HESI MED-SURG COMPREHENSIVE EXAM
2026/2027 Complete Test Bank with
Answers and Rationales
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
Question 1
A client arrives at the emergency department reporting chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which medication should the nurse anticipate being prescribed by the
healthcare provider?
A. Acetaminophen
B. Furosemide
C. Morphine
D. Metformin
Answer Answer: C. Morphine
Rationales:
• A. Acetaminophen - INANSWER: Acetaminophen is an analgesic and antipyretic but does not
address the vasodilation needed or the anxiety associated with acute coronary syndrome. It is
not indicated for cardiac chest pain.
• B. Furosemide - INANSWER: Furosemide is a loop diuretic used for fluid overload and heart
failure, not for acute management of chest pain in MI.
• C. Morphine - ANSWER: Morphine is indicated for acute MI as it provides analgesia, reduces
preload through venodilation, decreases anxiety, and reduces myocardial oxygen demand.
• D. Metformin - INANSWER: Metformin is an oral hypoglycemic agent used for diabetes
management and has no role in acute cardiac events.
Question 2
,A client who underwent cardiac stent placement four days ago arrives at the emergency department
reporting sudden onset of chest pressure and shortness of breath. Which action should the nurse take
FIRST?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
C. Draw cardiac enzymes
D. Prepare for thrombolytic therapy
Answer Answer: B. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
Rationales:
• A. Administer sublingual nitroglycerin - INANSWER: While nitroglycerin may be ordered, the
nurse must first assess and confirm the cardiac status before administering medications.
• B. Obtain a 12-lead ECG and begin continuous cardiac monitoring - ANSWER: This is the priority
action to assess for stent thrombosis or re-occlusion. A 12-lead ECG provides immediate
diagnostic information about ST changes indicating ischemia or infarction.
• C. Draw cardiac enzymes - INANSWER: While important, this is not the immediate priority.
Enzymes take time to result and don't provide immediate clinical decision-making data.
• D. Prepare for thrombolytic therapy - INANSWER: Thrombolytics are contraindicated within 2-4
weeks of stent placement. Emergent cardiac catheterization would be indicated instead.
Question 3
The nurse is caring for a client with congestive heart failure. Which is the PRIMARY nursing diagnosis for
this client?
A. Activity intolerance
B. Impaired gas exchange
C. Decreased cardiac output
D. Fluid volume excess
Answer Answer: C. Decreased cardiac output
Rationales:
• A. Activity intolerance - INANSWER: While clients with CHF experience activity intolerance, this
is a secondary problem resulting from the primary issue.
• B. Impaired gas exchange - INANSWER: This may occur secondary to pulmonary congestion but
is not the primary diagnosis.
• C. Decreased cardiac output - ANSWER: This is the primary nursing diagnosis as CHF is
fundamentally a problem of inadequate cardiac pumping ability. All other symptoms stem from
the heart's inability to maintain adequate output.
, • D. Fluid volume excess - INANSWER: Fluid retention occurs as a compensatory mechanism
secondary to decreased cardiac output. Treating the underlying cardiac issue is the priority.
Question 4
A client with atrial fibrillation is prescribed warfarin (Coumadin). Which statement by the client indicates
a need for further teaching?
A. "I will have my INR levels checked regularly."
B. "I should eat consistent amounts of green leafy vegetables each week."
C. "I can take ibuprofen for my headaches."
D. "I will use an electric razor instead of a straight razor."
Answer Answer: C. "I can take ibuprofen for my headaches."
Rationales:
• A. "I will have my INR levels checked regularly." - INANSWER: This statement is answer.
Regular INR monitoring is essential for warfarin therapy. Target INR for atrial fibrillation is
typically 2.0-3.0.
• B. "I should eat consistent amounts of green leafy vegetables each week." - INANSWER: This
statement is answer. Vitamin K affects warfarin's effectiveness, so consistent intake (not
avoidance) is recommended.
• C. "I can take ibuprofen for my headaches." - ANSWER: This statement indicates a need for
further teaching. NSAIDs like ibuprofen increase bleeding risk when combined with warfarin and
should be avoided. Acetaminophen is the preferred alternative.
• D. "I will use an electric razor instead of a straight razor." - INANSWER: This statement is
answer. Using an electric razor reduces the risk of cuts and bleeding while on anticoagulant
therapy.
Question 5
A client with a history of myocardial infarction asks the nurse about lifestyle modifications. Which
response by the nurse is MOST appropriate?
A. "You should avoid all physical activity to protect your heart."
B. "Moderate exercise, such as walking 30 minutes daily, can help strengthen your heart."
C. "You only need to modify your diet; exercise isn't necessary."
D. "Cardiac rehabilitation is only for clients with severe heart failure."
Answer Answer: B. "Moderate exercise, such as walking 30 minutes daily, can help strengthen your
heart."
Rationales:
, • A. "You should avoid all physical activity..." - INANSWER: Avoiding all activity leads to
deconditioning and is not recommended. Gradual, supervised exercise improves cardiac
function.
• B. "Moderate exercise, such as walking 30 minutes daily..." - ANSWER: Moderate aerobic
exercise is recommended post-MI to improve cardiovascular fitness, reduce recurrence risk, and
improve quality of life.
• C. "You only need to modify your diet..." - INANSWER: Both diet and exercise modifications are
essential components of cardiac rehabilitation.
• D. "Cardiac rehabilitation is only for clients with severe heart failure." - INANSWER: Cardiac
rehabilitation is recommended for all post-MI clients, not just those with severe conditions.
Question 6
The nurse is assessing a client who just had a pacemaker inserted. Which finding indicates a potential
pacemaker malfunction?
A. Heart rate of 72 beats per minute
B. Palpable pulse at the radial artery
C. Client reports feeling dizzy and lightheaded
D. Blood pressure of 118/76 mmHg
Answer Answer: C. Client reports feeling dizzy and lightheaded
Rationales:
• A. Heart rate of 72 beats per minute - INANSWER: This is a normal heart rate and indicates the
pacemaker is functioning properly.
• B. Palpable pulse at the radial artery - INANSWER: This indicates adequate cardiac output and
is an expected finding.
• C. Client reports feeling dizzy and lightheaded - ANSWER: Dizziness and lightheadedness may
indicate decreased cardiac output from pacemaker failure. The pacemaker may not be sensing
or pacing answerly, leading to inadequate heart rate.
• D. Blood pressure of 118/76 mmHg - INANSWER: This is a normal blood pressure and does not
indicate malfunction.
Question 7
A nurse is teaching a client with peripheral arterial disease (PAD) about foot care. Which instruction
should be INCLUDED?
A. "Soak your feet in hot water daily to improve circulation."
B. "Walk barefoot at home to allow your feet to breathe."
2026/2027 Complete Test Bank with
Answers and Rationales
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
Question 1
A client arrives at the emergency department reporting chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which medication should the nurse anticipate being prescribed by the
healthcare provider?
A. Acetaminophen
B. Furosemide
C. Morphine
D. Metformin
Answer Answer: C. Morphine
Rationales:
• A. Acetaminophen - INANSWER: Acetaminophen is an analgesic and antipyretic but does not
address the vasodilation needed or the anxiety associated with acute coronary syndrome. It is
not indicated for cardiac chest pain.
• B. Furosemide - INANSWER: Furosemide is a loop diuretic used for fluid overload and heart
failure, not for acute management of chest pain in MI.
• C. Morphine - ANSWER: Morphine is indicated for acute MI as it provides analgesia, reduces
preload through venodilation, decreases anxiety, and reduces myocardial oxygen demand.
• D. Metformin - INANSWER: Metformin is an oral hypoglycemic agent used for diabetes
management and has no role in acute cardiac events.
Question 2
,A client who underwent cardiac stent placement four days ago arrives at the emergency department
reporting sudden onset of chest pressure and shortness of breath. Which action should the nurse take
FIRST?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
C. Draw cardiac enzymes
D. Prepare for thrombolytic therapy
Answer Answer: B. Obtain a 12-lead electrocardiogram and begin continuous cardiac monitoring
Rationales:
• A. Administer sublingual nitroglycerin - INANSWER: While nitroglycerin may be ordered, the
nurse must first assess and confirm the cardiac status before administering medications.
• B. Obtain a 12-lead ECG and begin continuous cardiac monitoring - ANSWER: This is the priority
action to assess for stent thrombosis or re-occlusion. A 12-lead ECG provides immediate
diagnostic information about ST changes indicating ischemia or infarction.
• C. Draw cardiac enzymes - INANSWER: While important, this is not the immediate priority.
Enzymes take time to result and don't provide immediate clinical decision-making data.
• D. Prepare for thrombolytic therapy - INANSWER: Thrombolytics are contraindicated within 2-4
weeks of stent placement. Emergent cardiac catheterization would be indicated instead.
Question 3
The nurse is caring for a client with congestive heart failure. Which is the PRIMARY nursing diagnosis for
this client?
A. Activity intolerance
B. Impaired gas exchange
C. Decreased cardiac output
D. Fluid volume excess
Answer Answer: C. Decreased cardiac output
Rationales:
• A. Activity intolerance - INANSWER: While clients with CHF experience activity intolerance, this
is a secondary problem resulting from the primary issue.
• B. Impaired gas exchange - INANSWER: This may occur secondary to pulmonary congestion but
is not the primary diagnosis.
• C. Decreased cardiac output - ANSWER: This is the primary nursing diagnosis as CHF is
fundamentally a problem of inadequate cardiac pumping ability. All other symptoms stem from
the heart's inability to maintain adequate output.
, • D. Fluid volume excess - INANSWER: Fluid retention occurs as a compensatory mechanism
secondary to decreased cardiac output. Treating the underlying cardiac issue is the priority.
Question 4
A client with atrial fibrillation is prescribed warfarin (Coumadin). Which statement by the client indicates
a need for further teaching?
A. "I will have my INR levels checked regularly."
B. "I should eat consistent amounts of green leafy vegetables each week."
C. "I can take ibuprofen for my headaches."
D. "I will use an electric razor instead of a straight razor."
Answer Answer: C. "I can take ibuprofen for my headaches."
Rationales:
• A. "I will have my INR levels checked regularly." - INANSWER: This statement is answer.
Regular INR monitoring is essential for warfarin therapy. Target INR for atrial fibrillation is
typically 2.0-3.0.
• B. "I should eat consistent amounts of green leafy vegetables each week." - INANSWER: This
statement is answer. Vitamin K affects warfarin's effectiveness, so consistent intake (not
avoidance) is recommended.
• C. "I can take ibuprofen for my headaches." - ANSWER: This statement indicates a need for
further teaching. NSAIDs like ibuprofen increase bleeding risk when combined with warfarin and
should be avoided. Acetaminophen is the preferred alternative.
• D. "I will use an electric razor instead of a straight razor." - INANSWER: This statement is
answer. Using an electric razor reduces the risk of cuts and bleeding while on anticoagulant
therapy.
Question 5
A client with a history of myocardial infarction asks the nurse about lifestyle modifications. Which
response by the nurse is MOST appropriate?
A. "You should avoid all physical activity to protect your heart."
B. "Moderate exercise, such as walking 30 minutes daily, can help strengthen your heart."
C. "You only need to modify your diet; exercise isn't necessary."
D. "Cardiac rehabilitation is only for clients with severe heart failure."
Answer Answer: B. "Moderate exercise, such as walking 30 minutes daily, can help strengthen your
heart."
Rationales:
, • A. "You should avoid all physical activity..." - INANSWER: Avoiding all activity leads to
deconditioning and is not recommended. Gradual, supervised exercise improves cardiac
function.
• B. "Moderate exercise, such as walking 30 minutes daily..." - ANSWER: Moderate aerobic
exercise is recommended post-MI to improve cardiovascular fitness, reduce recurrence risk, and
improve quality of life.
• C. "You only need to modify your diet..." - INANSWER: Both diet and exercise modifications are
essential components of cardiac rehabilitation.
• D. "Cardiac rehabilitation is only for clients with severe heart failure." - INANSWER: Cardiac
rehabilitation is recommended for all post-MI clients, not just those with severe conditions.
Question 6
The nurse is assessing a client who just had a pacemaker inserted. Which finding indicates a potential
pacemaker malfunction?
A. Heart rate of 72 beats per minute
B. Palpable pulse at the radial artery
C. Client reports feeling dizzy and lightheaded
D. Blood pressure of 118/76 mmHg
Answer Answer: C. Client reports feeling dizzy and lightheaded
Rationales:
• A. Heart rate of 72 beats per minute - INANSWER: This is a normal heart rate and indicates the
pacemaker is functioning properly.
• B. Palpable pulse at the radial artery - INANSWER: This indicates adequate cardiac output and
is an expected finding.
• C. Client reports feeling dizzy and lightheaded - ANSWER: Dizziness and lightheadedness may
indicate decreased cardiac output from pacemaker failure. The pacemaker may not be sensing
or pacing answerly, leading to inadequate heart rate.
• D. Blood pressure of 118/76 mmHg - INANSWER: This is a normal blood pressure and does not
indicate malfunction.
Question 7
A nurse is teaching a client with peripheral arterial disease (PAD) about foot care. Which instruction
should be INCLUDED?
A. "Soak your feet in hot water daily to improve circulation."
B. "Walk barefoot at home to allow your feet to breathe."
