1|Page
EVOLVE Elsevier HESI Medical-Surgical Exit Exam
Version 4 Study Guide 2025 | Updated HESI Med-Surg
Practice Questions, Answers & Next Gen NCLEX Review
Master the HESI Medical-Surgical Exit Exam Version 4 (2025) with this complete Elsevier
Evolve-based study guide. Includes Next Generation NCLEX-style case questions, clinical
judgment frameworks, pharmacology, critical-care nursing, and detailed answer rationales—
aligned with the newest HESI V4 content outline.
• HESI Med Surg Exit Exam Version 4 2025
• Elsevier Evolve HESI Version 4 study guide
• HESI Exit Exam V4 answers and rationales
• HESI Med Surg Next Gen questions
•
The clinical manifestations in a 'pink puffer' patient include all of the following except:
Barrel chest
Pink skin
Sitting in a 'tripod' position
Blue Skin-'cyanotic' - ANSWER-Blue Skin-'cyanotic'
The #1 risk factor for COPD is cigarette smoking. True or False?
True
False - ANSWER-True
A COPD patient exhibits peripheral edema, jugular vein distention and weight gain. They may be
experiencing right sided heart failure.
,2|Page
True
False - ANSWER-True
A COPD patient has a GOLD 2, moderate level of severity. The patients FEV1 results are:
Greater than or equal to 80%
30% - 50%
50% - 80%
Less than 30% - ANSWER-50% - 80%
Gold initiative for Chronic Obstructive Lung Disease are classified as:
GOLD 1: Mild > or equal to 80%
GOLD 2: Moderate 50% - 80%
GOLD 3: Severe 30% - 50%
GOLD 4: Very Severe < 30% - ANSWER-Gold initiative for Chronic Obstructive Lung Disease are classified
as:
GOLD 1: Mild > or equal to 80%
GOLD 2: Moderate 50% - 80%
GOLD 3: Severe 30% - 50%
GOLD 4: Very Severe < 30%
A bronchodilator should be used before performing postural drainage and chest physiotherapy because
it will open the airways and allow for easier removal of secretions.
True
False - ANSWER-True
Nursing interventions for a patient with COPD include drug therapy as ordered, oxygen therapy as
ordered and respiratory care.
True
False - ANSWER-True
,3|Page
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will
enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse
instruct the client to assume?
Sitting up in bed
Side-lying in bed
Sitting up and leaning on an overbed table
Sitting up in a recliner chair - ANSWER-Sitting up and leaning on an overbed table
The nurse has given instructions on pursed-lip breathing to a client with COPD. Which statement by the
client would indicate effective teaching?
"I should tighten my abdominal muscles with exhalation."
"I should inhale through my mouth very deeply."
"I should make inhalation twice as long as exhalation."
"I should tighten my abdominal muscles with inhalation." - ANSWER-"I should tighten my abdominal
muscles with exhalation."
Which assessment finding in a client with COPD indicates to the nurse that the client's respiratory
problem is chronic?
Wheezing on exhalation
Productive cough
Generalized cyanosis
Clubbing in fingers - ANSWER-Clubbing in fingers
A nurse instructs a COPD client to use the pursed-lip method of breathing and evaluates the teaching by
asking that client about the purpose of this type of breathing. The nurse determines that the client
understands if the client states that the primary purpose of pursed-lip breathing is to promote which
outcome?
Promote oxygen intake
Strengthen the diaphragm
Strengthen the intercostal muscles
Promote carbon dioxide elimination - ANSWER-Promote carbon dioxide elimination
, 4|Page
Morphine may be given to a patient with COPD.
True
False - ANSWER-False
List the gender differences between men and female in COPD. - ANSWER-In men, COPD is more
common, the number of men with COPD is not increasing, and men have a poorer response to O2
therapy compared to women (Harding, et. al., 2020).
In women, the number of women with COPD is increasing (likely due to an increase in the number of
women smoking), more women than men die from COPD, and women with COPD have a lower quality of
life due to more frequent exacerbations and increased dyspnea (Harding, et. al., 2020).
What is the AATD gene? - ANSWER-The AATD gene (also known as alpha-1 antitrypsin deficiency), is an
autosomal recessive disorder that effects the lungs and liver, giving affected patient a genetic risk factor
for developing COPD (Harding, et. al., 2020).
Describe in your words the pathophysiology of COPD. - ANSWER-As found on page 561 of the Lewis
Med-Surg. textbook, the pathophysiology of COPD is chronic inflammation of the airways, lungs, and
pulmonary blood vessels, caused by the loss of elastic recoil and airflow obstruction, which is the result
of an over production and secretion of mucous, mucosal edema, and bronchospasm (Harding, et. al.,
2020).
When is a diagnosis of COPD made? How is it made? - ANSWER-As found on page 565 of the Lewis Med-
Surg. textbook, a diagnosis of COPD is made using spirometry, which confirms the presence of an airflow
obstruction and determines the severity of the COPD. This diagnosis is made when the FEV1/FVC ratio is
less than 70% (Harding, et. al., 2020).
List the surgical therapies used to help manage severe COPD. Is every patient a candidate? - ANSWER-As
found on page 566 of the Lewis Med-Surg. textbook, surgical therapies used to manage severe COPD
include lung volume reduction, bullectomy, and lung transplants. Not every patient is a surgical
candidate when it comes to severe COPD management surgeries (Harding, et. al., 2020).
Describe how O2 toxicity can occur. - ANSWER-As found on page 567 of the Lewis Med-Surg. textbook,
O2 toxicity can occur when a patient has prolonged exposure to a high level of O2. Prolonged exposure
EVOLVE Elsevier HESI Medical-Surgical Exit Exam
Version 4 Study Guide 2025 | Updated HESI Med-Surg
Practice Questions, Answers & Next Gen NCLEX Review
Master the HESI Medical-Surgical Exit Exam Version 4 (2025) with this complete Elsevier
Evolve-based study guide. Includes Next Generation NCLEX-style case questions, clinical
judgment frameworks, pharmacology, critical-care nursing, and detailed answer rationales—
aligned with the newest HESI V4 content outline.
• HESI Med Surg Exit Exam Version 4 2025
• Elsevier Evolve HESI Version 4 study guide
• HESI Exit Exam V4 answers and rationales
• HESI Med Surg Next Gen questions
•
The clinical manifestations in a 'pink puffer' patient include all of the following except:
Barrel chest
Pink skin
Sitting in a 'tripod' position
Blue Skin-'cyanotic' - ANSWER-Blue Skin-'cyanotic'
The #1 risk factor for COPD is cigarette smoking. True or False?
True
False - ANSWER-True
A COPD patient exhibits peripheral edema, jugular vein distention and weight gain. They may be
experiencing right sided heart failure.
,2|Page
True
False - ANSWER-True
A COPD patient has a GOLD 2, moderate level of severity. The patients FEV1 results are:
Greater than or equal to 80%
30% - 50%
50% - 80%
Less than 30% - ANSWER-50% - 80%
Gold initiative for Chronic Obstructive Lung Disease are classified as:
GOLD 1: Mild > or equal to 80%
GOLD 2: Moderate 50% - 80%
GOLD 3: Severe 30% - 50%
GOLD 4: Very Severe < 30% - ANSWER-Gold initiative for Chronic Obstructive Lung Disease are classified
as:
GOLD 1: Mild > or equal to 80%
GOLD 2: Moderate 50% - 80%
GOLD 3: Severe 30% - 50%
GOLD 4: Very Severe < 30%
A bronchodilator should be used before performing postural drainage and chest physiotherapy because
it will open the airways and allow for easier removal of secretions.
True
False - ANSWER-True
Nursing interventions for a patient with COPD include drug therapy as ordered, oxygen therapy as
ordered and respiratory care.
True
False - ANSWER-True
,3|Page
The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will
enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse
instruct the client to assume?
Sitting up in bed
Side-lying in bed
Sitting up and leaning on an overbed table
Sitting up in a recliner chair - ANSWER-Sitting up and leaning on an overbed table
The nurse has given instructions on pursed-lip breathing to a client with COPD. Which statement by the
client would indicate effective teaching?
"I should tighten my abdominal muscles with exhalation."
"I should inhale through my mouth very deeply."
"I should make inhalation twice as long as exhalation."
"I should tighten my abdominal muscles with inhalation." - ANSWER-"I should tighten my abdominal
muscles with exhalation."
Which assessment finding in a client with COPD indicates to the nurse that the client's respiratory
problem is chronic?
Wheezing on exhalation
Productive cough
Generalized cyanosis
Clubbing in fingers - ANSWER-Clubbing in fingers
A nurse instructs a COPD client to use the pursed-lip method of breathing and evaluates the teaching by
asking that client about the purpose of this type of breathing. The nurse determines that the client
understands if the client states that the primary purpose of pursed-lip breathing is to promote which
outcome?
Promote oxygen intake
Strengthen the diaphragm
Strengthen the intercostal muscles
Promote carbon dioxide elimination - ANSWER-Promote carbon dioxide elimination
, 4|Page
Morphine may be given to a patient with COPD.
True
False - ANSWER-False
List the gender differences between men and female in COPD. - ANSWER-In men, COPD is more
common, the number of men with COPD is not increasing, and men have a poorer response to O2
therapy compared to women (Harding, et. al., 2020).
In women, the number of women with COPD is increasing (likely due to an increase in the number of
women smoking), more women than men die from COPD, and women with COPD have a lower quality of
life due to more frequent exacerbations and increased dyspnea (Harding, et. al., 2020).
What is the AATD gene? - ANSWER-The AATD gene (also known as alpha-1 antitrypsin deficiency), is an
autosomal recessive disorder that effects the lungs and liver, giving affected patient a genetic risk factor
for developing COPD (Harding, et. al., 2020).
Describe in your words the pathophysiology of COPD. - ANSWER-As found on page 561 of the Lewis
Med-Surg. textbook, the pathophysiology of COPD is chronic inflammation of the airways, lungs, and
pulmonary blood vessels, caused by the loss of elastic recoil and airflow obstruction, which is the result
of an over production and secretion of mucous, mucosal edema, and bronchospasm (Harding, et. al.,
2020).
When is a diagnosis of COPD made? How is it made? - ANSWER-As found on page 565 of the Lewis Med-
Surg. textbook, a diagnosis of COPD is made using spirometry, which confirms the presence of an airflow
obstruction and determines the severity of the COPD. This diagnosis is made when the FEV1/FVC ratio is
less than 70% (Harding, et. al., 2020).
List the surgical therapies used to help manage severe COPD. Is every patient a candidate? - ANSWER-As
found on page 566 of the Lewis Med-Surg. textbook, surgical therapies used to manage severe COPD
include lung volume reduction, bullectomy, and lung transplants. Not every patient is a surgical
candidate when it comes to severe COPD management surgeries (Harding, et. al., 2020).
Describe how O2 toxicity can occur. - ANSWER-As found on page 567 of the Lewis Med-Surg. textbook,
O2 toxicity can occur when a patient has prolonged exposure to a high level of O2. Prolonged exposure
