Med Surge HESI Exam ACTUAL
EXAM 2026/2027 Version 1 2 |
Medical Surgical HESI | Verified Q&A
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (20 Questions)
Q1: A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse notes a serum
potassium level of 3.2 mEq/L. The patient reports muscle weakness and cramping. What is the priority
nursing intervention?
A. Administer potassium chloride IV push
B. Notify the provider and administer oral potassium supplements as ordered
C. Increase the furosemide dose to improve cardiac output
D. Encourage the patient to eat bananas and drink orange juice
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) from loop diuretics requires provider notification and
replacement therapy. Oral potassium is preferred for mild to moderate deficits; IV potassium must
never be given push due to risk of cardiac arrest.
Q2: A patient with atrial fibrillation is prescribed warfarin 5 mg daily. Which laboratory value requires
immediate notification to the provider?
A. INR 2.5
B. INR 4.8
C. INR 1.8
D. INR 2.0
Correct Answer: B
Rationale: Therapeutic INR for atrial fibrillation is 2.0-3.0. An INR of 4.8 indicates supratherapeutic
anticoagulation with high bleeding risk and requires immediate intervention.
,Q3: [Select All That Apply] Which findings are consistent with left-sided heart failure?
A. Jugular venous distension
B. Pulmonary crackles
C. Orthopnea
D. Hepatomegaly
E. Fatigue
F. Pink frothy sputum
Correct Answer: B, C, E, F
Rationale: Left-sided heart failure causes pulmonary congestion (crackles, orthopnea, pink frothy
sputum) and decreased cardiac output (fatigue). Jugular venous distension and hepatomegaly are right-
sided heart failure manifestations.
Q4: A patient with chest pain is diagnosed with an ST-elevation myocardial infarction (STEMI). Which
medication should the nurse administer within 30 minutes of arrival?
A. Clopidogrel 75 mg PO
B. Metoprolol 25 mg PO
C. Aspirin 325 mg chewable
D. Atorvastatin 80 mg PO
Correct Answer: C
Rationale: Aspirin reduces mortality in acute MI by inhibiting platelet aggregation and should be given
immediately to all patients without contraindications.
Q5: A patient with a history of hypertension reports a severe headache and blood pressure of 220/130
mmHg. The nurse notes papilledema on examination. Which condition is most likely?
A. Hypertensive urgency
B. Hypertensive emergency
C. Secondary hypertension
D. Malignant hypertension requiring only oral medications
Correct Answer: B
Rationale: Hypertensive emergency is characterized by severe hypertension (>180/120 mmHg) with
evidence of acute target organ damage (papilledema indicates encephalopathy), requiring IV
antihypertensive therapy.
,Q6: A patient with heart failure has a serum BNP level of 850 pg/mL. Which action should the nurse
take?
A. Document the findings as normal
B. Notify the provider immediately
C. Prepare for emergency dialysis
D. Assess for worsening heart failure
Correct Answer: D
Rationale: BNP > 400 pg/mL suggests heart failure exacerbation. The nurse should assess for symptoms
of worsening failure (dyspnea, edema, weight gain) and report findings to the provider.
Q7: A patient with third-degree heart block has a heart rate of 32 beats/minute and is symptomatic.
Which intervention is priority?
A. Administer atropine 0.5 mg IV
B. Prepare for transcutaneous pacing
C. Start dopamine infusion
D. Administer epinephrine 1 mg IV
Correct Answer: B
Rationale: Symptomatic third-degree heart block requires immediate transcutaneous pacing. Atropine is
often ineffective in third-degree blocks; pacing is the definitive treatment.
Q8: [Ordered Response] Place the following actions in priority order for a patient with suspected
pulmonary embolism:
1. Administer supplemental oxygen
2. Obtain a 12-lead ECG
3. Assess ABCs and vital signs
4. Prepare for possible thrombolytic therapy
5. Notify the provider
Correct Answer: 3, 1, 5, 2, 4
Rationale: Nursing priorities follow ABCs: assess stability first, provide oxygen for hypoxemia, notify
provider of suspected PE, obtain ECG to rule out MI, then prepare for definitive treatment if massive PE
is confirmed.
, Q9: A patient with peripheral artery disease reports leg pain when walking 50 yards that resolves with
rest. How should the nurse document this finding?
A. Rest pain
B. Intermittent claudication
C. Critical limb ischemia
D. Arterial ulceration
Correct Answer: B
Rationale: Intermittent claudication is reproducible muscle pain with exertion that resolves with rest,
classic for PAD. Rest pain occurs at rest and indicates severe disease.
Q10: A patient receiving heparin therapy has an aPTT of 90 seconds (control 30 seconds). Which action
is appropriate?
A. Continue current heparin dose
B. Hold the next dose and notify the provider
C. Administer protamine sulfate immediately
D. Increase the heparin infusion rate
Correct Answer: B
Rationale: Therapeutic aPTT is 1.5-2.5 times control (45-75 seconds). 90 seconds indicates
supratherapeutic anticoagulation; hold the dose and notify the provider to prevent bleeding
complications.
Q11: [Medication Calculation] A patient is prescribed digoxin 0.125 mg PO daily. The pharmacy sends
digoxin 0.25 mg tablets. How many tablets should the nurse administer?
A. 0.5 tablets
B. 1 tablet
C. 2 tablets
D. 0.25 tablets
Correct Answer: A
Rationale: Calculation: 0.125 mg ÷ 0.25 mg/tablet = 0.5 tablet. Always verify apical pulse for 1 full
minute before administration; hold if < 60 bpm in adults.
Q12: A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. Which patient
statement indicates understanding of discharge teaching?
EXAM 2026/2027 Version 1 2 |
Medical Surgical HESI | Verified Q&A
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (20 Questions)
Q1: A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse notes a serum
potassium level of 3.2 mEq/L. The patient reports muscle weakness and cramping. What is the priority
nursing intervention?
A. Administer potassium chloride IV push
B. Notify the provider and administer oral potassium supplements as ordered
C. Increase the furosemide dose to improve cardiac output
D. Encourage the patient to eat bananas and drink orange juice
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) from loop diuretics requires provider notification and
replacement therapy. Oral potassium is preferred for mild to moderate deficits; IV potassium must
never be given push due to risk of cardiac arrest.
Q2: A patient with atrial fibrillation is prescribed warfarin 5 mg daily. Which laboratory value requires
immediate notification to the provider?
A. INR 2.5
B. INR 4.8
C. INR 1.8
D. INR 2.0
Correct Answer: B
Rationale: Therapeutic INR for atrial fibrillation is 2.0-3.0. An INR of 4.8 indicates supratherapeutic
anticoagulation with high bleeding risk and requires immediate intervention.
,Q3: [Select All That Apply] Which findings are consistent with left-sided heart failure?
A. Jugular venous distension
B. Pulmonary crackles
C. Orthopnea
D. Hepatomegaly
E. Fatigue
F. Pink frothy sputum
Correct Answer: B, C, E, F
Rationale: Left-sided heart failure causes pulmonary congestion (crackles, orthopnea, pink frothy
sputum) and decreased cardiac output (fatigue). Jugular venous distension and hepatomegaly are right-
sided heart failure manifestations.
Q4: A patient with chest pain is diagnosed with an ST-elevation myocardial infarction (STEMI). Which
medication should the nurse administer within 30 minutes of arrival?
A. Clopidogrel 75 mg PO
B. Metoprolol 25 mg PO
C. Aspirin 325 mg chewable
D. Atorvastatin 80 mg PO
Correct Answer: C
Rationale: Aspirin reduces mortality in acute MI by inhibiting platelet aggregation and should be given
immediately to all patients without contraindications.
Q5: A patient with a history of hypertension reports a severe headache and blood pressure of 220/130
mmHg. The nurse notes papilledema on examination. Which condition is most likely?
A. Hypertensive urgency
B. Hypertensive emergency
C. Secondary hypertension
D. Malignant hypertension requiring only oral medications
Correct Answer: B
Rationale: Hypertensive emergency is characterized by severe hypertension (>180/120 mmHg) with
evidence of acute target organ damage (papilledema indicates encephalopathy), requiring IV
antihypertensive therapy.
,Q6: A patient with heart failure has a serum BNP level of 850 pg/mL. Which action should the nurse
take?
A. Document the findings as normal
B. Notify the provider immediately
C. Prepare for emergency dialysis
D. Assess for worsening heart failure
Correct Answer: D
Rationale: BNP > 400 pg/mL suggests heart failure exacerbation. The nurse should assess for symptoms
of worsening failure (dyspnea, edema, weight gain) and report findings to the provider.
Q7: A patient with third-degree heart block has a heart rate of 32 beats/minute and is symptomatic.
Which intervention is priority?
A. Administer atropine 0.5 mg IV
B. Prepare for transcutaneous pacing
C. Start dopamine infusion
D. Administer epinephrine 1 mg IV
Correct Answer: B
Rationale: Symptomatic third-degree heart block requires immediate transcutaneous pacing. Atropine is
often ineffective in third-degree blocks; pacing is the definitive treatment.
Q8: [Ordered Response] Place the following actions in priority order for a patient with suspected
pulmonary embolism:
1. Administer supplemental oxygen
2. Obtain a 12-lead ECG
3. Assess ABCs and vital signs
4. Prepare for possible thrombolytic therapy
5. Notify the provider
Correct Answer: 3, 1, 5, 2, 4
Rationale: Nursing priorities follow ABCs: assess stability first, provide oxygen for hypoxemia, notify
provider of suspected PE, obtain ECG to rule out MI, then prepare for definitive treatment if massive PE
is confirmed.
, Q9: A patient with peripheral artery disease reports leg pain when walking 50 yards that resolves with
rest. How should the nurse document this finding?
A. Rest pain
B. Intermittent claudication
C. Critical limb ischemia
D. Arterial ulceration
Correct Answer: B
Rationale: Intermittent claudication is reproducible muscle pain with exertion that resolves with rest,
classic for PAD. Rest pain occurs at rest and indicates severe disease.
Q10: A patient receiving heparin therapy has an aPTT of 90 seconds (control 30 seconds). Which action
is appropriate?
A. Continue current heparin dose
B. Hold the next dose and notify the provider
C. Administer protamine sulfate immediately
D. Increase the heparin infusion rate
Correct Answer: B
Rationale: Therapeutic aPTT is 1.5-2.5 times control (45-75 seconds). 90 seconds indicates
supratherapeutic anticoagulation; hold the dose and notify the provider to prevent bleeding
complications.
Q11: [Medication Calculation] A patient is prescribed digoxin 0.125 mg PO daily. The pharmacy sends
digoxin 0.25 mg tablets. How many tablets should the nurse administer?
A. 0.5 tablets
B. 1 tablet
C. 2 tablets
D. 0.25 tablets
Correct Answer: A
Rationale: Calculation: 0.125 mg ÷ 0.25 mg/tablet = 0.5 tablet. Always verify apical pulse for 1 full
minute before administration; hold if < 60 bpm in adults.
Q12: A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. Which patient
statement indicates understanding of discharge teaching?
