The Ultimate and Complete Evolve Elsevier HESI Medical-Surgical Nursing
Study Guide 2025–2026, Covering Adult Health Assessment and Clinical
Judgment Development, Cardiovascular Respiratory Neurological and
Gastrointestinal Disorders, Endocrine Renal and Musculoskeletal System
Conditions, Fluid and Electrolyte and Acid-Base Balance Management,
Infection Control Sepsis and Shock Recognition, Perioperative and
Postoperative Nursing Care, Pharmacology and Safe Medication
Administration in Medical-Surgical Settings, Prioritization Delegation and
Patient Safety Principles, NCLEX and HESI-Style Practice Questions with
Verified Answers and Detailed Rationales, Real Clinical Case Studies, Step-
by-Step Nursing Care Plans, and Proven Strategies to Successfully Master
Evolve Elsevier HESI Medical-Surgical Content and Excel in Nursing Exams
Question 1: A 65-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increased shortness of breath, a
productive cough with yellow sputum, and a respiratory rate of 28 breaths per minute. His
oxygen saturation is 88% on room air. Which of the following nursing interventions should
the nurse prioritize first in the plan of care for this patient?
A. Administering a broad-spectrum intravenous antibiotic as prescribed by the healthcare
provider B. Applying a continuous positive airway pressure (CPAP) machine to improve
oxygenation C. Administering supplemental oxygen via nasal cannula to maintain SpO2 above
90% D. Encouraging the patient to use the incentive spirometer every hour while awake
CORRECT ANSWER: C. Administering supplemental oxygen via nasal cannula to maintain
SpO2 above 90%
Rationale: In a patient with an acute exacerbation of COPD presenting with hypoxemia (SpO2
88%), the immediate priority is to correct the hypoxia by administering supplemental oxygen.
Target SpO2 for COPD patients is typically 88-92% to avoid suppressing the hypoxic drive. While
antibiotics may be necessary for a bacterial infection, and respiratory support might be needed
later, the initial and most critical step is to improve oxygen saturation to prevent tissue hypoxia.
Question 2: A patient with a chest tube connected to a closed drainage system accidentally
pulls the tube out of the chest wall while attempting to reposition in bed. The nurse observes
the chest tube site and notes an audible sucking sound. What is the immediate priority action
for the nurse to take?
A. Call the healthcare provider immediately to report the dislodgement B. Cover the site with a
sterile occlusive dressing taped on three sides C. Instruct the patient to perform the Valsalva
,maneuver and hold their breath D. Attempt to reinsert the chest tube using strict sterile
technique
CORRECT ANSWER: B. Cover the site with a sterile occlusive dressing taped on three sides
Rationale: When a chest tube is accidentally dislodged, the immediate risk is the development
of a tension pneumothorax due to air entering the pleural space through the open wound. The
nurse must immediately cover the site with a sterile occlusive dressing taped on three sides to
allow air to escape during exhalation but prevent air from entering during inhalation.
Reinserting the tube is outside the nurse's scope of practice, and calling the provider delays this
critical, life-saving intervention.
Question 3: A nurse is caring for a patient newly diagnosed with active pulmonary
tuberculosis (TB). The patient is placed in an airborne infection isolation room. Which of the
following statements by the patient indicates a correct understanding of the isolation
precautions and disease transmission?
A. "I can share my meals and utensils with my roommate as long as I wash them first." B. "The
tuberculosis bacteria are primarily spread through droplet nuclei that remain suspended in the
air." C. "I only need to wear a mask when I leave my room to go to the cafeteria for lunch." D.
"The healthcare workers entering my room only need to wear a standard surgical mask."
CORRECT ANSWER: B. "The tuberculosis bacteria are primarily spread through droplet nuclei
that remain suspended in the air."
Rationale: Pulmonary tuberculosis is transmitted via airborne droplet nuclei, which are small
particles that can remain suspended in the air for prolonged periods and travel over long
distances. Standard surgical masks do not provide adequate protection for healthcare workers;
they must wear fit-tested N95 respirators. Patients with TB should not share meals, and they
must wear a surgical mask when leaving the room to prevent the spread of droplets, but the
primary mode of transmission is airborne.
Question 4: A patient with a history of severe persistent asthma is being discharged home
and is prescribed a peak flow meter. The nurse is teaching the patient how to use the device
and interpret the results. The patient's personal best peak expiratory flow rate (PEFR) is 400
liters per minute. Today, the patient's PEFR is 260 liters per minute. According to the asthma
action plan, which zone is the patient in, and what is the appropriate action?
A. Green zone; continue current maintenance medications as prescribed B. Yellow zone; use a
short-acting beta-agonist rescue inhaler and contact the healthcare provider C. Red zone; seek
emergency medical care immediately D. Yellow zone; decrease the dose of inhaled
corticosteroids to prevent side effects
CORRECT ANSWER: B. Yellow zone; use a short-acting beta-agonist rescue inhaler and contact
the healthcare provider
,Rationale: The peak flow meter zones are calculated based on the personal best. The green
zone is 80-100% (320-400 L/min), the yellow zone is 50-79% (200-319 L/min), and the red zone
is below 50% (less than 200 L/min). A PEFR of 260 L/min falls into the yellow zone (65% of
personal best), indicating caution. The appropriate action is to use a quick-relief rescue inhaler
(like albuterol) and contact the healthcare provider for further instructions, as this indicates
worsening asthma control.
Question 5: A nurse is caring for a patient admitted with bacterial pneumonia. The patient
has a fever of 102.2°F (39°C), a productive cough, and reports pleuritic chest pain. The
patient's oxygen saturation is 92% on room air. Which of the following positions should the
nurse place the patient in to optimize ventilation and perfusion?
A. Supine with the head of the bed flat B. Trendelenburg position to increase venous return C.
High-Fowler's position with the head of the bed elevated 90 degrees D. Prone position with the
head turned to the side
CORRECT ANSWER: C. High-Fowler's position with the head of the bed elevated 90 degrees
Rationale: The High-Fowler's position (head of the bed elevated 90 degrees) is the optimal
position for a patient with pneumonia. This position allows for maximum chest expansion,
lowers the diaphragm, and facilitates easier breathing by reducing the pressure of abdominal
contents on the lungs. It also helps prevent aspiration and improves oxygenation. The supine
and Trendelenburg positions restrict lung expansion, and the prone position is generally
reserved for severe ARDS, not uncomplicated pneumonia.
Question 6: A patient is on mechanical ventilation via an endotracheal tube. The high-
pressure alarm on the ventilator sounds continuously. The nurse assesses the patient and
notes that the patient is biting on the endotracheal tube. What is the most appropriate initial
nursing action to resolve this issue?
A. Increase the sedation level to paralyze the patient completely B. Insert a bite block or oral
airway to prevent occlusion of the tube C. Suction the endotracheal tube to remove any thick
secretions D. Disconnect the patient from the ventilator and manually bag the patient
CORRECT ANSWER: B. Insert a bite block or oral airway to prevent occlusion of the tube
Rationale: The high-pressure alarm on a ventilator indicates increased resistance to the delivery
of the tidal volume. Common causes include the patient biting on the endotracheal tube,
kinking of the tubing, or the accumulation of thick secretions. Since the nurse has identified
that the patient is biting the tube, the most appropriate initial action is to insert a bite block to
keep the airway patent. Increasing sedation to the point of paralysis is an extreme measure,
and while suctioning or manual bagging might be needed if the cause is unknown, addressing
the identified biting is the priority.
, Question 7: A 55-year-old female patient is admitted to the medical-surgical unit with a
suspected pulmonary embolism (PE). The patient reports sudden onset of severe shortness of
breath and sharp, stabbing chest pain that worsens with deep inspiration. Which of the
following assessment findings would the nurse most likely expect to observe in this patient?
A. Bradycardia and hypotension B. Tachypnea and tachycardia C. Bilateral crackles and pink
frothy sputum D. Tracheal deviation and absent breath sounds on the right
CORRECT ANSWER: B. Tachypnea and tachycardia
Rationale: A pulmonary embolism occurs when a blood clot obstructs the pulmonary artery or
one of its branches, leading to impaired gas exchange and increased pulmonary vascular
resistance. The classic signs and symptoms include sudden onset dyspnea, pleuritic chest pain,
tachypnea (rapid breathing), and tachycardia (rapid heart rate) as the body attempts to
compensate for hypoxia. Bradycardia and hypotension may occur late in massive PE leading to
shock, but tachycardia is the initial compensatory response. Bilateral crackles suggest
pulmonary edema, and tracheal deviation suggests a tension pneumothorax.
Question 8: A patient is scheduled to undergo a thoracentesis to remove a large pleural
effusion. The procedure is performed at the bedside, and 1200 mL of straw-colored fluid is
successfully removed. Following the procedure, which of the following nursing actions is the
highest priority to ensure patient safety?
A. Encourage the patient to drink 2 liters of fluid to replace the lost volume B. Monitor the
puncture site for signs of bleeding or fluid leakage C. Position the patient in a supine position
with the head of the bed flat D. Administer a prescribed dose of prophylactic intravenous
antibiotics
CORRECT ANSWER: B. Monitor the puncture site for signs of bleeding or fluid leakage
Rationale: Following a thoracentesis, the nurse must closely monitor the patient for
complications such as pneumothorax, bleeding, or infection. Monitoring the puncture site for
signs of bleeding or fluid leakage is a critical nursing action to ensure the site is healing properly
and to prevent hypovolemia or skin breakdown. The patient should be positioned on the
unaffected side to allow the lung to re-expand, not flat. Encouraging excessive fluid intake is
not necessary, and prophylactic antibiotics are not routinely prescribed post-thoracentesis
unless specifically indicated.
Question 9: A 12-year-old child is admitted to the pediatric unit with an exacerbation of cystic
fibrosis (CF). The child is prescribed pancreatic enzyme replacement therapy (PERT) to aid in
digestion. When teaching the parents about the administration of these enzymes, which of
the following instructions is most important to include?
A. Administer the enzymes 30 minutes after the child finishes a meal or snack B. Crush the
enteric-coated beads and mix them with a large volume of hot applesauce C. Administer the
Study Guide 2025–2026, Covering Adult Health Assessment and Clinical
Judgment Development, Cardiovascular Respiratory Neurological and
Gastrointestinal Disorders, Endocrine Renal and Musculoskeletal System
Conditions, Fluid and Electrolyte and Acid-Base Balance Management,
Infection Control Sepsis and Shock Recognition, Perioperative and
Postoperative Nursing Care, Pharmacology and Safe Medication
Administration in Medical-Surgical Settings, Prioritization Delegation and
Patient Safety Principles, NCLEX and HESI-Style Practice Questions with
Verified Answers and Detailed Rationales, Real Clinical Case Studies, Step-
by-Step Nursing Care Plans, and Proven Strategies to Successfully Master
Evolve Elsevier HESI Medical-Surgical Content and Excel in Nursing Exams
Question 1: A 65-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increased shortness of breath, a
productive cough with yellow sputum, and a respiratory rate of 28 breaths per minute. His
oxygen saturation is 88% on room air. Which of the following nursing interventions should
the nurse prioritize first in the plan of care for this patient?
A. Administering a broad-spectrum intravenous antibiotic as prescribed by the healthcare
provider B. Applying a continuous positive airway pressure (CPAP) machine to improve
oxygenation C. Administering supplemental oxygen via nasal cannula to maintain SpO2 above
90% D. Encouraging the patient to use the incentive spirometer every hour while awake
CORRECT ANSWER: C. Administering supplemental oxygen via nasal cannula to maintain
SpO2 above 90%
Rationale: In a patient with an acute exacerbation of COPD presenting with hypoxemia (SpO2
88%), the immediate priority is to correct the hypoxia by administering supplemental oxygen.
Target SpO2 for COPD patients is typically 88-92% to avoid suppressing the hypoxic drive. While
antibiotics may be necessary for a bacterial infection, and respiratory support might be needed
later, the initial and most critical step is to improve oxygen saturation to prevent tissue hypoxia.
Question 2: A patient with a chest tube connected to a closed drainage system accidentally
pulls the tube out of the chest wall while attempting to reposition in bed. The nurse observes
the chest tube site and notes an audible sucking sound. What is the immediate priority action
for the nurse to take?
A. Call the healthcare provider immediately to report the dislodgement B. Cover the site with a
sterile occlusive dressing taped on three sides C. Instruct the patient to perform the Valsalva
,maneuver and hold their breath D. Attempt to reinsert the chest tube using strict sterile
technique
CORRECT ANSWER: B. Cover the site with a sterile occlusive dressing taped on three sides
Rationale: When a chest tube is accidentally dislodged, the immediate risk is the development
of a tension pneumothorax due to air entering the pleural space through the open wound. The
nurse must immediately cover the site with a sterile occlusive dressing taped on three sides to
allow air to escape during exhalation but prevent air from entering during inhalation.
Reinserting the tube is outside the nurse's scope of practice, and calling the provider delays this
critical, life-saving intervention.
Question 3: A nurse is caring for a patient newly diagnosed with active pulmonary
tuberculosis (TB). The patient is placed in an airborne infection isolation room. Which of the
following statements by the patient indicates a correct understanding of the isolation
precautions and disease transmission?
A. "I can share my meals and utensils with my roommate as long as I wash them first." B. "The
tuberculosis bacteria are primarily spread through droplet nuclei that remain suspended in the
air." C. "I only need to wear a mask when I leave my room to go to the cafeteria for lunch." D.
"The healthcare workers entering my room only need to wear a standard surgical mask."
CORRECT ANSWER: B. "The tuberculosis bacteria are primarily spread through droplet nuclei
that remain suspended in the air."
Rationale: Pulmonary tuberculosis is transmitted via airborne droplet nuclei, which are small
particles that can remain suspended in the air for prolonged periods and travel over long
distances. Standard surgical masks do not provide adequate protection for healthcare workers;
they must wear fit-tested N95 respirators. Patients with TB should not share meals, and they
must wear a surgical mask when leaving the room to prevent the spread of droplets, but the
primary mode of transmission is airborne.
Question 4: A patient with a history of severe persistent asthma is being discharged home
and is prescribed a peak flow meter. The nurse is teaching the patient how to use the device
and interpret the results. The patient's personal best peak expiratory flow rate (PEFR) is 400
liters per minute. Today, the patient's PEFR is 260 liters per minute. According to the asthma
action plan, which zone is the patient in, and what is the appropriate action?
A. Green zone; continue current maintenance medications as prescribed B. Yellow zone; use a
short-acting beta-agonist rescue inhaler and contact the healthcare provider C. Red zone; seek
emergency medical care immediately D. Yellow zone; decrease the dose of inhaled
corticosteroids to prevent side effects
CORRECT ANSWER: B. Yellow zone; use a short-acting beta-agonist rescue inhaler and contact
the healthcare provider
,Rationale: The peak flow meter zones are calculated based on the personal best. The green
zone is 80-100% (320-400 L/min), the yellow zone is 50-79% (200-319 L/min), and the red zone
is below 50% (less than 200 L/min). A PEFR of 260 L/min falls into the yellow zone (65% of
personal best), indicating caution. The appropriate action is to use a quick-relief rescue inhaler
(like albuterol) and contact the healthcare provider for further instructions, as this indicates
worsening asthma control.
Question 5: A nurse is caring for a patient admitted with bacterial pneumonia. The patient
has a fever of 102.2°F (39°C), a productive cough, and reports pleuritic chest pain. The
patient's oxygen saturation is 92% on room air. Which of the following positions should the
nurse place the patient in to optimize ventilation and perfusion?
A. Supine with the head of the bed flat B. Trendelenburg position to increase venous return C.
High-Fowler's position with the head of the bed elevated 90 degrees D. Prone position with the
head turned to the side
CORRECT ANSWER: C. High-Fowler's position with the head of the bed elevated 90 degrees
Rationale: The High-Fowler's position (head of the bed elevated 90 degrees) is the optimal
position for a patient with pneumonia. This position allows for maximum chest expansion,
lowers the diaphragm, and facilitates easier breathing by reducing the pressure of abdominal
contents on the lungs. It also helps prevent aspiration and improves oxygenation. The supine
and Trendelenburg positions restrict lung expansion, and the prone position is generally
reserved for severe ARDS, not uncomplicated pneumonia.
Question 6: A patient is on mechanical ventilation via an endotracheal tube. The high-
pressure alarm on the ventilator sounds continuously. The nurse assesses the patient and
notes that the patient is biting on the endotracheal tube. What is the most appropriate initial
nursing action to resolve this issue?
A. Increase the sedation level to paralyze the patient completely B. Insert a bite block or oral
airway to prevent occlusion of the tube C. Suction the endotracheal tube to remove any thick
secretions D. Disconnect the patient from the ventilator and manually bag the patient
CORRECT ANSWER: B. Insert a bite block or oral airway to prevent occlusion of the tube
Rationale: The high-pressure alarm on a ventilator indicates increased resistance to the delivery
of the tidal volume. Common causes include the patient biting on the endotracheal tube,
kinking of the tubing, or the accumulation of thick secretions. Since the nurse has identified
that the patient is biting the tube, the most appropriate initial action is to insert a bite block to
keep the airway patent. Increasing sedation to the point of paralysis is an extreme measure,
and while suctioning or manual bagging might be needed if the cause is unknown, addressing
the identified biting is the priority.
, Question 7: A 55-year-old female patient is admitted to the medical-surgical unit with a
suspected pulmonary embolism (PE). The patient reports sudden onset of severe shortness of
breath and sharp, stabbing chest pain that worsens with deep inspiration. Which of the
following assessment findings would the nurse most likely expect to observe in this patient?
A. Bradycardia and hypotension B. Tachypnea and tachycardia C. Bilateral crackles and pink
frothy sputum D. Tracheal deviation and absent breath sounds on the right
CORRECT ANSWER: B. Tachypnea and tachycardia
Rationale: A pulmonary embolism occurs when a blood clot obstructs the pulmonary artery or
one of its branches, leading to impaired gas exchange and increased pulmonary vascular
resistance. The classic signs and symptoms include sudden onset dyspnea, pleuritic chest pain,
tachypnea (rapid breathing), and tachycardia (rapid heart rate) as the body attempts to
compensate for hypoxia. Bradycardia and hypotension may occur late in massive PE leading to
shock, but tachycardia is the initial compensatory response. Bilateral crackles suggest
pulmonary edema, and tracheal deviation suggests a tension pneumothorax.
Question 8: A patient is scheduled to undergo a thoracentesis to remove a large pleural
effusion. The procedure is performed at the bedside, and 1200 mL of straw-colored fluid is
successfully removed. Following the procedure, which of the following nursing actions is the
highest priority to ensure patient safety?
A. Encourage the patient to drink 2 liters of fluid to replace the lost volume B. Monitor the
puncture site for signs of bleeding or fluid leakage C. Position the patient in a supine position
with the head of the bed flat D. Administer a prescribed dose of prophylactic intravenous
antibiotics
CORRECT ANSWER: B. Monitor the puncture site for signs of bleeding or fluid leakage
Rationale: Following a thoracentesis, the nurse must closely monitor the patient for
complications such as pneumothorax, bleeding, or infection. Monitoring the puncture site for
signs of bleeding or fluid leakage is a critical nursing action to ensure the site is healing properly
and to prevent hypovolemia or skin breakdown. The patient should be positioned on the
unaffected side to allow the lung to re-expand, not flat. Encouraging excessive fluid intake is
not necessary, and prophylactic antibiotics are not routinely prescribed post-thoracentesis
unless specifically indicated.
Question 9: A 12-year-old child is admitted to the pediatric unit with an exacerbation of cystic
fibrosis (CF). The child is prescribed pancreatic enzyme replacement therapy (PERT) to aid in
digestion. When teaching the parents about the administration of these enzymes, which of
the following instructions is most important to include?
A. Administer the enzymes 30 minutes after the child finishes a meal or snack B. Crush the
enteric-coated beads and mix them with a large volume of hot applesauce C. Administer the
