2026 EVOLVE ELSEVIER HESI
MEDICAL-SURGICAL NURSING EXAM |
Complete 200 Q&A Practice Assessment | HESI
Med-Surg Blueprint & NCLEX-RN Aligned | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A 68-year-old male is admitted with acute anterior wall myocardial infarction (MI).
Twelve hours post-admission, he develops ventricular tachycardia with a rate of 180
bpm and blood pressure of 78/50 mmHg. Which intervention should the nurse
implement first?
A. Administer amiodarone 150 mg IV push over 10 minutes
B. Prepare for synchronized cardioversion at 100 joules
C. Establish IV access and administer lidocaine 1 mg/kg IV push
D. Defibrillate immediately with 200 joules unsynchronized shock [CORRECT]
Correct Answer: D
Rationale: This patient is in unstable ventricular tachycardia with signs of hemodynamic
compromise (systolic BP <90 mmHg, altered perfusion). According to ACLS protocols
and the ABCs of emergency care, immediate unsynchronized defibrillation is indicated
,for pulseless VT or unstable VT with hemodynamic collapse. The patient is hypotensive
(78/50), indicating inadequate cardiac output.
● A is incorrect: Amiodarone is appropriate for stable VT or after failed
cardioversion, but not as first-line for unstable VT with hypotension.
● B is incorrect: Synchronized cardioversion is used for unstable tachycardias with
a pulse (SVT, atrial fibrillation with RVR), not for VT with hemodynamic collapse.
● C is incorrect: Lidocaine is no longer first-line in ACLS protocols and would delay
definitive treatment. The priority is immediate electrical therapy to restore
perfusing rhythm.
Q2: A nurse is caring for a patient with heart failure who is prescribed furosemide
(Lasix) 40 mg IV twice daily. Which assessment finding best indicates the medication is
achieving the desired therapeutic effect?
A. Decreased serum potassium level from 4.2 to 3.1 mEq/L
B. Weight loss of 2 kg over 24 hours [CORRECT]
C. Increased urine specific gravity from 1.010 to 1.025
D. Decreased blood pressure from 158/92 to 128/78 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic prescribed for heart failure to reduce fluid
volume overload. The primary therapeutic goal is removal of excess extracellular fluid,
best measured by daily weight changes (1 kg weight loss ≈ 1 liter fluid loss). A 2 kg loss
in 24 hours indicates effective diuresis.
● A is incorrect: Hypokalemia is an expected adverse effect of loop diuretics due to
potassium wasting in the distal tubule, not a therapeutic effect. The nurse should
monitor for this and administer potassium supplements as needed.
, ● C is incorrect: Increased urine specific gravity indicates concentrated urine
(dehydration or decreased renal perfusion), which is opposite of the expected
dilute urine from diuretic therapy.
● D is incorrect: While BP reduction may occur, it is not the primary indicator of
therapeutic effect for heart failure management; volume status (weight, edema,
JVD) is the priority assessment.
Q3: A patient with newly diagnosed hypertension is prescribed lisinopril (Zestril). Which
statement by the patient indicates understanding of the medication's mechanism of
action?
A. "This medication will help relax my blood vessels by blocking calcium channels."
B. "This drug works by preventing angiotensin II from forming, which lowers my blood
pressure." [CORRECT]
C. "This medication will reduce my blood pressure by increasing my heart rate."
D. "This drug blocks beta receptors to decrease my cardiac output."
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor (ACE-I). It works by inhibiting
angiotensin-converting enzyme, which prevents conversion of angiotensin I to
angiotensin II (a potent vasoconstrictor). This results in vasodilation, decreased
aldosterone secretion, and reduced blood pressure.
● A is incorrect: This describes calcium channel blockers (amlodipine, nifedipine),
not ACE inhibitors.
● C is incorrect: This describes the mechanism of vasodilators like hydralazine or
describes an incorrect understanding; increased heart rate would not lower BP.
● D is incorrect: This describes beta-blockers (metoprolol, carvedilol), which work
by blocking beta-1 receptors to decrease heart rate and contractility.
, Q4: A patient post-cardiac catheterization via the right femoral artery reports numbness
and tingling in the right foot. The nurse notes the right dorsalis pedis pulse is absent
compared to the left. Which is the priority nursing action?
A. Elevate the right leg on pillows to promote venous return
B. Apply a warm compress to the right groin insertion site
C. Notify the physician immediately and prepare for possible emergency intervention
[CORRECT]
D. Document the finding and reassess in 30 minutes
Correct Answer: C
Rationale: Absent pulse with neurological symptoms (numbness/tingling) indicates
acute arterial occlusion—a vascular emergency likely caused by thrombus formation,
dissection, or hematoma compression at the catheterization site. This threatens limb
viability. The nurse must immediately notify the provider for emergency intervention
(possible thrombectomy, angiography, or surgical repair).
● A is incorrect: Elevation could further compromise arterial perfusion; the leg
should be kept level or slightly dependent to maximize perfusion pressure.
● B is incorrect: Heat application is contraindicated with acute arterial insufficiency
as it increases metabolic demand without improving oxygen delivery, potentially
worsening tissue ischemia.
● D is incorrect: This is a never event—absent pulse with neurological changes
requires immediate intervention, not delayed reassessment.
Q5: A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse notes
today's INR is 4.8 (therapeutic range 2.0-3.0). Which action should the nurse take?
(Select all that apply.)
MEDICAL-SURGICAL NURSING EXAM |
Complete 200 Q&A Practice Assessment | HESI
Med-Surg Blueprint & NCLEX-RN Aligned | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A 68-year-old male is admitted with acute anterior wall myocardial infarction (MI).
Twelve hours post-admission, he develops ventricular tachycardia with a rate of 180
bpm and blood pressure of 78/50 mmHg. Which intervention should the nurse
implement first?
A. Administer amiodarone 150 mg IV push over 10 minutes
B. Prepare for synchronized cardioversion at 100 joules
C. Establish IV access and administer lidocaine 1 mg/kg IV push
D. Defibrillate immediately with 200 joules unsynchronized shock [CORRECT]
Correct Answer: D
Rationale: This patient is in unstable ventricular tachycardia with signs of hemodynamic
compromise (systolic BP <90 mmHg, altered perfusion). According to ACLS protocols
and the ABCs of emergency care, immediate unsynchronized defibrillation is indicated
,for pulseless VT or unstable VT with hemodynamic collapse. The patient is hypotensive
(78/50), indicating inadequate cardiac output.
● A is incorrect: Amiodarone is appropriate for stable VT or after failed
cardioversion, but not as first-line for unstable VT with hypotension.
● B is incorrect: Synchronized cardioversion is used for unstable tachycardias with
a pulse (SVT, atrial fibrillation with RVR), not for VT with hemodynamic collapse.
● C is incorrect: Lidocaine is no longer first-line in ACLS protocols and would delay
definitive treatment. The priority is immediate electrical therapy to restore
perfusing rhythm.
Q2: A nurse is caring for a patient with heart failure who is prescribed furosemide
(Lasix) 40 mg IV twice daily. Which assessment finding best indicates the medication is
achieving the desired therapeutic effect?
A. Decreased serum potassium level from 4.2 to 3.1 mEq/L
B. Weight loss of 2 kg over 24 hours [CORRECT]
C. Increased urine specific gravity from 1.010 to 1.025
D. Decreased blood pressure from 158/92 to 128/78 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic prescribed for heart failure to reduce fluid
volume overload. The primary therapeutic goal is removal of excess extracellular fluid,
best measured by daily weight changes (1 kg weight loss ≈ 1 liter fluid loss). A 2 kg loss
in 24 hours indicates effective diuresis.
● A is incorrect: Hypokalemia is an expected adverse effect of loop diuretics due to
potassium wasting in the distal tubule, not a therapeutic effect. The nurse should
monitor for this and administer potassium supplements as needed.
, ● C is incorrect: Increased urine specific gravity indicates concentrated urine
(dehydration or decreased renal perfusion), which is opposite of the expected
dilute urine from diuretic therapy.
● D is incorrect: While BP reduction may occur, it is not the primary indicator of
therapeutic effect for heart failure management; volume status (weight, edema,
JVD) is the priority assessment.
Q3: A patient with newly diagnosed hypertension is prescribed lisinopril (Zestril). Which
statement by the patient indicates understanding of the medication's mechanism of
action?
A. "This medication will help relax my blood vessels by blocking calcium channels."
B. "This drug works by preventing angiotensin II from forming, which lowers my blood
pressure." [CORRECT]
C. "This medication will reduce my blood pressure by increasing my heart rate."
D. "This drug blocks beta receptors to decrease my cardiac output."
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor (ACE-I). It works by inhibiting
angiotensin-converting enzyme, which prevents conversion of angiotensin I to
angiotensin II (a potent vasoconstrictor). This results in vasodilation, decreased
aldosterone secretion, and reduced blood pressure.
● A is incorrect: This describes calcium channel blockers (amlodipine, nifedipine),
not ACE inhibitors.
● C is incorrect: This describes the mechanism of vasodilators like hydralazine or
describes an incorrect understanding; increased heart rate would not lower BP.
● D is incorrect: This describes beta-blockers (metoprolol, carvedilol), which work
by blocking beta-1 receptors to decrease heart rate and contractility.
, Q4: A patient post-cardiac catheterization via the right femoral artery reports numbness
and tingling in the right foot. The nurse notes the right dorsalis pedis pulse is absent
compared to the left. Which is the priority nursing action?
A. Elevate the right leg on pillows to promote venous return
B. Apply a warm compress to the right groin insertion site
C. Notify the physician immediately and prepare for possible emergency intervention
[CORRECT]
D. Document the finding and reassess in 30 minutes
Correct Answer: C
Rationale: Absent pulse with neurological symptoms (numbness/tingling) indicates
acute arterial occlusion—a vascular emergency likely caused by thrombus formation,
dissection, or hematoma compression at the catheterization site. This threatens limb
viability. The nurse must immediately notify the provider for emergency intervention
(possible thrombectomy, angiography, or surgical repair).
● A is incorrect: Elevation could further compromise arterial perfusion; the leg
should be kept level or slightly dependent to maximize perfusion pressure.
● B is incorrect: Heat application is contraindicated with acute arterial insufficiency
as it increases metabolic demand without improving oxygen delivery, potentially
worsening tissue ischemia.
● D is incorrect: This is a never event—absent pulse with neurological changes
requires immediate intervention, not delayed reassessment.
Q5: A patient with atrial fibrillation is prescribed warfarin (Coumadin). The nurse notes
today's INR is 4.8 (therapeutic range 2.0-3.0). Which action should the nurse take?
(Select all that apply.)
