HESI Med Surg Exam Study Guide 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A 72-year-old male is admitted with acute decompensated heart failure. Vital signs: BP
168/94, HR 118, RR 28, SpO2 88% on room air. Assessment reveals bilateral crackles to
the apices, JVD +3, and 3+ pitting edema of the lower extremities. Which nursing action
is the highest priority?
A. Administer IV furosemide 40 mg as prescribed
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Obtain a 12-lead ECG
D. Insert a Foley catheter for strict intake and output monitoring
Correct Answer: B
Rationale: Using the ABC priority framework, this patient has acute hypoxemia (SpO2
88%) with signs of pulmonary edema. Oxygenation takes precedence over diuresis, ECG
acquisition, or urinary catheterization. While furosemide is critical for fluid removal, the
immediate threat is impaired gas exchange; supplemental oxygen must be initiated first
to improve oxygen saturation. Distractor A addresses the underlying pathophysiology
but does not address the immediate life-threatening hypoxemia. Distractor C is
important but not the highest priority in acute respiratory distress.
Question 2
A 68-year-old female post-MI day 3 develops sudden dyspnea, tachycardia, and
hypotension. A loud holosystolic murmur is auscultated at the apex. Which
complication should the nurse suspect?
A. Ventricular septal rupture
,B. Papillary muscle rupture with acute mitral regurgitation
C. Left ventricular free wall rupture
D. Right ventricular infarction
Correct Answer: B
Rationale: A new holosystolic murmur at the apex radiating to the axilla, accompanied
by acute pulmonary edema and hemodynamic collapse post-MI, is pathognomonic for
papillary muscle rupture causing acute mitral regurgitation. This typically occurs 2–7
days post-infarction. Distractor A (VSD) produces a holosystolic murmur at the left
sternal border with a thrill, not the apical location described. Distractor C presents with
tamponade physiology (Beck's triad) rather than a murmur. Distractor D causes JVD and
clear lungs, not pulmonary edema.
Question 3
The nurse is caring for four patients on a medical-surgical unit. Which patient should the
nurse assess first?
A. A 45-year-old post-appendectomy day 2 with pain 3/10 requesting oral analgesia
B. A 62-year-old with COPD on 2 L/min nasal cannula with SpO2 94%
C. A 78-year-old with new-onset atrial fibrillation, HR 154, BP 88/52, altered mental
status
D. A 55-year-old with stable angina awaiting discharge education
Correct Answer: C
Rationale: Using the unstable vs. stable priority framework, the patient with new-onset
atrial fibrillation with rapid ventricular response (RVR), hypotension, and altered mental
status is hemodynamically unstable and at risk for cardiovascular collapse, stroke, or
shock. This requires immediate assessment and potential synchronized cardioversion
per ACLS protocols. Distractor A is a stable post-op patient with mild pain. Distractor B
has acceptable oxygenation. Distractor D is stable and awaiting routine discharge
teaching.
, Question 4
A 58-year-old male with hypertension is prescribed lisinopril 10 mg daily. Which patient
teaching statement indicates correct understanding of this medication?
A. "I should stop taking this medication if I develop a dry cough."
B. "I need to check my blood pressure before taking each dose and hold it if systolic is
below 100."
C. "I should rise slowly from sitting to prevent dizziness from blood pressure drops."
D. "I can take ibuprofen regularly for arthritis pain while on this medication."
Correct Answer: C
Rationale: ACE inhibitors such as lisinopril can cause first-dose hypotension and
orthostatic hypotension; teaching patients to rise slowly prevents falls and injury.
Distractor A is incorrect because a dry cough, while common with ACE inhibitors, is not
an indication to discontinue without provider consultation—angioedema would be.
Distractor B describes inappropriate self-adjustment of antihypertensive therapy.
Distractor D is dangerous because NSAIDs reduce ACE inhibitor efficacy and increase
renal dysfunction risk.
Question 5
A patient with deep vein thrombosis is started on warfarin 5 mg daily while continuing
enoxaparin. The nurse reviews the patient's diet and notes consistent intake of leafy
green vegetables. Which laboratory value is most important to monitor?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Complete blood count with platelets
D. D-dimer level
Correct Answer: B
Rationale: Warfarin therapy requires INR monitoring to assess anticoagulation intensity,
with a typical therapeutic goal of 2.0–3.0 for DVT treatment. Vitamin K-rich foods (leafy
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A 72-year-old male is admitted with acute decompensated heart failure. Vital signs: BP
168/94, HR 118, RR 28, SpO2 88% on room air. Assessment reveals bilateral crackles to
the apices, JVD +3, and 3+ pitting edema of the lower extremities. Which nursing action
is the highest priority?
A. Administer IV furosemide 40 mg as prescribed
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Obtain a 12-lead ECG
D. Insert a Foley catheter for strict intake and output monitoring
Correct Answer: B
Rationale: Using the ABC priority framework, this patient has acute hypoxemia (SpO2
88%) with signs of pulmonary edema. Oxygenation takes precedence over diuresis, ECG
acquisition, or urinary catheterization. While furosemide is critical for fluid removal, the
immediate threat is impaired gas exchange; supplemental oxygen must be initiated first
to improve oxygen saturation. Distractor A addresses the underlying pathophysiology
but does not address the immediate life-threatening hypoxemia. Distractor C is
important but not the highest priority in acute respiratory distress.
Question 2
A 68-year-old female post-MI day 3 develops sudden dyspnea, tachycardia, and
hypotension. A loud holosystolic murmur is auscultated at the apex. Which
complication should the nurse suspect?
A. Ventricular septal rupture
,B. Papillary muscle rupture with acute mitral regurgitation
C. Left ventricular free wall rupture
D. Right ventricular infarction
Correct Answer: B
Rationale: A new holosystolic murmur at the apex radiating to the axilla, accompanied
by acute pulmonary edema and hemodynamic collapse post-MI, is pathognomonic for
papillary muscle rupture causing acute mitral regurgitation. This typically occurs 2–7
days post-infarction. Distractor A (VSD) produces a holosystolic murmur at the left
sternal border with a thrill, not the apical location described. Distractor C presents with
tamponade physiology (Beck's triad) rather than a murmur. Distractor D causes JVD and
clear lungs, not pulmonary edema.
Question 3
The nurse is caring for four patients on a medical-surgical unit. Which patient should the
nurse assess first?
A. A 45-year-old post-appendectomy day 2 with pain 3/10 requesting oral analgesia
B. A 62-year-old with COPD on 2 L/min nasal cannula with SpO2 94%
C. A 78-year-old with new-onset atrial fibrillation, HR 154, BP 88/52, altered mental
status
D. A 55-year-old with stable angina awaiting discharge education
Correct Answer: C
Rationale: Using the unstable vs. stable priority framework, the patient with new-onset
atrial fibrillation with rapid ventricular response (RVR), hypotension, and altered mental
status is hemodynamically unstable and at risk for cardiovascular collapse, stroke, or
shock. This requires immediate assessment and potential synchronized cardioversion
per ACLS protocols. Distractor A is a stable post-op patient with mild pain. Distractor B
has acceptable oxygenation. Distractor D is stable and awaiting routine discharge
teaching.
, Question 4
A 58-year-old male with hypertension is prescribed lisinopril 10 mg daily. Which patient
teaching statement indicates correct understanding of this medication?
A. "I should stop taking this medication if I develop a dry cough."
B. "I need to check my blood pressure before taking each dose and hold it if systolic is
below 100."
C. "I should rise slowly from sitting to prevent dizziness from blood pressure drops."
D. "I can take ibuprofen regularly for arthritis pain while on this medication."
Correct Answer: C
Rationale: ACE inhibitors such as lisinopril can cause first-dose hypotension and
orthostatic hypotension; teaching patients to rise slowly prevents falls and injury.
Distractor A is incorrect because a dry cough, while common with ACE inhibitors, is not
an indication to discontinue without provider consultation—angioedema would be.
Distractor B describes inappropriate self-adjustment of antihypertensive therapy.
Distractor D is dangerous because NSAIDs reduce ACE inhibitor efficacy and increase
renal dysfunction risk.
Question 5
A patient with deep vein thrombosis is started on warfarin 5 mg daily while continuing
enoxaparin. The nurse reviews the patient's diet and notes consistent intake of leafy
green vegetables. Which laboratory value is most important to monitor?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Complete blood count with platelets
D. D-dimer level
Correct Answer: B
Rationale: Warfarin therapy requires INR monitoring to assess anticoagulation intensity,
with a typical therapeutic goal of 2.0–3.0 for DVT treatment. Vitamin K-rich foods (leafy
