1|Page
# HESI PN MEDICAL-SURGICAL PROCTORED
EXAM
## VERSION 10 | 2026-2027 EDITION | 180
QUESTIONS | DETAILED RATIONALES
**GRADED A+ | FIRST-TIME PASS
GUARANTEE**
# SECTION I: CARDIOVASCULAR DISORDERS (Questions 1-25)
**1. A practical nurse is caring for a client with heart failure (HF).
Which assessment finding requires immediate intervention?**
A) Weight gain of 2 pounds in 24 hours
B) Crackles in the lung bases
C) 2+ pitting edema in the lower extremities
D) Jugular vein distention when sitting upright
**Correct Answer: B**
**Rationale:** Crackles in the lung bases indicate pulmonary
congestion (fluid in the alveoli), a sign of worsening heart failure that
requires immediate intervention (e.g., diuretics, oxygen). Weight gain (2
,2|Page
lbs in 24 hours) and edema are signs of fluid overload but less emergent
than crackles. JVD may be present in HF but is not as urgent as
pulmonary congestion.
---
**2. A client with hypertension is prescribed hydrochlorothiazide
(HCTZ). Which instruction should the PN include in discharge
teaching?**
A) Take the medication at bedtime to avoid dizziness
B) Increase intake of potassium-rich foods (bananas, oranges)
C) Limit fluid intake to 1 liter per day
D) Take the medication with a high-fat meal
**Correct Answer: B**
**Rationale:** HCTZ is a thiazide diuretic that can cause hypokalemia
(low potassium). Clients should increase intake of potassium-rich foods
(bananas, oranges, potatoes, spinach). HCTZ should be taken in the
morning to avoid nocturia. Fluid restriction is not indicated.
---
,3|Page
**3. A client with angina pectoris is prescribed nitroglycerin sublingual
tablets. Which instruction is most important?**
A) Take one tablet every 5 minutes until pain is relieved, up to 3 doses
B) Swallow the tablet with a full glass of water
C) Store the tablets in the refrigerator
D) Nitroglycerin should cause a mild headache; if not, it is ineffective
**Correct Answer: A**
**Rationale:** Nitroglycerin sublingual is taken at the onset of chest
pain: one tablet q5min for up to 3 doses. If pain persists after 3 doses,
call 911. Tablets are stored in a dark, dry container (not refrigerated).
Sublingual tablets must be dissolved under the tongue, not swallowed.
---
**4. A client with heart failure is prescribed furosemide (Lasix). The PN
should monitor for which adverse effect?**
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
, 4|Page
D) Hypoglycemia
**Correct Answer: B**
**Rationale:** Furosemide is a loop diuretic that causes excretion of
potassium (hypokalemia). Hypokalemia increases the risk of digoxin
toxicity (if on digoxin) and cardiac dysrhythmias. Monitor electrolytes
and consider potassium supplements or potassium-sparing diuretics.
---
**5. A client with peripheral artery disease (PAD) reports leg pain when
walking that resolves with rest. The PN recognizes this as:**
A) Rest pain
B) Claudication
C) Venous stasis
D) Neuropathy
**Correct Answer: B**
**Rationale:** Intermittent claudication is muscle pain (cramping) in
the legs with exercise that resolves with rest, caused by inadequate blood
# HESI PN MEDICAL-SURGICAL PROCTORED
EXAM
## VERSION 10 | 2026-2027 EDITION | 180
QUESTIONS | DETAILED RATIONALES
**GRADED A+ | FIRST-TIME PASS
GUARANTEE**
# SECTION I: CARDIOVASCULAR DISORDERS (Questions 1-25)
**1. A practical nurse is caring for a client with heart failure (HF).
Which assessment finding requires immediate intervention?**
A) Weight gain of 2 pounds in 24 hours
B) Crackles in the lung bases
C) 2+ pitting edema in the lower extremities
D) Jugular vein distention when sitting upright
**Correct Answer: B**
**Rationale:** Crackles in the lung bases indicate pulmonary
congestion (fluid in the alveoli), a sign of worsening heart failure that
requires immediate intervention (e.g., diuretics, oxygen). Weight gain (2
,2|Page
lbs in 24 hours) and edema are signs of fluid overload but less emergent
than crackles. JVD may be present in HF but is not as urgent as
pulmonary congestion.
---
**2. A client with hypertension is prescribed hydrochlorothiazide
(HCTZ). Which instruction should the PN include in discharge
teaching?**
A) Take the medication at bedtime to avoid dizziness
B) Increase intake of potassium-rich foods (bananas, oranges)
C) Limit fluid intake to 1 liter per day
D) Take the medication with a high-fat meal
**Correct Answer: B**
**Rationale:** HCTZ is a thiazide diuretic that can cause hypokalemia
(low potassium). Clients should increase intake of potassium-rich foods
(bananas, oranges, potatoes, spinach). HCTZ should be taken in the
morning to avoid nocturia. Fluid restriction is not indicated.
---
,3|Page
**3. A client with angina pectoris is prescribed nitroglycerin sublingual
tablets. Which instruction is most important?**
A) Take one tablet every 5 minutes until pain is relieved, up to 3 doses
B) Swallow the tablet with a full glass of water
C) Store the tablets in the refrigerator
D) Nitroglycerin should cause a mild headache; if not, it is ineffective
**Correct Answer: A**
**Rationale:** Nitroglycerin sublingual is taken at the onset of chest
pain: one tablet q5min for up to 3 doses. If pain persists after 3 doses,
call 911. Tablets are stored in a dark, dry container (not refrigerated).
Sublingual tablets must be dissolved under the tongue, not swallowed.
---
**4. A client with heart failure is prescribed furosemide (Lasix). The PN
should monitor for which adverse effect?**
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
, 4|Page
D) Hypoglycemia
**Correct Answer: B**
**Rationale:** Furosemide is a loop diuretic that causes excretion of
potassium (hypokalemia). Hypokalemia increases the risk of digoxin
toxicity (if on digoxin) and cardiac dysrhythmias. Monitor electrolytes
and consider potassium supplements or potassium-sparing diuretics.
---
**5. A client with peripheral artery disease (PAD) reports leg pain when
walking that resolves with rest. The PN recognizes this as:**
A) Rest pain
B) Claudication
C) Venous stasis
D) Neuropathy
**Correct Answer: B**
**Rationale:** Intermittent claudication is muscle pain (cramping) in
the legs with exercise that resolves with rest, caused by inadequate blood
