MEDICAL-SURGICAL HESI COMPREHENSIVE PRACTICE
EXAM 120 QUESTIONS WITH ANSWERS AND
DETAILED RATIONALES
Exam Instructions
This comprehensive practice examination is designed to simulate the actual HESI
Medical-Surgical exam. Each question includes the correct answer followed by a
detailed rationale explaining the underlying principles and clinical reasoning. Use
this exam to assess your knowledge and identify areas requiring further study.
Cardiovascular System (Questions 1-20)
Question 1
A client with left-sided heart failure is experiencing dyspnea and has crackles in
the lung bases. What is the priority nursing action?
A. Increase IV fluids
B. Place the client in high Fowler's position
C. Encourage ambulation
D. Administer antacids
Answer: B. Place the client in high Fowler's position
Rationale: High Fowler's position facilitates lung expansion by decreasing venous
return (preload) and allowing the diaphragm to descend fully. This position uses
gravity to redistribute pulmonary congestion, improving oxygenation and reducing
dyspnea. Increasing IV fluids (A) would worsen fluid overload. Ambulation (C)
would increase cardiac workload and oxygen demand. Antacids (D) are not
indicated for heart failure symptoms.
Question 2
A client with a history of atrial fibrillation reports sudden onset of dizziness. What
should the nurse assess first?
A. Blood pressure
B. Heart rate
,C. Oxygen saturation
D. Blood glucose
Answer: B. Heart rate
Rationale: In a client with atrial fibrillation, dizziness often indicates an irregular
or rapid ventricular response that compromises cardiac output. Assessing heart rate
provides immediate information about the rhythm's effect on hemodynamic
stability. While blood pressure (A) and oxygen saturation (C) are important, heart
rate assessment is the priority to identify rate-related causes of dizziness. Blood
glucose (D) is less likely to be the cause in this scenario.
Question 3
A client who had a myocardial infarction 3 days ago is taught to move the legs
while resting in bed. What is the expected outcome of this exercise?
A. Prepare the client for ambulation
B. Promote urinary and intestinal elimination
C. Prevent thrombophlebitis and blood clot formation
D. Decrease the likelihood of pressure ulcer formation
Answer: C. Prevent thrombophlebitis and blood clot formation
Rationale: Leg exercises while on bed rest promote venous return through the
skeletal muscle pump mechanism. This prevents venous stasis in the lower
extremities, reducing the risk of deep vein thrombosis and subsequent pulmonary
embolism. These exercises are not primarily intended to prepare for ambulation
(A), promote elimination (B), or prevent pressure ulcers (D), though they may have
secondary benefits.
Question 4
A client with acute coronary syndrome continues to report chest pain after one
dose of sublingual nitroglycerin. What should the nurse do next?
A. Administer morphine sulfate IV
B. Administer a second dose of nitroglycerin
C. Obtain a 12-lead ECG
D. Notify the healthcare provider
Answer: B. Administer a second dose of nitroglycerin
,Rationale: The standard protocol for chest pain includes administering up to three
doses of sublingual nitroglycerin 5 minutes apart, provided the systolic blood
pressure remains above 90-100 mmHg. The second dose should be given before
moving to other interventions. Morphine (A) may be given if pain persists after
nitroglycerin. ECG (C) and provider notification (D) are important but should
occur after addressing the immediate pain.
Question 5
A client with heart failure reports a 3-pound weight gain in 24 hours. What should
the nurse do first?
A. Administer furosemide as prescribed
B. Assess for peripheral edema
C. Restrict fluid intake
D. Notify the healthcare provider
Answer: B. Assess for peripheral edema
Rationale: Rapid weight gain in heart failure indicates fluid retention. Before
implementing interventions, the nurse should complete the assessment by
evaluating for peripheral edema, jugular venous distention, and lung sounds to
confirm fluid overload and guide subsequent actions. Furosemide administration
(A) may be indicated but requires assessment first. Fluid restriction (C) and
provider notification (D) should follow a complete assessment.
Question 6
A client is receiving IV furosemide. Which assessment finding indicates the
medication is having the desired effect?
A. Increased blood pressure
B. Increased urine output
C. Decreased pain
D. Decreased premature ventricular contractions
Answer: B. Increased urine output
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle
to inhibit sodium and water reabsorption, resulting in increased urine output. This
diuretic effect reduces fluid volume overload in conditions like heart failure.
Furosemide does not directly increase blood pressure (A), decrease pain (C), or
decrease arrhythmias (D), though improved fluid balance may secondarily affect
these parameters.
, Question 7
A client has a pulmonary artery catheter inserted. When the nurse wedges the
catheter, what information is obtained?
A. Cardiac output
B. Right atrial blood flow
C. Left end-diastolic pressure
D. Cardiac index
Answer: C. Left end-diastolic pressure
Rationale: When the balloon-tipped pulmonary artery catheter is wedged in a
branch of the pulmonary artery, it creates a static column of blood that reflects
pressure back from the left atrium. During diastole when the mitral valve is open,
this pulmonary artery wedge pressure (PAWP) indirectly reflects left ventricular
end-diastolic pressure (LVEDP), a measure of left ventricular preload. Cardiac
output (A) is measured by thermodilution, not wedge pressure. Cardiac index (D)
is calculated from cardiac output and body surface area.
Question 8
A client after percutaneous transluminal coronary angioplasty (PTCA) has the
femoral sheath in place. What is the priority nursing assessment?
A. Pain level
B. Distal pulses
C. Incisional drainage
D. Temperature
Answer: B. Distal pulses
Rationale: After PTCA with femoral access, assessing distal pulses (dorsalis pedis
and posterior tibial) is critical to ensure adequate blood flow to the extremity and
detect complications such as arterial thrombosis, embolism, or hemorrhage at the
access site. Comparing bilateral pulses establishes a baseline for early
identification of vascular compromise. Pain (A), drainage (C), and temperature (D)
are important but secondary to perfusion assessment.
EXAM 120 QUESTIONS WITH ANSWERS AND
DETAILED RATIONALES
Exam Instructions
This comprehensive practice examination is designed to simulate the actual HESI
Medical-Surgical exam. Each question includes the correct answer followed by a
detailed rationale explaining the underlying principles and clinical reasoning. Use
this exam to assess your knowledge and identify areas requiring further study.
Cardiovascular System (Questions 1-20)
Question 1
A client with left-sided heart failure is experiencing dyspnea and has crackles in
the lung bases. What is the priority nursing action?
A. Increase IV fluids
B. Place the client in high Fowler's position
C. Encourage ambulation
D. Administer antacids
Answer: B. Place the client in high Fowler's position
Rationale: High Fowler's position facilitates lung expansion by decreasing venous
return (preload) and allowing the diaphragm to descend fully. This position uses
gravity to redistribute pulmonary congestion, improving oxygenation and reducing
dyspnea. Increasing IV fluids (A) would worsen fluid overload. Ambulation (C)
would increase cardiac workload and oxygen demand. Antacids (D) are not
indicated for heart failure symptoms.
Question 2
A client with a history of atrial fibrillation reports sudden onset of dizziness. What
should the nurse assess first?
A. Blood pressure
B. Heart rate
,C. Oxygen saturation
D. Blood glucose
Answer: B. Heart rate
Rationale: In a client with atrial fibrillation, dizziness often indicates an irregular
or rapid ventricular response that compromises cardiac output. Assessing heart rate
provides immediate information about the rhythm's effect on hemodynamic
stability. While blood pressure (A) and oxygen saturation (C) are important, heart
rate assessment is the priority to identify rate-related causes of dizziness. Blood
glucose (D) is less likely to be the cause in this scenario.
Question 3
A client who had a myocardial infarction 3 days ago is taught to move the legs
while resting in bed. What is the expected outcome of this exercise?
A. Prepare the client for ambulation
B. Promote urinary and intestinal elimination
C. Prevent thrombophlebitis and blood clot formation
D. Decrease the likelihood of pressure ulcer formation
Answer: C. Prevent thrombophlebitis and blood clot formation
Rationale: Leg exercises while on bed rest promote venous return through the
skeletal muscle pump mechanism. This prevents venous stasis in the lower
extremities, reducing the risk of deep vein thrombosis and subsequent pulmonary
embolism. These exercises are not primarily intended to prepare for ambulation
(A), promote elimination (B), or prevent pressure ulcers (D), though they may have
secondary benefits.
Question 4
A client with acute coronary syndrome continues to report chest pain after one
dose of sublingual nitroglycerin. What should the nurse do next?
A. Administer morphine sulfate IV
B. Administer a second dose of nitroglycerin
C. Obtain a 12-lead ECG
D. Notify the healthcare provider
Answer: B. Administer a second dose of nitroglycerin
,Rationale: The standard protocol for chest pain includes administering up to three
doses of sublingual nitroglycerin 5 minutes apart, provided the systolic blood
pressure remains above 90-100 mmHg. The second dose should be given before
moving to other interventions. Morphine (A) may be given if pain persists after
nitroglycerin. ECG (C) and provider notification (D) are important but should
occur after addressing the immediate pain.
Question 5
A client with heart failure reports a 3-pound weight gain in 24 hours. What should
the nurse do first?
A. Administer furosemide as prescribed
B. Assess for peripheral edema
C. Restrict fluid intake
D. Notify the healthcare provider
Answer: B. Assess for peripheral edema
Rationale: Rapid weight gain in heart failure indicates fluid retention. Before
implementing interventions, the nurse should complete the assessment by
evaluating for peripheral edema, jugular venous distention, and lung sounds to
confirm fluid overload and guide subsequent actions. Furosemide administration
(A) may be indicated but requires assessment first. Fluid restriction (C) and
provider notification (D) should follow a complete assessment.
Question 6
A client is receiving IV furosemide. Which assessment finding indicates the
medication is having the desired effect?
A. Increased blood pressure
B. Increased urine output
C. Decreased pain
D. Decreased premature ventricular contractions
Answer: B. Increased urine output
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle
to inhibit sodium and water reabsorption, resulting in increased urine output. This
diuretic effect reduces fluid volume overload in conditions like heart failure.
Furosemide does not directly increase blood pressure (A), decrease pain (C), or
decrease arrhythmias (D), though improved fluid balance may secondarily affect
these parameters.
, Question 7
A client has a pulmonary artery catheter inserted. When the nurse wedges the
catheter, what information is obtained?
A. Cardiac output
B. Right atrial blood flow
C. Left end-diastolic pressure
D. Cardiac index
Answer: C. Left end-diastolic pressure
Rationale: When the balloon-tipped pulmonary artery catheter is wedged in a
branch of the pulmonary artery, it creates a static column of blood that reflects
pressure back from the left atrium. During diastole when the mitral valve is open,
this pulmonary artery wedge pressure (PAWP) indirectly reflects left ventricular
end-diastolic pressure (LVEDP), a measure of left ventricular preload. Cardiac
output (A) is measured by thermodilution, not wedge pressure. Cardiac index (D)
is calculated from cardiac output and body surface area.
Question 8
A client after percutaneous transluminal coronary angioplasty (PTCA) has the
femoral sheath in place. What is the priority nursing assessment?
A. Pain level
B. Distal pulses
C. Incisional drainage
D. Temperature
Answer: B. Distal pulses
Rationale: After PTCA with femoral access, assessing distal pulses (dorsalis pedis
and posterior tibial) is critical to ensure adequate blood flow to the extremity and
detect complications such as arterial thrombosis, embolism, or hemorrhage at the
access site. Comparing bilateral pulses establishes a baseline for early
identification of vascular compromise. Pain (A), drainage (C), and temperature (D)
are important but secondary to perfusion assessment.
