HESI RN V1 MEDSURGE EXAM (LATEST UPDATE)
Actual Exam | Adult Medical‑Surgical Nursing –
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
Cardiovascular & Hematologic Disorders
Q1: A patient returns from cardiac catheterization with a femoral artery sheath in place.
Thirty minutes after arrival, the blood pressure drops from 132/84 to 88/52, the patient
becomes diaphoretic, and the dressing over the sheath site is saturated with bright red
blood. What is the nurse's first action?
A. Notify the physician
B. Obtain a stat hemoglobin and hematocrit
C. Apply direct pressure above the puncture site and call for help [CORRECT]
D. Elevate the head of the bed to 45 degrees
Correct Answer: C
Rationale: When a post-cath patient drops their pressure and shows active hemorrhage
from the access site, the immediate priority is to control the bleeding with direct
pressure while getting additional help. You can notify the provider and draw labs once
the life-threatening bleed is managed.
Q2: A patient with newly diagnosed heart failure is being discharged on furosemide,
lisinopril, and carvedilol. Which statement by the patient indicates understanding of
dietary self-management?
A. "I will drink at least 3 liters of water daily to stay hydrated."
B. "I can use salt substitute freely since I am cutting out table salt."
C. "I will weigh myself every morning and call if I gain 3 pounds in one day." [CORRECT]
D. "I should eat plenty of canned soups since they are easy to prepare."
Correct Answer: C
Rationale: Daily weights are the best early warning system for fluid retention in heart
failure, and a 2–3 pound gain in a day or 5 pounds in a week warrants a call to the
,provider. Canned soups are sodium bombs, and many salt substitutes contain
potassium—which can be dangerous with an ACE inhibitor.
Q3: Which intervention is most appropriate for a postoperative patient at high risk for
deep vein thrombosis?
A. Massage the calves every 4 hours to promote circulation
B. Apply knee-high compression stockings and encourage early ambulation [CORRECT]
C. Keep the patient on strict bed rest for 48 hours to prevent clot dislodgement
D. Place a pillow under the knees to promote venous return
Correct Answer: B
Rationale: Compression devices or stockings combined with early ambulation are
evidence-based DVT prophylaxis. Massaging a calf could dislodge a clot, bed rest
increases venous stasis, and pillows under the knees actually impede venous return.
Q4: A patient has a hemoglobin of 9.2 g/dL and a hematocrit of 27%. These findings are
consistent with:
A. Polycythemia vera
B. Severe dehydration
C. Anemia [CORRECT]
D. Normal adult male values
Correct Answer: C
Rationale: A hemoglobin below 12 g/dL in women or 13 g/dL in men indicates anemia,
and the hematocrit is roughly three times the hemoglobin value. These values are far
too low to represent normal status, dehydration, or a proliferative bone marrow disorder.
Q5: A patient on warfarin has an INR of 4.8. The prescribed therapeutic range is 2.0–3.0.
What is the nurse's priority action?
A. Administer the scheduled warfarin dose
B. Hold the next dose and notify the provider [CORRECT]
C. Administer vitamin K without consulting the provider
D. Increase the warfarin dose to bring the INR down faster
Correct Answer: B
Rationale: An INR of 4.8 places the patient at significant bleeding risk. The nurse should
hold the next warfarin dose and contact the provider for guidance, which may include
holding additional doses or ordering low-dose vitamin K.
, Q6: A 58-year-old woman presents to the emergency department with fatigue, nausea,
and jaw pain that started while she was gardening. She denies chest pain. Which
nursing action is priority?
A. Obtain a 12-lead EKG [CORRECT]
B. Administer sublingual nitroglycerin
C. Start an IV and draw cardiac enzymes only
D. Reassure her that women often have atypical symptoms and schedule a stress test
Correct Answer: A
Rationale: Atypical MI presentations in women—like jaw pain, nausea, and fatigue—are
still emergencies. A 12-lead EKG is the fastest way to identify ST-elevation and activate
the cath lab protocol. You do not wait for enzymes or dismiss the symptoms.
Q7: A patient with heart failure asks why they need to take an ACE inhibitor. The nurse
explains that the primary benefit is:
A. To increase heart rate and cardiac output
B. To reduce afterload and prevent cardiac remodeling [CORRECT]
C. To eliminate excess fluid through diuresis
D. To slow the heart rate and reduce contractility
Correct Answer: B
Rationale: ACE inhibitors block the renin-angiotensin-aldosterone system, which
reduces afterload and prevents the pathologic ventricular remodeling that worsens
heart failure over time. They are not primarily diuretics or negative inotropes.
Q8: A patient with sepsis develops oozing from IV sites, petechiae, and a dropping
platelet count. Fibrinogen is low and D-dimer is markedly elevated. The nurse
recognizes these findings as consistent with:
A. Immune thrombocytopenic purpura
B. Disseminated intravascular coagulation [CORRECT]
C. Heparin-induced thrombocytopenia
D. Von Willebrand disease
Correct Answer: B
Rationale: In DIC, widespread clotting consumes platelets and clotting factors, leading
to both microvascular thrombosis and bleeding. The combination of low fibrinogen, high
D-dimer, thrombocytopenia, and clinical bleeding in a septic patient is the classic
presentation.
Actual Exam | Adult Medical‑Surgical Nursing –
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
Cardiovascular & Hematologic Disorders
Q1: A patient returns from cardiac catheterization with a femoral artery sheath in place.
Thirty minutes after arrival, the blood pressure drops from 132/84 to 88/52, the patient
becomes diaphoretic, and the dressing over the sheath site is saturated with bright red
blood. What is the nurse's first action?
A. Notify the physician
B. Obtain a stat hemoglobin and hematocrit
C. Apply direct pressure above the puncture site and call for help [CORRECT]
D. Elevate the head of the bed to 45 degrees
Correct Answer: C
Rationale: When a post-cath patient drops their pressure and shows active hemorrhage
from the access site, the immediate priority is to control the bleeding with direct
pressure while getting additional help. You can notify the provider and draw labs once
the life-threatening bleed is managed.
Q2: A patient with newly diagnosed heart failure is being discharged on furosemide,
lisinopril, and carvedilol. Which statement by the patient indicates understanding of
dietary self-management?
A. "I will drink at least 3 liters of water daily to stay hydrated."
B. "I can use salt substitute freely since I am cutting out table salt."
C. "I will weigh myself every morning and call if I gain 3 pounds in one day." [CORRECT]
D. "I should eat plenty of canned soups since they are easy to prepare."
Correct Answer: C
Rationale: Daily weights are the best early warning system for fluid retention in heart
failure, and a 2–3 pound gain in a day or 5 pounds in a week warrants a call to the
,provider. Canned soups are sodium bombs, and many salt substitutes contain
potassium—which can be dangerous with an ACE inhibitor.
Q3: Which intervention is most appropriate for a postoperative patient at high risk for
deep vein thrombosis?
A. Massage the calves every 4 hours to promote circulation
B. Apply knee-high compression stockings and encourage early ambulation [CORRECT]
C. Keep the patient on strict bed rest for 48 hours to prevent clot dislodgement
D. Place a pillow under the knees to promote venous return
Correct Answer: B
Rationale: Compression devices or stockings combined with early ambulation are
evidence-based DVT prophylaxis. Massaging a calf could dislodge a clot, bed rest
increases venous stasis, and pillows under the knees actually impede venous return.
Q4: A patient has a hemoglobin of 9.2 g/dL and a hematocrit of 27%. These findings are
consistent with:
A. Polycythemia vera
B. Severe dehydration
C. Anemia [CORRECT]
D. Normal adult male values
Correct Answer: C
Rationale: A hemoglobin below 12 g/dL in women or 13 g/dL in men indicates anemia,
and the hematocrit is roughly three times the hemoglobin value. These values are far
too low to represent normal status, dehydration, or a proliferative bone marrow disorder.
Q5: A patient on warfarin has an INR of 4.8. The prescribed therapeutic range is 2.0–3.0.
What is the nurse's priority action?
A. Administer the scheduled warfarin dose
B. Hold the next dose and notify the provider [CORRECT]
C. Administer vitamin K without consulting the provider
D. Increase the warfarin dose to bring the INR down faster
Correct Answer: B
Rationale: An INR of 4.8 places the patient at significant bleeding risk. The nurse should
hold the next warfarin dose and contact the provider for guidance, which may include
holding additional doses or ordering low-dose vitamin K.
, Q6: A 58-year-old woman presents to the emergency department with fatigue, nausea,
and jaw pain that started while she was gardening. She denies chest pain. Which
nursing action is priority?
A. Obtain a 12-lead EKG [CORRECT]
B. Administer sublingual nitroglycerin
C. Start an IV and draw cardiac enzymes only
D. Reassure her that women often have atypical symptoms and schedule a stress test
Correct Answer: A
Rationale: Atypical MI presentations in women—like jaw pain, nausea, and fatigue—are
still emergencies. A 12-lead EKG is the fastest way to identify ST-elevation and activate
the cath lab protocol. You do not wait for enzymes or dismiss the symptoms.
Q7: A patient with heart failure asks why they need to take an ACE inhibitor. The nurse
explains that the primary benefit is:
A. To increase heart rate and cardiac output
B. To reduce afterload and prevent cardiac remodeling [CORRECT]
C. To eliminate excess fluid through diuresis
D. To slow the heart rate and reduce contractility
Correct Answer: B
Rationale: ACE inhibitors block the renin-angiotensin-aldosterone system, which
reduces afterload and prevents the pathologic ventricular remodeling that worsens
heart failure over time. They are not primarily diuretics or negative inotropes.
Q8: A patient with sepsis develops oozing from IV sites, petechiae, and a dropping
platelet count. Fibrinogen is low and D-dimer is markedly elevated. The nurse
recognizes these findings as consistent with:
A. Immune thrombocytopenic purpura
B. Disseminated intravascular coagulation [CORRECT]
C. Heparin-induced thrombocytopenia
D. Von Willebrand disease
Correct Answer: B
Rationale: In DIC, widespread clotting consumes platelets and clotting factors, leading
to both microvascular thrombosis and bleeding. The combination of low fibrinogen, high
D-dimer, thrombocytopenia, and clinical bleeding in a septic patient is the classic
presentation.
