HESI Med Surg Final Exam Adult
Medical-Surgical Nursing Comprehensive
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is admitted with chest pain rated 8/10 that began 45 minutes ago while
mowing the lawn. Vital signs: BP 92/58, HR 112, RR 24, SpO2 91% on room air. The 12-lead
ECG shows ST-segment elevation in leads V1–V4. The nurse receives orders for morphine,
aspirin, nitroglycerin, and metoprolol. Which medication should the nurse administer first?
A. Morphine sulfate 2 mg IV push for pain relief
B. Aspirin 325 mg chewable for antiplatelet effect
C. Nitroglycerin 0.4 mg sublingual for vasodilation
D. Metoprolol 25 mg PO for rate control ✓ CORRECT
Correct Answer: D
Rationale: In an inferior wall MI with ST elevation in V1–V4, the priority is to assess for right
ventricular involvement before giving nitroglycerin, which can cause profound hypotension in
right ventricular infarction. Metoprolol should be held if the patient is hypotensive (SBP <90),
has signs of heart failure, or has right ventricular involvement, making it the medication that
requires the most careful clinical assessment before administration. Aspirin is standard and
safe to give immediately, and morphine is appropriate for unrelieved pain, but neither carries
the same risk of hemodynamic collapse as a beta-blocker in this unstable patient. HESI exam
strategy: Always check vital signs and ECG findings before administering beta-blockers or
nitrates in acute MI — hemodynamic stability determines medication safety.
Question 2 of 50
,A 54-year-old female with a history of atrial fibrillation on warfarin therapy presents to the
emergency department after a fall from a stepladder. Her INR is 6.8, and a CT scan reveals a
small subdural hematoma. The provider orders vitamin K 10 mg IV and fresh frozen plasma
(FFP). The nurse should anticipate administering the FFP within what timeframe to achieve
rapid reversal of warfarin effect?
A. Over 4 hours to prevent fluid overload
B. Within 30 minutes of starting the vitamin K infusion
C. As a rapid infusion over 15–30 minutes ✓ CORRECT
D. Over 2 hours concurrent with the vitamin K drip
Correct Answer: C
Rationale: Fresh frozen plasma must be administered as a rapid infusion over 15–30 minutes
to achieve immediate reversal of warfarin's anticoagulant effect, as FFP contains clotting
factors II, VII, IX, and X that are depleted by warfarin. Vitamin K takes 6–12 hours to
synthesize new clotting factors, so it does not address the acute bleeding risk in this patient
with an intracranial hemorrhage. Administering FFP over 4 hours or 2 hours would delay
factor replacement and allow continued bleeding into the subdural space, which is
life-threatening. HESI clinical pearl: In warfarin-associated intracranial hemorrhage, the goal
is immediate reversal with FFP or four-factor prothrombin complex concentrate; vitamin K is
adjunctive therapy for sustained reversal.
Question 3 of 50
A 72-year-old male with chronic heart failure is receiving IV furosemide 80 mg every 8 hours
for acute pulmonary edema. On the second day of therapy, the nurse notes muscle weakness,
diminished deep tendon reflexes, and a cardiac rhythm strip showing flattened T waves with
prominent U waves. Which electrolyte imbalance should the nurse suspect, and what is the
priority intervention?
A. Hyperkalemia; prepare to administer sodium polystyrene sulfonate
B. Hypokalemia; obtain a serum potassium level and hold the next dose of furosemide ✓
CORRECT
C. Hyponatremia; restrict free water intake and monitor neurologic status
D. Hypomagnesemia; administer magnesium sulfate 2 g IV push
Correct Answer: B
Rationale: Loop diuretics such as furosemide cause significant renal potassium wasting, and
the clinical presentation of muscle weakness, hyporeflexia, flattened T waves, and prominent
U waves on ECG is classic for hypokalemia. The priority intervention is to obtain a serum
potassium level to confirm the degree of depletion and hold the next dose of furosemide to
prevent further potassium loss until repletion is initiated. Hyperkalemia would present with
peaked T waves and widened QRS complexes, not flattened T waves and U waves, and
hyponatremia typically causes mental status changes rather than specific ECG abnormalities.
, HESI exam strategy: Always connect loop diuretic therapy to potassium and magnesium
monitoring — HESI frequently tests the cardiac consequences of electrolyte disturbances
caused by common medications.
Question 4 of 50
A 61-year-old female is admitted with new-onset heart failure with reduced ejection fraction
(HFrEF) at 30%. The provider orders lisinopril 5 mg PO daily, metoprolol succinate 25 mg PO
daily, and furosemide 40 mg PO daily. The nurse is reviewing the medication administration
schedule and recognizes that which medication should be initiated first before the others are
added?
A. Furosemide 40 mg PO daily to reduce preload and relieve congestion
B. Lisinopril 5 mg PO daily to inhibit the renin-angiotensin-aldosterone system ✓ CORRECT
C. Metoprolol succinate 25 mg PO daily to block sympathetic overstimulation
D. All three medications can be started simultaneously on day one
Correct Answer: B
Rationale: Current heart failure guidelines recommend initiating an ACE inhibitor such as
lisinopril first in HFrEF to reduce afterload, inhibit pathologic cardiac remodeling, and improve
survival, with beta-blockers added only after the patient is euvolemic and hemodynamically
stable. Starting metoprolol before adequate diuresis and ACE inhibitor titration can worsen
heart failure symptoms due to negative inotropic effects, and while furosemide addresses
congestion, it does not provide mortality benefit. HESI clinical pearl: The standard sequence
for HFrEF medication initiation is ACE inhibitor/ARB first, then beta-blocker once stable, then
aldosterone antagonist — this order of operations is frequently tested on medical-surgical
nursing exams.
Question 5 of 50
A 45-year-old male with sickle cell disease is admitted in vaso-occlusive crisis with severe
bilateral leg pain rated 9/10. His hemoglobin is 7.2 g/dL, and he is receiving IV morphine via
patient-controlled analgesia. The nurse notes that his oxygen saturation is 92% on 2 L nasal
cannula, and he reports increasing shortness of breath. Which intervention is the priority?
A. Increase the PCA morphine dose to achieve better pain control
B. Apply supplemental oxygen to maintain SpO2 at 94% or higher ✓ CORRECT
C. Administer a bolus of normal saline to improve perfusion
D. Prepare the patient for emergent exchange transfusion
Correct Answer: B
Rationale: Hypoxemia in a patient with sickle cell disease during vaso-occlusive crisis is a
priority concern because decreased oxygen tension promotes further sickling and can
precipitate acute chest syndrome, a leading cause of mortality in this population. Maintaining
Medical-Surgical Nursing Comprehensive
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is admitted with chest pain rated 8/10 that began 45 minutes ago while
mowing the lawn. Vital signs: BP 92/58, HR 112, RR 24, SpO2 91% on room air. The 12-lead
ECG shows ST-segment elevation in leads V1–V4. The nurse receives orders for morphine,
aspirin, nitroglycerin, and metoprolol. Which medication should the nurse administer first?
A. Morphine sulfate 2 mg IV push for pain relief
B. Aspirin 325 mg chewable for antiplatelet effect
C. Nitroglycerin 0.4 mg sublingual for vasodilation
D. Metoprolol 25 mg PO for rate control ✓ CORRECT
Correct Answer: D
Rationale: In an inferior wall MI with ST elevation in V1–V4, the priority is to assess for right
ventricular involvement before giving nitroglycerin, which can cause profound hypotension in
right ventricular infarction. Metoprolol should be held if the patient is hypotensive (SBP <90),
has signs of heart failure, or has right ventricular involvement, making it the medication that
requires the most careful clinical assessment before administration. Aspirin is standard and
safe to give immediately, and morphine is appropriate for unrelieved pain, but neither carries
the same risk of hemodynamic collapse as a beta-blocker in this unstable patient. HESI exam
strategy: Always check vital signs and ECG findings before administering beta-blockers or
nitrates in acute MI — hemodynamic stability determines medication safety.
Question 2 of 50
,A 54-year-old female with a history of atrial fibrillation on warfarin therapy presents to the
emergency department after a fall from a stepladder. Her INR is 6.8, and a CT scan reveals a
small subdural hematoma. The provider orders vitamin K 10 mg IV and fresh frozen plasma
(FFP). The nurse should anticipate administering the FFP within what timeframe to achieve
rapid reversal of warfarin effect?
A. Over 4 hours to prevent fluid overload
B. Within 30 minutes of starting the vitamin K infusion
C. As a rapid infusion over 15–30 minutes ✓ CORRECT
D. Over 2 hours concurrent with the vitamin K drip
Correct Answer: C
Rationale: Fresh frozen plasma must be administered as a rapid infusion over 15–30 minutes
to achieve immediate reversal of warfarin's anticoagulant effect, as FFP contains clotting
factors II, VII, IX, and X that are depleted by warfarin. Vitamin K takes 6–12 hours to
synthesize new clotting factors, so it does not address the acute bleeding risk in this patient
with an intracranial hemorrhage. Administering FFP over 4 hours or 2 hours would delay
factor replacement and allow continued bleeding into the subdural space, which is
life-threatening. HESI clinical pearl: In warfarin-associated intracranial hemorrhage, the goal
is immediate reversal with FFP or four-factor prothrombin complex concentrate; vitamin K is
adjunctive therapy for sustained reversal.
Question 3 of 50
A 72-year-old male with chronic heart failure is receiving IV furosemide 80 mg every 8 hours
for acute pulmonary edema. On the second day of therapy, the nurse notes muscle weakness,
diminished deep tendon reflexes, and a cardiac rhythm strip showing flattened T waves with
prominent U waves. Which electrolyte imbalance should the nurse suspect, and what is the
priority intervention?
A. Hyperkalemia; prepare to administer sodium polystyrene sulfonate
B. Hypokalemia; obtain a serum potassium level and hold the next dose of furosemide ✓
CORRECT
C. Hyponatremia; restrict free water intake and monitor neurologic status
D. Hypomagnesemia; administer magnesium sulfate 2 g IV push
Correct Answer: B
Rationale: Loop diuretics such as furosemide cause significant renal potassium wasting, and
the clinical presentation of muscle weakness, hyporeflexia, flattened T waves, and prominent
U waves on ECG is classic for hypokalemia. The priority intervention is to obtain a serum
potassium level to confirm the degree of depletion and hold the next dose of furosemide to
prevent further potassium loss until repletion is initiated. Hyperkalemia would present with
peaked T waves and widened QRS complexes, not flattened T waves and U waves, and
hyponatremia typically causes mental status changes rather than specific ECG abnormalities.
, HESI exam strategy: Always connect loop diuretic therapy to potassium and magnesium
monitoring — HESI frequently tests the cardiac consequences of electrolyte disturbances
caused by common medications.
Question 4 of 50
A 61-year-old female is admitted with new-onset heart failure with reduced ejection fraction
(HFrEF) at 30%. The provider orders lisinopril 5 mg PO daily, metoprolol succinate 25 mg PO
daily, and furosemide 40 mg PO daily. The nurse is reviewing the medication administration
schedule and recognizes that which medication should be initiated first before the others are
added?
A. Furosemide 40 mg PO daily to reduce preload and relieve congestion
B. Lisinopril 5 mg PO daily to inhibit the renin-angiotensin-aldosterone system ✓ CORRECT
C. Metoprolol succinate 25 mg PO daily to block sympathetic overstimulation
D. All three medications can be started simultaneously on day one
Correct Answer: B
Rationale: Current heart failure guidelines recommend initiating an ACE inhibitor such as
lisinopril first in HFrEF to reduce afterload, inhibit pathologic cardiac remodeling, and improve
survival, with beta-blockers added only after the patient is euvolemic and hemodynamically
stable. Starting metoprolol before adequate diuresis and ACE inhibitor titration can worsen
heart failure symptoms due to negative inotropic effects, and while furosemide addresses
congestion, it does not provide mortality benefit. HESI clinical pearl: The standard sequence
for HFrEF medication initiation is ACE inhibitor/ARB first, then beta-blocker once stable, then
aldosterone antagonist — this order of operations is frequently tested on medical-surgical
nursing exams.
Question 5 of 50
A 45-year-old male with sickle cell disease is admitted in vaso-occlusive crisis with severe
bilateral leg pain rated 9/10. His hemoglobin is 7.2 g/dL, and he is receiving IV morphine via
patient-controlled analgesia. The nurse notes that his oxygen saturation is 92% on 2 L nasal
cannula, and he reports increasing shortness of breath. Which intervention is the priority?
A. Increase the PCA morphine dose to achieve better pain control
B. Apply supplemental oxygen to maintain SpO2 at 94% or higher ✓ CORRECT
C. Administer a bolus of normal saline to improve perfusion
D. Prepare the patient for emergent exchange transfusion
Correct Answer: B
Rationale: Hypoxemia in a patient with sickle cell disease during vaso-occlusive crisis is a
priority concern because decreased oxygen tension promotes further sickling and can
precipitate acute chest syndrome, a leading cause of mortality in this population. Maintaining
