HESI MED-SURG EXAM
COMPREHENSIVE REVIEW 2026 –
TOPIC TEST QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Cardiovascular Disorders
1. A client with heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which assessment finding is most concerning?
• A. Heart rate of 58 bpm
• B. Serum potassium of 3.1 mEq/L
*Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity,
leading to dysrhythmias. Digoxin should be held if HR <60 in an adult, but
potassium is more critical here.*
• C. Blood pressure 110/70 mmHg
• D. Urine output 30 mL/hr
2. A client presents with chest pain radiating to the jaw, diaphoresis, and
nausea. ECG shows ST-segment elevation in leads II, III, and aVF. Which
intervention is priority?
• A. Administer sublingual nitroglycerin
• B. Prepare for percutaneous coronary intervention (PCI)
*Rationale: ST-elevation MI (inferior wall) requires rapid reperfusion with PCI
within 90 minutes of arrival.*
, • C. Give morphine sulfate IV
• D. Obtain cardiac enzymes
3. A nurse is caring for a client post-cardiac catheterization via the femoral
artery. The client reports severe back pain and the insertion site is not bleeding.
What is the nurse’s priority action?
• A. Apply pressure to the insertion site
• B. Assess for retroperitoneal bleeding
Rationale: Severe back pain with stable insertion site suggests retroperitoneal
bleeding, a life-threatening complication.
• C. Increase IV fluids
• D. Reposition the client
4. A client with hypertension is started on lisinopril. Which adverse effect
requires immediate intervention?
• A. Dry cough
• B. Angioedema (swelling of lips/tongue)
Rationale: Angioedema is a serious allergic reaction to ACE inhibitors that can
compromise the airway.
• C. Dizziness
• D. Hyperkalemia
5. A client with atrial fibrillation is on warfarin (Coumadin). INR is 4.5. The
client has no active bleeding. What should the nurse do first?
• A. Administer vitamin K
• B. Hold the next dose of warfarin
*Rationale: INR goal for AF is 2-3. INR 4.5 without bleeding → hold warfarin
and notify provider; vitamin K reserved for bleeding or very high INR (>10).*
• C. Give protamine sulfate
• D. Increase warfarin dose
Respiratory Disorders
6. A client with COPD has an oxygen saturation of 86% on 2 L nasal cannula.
What is the best action?
• A. Increase O2 to 4 L
, • B. Assess respiratory rate and depth
Rationale: COPD clients rely on hypoxic drive; increasing O2 too rapidly may
depress ventilation. Assess first.
• C. Apply a non-rebreather mask
• D. Obtain a chest x-ray
7. A client post-operative day 1 after abdominal surgery has a temperature of
38.5°C (101.3°F), heart rate 110, and crackles in the right lower lobe. The nurse
suspects:
• A. Pulmonary embolism
• B. Atelectasis
Rationale: Early post-op fever with localized crackles suggests atelectasis due to
hypoventilation. Encourage incentive spirometry.
• C. Pneumonia
• D. Wound infection
8. A client with asthma is using a peak flow meter. The reading is 50% of
personal best. What should the nurse do?
• A. Continue monitoring
• B. Administer a rescue inhaler (albuterol)
*Rationale: Peak flow 50-80% indicates moderate exacerbation; <50%
indicates severe. Albuterol is indicated.*
• C. Call a rapid response
• D. Give oral prednisone
9. A client with a pulmonary embolism is on heparin drip. Which lab value
indicates therapeutic effect?
• A. INR 2.5
• B. aPTT 70 seconds (control 30)
*Rationale: Heparin therapeutic goal is aPTT 1.5–2.5 times normal (60-80
seconds).*
• C. Platelets 150,000
• D. Hemoglobin 14 g/dL
10. A client with pneumonia has a new onset of confusion and blood pressure
80/50 mmHg. What is the priority intervention?
• A. Administer antipyretic
• B. Start IV fluids and broad-spectrum antibiotics
Rationale: Confusion + hypotension in pneumonia suggests sepsis. Fluid
resuscitation and antibiotics are priority.
• C. Obtain sputum culture
COMPREHENSIVE REVIEW 2026 –
TOPIC TEST QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Cardiovascular Disorders
1. A client with heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which assessment finding is most concerning?
• A. Heart rate of 58 bpm
• B. Serum potassium of 3.1 mEq/L
*Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity,
leading to dysrhythmias. Digoxin should be held if HR <60 in an adult, but
potassium is more critical here.*
• C. Blood pressure 110/70 mmHg
• D. Urine output 30 mL/hr
2. A client presents with chest pain radiating to the jaw, diaphoresis, and
nausea. ECG shows ST-segment elevation in leads II, III, and aVF. Which
intervention is priority?
• A. Administer sublingual nitroglycerin
• B. Prepare for percutaneous coronary intervention (PCI)
*Rationale: ST-elevation MI (inferior wall) requires rapid reperfusion with PCI
within 90 minutes of arrival.*
, • C. Give morphine sulfate IV
• D. Obtain cardiac enzymes
3. A nurse is caring for a client post-cardiac catheterization via the femoral
artery. The client reports severe back pain and the insertion site is not bleeding.
What is the nurse’s priority action?
• A. Apply pressure to the insertion site
• B. Assess for retroperitoneal bleeding
Rationale: Severe back pain with stable insertion site suggests retroperitoneal
bleeding, a life-threatening complication.
• C. Increase IV fluids
• D. Reposition the client
4. A client with hypertension is started on lisinopril. Which adverse effect
requires immediate intervention?
• A. Dry cough
• B. Angioedema (swelling of lips/tongue)
Rationale: Angioedema is a serious allergic reaction to ACE inhibitors that can
compromise the airway.
• C. Dizziness
• D. Hyperkalemia
5. A client with atrial fibrillation is on warfarin (Coumadin). INR is 4.5. The
client has no active bleeding. What should the nurse do first?
• A. Administer vitamin K
• B. Hold the next dose of warfarin
*Rationale: INR goal for AF is 2-3. INR 4.5 without bleeding → hold warfarin
and notify provider; vitamin K reserved for bleeding or very high INR (>10).*
• C. Give protamine sulfate
• D. Increase warfarin dose
Respiratory Disorders
6. A client with COPD has an oxygen saturation of 86% on 2 L nasal cannula.
What is the best action?
• A. Increase O2 to 4 L
, • B. Assess respiratory rate and depth
Rationale: COPD clients rely on hypoxic drive; increasing O2 too rapidly may
depress ventilation. Assess first.
• C. Apply a non-rebreather mask
• D. Obtain a chest x-ray
7. A client post-operative day 1 after abdominal surgery has a temperature of
38.5°C (101.3°F), heart rate 110, and crackles in the right lower lobe. The nurse
suspects:
• A. Pulmonary embolism
• B. Atelectasis
Rationale: Early post-op fever with localized crackles suggests atelectasis due to
hypoventilation. Encourage incentive spirometry.
• C. Pneumonia
• D. Wound infection
8. A client with asthma is using a peak flow meter. The reading is 50% of
personal best. What should the nurse do?
• A. Continue monitoring
• B. Administer a rescue inhaler (albuterol)
*Rationale: Peak flow 50-80% indicates moderate exacerbation; <50%
indicates severe. Albuterol is indicated.*
• C. Call a rapid response
• D. Give oral prednisone
9. A client with a pulmonary embolism is on heparin drip. Which lab value
indicates therapeutic effect?
• A. INR 2.5
• B. aPTT 70 seconds (control 30)
*Rationale: Heparin therapeutic goal is aPTT 1.5–2.5 times normal (60-80
seconds).*
• C. Platelets 150,000
• D. Hemoglobin 14 g/dL
10. A client with pneumonia has a new onset of confusion and blood pressure
80/50 mmHg. What is the priority intervention?
• A. Administer antipyretic
• B. Start IV fluids and broad-spectrum antibiotics
Rationale: Confusion + hypotension in pneumonia suggests sepsis. Fluid
resuscitation and antibiotics are priority.
• C. Obtain sputum culture
