1
HESI RN Med Surg Exam Guide Questions and
Answers Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales |
Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-20]
Q1: The nurse is assessing a patient with Heart Failure with Reduced Ejection Fraction (HFrEF).
Which assessment finding is most indicative of impaired cardiac output?
A. Weight gain of 1 kg (2.2 lbs) in one week
B. Bibasilar crackles upon auscultation
C. Dyspnea upon exertion
D. Resting heart rate of 58 bpm
Correct Answer: B
Rationale: In HFrEF, the heart cannot pump efficiently, leading to fluid backup in the lungs
(pulmonary congestion). Bibasilar crackles are the classic auscultation sign of this fluid overload.
While weight gain (A) and exertional dyspnea (C) are signs of HF, crackles represent a more
immediate physiological change in gas exchange caused by the failure. A resting heart rate of 58
bpm (D) is often a therapeutic goal in HF (via beta-blockers) and not indicative of failure.
Q2: A patient with heart failure reports consuming a large amount of Chinese food the previous
night. The nurse instructs the patient to monitor for which symptom due to the high sodium
content?
A. Polyuria and excessive thirst
B. Increased shortness of breath and peripheral edema
C. Hypokalemia and muscle weakness
D. Bradycardia and hypotension
Correct Answer: B
,2
Rationale: Sodium retains water. In HF, high sodium intake leads to fluid retention, increasing
preload and causing worsening symptoms such as shortness of breath (from pulmonary
congestion) and peripheral edema. Options A and D are incorrect because sodium causes fluid
retention, not diuresis or hypotension (unless the heart suddenly decompensates). Hypokalemia
(C) is typically caused by diuretics, not dietary intake.
Q3: A patient is prescribed Furosemide (Lasix) for pulmonary edema. Which laboratory result
should the nurse monitor most closely as an adverse effect of this therapy?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Increased hemoglobin
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes the excretion of sodium, water, and
potassium. Hypokalemia is a major risk that can lead to fatal cardiac arrhythmias, especially in
patients with heart failure. Options A and C are incorrect because furosemide typically causes
hyponatremia and hypocalcemia. Hemoglobin (D) is not directly affected by diuresis.
Q4: The nurse is teaching a patient about Lisinopril, an ACE inhibitor. Which statement by the
patient indicates a need for further teaching?
A. "I will call my doctor if I develop a persistent dry cough."
B. "I should avoid salt substitutes high in potassium."
C. "I can take this medication with or without food."
D. "I will stand up slowly to prevent dizziness."
Correct Answer: B
Rationale: Lisinopril causes potassium retention. Taking salt substitutes (which are often
potassium chloride) can lead to severe hyperkalemia. Therefore, the patient should be instructed
to avoid them. Options A, C, and D are correct statements regarding side effects (cough),
administration (flexible with food), and safety (orthostatic hypotension prevention).
,3
Q5: A patient is diagnosed with Dilated Cardiomyopathy and has an S3 heart sound. What does
the S3 sound signify in this patient?
A. Atrial gallop caused by hypertension
B. Ventricular gallop caused by rapid filling of a stiff ventricle
C. Murmur caused by aortic stenosis
D. Pericardial friction rub caused by inflammation
Correct Answer: B
Rationale: An S3 heart sound (ventricular gallop) is caused by blood rushing into a distended,
non-compliant ventricle during early diastole. It is a hallmark sign of heart failure and volume
overload. Option A refers to an S4 (atrial gallop). Option C refers to a murmur. Option D refers
to pericarditis.
Q6: A patient admitted with an ST-Elevation Myocardial Infarction (STEMI) is being prepared
for transfer to the cardiac catheterization lab. The goal "door-to-balloon" time should be within
how many minutes?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Correct Answer: C
Rationale: Current AHA/ACC guidelines recommend a door-to-balloon time of 90 minutes or
less for patients with STEMI undergoing primary Percutaneous Coronary Intervention (PCI).
Faster reperfusion reduces myocardial damage and improves survival rates. Times longer than 90
minutes are associated with increased mortality.
Q7: Which medication is the first-line treatment for the relief of chest pain in a patient suspected
of having an Acute Coronary Syndrome (ACS)?
, 4
A. Morphine Sulfate
B. Nitroglycerin
C. Aspirin
D. Oxygen
Correct Answer: B
Rationale: Nitroglycerin is the first-line pharmacologic intervention for chest pain because it is a
potent vasodilator that reduces myocardial oxygen demand by decreasing preload and afterload.
Morphine (A) and Oxygen (D) are part of the MONA protocol but are secondary to nitroglycerin
for immediate pain relief. Aspirin (C) is antiplatelet and prevents clot extension but does not
relieve pain immediately.
Q8: A patient with hypertension asks about the DASH diet. Which selection from the menu
indicates the patient understands the dietary teaching?
A. Fried chicken breast, mashed potatoes with gravy, corn
B. Grilled salmon, steamed broccoli, brown rice
C. Pepperoni pizza, side salad with ranch dressing
D. Cured ham, macaroni and cheese, canned peas
Correct Answer: B
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits,
vegetables, whole grains, and lean proteins while limiting red meat, saturated fat, and sodium.
Grilled salmon, broccoli, and brown rice fit these criteria perfectly. Options A, C, and D are high
in sodium, saturated fats, and processed foods, which are restricted in the DASH diet.
Q9: The nurse is caring for a patient taking Digoxin (Lanoxin). Which finding is most
concerning for Digoxin toxicity?
A. Heart rate of 68 bpm
B. Serum potassium level of 3.0 mEq/L
C. Complaints of yellow-tinged vision
HESI RN Med Surg Exam Guide Questions and
Answers Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales |
Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-20]
Q1: The nurse is assessing a patient with Heart Failure with Reduced Ejection Fraction (HFrEF).
Which assessment finding is most indicative of impaired cardiac output?
A. Weight gain of 1 kg (2.2 lbs) in one week
B. Bibasilar crackles upon auscultation
C. Dyspnea upon exertion
D. Resting heart rate of 58 bpm
Correct Answer: B
Rationale: In HFrEF, the heart cannot pump efficiently, leading to fluid backup in the lungs
(pulmonary congestion). Bibasilar crackles are the classic auscultation sign of this fluid overload.
While weight gain (A) and exertional dyspnea (C) are signs of HF, crackles represent a more
immediate physiological change in gas exchange caused by the failure. A resting heart rate of 58
bpm (D) is often a therapeutic goal in HF (via beta-blockers) and not indicative of failure.
Q2: A patient with heart failure reports consuming a large amount of Chinese food the previous
night. The nurse instructs the patient to monitor for which symptom due to the high sodium
content?
A. Polyuria and excessive thirst
B. Increased shortness of breath and peripheral edema
C. Hypokalemia and muscle weakness
D. Bradycardia and hypotension
Correct Answer: B
,2
Rationale: Sodium retains water. In HF, high sodium intake leads to fluid retention, increasing
preload and causing worsening symptoms such as shortness of breath (from pulmonary
congestion) and peripheral edema. Options A and D are incorrect because sodium causes fluid
retention, not diuresis or hypotension (unless the heart suddenly decompensates). Hypokalemia
(C) is typically caused by diuretics, not dietary intake.
Q3: A patient is prescribed Furosemide (Lasix) for pulmonary edema. Which laboratory result
should the nurse monitor most closely as an adverse effect of this therapy?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Increased hemoglobin
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes the excretion of sodium, water, and
potassium. Hypokalemia is a major risk that can lead to fatal cardiac arrhythmias, especially in
patients with heart failure. Options A and C are incorrect because furosemide typically causes
hyponatremia and hypocalcemia. Hemoglobin (D) is not directly affected by diuresis.
Q4: The nurse is teaching a patient about Lisinopril, an ACE inhibitor. Which statement by the
patient indicates a need for further teaching?
A. "I will call my doctor if I develop a persistent dry cough."
B. "I should avoid salt substitutes high in potassium."
C. "I can take this medication with or without food."
D. "I will stand up slowly to prevent dizziness."
Correct Answer: B
Rationale: Lisinopril causes potassium retention. Taking salt substitutes (which are often
potassium chloride) can lead to severe hyperkalemia. Therefore, the patient should be instructed
to avoid them. Options A, C, and D are correct statements regarding side effects (cough),
administration (flexible with food), and safety (orthostatic hypotension prevention).
,3
Q5: A patient is diagnosed with Dilated Cardiomyopathy and has an S3 heart sound. What does
the S3 sound signify in this patient?
A. Atrial gallop caused by hypertension
B. Ventricular gallop caused by rapid filling of a stiff ventricle
C. Murmur caused by aortic stenosis
D. Pericardial friction rub caused by inflammation
Correct Answer: B
Rationale: An S3 heart sound (ventricular gallop) is caused by blood rushing into a distended,
non-compliant ventricle during early diastole. It is a hallmark sign of heart failure and volume
overload. Option A refers to an S4 (atrial gallop). Option C refers to a murmur. Option D refers
to pericarditis.
Q6: A patient admitted with an ST-Elevation Myocardial Infarction (STEMI) is being prepared
for transfer to the cardiac catheterization lab. The goal "door-to-balloon" time should be within
how many minutes?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Correct Answer: C
Rationale: Current AHA/ACC guidelines recommend a door-to-balloon time of 90 minutes or
less for patients with STEMI undergoing primary Percutaneous Coronary Intervention (PCI).
Faster reperfusion reduces myocardial damage and improves survival rates. Times longer than 90
minutes are associated with increased mortality.
Q7: Which medication is the first-line treatment for the relief of chest pain in a patient suspected
of having an Acute Coronary Syndrome (ACS)?
, 4
A. Morphine Sulfate
B. Nitroglycerin
C. Aspirin
D. Oxygen
Correct Answer: B
Rationale: Nitroglycerin is the first-line pharmacologic intervention for chest pain because it is a
potent vasodilator that reduces myocardial oxygen demand by decreasing preload and afterload.
Morphine (A) and Oxygen (D) are part of the MONA protocol but are secondary to nitroglycerin
for immediate pain relief. Aspirin (C) is antiplatelet and prevents clot extension but does not
relieve pain immediately.
Q8: A patient with hypertension asks about the DASH diet. Which selection from the menu
indicates the patient understands the dietary teaching?
A. Fried chicken breast, mashed potatoes with gravy, corn
B. Grilled salmon, steamed broccoli, brown rice
C. Pepperoni pizza, side salad with ranch dressing
D. Cured ham, macaroni and cheese, canned peas
Correct Answer: B
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits,
vegetables, whole grains, and lean proteins while limiting red meat, saturated fat, and sodium.
Grilled salmon, broccoli, and brown rice fit these criteria perfectly. Options A, C, and D are high
in sodium, saturated fats, and processed foods, which are restricted in the DASH diet.
Q9: The nurse is caring for a patient taking Digoxin (Lanoxin). Which finding is most
concerning for Digoxin toxicity?
A. Heart rate of 68 bpm
B. Serum potassium level of 3.0 mEq/L
C. Complaints of yellow-tinged vision
