HESI Medical-Surgical Nursing ACTUAL EXAM
2026/2027 | Adult Health & Clinical Judgment |
Verified Q&A | A+ Graded | Pass Guaranteed
Section 1: Cardiovascular Disorders (Questions 1–16)
Q1: A 72-year-old male is admitted with acute decompensated heart failure. Vital signs: BP 98/64, HR
118, RR 28, SpO2 86% on room air. Lung assessment reveals bilateral crackles to the apices. Which is the
nurse's priority action?
A. Administer IV furosemide 40 mg immediately.
B. Apply high-flow oxygen via non-rebreather mask and obtain ABG. [CORRECT]
C. Insert a Foley catheter for strict intake and output monitoring.
D. Begin IV nitroglycerin infusion for afterload reduction.
Correct Answer: B
Rationale: Severe hypoxemia with bilateral crackles indicates pulmonary edema. High-flow oxygen
restores adequate oxygenation first, preventing hypoxic organ damage while preparing additional
interventions.
Q2: A 68-year-old female 2 days post-MI reports sudden shortness of breath and pleuritic chest pain.
Vital signs: BP 102/70, HR 110, RR 32, SpO2 88%. Which assessment finding would most support the
nurse's suspicion of pulmonary embolism?
A. Clear lung sounds bilaterally
B. Unequal peripheral pulses
C. Sudden onset of tachypnea, hypoxemia, and pleuritic pain with clear lungs [CORRECT]
D. Bilateral basilar crackles
Correct Answer: C
Rationale: The classic triad of sudden tachypnea, hypoxemia, and pleuritic chest pain with clear lung
fields strongly suggests pulmonary embolism. This presentation requires immediate intervention and
diagnostic workup.
Q3: A 55-year-old male with new-onset atrial fibrillation is prescribed warfarin. The nurse teaches the
patient about dietary restrictions. Which statement by the patient indicates understanding?
,A. "I should avoid all green vegetables completely."
B. "I need to keep my vitamin K intake consistent from week to week." [CORRECT]
C. "I can eat as much spinach as I want because it is healthy."
D. "I should double my vitamin K intake to balance the warfarin."
Correct Answer: B
Rationale: Consistent vitamin K intake allows stable warfarin dosing and predictable INR levels. Sudden
increases or decreases in vitamin K consumption alter anticoagulation effectiveness and increase
bleeding or clotting risk.
Q4: A patient receiving heparin infusion for DVT prophylaxis has the following labs: aPTT 95 seconds
(control 30 seconds), platelets 85,000/mm³. Which is the nurse's priority action?
A. Continue the heparin infusion at the current rate.
B. Stop the heparin infusion immediately and notify the provider. [CORRECT]
C. Increase the heparin rate to achieve therapeutic aPTT.
D. Administer protamine sulfate prophylactically.
Correct Answer: B
Rationale: A prolonged aPTT with thrombocytopenia suggests heparin-induced thrombocytopenia (HIT),
a potentially life-threatening immune reaction. Discontinuing heparin immediately prevents further
platelet destruction and thrombotic complications.
Q5: A 62-year-old male with hypertension reports a severe headache, blurred vision, and chest pressure.
Vital signs: BP 220/130, HR 96, RR 18. Which is the nurse's priority intervention?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead ECG and cardiac enzymes.
C. Administer IV antihypertensive per protocol and reduce BP gradually. [CORRECT]
D. Have the patient perform vagal maneuvers.
Correct Answer: C
Rationale: Hypertensive emergency requires controlled BP reduction to prevent cerebral, cardiac, and
renal ischemia. Rapid or excessive lowering causes organ hypoperfusion; gradual reduction (10–20% in
first hour) protects vital organs.
Q6: A patient with heart failure is prescribed carvedilol. The nurse monitors for which adverse effect
that requires immediate intervention?
,A. Bradycardia and hypotension [CORRECT]
B. Hyperglycemia
C. Urinary retention
D. Hyperkalemia
Correct Answer: A
Rationale: Carvedilol is a non-selective beta-blocker with alpha-blocking properties that can cause
significant bradycardia and hypotension. Monitoring heart rate and blood pressure ensures safe titration
and prevents cardiovascular collapse.
Q7: A 78-year-old female post-cardiac catheterization via femoral approach reports severe back pain
and a dropping blood pressure. The dressing site appears unchanged. Which condition does the nurse
suspect?
A. Allergic reaction to contrast dye
B. Retroperitoneal hemorrhage [CORRECT]
C. Cardiac tamponade
D. Pulmonary embolism
Correct Answer: B
Rationale: Severe back pain with hypotension after femoral catheterization suggests retroperitoneal
bleeding, even without visible dressing changes. This serious complication requires immediate provider
notification and hemodynamic support.
Q8: A patient with peripheral arterial disease (PAD) has a non-healing ulcer on the great toe. The nurse
is planning wound care. Which intervention is most appropriate?
A. Apply warm moist compresses to increase blood flow.
B. Keep the foot dependent to improve arterial perfusion.
C. Protect the ulcer from trauma, avoid heat, and refer to vascular specialist. [CORRECT]
D. Massage the affected limb to stimulate circulation.
Correct Answer: C
Rationale: PAD ulcers require protection from mechanical trauma and thermal injury due to impaired
sensation and healing capacity. Vascular specialist referral addresses underlying perfusion deficits and
prevents progression to gangrene.
Q9: A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. The nurse teaches the
patient about home antibiotic therapy. Which statement indicates understanding?
, A. "I can skip doses if I feel better to save medication."
B. "I must complete the full course even if my symptoms improve to eradicate the infection." [CORRECT]
C. "I should stop the antibiotics if I develop diarrhea."
D. "I can switch to oral antibiotics after 1 week."
Correct Answer: B
Rationale: Endocarditis requires prolonged IV antibiotic therapy to eradicate valvular vegetations.
Incomplete treatment leads to relapse, valvular destruction, and systemic embolization, making
adherence critical for cure.
Q10: A patient with third-degree heart block is symptomatic with dizziness and fatigue. The nurse
prepares for which intervention?
A. Administer atropine 0.5 mg IV push.
B. Prepare for temporary transcutaneous or transvenous pacemaker placement. [CORRECT]
C. Begin IV isoproterenol drip.
D. Perform synchronized cardioversion.
Correct Answer: B
Rationale: Symptomatic third-degree heart block requires cardiac pacing to maintain adequate heart
rate and perfusion. Temporary pacing stabilizes the patient while determining the need for permanent
pacemaker implantation.
Q11: A patient post-CABG surgery day 2 has chest tube drainage of 150 mL/hour for 3 consecutive
hours. The patient is tachycardic and hypotensive. Which is the nurse's priority action?
A. Increase the suction on the chest tubes.
B. Notify the surgeon immediately and prepare for possible return to OR. [CORRECT]
C. Administer IV fluid bolus to replace volume.
D. Remove the chest tubes to relieve tension.
Correct Answer: B
Rationale: Hemorrhage exceeding 100–150 mL/hour for 2–3 hours post-CABG indicates significant
bleeding requiring surgical re-exploration. Immediate surgeon notification and OR preparation address
the life-threatening blood loss.
Q12: A patient with chronic heart failure is prescribed spironolactone. The nurse monitors for which
electrolyte imbalance?
2026/2027 | Adult Health & Clinical Judgment |
Verified Q&A | A+ Graded | Pass Guaranteed
Section 1: Cardiovascular Disorders (Questions 1–16)
Q1: A 72-year-old male is admitted with acute decompensated heart failure. Vital signs: BP 98/64, HR
118, RR 28, SpO2 86% on room air. Lung assessment reveals bilateral crackles to the apices. Which is the
nurse's priority action?
A. Administer IV furosemide 40 mg immediately.
B. Apply high-flow oxygen via non-rebreather mask and obtain ABG. [CORRECT]
C. Insert a Foley catheter for strict intake and output monitoring.
D. Begin IV nitroglycerin infusion for afterload reduction.
Correct Answer: B
Rationale: Severe hypoxemia with bilateral crackles indicates pulmonary edema. High-flow oxygen
restores adequate oxygenation first, preventing hypoxic organ damage while preparing additional
interventions.
Q2: A 68-year-old female 2 days post-MI reports sudden shortness of breath and pleuritic chest pain.
Vital signs: BP 102/70, HR 110, RR 32, SpO2 88%. Which assessment finding would most support the
nurse's suspicion of pulmonary embolism?
A. Clear lung sounds bilaterally
B. Unequal peripheral pulses
C. Sudden onset of tachypnea, hypoxemia, and pleuritic pain with clear lungs [CORRECT]
D. Bilateral basilar crackles
Correct Answer: C
Rationale: The classic triad of sudden tachypnea, hypoxemia, and pleuritic chest pain with clear lung
fields strongly suggests pulmonary embolism. This presentation requires immediate intervention and
diagnostic workup.
Q3: A 55-year-old male with new-onset atrial fibrillation is prescribed warfarin. The nurse teaches the
patient about dietary restrictions. Which statement by the patient indicates understanding?
,A. "I should avoid all green vegetables completely."
B. "I need to keep my vitamin K intake consistent from week to week." [CORRECT]
C. "I can eat as much spinach as I want because it is healthy."
D. "I should double my vitamin K intake to balance the warfarin."
Correct Answer: B
Rationale: Consistent vitamin K intake allows stable warfarin dosing and predictable INR levels. Sudden
increases or decreases in vitamin K consumption alter anticoagulation effectiveness and increase
bleeding or clotting risk.
Q4: A patient receiving heparin infusion for DVT prophylaxis has the following labs: aPTT 95 seconds
(control 30 seconds), platelets 85,000/mm³. Which is the nurse's priority action?
A. Continue the heparin infusion at the current rate.
B. Stop the heparin infusion immediately and notify the provider. [CORRECT]
C. Increase the heparin rate to achieve therapeutic aPTT.
D. Administer protamine sulfate prophylactically.
Correct Answer: B
Rationale: A prolonged aPTT with thrombocytopenia suggests heparin-induced thrombocytopenia (HIT),
a potentially life-threatening immune reaction. Discontinuing heparin immediately prevents further
platelet destruction and thrombotic complications.
Q5: A 62-year-old male with hypertension reports a severe headache, blurred vision, and chest pressure.
Vital signs: BP 220/130, HR 96, RR 18. Which is the nurse's priority intervention?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead ECG and cardiac enzymes.
C. Administer IV antihypertensive per protocol and reduce BP gradually. [CORRECT]
D. Have the patient perform vagal maneuvers.
Correct Answer: C
Rationale: Hypertensive emergency requires controlled BP reduction to prevent cerebral, cardiac, and
renal ischemia. Rapid or excessive lowering causes organ hypoperfusion; gradual reduction (10–20% in
first hour) protects vital organs.
Q6: A patient with heart failure is prescribed carvedilol. The nurse monitors for which adverse effect
that requires immediate intervention?
,A. Bradycardia and hypotension [CORRECT]
B. Hyperglycemia
C. Urinary retention
D. Hyperkalemia
Correct Answer: A
Rationale: Carvedilol is a non-selective beta-blocker with alpha-blocking properties that can cause
significant bradycardia and hypotension. Monitoring heart rate and blood pressure ensures safe titration
and prevents cardiovascular collapse.
Q7: A 78-year-old female post-cardiac catheterization via femoral approach reports severe back pain
and a dropping blood pressure. The dressing site appears unchanged. Which condition does the nurse
suspect?
A. Allergic reaction to contrast dye
B. Retroperitoneal hemorrhage [CORRECT]
C. Cardiac tamponade
D. Pulmonary embolism
Correct Answer: B
Rationale: Severe back pain with hypotension after femoral catheterization suggests retroperitoneal
bleeding, even without visible dressing changes. This serious complication requires immediate provider
notification and hemodynamic support.
Q8: A patient with peripheral arterial disease (PAD) has a non-healing ulcer on the great toe. The nurse
is planning wound care. Which intervention is most appropriate?
A. Apply warm moist compresses to increase blood flow.
B. Keep the foot dependent to improve arterial perfusion.
C. Protect the ulcer from trauma, avoid heat, and refer to vascular specialist. [CORRECT]
D. Massage the affected limb to stimulate circulation.
Correct Answer: C
Rationale: PAD ulcers require protection from mechanical trauma and thermal injury due to impaired
sensation and healing capacity. Vascular specialist referral addresses underlying perfusion deficits and
prevents progression to gangrene.
Q9: A patient with infective endocarditis is prescribed IV antibiotics for 6 weeks. The nurse teaches the
patient about home antibiotic therapy. Which statement indicates understanding?
, A. "I can skip doses if I feel better to save medication."
B. "I must complete the full course even if my symptoms improve to eradicate the infection." [CORRECT]
C. "I should stop the antibiotics if I develop diarrhea."
D. "I can switch to oral antibiotics after 1 week."
Correct Answer: B
Rationale: Endocarditis requires prolonged IV antibiotic therapy to eradicate valvular vegetations.
Incomplete treatment leads to relapse, valvular destruction, and systemic embolization, making
adherence critical for cure.
Q10: A patient with third-degree heart block is symptomatic with dizziness and fatigue. The nurse
prepares for which intervention?
A. Administer atropine 0.5 mg IV push.
B. Prepare for temporary transcutaneous or transvenous pacemaker placement. [CORRECT]
C. Begin IV isoproterenol drip.
D. Perform synchronized cardioversion.
Correct Answer: B
Rationale: Symptomatic third-degree heart block requires cardiac pacing to maintain adequate heart
rate and perfusion. Temporary pacing stabilizes the patient while determining the need for permanent
pacemaker implantation.
Q11: A patient post-CABG surgery day 2 has chest tube drainage of 150 mL/hour for 3 consecutive
hours. The patient is tachycardic and hypotensive. Which is the nurse's priority action?
A. Increase the suction on the chest tubes.
B. Notify the surgeon immediately and prepare for possible return to OR. [CORRECT]
C. Administer IV fluid bolus to replace volume.
D. Remove the chest tubes to relieve tension.
Correct Answer: B
Rationale: Hemorrhage exceeding 100–150 mL/hour for 2–3 hours post-CABG indicates significant
bleeding requiring surgical re-exploration. Immediate surgeon notification and OR preparation address
the life-threatening blood loss.
Q12: A patient with chronic heart failure is prescribed spironolactone. The nurse monitors for which
electrolyte imbalance?
