HESI Medical-Surgical Nursing ACTUAL
EXAM 2026/2027 Updated Edition | 150
Practice Q&A with Explanations | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1–18)
Q1: A 74-year-old male with HFrEF (EF 30%) presents with worsening dyspnea, weight gain 6 lbs in 3
days, and bilateral crackles to mid-lung fields. Vital signs: BP 96/62, HR 112, RR 26, SpO2 88% on room
air. Which is the nurse's priority intervention?
A. Administer IV morphine 2 mg for anxiety.
B. Apply high-flow oxygen via non-rebreather mask and prepare for IV diuretic administration.
[CORRECT]
C. Insert a Foley catheter for strict I&O monitoring.
D. Administer oral metoprolol to reduce heart rate.
Correct Answer: B
Rationale: Acute decompensated heart failure with hypoxemia requires immediate oxygenation
support. High-flow oxygen restores saturation while IV loop diuretics reduce pulmonary congestion and
improve respiratory status.
Q2: A 68-year-old female 4 hours post-PCI with drug-eluting stent reports chest pressure and
diaphoresis. Vital signs: BP 86/54, HR 118, RR 22. Which is the nurse's priority action?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead ECG and activate the rapid response team for possible stent thrombosis. [CORRECT]
C. Give aspirin 325 mg orally.
D. Position the patient in high Fowler's.
Correct Answer: B
Rationale: Hypotension with chest pain post-PCI suggests acute stent thrombosis, a life-threatening
emergency. Immediate ECG and rapid response activation enable prompt reperfusion intervention and
prevent extensive myocardial damage.
,Q3: A 62-year-old male with atrial fibrillation (CHADS₂-VASc score 4) is prescribed apixaban. The nurse
teaches the patient about this medication. Which statement indicates understanding?
A. "I need regular blood tests to check my INR levels."
B. "I should take this medication twice daily with food, and I do not need routine INR monitoring."
[CORRECT]
C. "I can stop taking this if I miss a dose and feel fine."
D. "This medication will convert my atrial fibrillation back to normal rhythm."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant with predictable pharmacokinetics requiring no INR
monitoring. Twice-daily dosing with food maintains therapeutic anticoagulation for stroke prevention in
atrial fibrillation.
Q4: A patient with hypertrophic cardiomyopathy (HCM) develops syncope during exertion. The nurse
teaches the patient about activity restrictions. Which statement by the patient indicates understanding?
A. "I should participate in competitive sports to build cardiac strength."
B. "I must avoid strenuous exercise and dehydration to prevent sudden cardiac arrest from outflow
obstruction." [CORRECT]
C. "I can drink minimal fluids to reduce my heart's workload."
D. "I should take diuretics before exercise to prevent fluid overload."
Correct Answer: B
Rationale: HCM causes dynamic left ventricular outflow tract obstruction exacerbated by exertion and
hypovolemia. Avoiding strenuous activity and maintaining hydration prevents fatal arrhythmias and
sudden cardiac death.
Q5: A patient with acute STEMI receives alteplase (tPA) 90 minutes after symptom onset. The nurse
monitors for which complication?
A. Hyperglycemia
B. Reperfusion arrhythmias and bleeding, including intracranial hemorrhage [CORRECT]
C. Hypertensive crisis
D. Bradycardia only
Correct Answer: B
Rationale: Thrombolytic therapy dissolves coronary and systemic clots, causing reperfusion arrhythmias
,when blood flow restores and bleeding from impaired coagulation. Vigilant neurological and cardiac
monitoring detects these complications early.
Q6: A patient with heart failure is prescribed sacubitril/valsartan (Entresto). The nurse monitors for
which adverse effect?
A. Hyperkalemia and hypotension [CORRECT]
B. Hypoglycemia
C. Urinary retention
D. Hypercalcemia
Correct Answer: A
Rationale: Sacubitril/valsartan combines neprilysin inhibition with ARB effects, causing vasodilation and
potassium retention. Monitoring potassium and blood pressure prevents dangerous hyperkalemia and
symptomatic hypotension.
Q7: A 58-year-old male post-CABG day 3 has mediastinal chest tube drainage of 175 mL/hour for 2
hours. The patient is anxious, HR 128, BP 88/56. Which is the nurse's priority action?
A. Reassure the patient and continue monitoring.
B. Notify the surgeon immediately and prepare for possible mediastinal exploration. [CORRECT]
C. Administer a fluid bolus and increase chest tube suction.
D. Remove the chest tubes to relieve tension.
Correct Answer: B
Rationale: Mediastinal drainage exceeding 100–150 mL/hour for 2 hours post-CABG indicates significant
hemorrhage requiring surgical re-exploration. Immediate surgeon notification addresses the source of
bleeding before cardiovascular collapse occurs.
Q8: A patient with peripheral artery disease (PAD) has a non-healing ulcer on the lateral malleolus with
pale base and minimal granulation tissue. The nurse plans care. Which intervention is most appropriate?
A. Apply warm moist compresses to increase blood flow.
B. Keep the ulcer dry, protect from trauma, and avoid heat; refer to vascular surgery for
revascularization assessment. [CORRECT]
C. Elevate the leg above heart level continuously.
D. Massage the area to stimulate collateral circulation.
Correct Answer: B
Rationale: Ischemic PAD ulcers have poor perfusion and minimal healing capacity without
, revascularization. Protecting the limb from trauma and thermal injury prevents progression to gangrene
while vascular assessment determines intervention needs.
Q9: A patient with infective endocarditis has a new-onset headache, visual changes, and right-sided
weakness. Which complication does the nurse suspect?
A. Meningitis
B. Septic emboli causing stroke [CORRECT]
C. Hypoglycemia
D. Medication toxicity
Correct Answer: B
Rationale: Infective endocarditis produces valvular vegetations that fragment and embolize to cerebral
vessels. New neurological deficits indicate septic embolization requiring urgent imaging and potential
neurosurgical intervention.
Q10: A patient with third-degree AV block has a heart rate of 38 bpm, syncope, and hypotension. The
nurse prepares for which intervention?
A. Atropine 1 mg IV push.
B. Transcutaneous pacing pads placement and preparation for transvenous pacemaker. [CORRECT]
C. Dopamine infusion at 2 mcg/kg/min.
D. Defibrillation at 200 joules.
Correct Answer: B
Rationale: Symptomatic complete heart block with hemodynamic compromise requires immediate
cardiac pacing. Transcutaneous pacing provides temporary stabilization while preparing for definitive
transvenous pacemaker placement.
Q11: A patient with dilated cardiomyopathy (EF 20%) is being discharged on carvedilol, lisinopril,
spironolactone, and furosemide. The nurse teaches about daily weights. Which instruction is correct?
A. "Weigh yourself once weekly at any time of day."
B. "Weigh yourself every morning after urinating, before eating, wearing similar clothing, and report a 3-
pound gain in 1 day or 5 pounds in 1 week." [CORRECT]
C. "Weigh yourself after dinner for the most accurate reading."
D. "Only weigh yourself when you feel bloated or short of breath."
Correct Answer: B
Rationale: Daily morning weights under consistent conditions detect fluid retention early in heart
EXAM 2026/2027 Updated Edition | 150
Practice Q&A with Explanations | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1–18)
Q1: A 74-year-old male with HFrEF (EF 30%) presents with worsening dyspnea, weight gain 6 lbs in 3
days, and bilateral crackles to mid-lung fields. Vital signs: BP 96/62, HR 112, RR 26, SpO2 88% on room
air. Which is the nurse's priority intervention?
A. Administer IV morphine 2 mg for anxiety.
B. Apply high-flow oxygen via non-rebreather mask and prepare for IV diuretic administration.
[CORRECT]
C. Insert a Foley catheter for strict I&O monitoring.
D. Administer oral metoprolol to reduce heart rate.
Correct Answer: B
Rationale: Acute decompensated heart failure with hypoxemia requires immediate oxygenation
support. High-flow oxygen restores saturation while IV loop diuretics reduce pulmonary congestion and
improve respiratory status.
Q2: A 68-year-old female 4 hours post-PCI with drug-eluting stent reports chest pressure and
diaphoresis. Vital signs: BP 86/54, HR 118, RR 22. Which is the nurse's priority action?
A. Administer sublingual nitroglycerin.
B. Obtain a 12-lead ECG and activate the rapid response team for possible stent thrombosis. [CORRECT]
C. Give aspirin 325 mg orally.
D. Position the patient in high Fowler's.
Correct Answer: B
Rationale: Hypotension with chest pain post-PCI suggests acute stent thrombosis, a life-threatening
emergency. Immediate ECG and rapid response activation enable prompt reperfusion intervention and
prevent extensive myocardial damage.
,Q3: A 62-year-old male with atrial fibrillation (CHADS₂-VASc score 4) is prescribed apixaban. The nurse
teaches the patient about this medication. Which statement indicates understanding?
A. "I need regular blood tests to check my INR levels."
B. "I should take this medication twice daily with food, and I do not need routine INR monitoring."
[CORRECT]
C. "I can stop taking this if I miss a dose and feel fine."
D. "This medication will convert my atrial fibrillation back to normal rhythm."
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant with predictable pharmacokinetics requiring no INR
monitoring. Twice-daily dosing with food maintains therapeutic anticoagulation for stroke prevention in
atrial fibrillation.
Q4: A patient with hypertrophic cardiomyopathy (HCM) develops syncope during exertion. The nurse
teaches the patient about activity restrictions. Which statement by the patient indicates understanding?
A. "I should participate in competitive sports to build cardiac strength."
B. "I must avoid strenuous exercise and dehydration to prevent sudden cardiac arrest from outflow
obstruction." [CORRECT]
C. "I can drink minimal fluids to reduce my heart's workload."
D. "I should take diuretics before exercise to prevent fluid overload."
Correct Answer: B
Rationale: HCM causes dynamic left ventricular outflow tract obstruction exacerbated by exertion and
hypovolemia. Avoiding strenuous activity and maintaining hydration prevents fatal arrhythmias and
sudden cardiac death.
Q5: A patient with acute STEMI receives alteplase (tPA) 90 minutes after symptom onset. The nurse
monitors for which complication?
A. Hyperglycemia
B. Reperfusion arrhythmias and bleeding, including intracranial hemorrhage [CORRECT]
C. Hypertensive crisis
D. Bradycardia only
Correct Answer: B
Rationale: Thrombolytic therapy dissolves coronary and systemic clots, causing reperfusion arrhythmias
,when blood flow restores and bleeding from impaired coagulation. Vigilant neurological and cardiac
monitoring detects these complications early.
Q6: A patient with heart failure is prescribed sacubitril/valsartan (Entresto). The nurse monitors for
which adverse effect?
A. Hyperkalemia and hypotension [CORRECT]
B. Hypoglycemia
C. Urinary retention
D. Hypercalcemia
Correct Answer: A
Rationale: Sacubitril/valsartan combines neprilysin inhibition with ARB effects, causing vasodilation and
potassium retention. Monitoring potassium and blood pressure prevents dangerous hyperkalemia and
symptomatic hypotension.
Q7: A 58-year-old male post-CABG day 3 has mediastinal chest tube drainage of 175 mL/hour for 2
hours. The patient is anxious, HR 128, BP 88/56. Which is the nurse's priority action?
A. Reassure the patient and continue monitoring.
B. Notify the surgeon immediately and prepare for possible mediastinal exploration. [CORRECT]
C. Administer a fluid bolus and increase chest tube suction.
D. Remove the chest tubes to relieve tension.
Correct Answer: B
Rationale: Mediastinal drainage exceeding 100–150 mL/hour for 2 hours post-CABG indicates significant
hemorrhage requiring surgical re-exploration. Immediate surgeon notification addresses the source of
bleeding before cardiovascular collapse occurs.
Q8: A patient with peripheral artery disease (PAD) has a non-healing ulcer on the lateral malleolus with
pale base and minimal granulation tissue. The nurse plans care. Which intervention is most appropriate?
A. Apply warm moist compresses to increase blood flow.
B. Keep the ulcer dry, protect from trauma, and avoid heat; refer to vascular surgery for
revascularization assessment. [CORRECT]
C. Elevate the leg above heart level continuously.
D. Massage the area to stimulate collateral circulation.
Correct Answer: B
Rationale: Ischemic PAD ulcers have poor perfusion and minimal healing capacity without
, revascularization. Protecting the limb from trauma and thermal injury prevents progression to gangrene
while vascular assessment determines intervention needs.
Q9: A patient with infective endocarditis has a new-onset headache, visual changes, and right-sided
weakness. Which complication does the nurse suspect?
A. Meningitis
B. Septic emboli causing stroke [CORRECT]
C. Hypoglycemia
D. Medication toxicity
Correct Answer: B
Rationale: Infective endocarditis produces valvular vegetations that fragment and embolize to cerebral
vessels. New neurological deficits indicate septic embolization requiring urgent imaging and potential
neurosurgical intervention.
Q10: A patient with third-degree AV block has a heart rate of 38 bpm, syncope, and hypotension. The
nurse prepares for which intervention?
A. Atropine 1 mg IV push.
B. Transcutaneous pacing pads placement and preparation for transvenous pacemaker. [CORRECT]
C. Dopamine infusion at 2 mcg/kg/min.
D. Defibrillation at 200 joules.
Correct Answer: B
Rationale: Symptomatic complete heart block with hemodynamic compromise requires immediate
cardiac pacing. Transcutaneous pacing provides temporary stabilization while preparing for definitive
transvenous pacemaker placement.
Q11: A patient with dilated cardiomyopathy (EF 20%) is being discharged on carvedilol, lisinopril,
spironolactone, and furosemide. The nurse teaches about daily weights. Which instruction is correct?
A. "Weigh yourself once weekly at any time of day."
B. "Weigh yourself every morning after urinating, before eating, wearing similar clothing, and report a 3-
pound gain in 1 day or 5 pounds in 1 week." [CORRECT]
C. "Weigh yourself after dinner for the most accurate reading."
D. "Only weigh yourself when you feel bloated or short of breath."
Correct Answer: B
Rationale: Daily morning weights under consistent conditions detect fluid retention early in heart
