nurse to take?
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
D.Inform the nurse that her behavior is disruptive to the rest of the staff. - ANS :Correct Answer: A
Rationale:Continuing with the shift report is the best immediate action because it allows the nurse who was
floated some cooling off time. At a later time (after the nurse has cooled off) the charge nurse should discuss the
conduct of the nurse in private. Option B encourages the nurse to shirk the float assignment. Option C is
disruptive. Reprimanding the nurse in front of the staff would increase the nurse's hostility, so the nurse should
be counseled in private.
A 20-year-old female client calls the nurse to report a lump she found in her breast. Which response is the
best for the nurse to provide?
A) Check it again in one month, and if it is still there schedule an appointment.
B) Most lumps are benign, but it is always best to come in for an examination.
C) Try not to worry too much about it, because usually, most lumps are benign.
D) If you are in your menstrual period it is not a good time to check for lumps. - ANS :B) Most lumps are
benign, but it is always best to come in for an examination.
ADMIN 3
, EVOLVE ELSEVIER HESI MED SURG
(B) provides the best response because it addresses the client's anxiety most effectively and encourages prompt
and immediate action for a potential problem. (A) postpones treatment if the lump is malignant, and does not
relieve the client's anxiety. (C and D) provide false reassurance and do not help relieve anxiety.
The nurse should be correct in withholding a dose of digoxin in a client with congestive heart failure without
specific instruction from the healthcare provider if the client's
A) serum digoxin level is 1.5.
B) blood pressure is 104/68.
C) serum potassium level is 3.
D) apical pulse is 68/min. - ANS :C) serum potassium level is 3.
Hypokalemia (C) can precipitate digitalis toxicity in persons receiving digoxin which will increase the chance of
dangerous dysrhythmias (normal potassium level is 3.5 to 5.5 mEq/L). The therapeutic range for digoxin is 0.8 to
2 ng/ml (toxic levels= >2 ng/ml); (A) is within this range. (B) would not warrant the nurse withholding the
digoxin. The nurse should withhold the digoxin if the apical pulse is less than 60/min (D).
In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory test results
to indicate a decreased serum level of which substance?
A) Sodium.
B) Antidiuretic hormone.
C) Potassium.
D) Glucose. - ANS :C) Potassium.
Clients with primary aldosteronism exhibit a profound decline in the serum levels of potassium (C)
(hypokalemia)--hypertension is the most prominent and universal sign. (A) is normal or elevated, depending on
the amount of water reabsorbed with the sodium. (B) is decreased with diabetes insipidus. (D) is not affected by
primary aldosteronism.
Based on the analysis of the client's atrial fibrillation, the nurse should prepare the client for which treatment
protocol?
A) Diuretic therapy.
B) Pacemaker implantation.
C) Anticoagulation therapy.
ADMIN 4
