HESI MED SURGICAL (EVOLVE) EXAM 2026 WITH 100% ACCURATE ANSWERS.
Cardiovascular Disorders (Questions 1-20)
1. A client is admitted with acute decompensated heart failure (HF). Which
assessment finding best indicates that treatment is improving the client’s fluid
status?
A. Heart rate decreases from 110 to 104 beats/min
B. Jugular venous distention decreases from +3 to +1
C. Blood pressure increases from 90/50 to 100/60 mm Hg
D. Oxygen saturation rises from 90% to 94% on room air
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: B
Rationale: Jugular venous distention (JVD) is a direct, reliable indicator of right-
heart filling pressure and central venous pressure, reflecting volume overload. A
decrease in JVD is a specific sign that diuresis is effectively reducing fluid volume.
While the other changes (heart rate, BP, SpO2) can be positive, they are
influenced by many factors (e.g., pain, anxiety, positioning) and are less direct
indicators of fluid status than JVD.
</details>
,2. A client with atrial fibrillation is prescribed digoxin. Which finding requires
immediate action before administration?
A. Serum potassium 3.0 mEq/L
B. Apical heart rate 62 beats/min
C. Blood pressure 130/80 mm Hg
D. Serum digoxin level 1.2 ng/mL
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: A
Rationale: Hypokalemia (serum K+ < 3.5 mEq/L) potentiates the effects of digoxin
and significantly increases the risk of digoxin toxicity, which can lead to fatal
dysrhythmias. The nurse should hold the digoxin and notify the healthcare
provider. A heart rate of 62 is acceptable for a client on digoxin (hold if < 60). BP is
stable, and the digoxin level (1.2 ng/mL) is within the therapeutic range (0.5-2
ng/mL).
</details>
3. A client with unstable angina has chest pain that is unrelieved by three
sublingual nitroglycerin tablets 5 minutes apart. What should the nurse do next?
A. Administer another nitroglycerin tablet and reassess in 5 minutes
,B. Apply oxygen at 2 L/min via nasal cannula and repeat vital signs
C. Activate the rapid response team and prepare for possible myocardial
infarction
D. Place the client in a supine position to increase preload
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: C
Rationale: Chest pain unrelieved by three nitroglycerin doses over 15 minutes is a
key indicator of an acute myocardial infarction (MI), not just unstable angina. The
priority is to activate emergency personnel (Rapid Response Team) and prepare
for immediate interventions, including a 12-lead ECG, aspirin, possible morphine,
and reperfusion therapy.
</details>
4. A patient is 2 hours post-cardiac catheterization via the right femoral artery.
Which finding should be reported immediately?
A. Blood pressure 118/72 mm Hg
B. Slight oozing of serosanguineous fluid at the insertion site
C. Complaints of mild back discomfort
D. Right foot is pale, cool to touch, and the dorsalis pedis pulse is weak
, <details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: D
Rationale: A pale, cool foot with a weak or absent pulse distal to the insertion site
suggests arterial occlusion or a significant retroperitoneal bleed, which is a
medical emergency. This requires immediate intervention to restore blood flow
and prevent tissue loss. Minor oozing and mild back pain are common, but any
change in distal perfusion is critical.
</details>
5. Which laboratory value is most important to monitor for a patient receiving
warfarin therapy for atrial fibrillation?
A. aPTT
B. Platelet count
C. INR
D. Bleeding time
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: C
Cardiovascular Disorders (Questions 1-20)
1. A client is admitted with acute decompensated heart failure (HF). Which
assessment finding best indicates that treatment is improving the client’s fluid
status?
A. Heart rate decreases from 110 to 104 beats/min
B. Jugular venous distention decreases from +3 to +1
C. Blood pressure increases from 90/50 to 100/60 mm Hg
D. Oxygen saturation rises from 90% to 94% on room air
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: B
Rationale: Jugular venous distention (JVD) is a direct, reliable indicator of right-
heart filling pressure and central venous pressure, reflecting volume overload. A
decrease in JVD is a specific sign that diuresis is effectively reducing fluid volume.
While the other changes (heart rate, BP, SpO2) can be positive, they are
influenced by many factors (e.g., pain, anxiety, positioning) and are less direct
indicators of fluid status than JVD.
</details>
,2. A client with atrial fibrillation is prescribed digoxin. Which finding requires
immediate action before administration?
A. Serum potassium 3.0 mEq/L
B. Apical heart rate 62 beats/min
C. Blood pressure 130/80 mm Hg
D. Serum digoxin level 1.2 ng/mL
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: A
Rationale: Hypokalemia (serum K+ < 3.5 mEq/L) potentiates the effects of digoxin
and significantly increases the risk of digoxin toxicity, which can lead to fatal
dysrhythmias. The nurse should hold the digoxin and notify the healthcare
provider. A heart rate of 62 is acceptable for a client on digoxin (hold if < 60). BP is
stable, and the digoxin level (1.2 ng/mL) is within the therapeutic range (0.5-2
ng/mL).
</details>
3. A client with unstable angina has chest pain that is unrelieved by three
sublingual nitroglycerin tablets 5 minutes apart. What should the nurse do next?
A. Administer another nitroglycerin tablet and reassess in 5 minutes
,B. Apply oxygen at 2 L/min via nasal cannula and repeat vital signs
C. Activate the rapid response team and prepare for possible myocardial
infarction
D. Place the client in a supine position to increase preload
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: C
Rationale: Chest pain unrelieved by three nitroglycerin doses over 15 minutes is a
key indicator of an acute myocardial infarction (MI), not just unstable angina. The
priority is to activate emergency personnel (Rapid Response Team) and prepare
for immediate interventions, including a 12-lead ECG, aspirin, possible morphine,
and reperfusion therapy.
</details>
4. A patient is 2 hours post-cardiac catheterization via the right femoral artery.
Which finding should be reported immediately?
A. Blood pressure 118/72 mm Hg
B. Slight oozing of serosanguineous fluid at the insertion site
C. Complaints of mild back discomfort
D. Right foot is pale, cool to touch, and the dorsalis pedis pulse is weak
, <details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: D
Rationale: A pale, cool foot with a weak or absent pulse distal to the insertion site
suggests arterial occlusion or a significant retroperitoneal bleed, which is a
medical emergency. This requires immediate intervention to restore blood flow
and prevent tissue loss. Minor oozing and mild back pain are common, but any
change in distal perfusion is critical.
</details>
5. Which laboratory value is most important to monitor for a patient receiving
warfarin therapy for atrial fibrillation?
A. aPTT
B. Platelet count
C. INR
D. Bleeding time
<details> <summary><strong>Answer & Rationale</strong></summary>
Correct Answer: C
