EVOLVE HESI MED SURG EXAM 2026 WITH 100% ACCURATE ANSWERS.
Cardiovascular (20 questions)
A client with heart failure has crackles in both lungs and an S3 gallop. Which
medication does the nurse anticipate first?
a) Digoxin
b) Metoprolol
c) Furosemide
d) Spironolactone
Answer: c) Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload, relieving pulmonary
congestion and crackles. S3 indicates fluid overload.
A client post-MI develops sudden hypotension, distended neck veins, and muffled
heart sounds. What is the priority action?
a) Administer IV fluids
b) Prepare for pericardiocentesis
c) Administer nitroglycerin
d) Start dopamine drip
Answer: b) Prepare for pericardiocentesis
,Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) indicates cardiac
tamponade; pericardiocentesis is life-saving.
Which lab value is most concerning in a client with atrial fibrillation taking
warfarin?
a) INR 2.5
b) INR 3.2
c) INR 4.8
d) INR 1.8
Answer: c) INR 4.8
*Rationale: Target INR for AF is 2-3. INR >4 increases bleeding risk significantly.*
A client with unstable angina reports chest pain unrelieved by nitroglycerin. What
is the next action?
a) Repeat nitroglycerin in 15 min
b) Administer morphine IV
c) Obtain a 12-lead ECG
d) Give aspirin 324 mg PO
Answer: b) Administer morphine IV
,Rationale: Morphine reduces preload and pain; if pain persists after 3
nitroglycerin doses, morphine is indicated per ACLS.
In a client with hypertension taking lisinopril, which finding requires immediate
intervention?
a) Dry cough
b) Serum potassium 5.9 mEq/L
c) Serum sodium 135 mEq/L
d) BP 130/80 mmHg
Answer: b) Serum potassium 5.9 mEq/L
*Rationale: ACE inhibitors can cause hyperkalemia; K+ >5.5 risks dysrhythmias.*
A client with peripheral artery disease reports leg pain at rest. The nurse expects
which finding?
a) Edematous, warm legs
b) Diminished pulses and shiny skin
c) Brownish discoloration around ankles
d) Positive Homans’ sign
Answer: b) Diminished pulses and shiny skin
, Rationale: PAD causes decreased perfusion → hair loss, shiny skin, diminished
pulses, and rest pain.
After cardiac catheterization via femoral artery, the client reports sudden severe
groin pain with a pulsatile mass. What is the priority?
a) Apply sandbag to groin
b) Notify HCP stat
c) Increase IV fluids
d) Remove the pressure dressing
Answer: b) Notify HCP stat
Rationale: Pulsatile mass suggests pseudoaneurysm or retroperitoneal bleed;
requires immediate evaluation.
A client with infective endocarditis develops left-sided weakness and expressive
aphasia. The nurse suspects:
a) Migraine
b) Septic emboli to brain
c) Medication reaction
d) Hypoglycemia
Answer: b) Septic emboli to brain
Cardiovascular (20 questions)
A client with heart failure has crackles in both lungs and an S3 gallop. Which
medication does the nurse anticipate first?
a) Digoxin
b) Metoprolol
c) Furosemide
d) Spironolactone
Answer: c) Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload, relieving pulmonary
congestion and crackles. S3 indicates fluid overload.
A client post-MI develops sudden hypotension, distended neck veins, and muffled
heart sounds. What is the priority action?
a) Administer IV fluids
b) Prepare for pericardiocentesis
c) Administer nitroglycerin
d) Start dopamine drip
Answer: b) Prepare for pericardiocentesis
,Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) indicates cardiac
tamponade; pericardiocentesis is life-saving.
Which lab value is most concerning in a client with atrial fibrillation taking
warfarin?
a) INR 2.5
b) INR 3.2
c) INR 4.8
d) INR 1.8
Answer: c) INR 4.8
*Rationale: Target INR for AF is 2-3. INR >4 increases bleeding risk significantly.*
A client with unstable angina reports chest pain unrelieved by nitroglycerin. What
is the next action?
a) Repeat nitroglycerin in 15 min
b) Administer morphine IV
c) Obtain a 12-lead ECG
d) Give aspirin 324 mg PO
Answer: b) Administer morphine IV
,Rationale: Morphine reduces preload and pain; if pain persists after 3
nitroglycerin doses, morphine is indicated per ACLS.
In a client with hypertension taking lisinopril, which finding requires immediate
intervention?
a) Dry cough
b) Serum potassium 5.9 mEq/L
c) Serum sodium 135 mEq/L
d) BP 130/80 mmHg
Answer: b) Serum potassium 5.9 mEq/L
*Rationale: ACE inhibitors can cause hyperkalemia; K+ >5.5 risks dysrhythmias.*
A client with peripheral artery disease reports leg pain at rest. The nurse expects
which finding?
a) Edematous, warm legs
b) Diminished pulses and shiny skin
c) Brownish discoloration around ankles
d) Positive Homans’ sign
Answer: b) Diminished pulses and shiny skin
, Rationale: PAD causes decreased perfusion → hair loss, shiny skin, diminished
pulses, and rest pain.
After cardiac catheterization via femoral artery, the client reports sudden severe
groin pain with a pulsatile mass. What is the priority?
a) Apply sandbag to groin
b) Notify HCP stat
c) Increase IV fluids
d) Remove the pressure dressing
Answer: b) Notify HCP stat
Rationale: Pulsatile mass suggests pseudoaneurysm or retroperitoneal bleed;
requires immediate evaluation.
A client with infective endocarditis develops left-sided weakness and expressive
aphasia. The nurse suspects:
a) Migraine
b) Septic emboli to brain
c) Medication reaction
d) Hypoglycemia
Answer: b) Septic emboli to brain
