Page 1 of 146
2026 EVOLVE ELSEVIER HESI MED SURG
EXAM |NEW Updated 2026/2027 WITH
130Qs&As |ALREADY GRADED A+
Q1. A client with heart failure is prescribed furosemide (Lasix)
40 mg IV push. Which assessment finding indicates that the
medication is achieving its intended effect?
A) Blood pressure increases from 110/70 to 130/80 mmHg
B) Urine output decreases to 20 mL/hour
C) Jugular vein distension becomes more pronounced
D) Weight decreases by 2 kg in 24 hours
Answer: D
Rationale: Furosemide is a loop diuretic used to reduce fluid
overload. The primary intended effect is diuresis, which should
result in weight loss (each kilogram lost approximates 1 liter of
fluid).
,Page 2 of 146
Q2. A client presents to the emergency department with chest
pain radiating to the left arm. The ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery (LAD)
B) Left circumflex artery (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery
Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior wall myocardial infarction, which is typically caused by
occlusion of the right coronary artery.
Q3. A client is 2 hours post-coronary artery bypass graft (CABG)
surgery. The nurse notes a sudden decrease in chest tube output
from 100 mL/hour to 10 mL/hour. Which action should the nurse
take first?
,Page 3 of 146
A) Document the finding as normal
B) Increase the suction on the chest tube
C) Assess for signs of cardiac tamponade
D) Notify the healthcare provider immediately
Answer: D
Rationale: A sudden decrease in chest tube output in the early post-
operative period could indicate clotting of the chest tube, which
may lead to cardiac tamponade. The provider must be notified
immediately, as this is an acute complication.
Q4. A client with hypertension and chronic kidney disease (CKD)
has a blood pressure of 162/94 mmHg at a follow-up visit.
Based on current guidelines, which blood pressure target is
recommended for this client to reduce cardiovascular and renal
risk?
A) <140/90 mmHg
B) <150/90 mmHg
, Page 4 of 146
C) <130/80 mmHg
D) <120/80 mmHg
Answer: C
*Rationale: For patients with hypertension and chronic kidney
disease, the recommended BP target is <130/80 mmHg to
reduce the risk of cardiovascular events and slow CKD
progression.*
Q5. A client with acute decompensated heart failure presents
with severe dyspnea, crackles in all lung fields, and an SpO₂ of
84% on 4 L nasal cannula. Which intervention should the nurse
implement first?
A) Administer IV furosemide as ordered
B) Place the client in a high-Fowler's position
C) Initiate non-invasive positive pressure ventilation (NIPPV)
D) Begin a dopamine infusion
2026 EVOLVE ELSEVIER HESI MED SURG
EXAM |NEW Updated 2026/2027 WITH
130Qs&As |ALREADY GRADED A+
Q1. A client with heart failure is prescribed furosemide (Lasix)
40 mg IV push. Which assessment finding indicates that the
medication is achieving its intended effect?
A) Blood pressure increases from 110/70 to 130/80 mmHg
B) Urine output decreases to 20 mL/hour
C) Jugular vein distension becomes more pronounced
D) Weight decreases by 2 kg in 24 hours
Answer: D
Rationale: Furosemide is a loop diuretic used to reduce fluid
overload. The primary intended effect is diuresis, which should
result in weight loss (each kilogram lost approximates 1 liter of
fluid).
,Page 2 of 146
Q2. A client presents to the emergency department with chest
pain radiating to the left arm. The ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery (LAD)
B) Left circumflex artery (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery
Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior wall myocardial infarction, which is typically caused by
occlusion of the right coronary artery.
Q3. A client is 2 hours post-coronary artery bypass graft (CABG)
surgery. The nurse notes a sudden decrease in chest tube output
from 100 mL/hour to 10 mL/hour. Which action should the nurse
take first?
,Page 3 of 146
A) Document the finding as normal
B) Increase the suction on the chest tube
C) Assess for signs of cardiac tamponade
D) Notify the healthcare provider immediately
Answer: D
Rationale: A sudden decrease in chest tube output in the early post-
operative period could indicate clotting of the chest tube, which
may lead to cardiac tamponade. The provider must be notified
immediately, as this is an acute complication.
Q4. A client with hypertension and chronic kidney disease (CKD)
has a blood pressure of 162/94 mmHg at a follow-up visit.
Based on current guidelines, which blood pressure target is
recommended for this client to reduce cardiovascular and renal
risk?
A) <140/90 mmHg
B) <150/90 mmHg
, Page 4 of 146
C) <130/80 mmHg
D) <120/80 mmHg
Answer: C
*Rationale: For patients with hypertension and chronic kidney
disease, the recommended BP target is <130/80 mmHg to
reduce the risk of cardiovascular events and slow CKD
progression.*
Q5. A client with acute decompensated heart failure presents
with severe dyspnea, crackles in all lung fields, and an SpO₂ of
84% on 4 L nasal cannula. Which intervention should the nurse
implement first?
A) Administer IV furosemide as ordered
B) Place the client in a high-Fowler's position
C) Initiate non-invasive positive pressure ventilation (NIPPV)
D) Begin a dopamine infusion
