HESI RN MedSurg V2 (PDF) | (2026) Nursing Exam
Questions | Medical Surgical
1. A client with heart failure is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate
action?
A. Serum potassium 3.8 mEq/L
B. Urine output 30 mL/hour
C. Bilateral crackles in lung bases
D. Blood pressure 90/60 mm Hg
Answer: D
RATIONALE: Hypotension (90/60 mm Hg) indicates
potential hypovolemia or excessive vasodilation.
Furosemide is a loop diuretic that reduces preload; giving
it when BP is already low can cause further hypotension,
leading to decreased organ perfusion (kidneys, brain).
Crackles are expected in heart failure. Potassium 3.8 is
normal. Urine output 30 mL/hour is acceptable.
1
,2. The nurse is caring for a client post-cardiac
catheterization via the femoral artery. The client reports
severe groin pain and a drop in hemoglobin. What is the
priority action?
A. Administer prescribed PRN acetaminophen
B. Assess the groin site for hematoma
C. Apply manual pressure above the insertion site
D. Document the findings
Answer: C
RATIONALE: Severe groin pain plus a drop in hemoglobin
after femoral artery catheterization suggests
retroperitoneal bleeding, a life-threatening complication.
Manual pressure above the insertion site (toward the
abdomen) compresses the femoral artery to control
bleeding. Acetaminophen does not treat bleeding. A
visible hematoma may not be present in retroperitoneal
bleeding.
2
,3. A client with unstable angina is on a heparin drip.
Which laboratory value indicates therapeutic effect?
A. aPTT 60 seconds (control 30 seconds)
B. INR 2.5
C. Platelets 150,000/mm³
D. PT 12 seconds
Answer: A
RATIONALE: For IV unfractionated heparin, the
therapeutic goal is an aPTT of 1.5 to 2.5 times the control
value. Control 30 seconds × 2 = 60 seconds, which is
therapeutic. INR monitors warfarin, not heparin. PT
monitors extrinsic pathway. Platelets assess for
thrombocytopenia, not therapeutic effect.
4. Which client is at highest risk for developing deep vein
thrombosis (DVT)?
A. Postoperative day 1 from knee replacement
B. Client with heart failure on diuretics
3
, C. Young adult with ankle sprain on bed rest
D. Client with pneumonia ambulating with assistance
Answer: A
RATIONALE: Major orthopedic surgery (knee replacement)
plus postoperative immobilization creates Virchow’s triad:
venous stasis, hypercoagulability, and vessel wall
damage. This is the highest DVT risk. Heart failure has
some risk but less than major surgery.
5. A client with COPD has an oxygen saturation of 88%
on 2 L/min nasal cannula. The nurse increases oxygen to
3 L/min. Thirty minutes later, the client is lethargic and
confused. What is the probable cause?
A. Carbon dioxide narcosis
B. Increased intracranial pressure
C. Acute asthma exacerbation
D. Pulmonary embolism
4
Questions | Medical Surgical
1. A client with heart failure is prescribed furosemide 40
mg IV push. Which assessment finding requires immediate
action?
A. Serum potassium 3.8 mEq/L
B. Urine output 30 mL/hour
C. Bilateral crackles in lung bases
D. Blood pressure 90/60 mm Hg
Answer: D
RATIONALE: Hypotension (90/60 mm Hg) indicates
potential hypovolemia or excessive vasodilation.
Furosemide is a loop diuretic that reduces preload; giving
it when BP is already low can cause further hypotension,
leading to decreased organ perfusion (kidneys, brain).
Crackles are expected in heart failure. Potassium 3.8 is
normal. Urine output 30 mL/hour is acceptable.
1
,2. The nurse is caring for a client post-cardiac
catheterization via the femoral artery. The client reports
severe groin pain and a drop in hemoglobin. What is the
priority action?
A. Administer prescribed PRN acetaminophen
B. Assess the groin site for hematoma
C. Apply manual pressure above the insertion site
D. Document the findings
Answer: C
RATIONALE: Severe groin pain plus a drop in hemoglobin
after femoral artery catheterization suggests
retroperitoneal bleeding, a life-threatening complication.
Manual pressure above the insertion site (toward the
abdomen) compresses the femoral artery to control
bleeding. Acetaminophen does not treat bleeding. A
visible hematoma may not be present in retroperitoneal
bleeding.
2
,3. A client with unstable angina is on a heparin drip.
Which laboratory value indicates therapeutic effect?
A. aPTT 60 seconds (control 30 seconds)
B. INR 2.5
C. Platelets 150,000/mm³
D. PT 12 seconds
Answer: A
RATIONALE: For IV unfractionated heparin, the
therapeutic goal is an aPTT of 1.5 to 2.5 times the control
value. Control 30 seconds × 2 = 60 seconds, which is
therapeutic. INR monitors warfarin, not heparin. PT
monitors extrinsic pathway. Platelets assess for
thrombocytopenia, not therapeutic effect.
4. Which client is at highest risk for developing deep vein
thrombosis (DVT)?
A. Postoperative day 1 from knee replacement
B. Client with heart failure on diuretics
3
, C. Young adult with ankle sprain on bed rest
D. Client with pneumonia ambulating with assistance
Answer: A
RATIONALE: Major orthopedic surgery (knee replacement)
plus postoperative immobilization creates Virchow’s triad:
venous stasis, hypercoagulability, and vessel wall
damage. This is the highest DVT risk. Heart failure has
some risk but less than major surgery.
5. A client with COPD has an oxygen saturation of 88%
on 2 L/min nasal cannula. The nurse increases oxygen to
3 L/min. Thirty minutes later, the client is lethargic and
confused. What is the probable cause?
A. Carbon dioxide narcosis
B. Increased intracranial pressure
C. Acute asthma exacerbation
D. Pulmonary embolism
4
