HESI RN Medical-Surgical V2 ACTUAL
EXAM 2026/2027 | Complete Practice with
Answers | Package Deal | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1–18)
Q1: A 68-year-old client is admitted with acute decompensated heart failure. Vital signs: BP 162/94, HR
118, RR 28, SpO₂ 88% on room air. Assessment reveals bilateral crackles, 2+ pitting edema in lower
extremities, and jugular venous distension. The provider orders furosemide 40 mg IV push. Which action
should the nurse take first?
A. Administer furosemide immediately and monitor urine output hourly.
B. Place the client in high Fowler's position and apply oxygen at 4 L/min via nasal cannula.
C. Place the client in high Fowler's position, apply oxygen, and then administer furosemide. [CORRECT]
D. Obtain a daily weight and restrict sodium intake before giving furosemide.
Correct Answer: C
Rationale: High Fowler's position and oxygen improve ventilation and oxygenation in acute pulmonary
edema. Furosemide then reduces fluid overload, which decreases cardiac preload and improves
breathing.
Q2: A 54-year-old client is 2 hours post-PCI with stent placement for an anterior wall MI. Vital signs: BP
98/62, HR 112, RR 20. The groin site is intact with a small hematoma. The client reports chest pressure
rated 6/10. Which intervention is the priority?
A. Apply a warm compress to the groin site to promote vasodilation.
B. Administer prescribed morphine 2 mg IV and obtain a 12-lead ECG. [CORRECT]
C. Increase the IV fluid rate to 150 mL/hr to support blood pressure.
D. Instruct the client to perform Valsalva maneuvers to reduce chest pressure.
Correct Answer: B
,Rationale: Chest pressure post-PCI may indicate recurrent ischemia or stent thrombosis. Morphine
relieves pain and reduces myocardial oxygen demand, while the ECG identifies re-infarction.
Q3: A client with atrial fibrillation is prescribed warfarin 5 mg daily. The INR is 4.2. The client has no
active bleeding. Which action should the nurse take?
A. Hold the next dose of warfarin and notify the provider. [CORRECT]
B. Administer vitamin K 10 mg IV immediately.
C. Continue the warfarin and recheck the INR in 1 week.
D. Administer protamine sulfate as an antidote.
Correct Answer: A
Rationale: An INR of 4.2 is above the therapeutic range of 2.0–3.0 for atrial fibrillation. Holding the dose
prevents bleeding risk while the provider determines dose adjustment.
Q4: A client with chronic heart failure is prescribed carvedilol 12.5 mg twice daily. The client's BP is
88/54 and HR 52. Which action should the nurse take?
A. Administer the dose and monitor for worsening bradycardia.
B. Hold the dose and notify the provider. [CORRECT]
C. Administer half the dose and recheck vital signs in 30 minutes.
D. Give the dose with a full glass of water to prevent hypotension.
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that can worsen hypotension and bradycardia. Holding the dose
prevents hemodynamic compromise until the provider evaluates.
Q5: A client with peripheral arterial disease reports severe leg pain at rest, especially at night. The
affected foot is pale, cool, and hairless with diminished pulses. Which nursing intervention is most
appropriate?
A. Apply a heating pad to the affected limb for 20 minutes before bed.
B. Elevate the leg above heart level to promote venous return.
C. Keep the leg in a dependent position and avoid pressure on heels. [CORRECT]
D. Massage the limb vigorously to stimulate circulation.
Correct Answer: C
,Rationale: Gravity-assisted blood flow in a dependent position improves perfusion in arterial
insufficiency. Avoiding heel pressure prevents skin breakdown in ischemic tissue.
Q6: A client with hypertension is prescribed lisinopril 10 mg daily. The client develops a persistent dry
cough. Which action should the nurse take?
A. Reassure the client that the cough will resolve with continued use.
B. Notify the provider to consider an ARB such as losartan. [CORRECT]
C. Recommend an over-the-counter cough suppressant.
D. Hold the next dose and monitor the cough for 48 hours.
Correct Answer: B
Rationale: ACE inhibitors like lisinopril commonly cause a dry cough due to bradykinin accumulation.
ARBs provide similar benefits without this side effect.
Q7: A client is admitted with infective endocarditis. The nurse is preparing to administer IV antibiotics.
Which action is essential before starting therapy?
A. Obtain blood cultures from two separate sites before the first antibiotic dose. [CORRECT]
B. Administer a prophylactic dose of vancomycin to prevent resistance.
C. Start the antibiotics and obtain cultures 2 hours later.
D. Place a central line before administering any antibiotics.
Correct Answer: A
Rationale: Blood cultures must be drawn before antibiotics to identify the causative organism and guide
targeted therapy. This ensures accurate diagnosis and effective treatment.
Q8: A client with aortic stenosis becomes dizzy and syncopal during ambulation. Vital signs: BP 92/58,
HR 48. Which action should the nurse take first?
A. Help the client to a sitting position and call for assistance. [CORRECT]
B. Encourage the client to continue walking to build tolerance.
C. Administer atropine 0.5 mg IV push immediately.
D. Place the client in Trendelenburg position to increase cerebral perfusion.
Correct Answer: A
, Rationale: Syncope in aortic stenosis indicates reduced cardiac output. Sitting prevents injury from a fall
while allowing the nurse to assess and intervene safely.
Q9: A client with dilated cardiomyopathy has an ejection fraction of 25%. The client asks why digoxin
was prescribed. Which response by the nurse is most accurate?
A. "Digoxin will dilate your coronary arteries to improve blood flow."
B. "Digoxin strengthens your heart's contractions and slows the heart rate." [CORRECT]
C. "Digoxin reduces fluid buildup by increasing kidney filtration."
D. "Digoxin prevents blood clots from forming in your heart chambers."
Correct Answer: B
Rationale: Digoxin is a positive inotrope that increases myocardial contractility and a negative
chronotrope that slows the heart rate. This improves cardiac output in heart failure.
Q10: A client with unstable angina is on a heparin infusion at 1,000 units/hr. The aPTT is 28 seconds
(control 30 seconds). Which action should the nurse take?
A. Continue the infusion at the current rate and recheck in 4 hours.
B. Increase the infusion rate per protocol and recheck the aPTT in 6 hours. [CORRECT]
C. Stop the infusion and administer protamine sulfate.
D. Decrease the infusion rate to prevent bleeding.
Correct Answer: B
Rationale: An aPTT below therapeutic range indicates subtherapeutic anticoagulation. Increasing the
rate per protocol achieves the target aPTT of 1.5–2.5 times control.
Q11: A client with heart failure is prescribed spironolactone 25 mg daily. Which finding requires
immediate nursing intervention?
A. Serum potassium of 5.8 mEq/L. [CORRECT]
B. Weight gain of 2 pounds in 3 days.
C. Mild ankle edema in the evening.
D. Fatigue with moderate exertion.
Correct Answer: A
EXAM 2026/2027 | Complete Practice with
Answers | Package Deal | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1–18)
Q1: A 68-year-old client is admitted with acute decompensated heart failure. Vital signs: BP 162/94, HR
118, RR 28, SpO₂ 88% on room air. Assessment reveals bilateral crackles, 2+ pitting edema in lower
extremities, and jugular venous distension. The provider orders furosemide 40 mg IV push. Which action
should the nurse take first?
A. Administer furosemide immediately and monitor urine output hourly.
B. Place the client in high Fowler's position and apply oxygen at 4 L/min via nasal cannula.
C. Place the client in high Fowler's position, apply oxygen, and then administer furosemide. [CORRECT]
D. Obtain a daily weight and restrict sodium intake before giving furosemide.
Correct Answer: C
Rationale: High Fowler's position and oxygen improve ventilation and oxygenation in acute pulmonary
edema. Furosemide then reduces fluid overload, which decreases cardiac preload and improves
breathing.
Q2: A 54-year-old client is 2 hours post-PCI with stent placement for an anterior wall MI. Vital signs: BP
98/62, HR 112, RR 20. The groin site is intact with a small hematoma. The client reports chest pressure
rated 6/10. Which intervention is the priority?
A. Apply a warm compress to the groin site to promote vasodilation.
B. Administer prescribed morphine 2 mg IV and obtain a 12-lead ECG. [CORRECT]
C. Increase the IV fluid rate to 150 mL/hr to support blood pressure.
D. Instruct the client to perform Valsalva maneuvers to reduce chest pressure.
Correct Answer: B
,Rationale: Chest pressure post-PCI may indicate recurrent ischemia or stent thrombosis. Morphine
relieves pain and reduces myocardial oxygen demand, while the ECG identifies re-infarction.
Q3: A client with atrial fibrillation is prescribed warfarin 5 mg daily. The INR is 4.2. The client has no
active bleeding. Which action should the nurse take?
A. Hold the next dose of warfarin and notify the provider. [CORRECT]
B. Administer vitamin K 10 mg IV immediately.
C. Continue the warfarin and recheck the INR in 1 week.
D. Administer protamine sulfate as an antidote.
Correct Answer: A
Rationale: An INR of 4.2 is above the therapeutic range of 2.0–3.0 for atrial fibrillation. Holding the dose
prevents bleeding risk while the provider determines dose adjustment.
Q4: A client with chronic heart failure is prescribed carvedilol 12.5 mg twice daily. The client's BP is
88/54 and HR 52. Which action should the nurse take?
A. Administer the dose and monitor for worsening bradycardia.
B. Hold the dose and notify the provider. [CORRECT]
C. Administer half the dose and recheck vital signs in 30 minutes.
D. Give the dose with a full glass of water to prevent hypotension.
Correct Answer: B
Rationale: Carvedilol is a beta-blocker that can worsen hypotension and bradycardia. Holding the dose
prevents hemodynamic compromise until the provider evaluates.
Q5: A client with peripheral arterial disease reports severe leg pain at rest, especially at night. The
affected foot is pale, cool, and hairless with diminished pulses. Which nursing intervention is most
appropriate?
A. Apply a heating pad to the affected limb for 20 minutes before bed.
B. Elevate the leg above heart level to promote venous return.
C. Keep the leg in a dependent position and avoid pressure on heels. [CORRECT]
D. Massage the limb vigorously to stimulate circulation.
Correct Answer: C
,Rationale: Gravity-assisted blood flow in a dependent position improves perfusion in arterial
insufficiency. Avoiding heel pressure prevents skin breakdown in ischemic tissue.
Q6: A client with hypertension is prescribed lisinopril 10 mg daily. The client develops a persistent dry
cough. Which action should the nurse take?
A. Reassure the client that the cough will resolve with continued use.
B. Notify the provider to consider an ARB such as losartan. [CORRECT]
C. Recommend an over-the-counter cough suppressant.
D. Hold the next dose and monitor the cough for 48 hours.
Correct Answer: B
Rationale: ACE inhibitors like lisinopril commonly cause a dry cough due to bradykinin accumulation.
ARBs provide similar benefits without this side effect.
Q7: A client is admitted with infective endocarditis. The nurse is preparing to administer IV antibiotics.
Which action is essential before starting therapy?
A. Obtain blood cultures from two separate sites before the first antibiotic dose. [CORRECT]
B. Administer a prophylactic dose of vancomycin to prevent resistance.
C. Start the antibiotics and obtain cultures 2 hours later.
D. Place a central line before administering any antibiotics.
Correct Answer: A
Rationale: Blood cultures must be drawn before antibiotics to identify the causative organism and guide
targeted therapy. This ensures accurate diagnosis and effective treatment.
Q8: A client with aortic stenosis becomes dizzy and syncopal during ambulation. Vital signs: BP 92/58,
HR 48. Which action should the nurse take first?
A. Help the client to a sitting position and call for assistance. [CORRECT]
B. Encourage the client to continue walking to build tolerance.
C. Administer atropine 0.5 mg IV push immediately.
D. Place the client in Trendelenburg position to increase cerebral perfusion.
Correct Answer: A
, Rationale: Syncope in aortic stenosis indicates reduced cardiac output. Sitting prevents injury from a fall
while allowing the nurse to assess and intervene safely.
Q9: A client with dilated cardiomyopathy has an ejection fraction of 25%. The client asks why digoxin
was prescribed. Which response by the nurse is most accurate?
A. "Digoxin will dilate your coronary arteries to improve blood flow."
B. "Digoxin strengthens your heart's contractions and slows the heart rate." [CORRECT]
C. "Digoxin reduces fluid buildup by increasing kidney filtration."
D. "Digoxin prevents blood clots from forming in your heart chambers."
Correct Answer: B
Rationale: Digoxin is a positive inotrope that increases myocardial contractility and a negative
chronotrope that slows the heart rate. This improves cardiac output in heart failure.
Q10: A client with unstable angina is on a heparin infusion at 1,000 units/hr. The aPTT is 28 seconds
(control 30 seconds). Which action should the nurse take?
A. Continue the infusion at the current rate and recheck in 4 hours.
B. Increase the infusion rate per protocol and recheck the aPTT in 6 hours. [CORRECT]
C. Stop the infusion and administer protamine sulfate.
D. Decrease the infusion rate to prevent bleeding.
Correct Answer: B
Rationale: An aPTT below therapeutic range indicates subtherapeutic anticoagulation. Increasing the
rate per protocol achieves the target aPTT of 1.5–2.5 times control.
Q11: A client with heart failure is prescribed spironolactone 25 mg daily. Which finding requires
immediate nursing intervention?
A. Serum potassium of 5.8 mEq/L. [CORRECT]
B. Weight gain of 2 pounds in 3 days.
C. Mild ankle edema in the evening.
D. Fatigue with moderate exertion.
Correct Answer: A
