Evolve Elsevier HESI Med-Surg Exam
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 – Q12
══════════════════════════════════════
Question 1 of 60
A 68-year-old male with a history of hypertension and hyperlipidemia is admitted with
crushing substernal chest pain radiating to his left jaw. Vital signs are BP 92/58, HR 112, RR
24, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in leads V1–V4.
After initiating oxygen and establishing IV access, which intervention is the nurse's
immediate priority?
A. Administer morphine sulfate 2 mg IV push for pain relief
B. Assist the provider with obtaining informed consent for emergent percutaneous coronary
intervention ✓ CORRECT
C. Give aspirin 325 mg chewable and sublingual nitroglycerin 0.4 mg
D. Insert a urinary catheter and prepare the patient for transfer to the step-down unit
Correct Answer: B
Rationale: In a patient with STEMI and hemodynamic instability, the priority is rapid
reperfusion therapy, and PCI is the preferred strategy when available within 90 minutes of first
medical contact. Delays in obtaining consent or mobilizing the cath lab directly increase
mortality and infarct size. While morphine and aspirin are appropriate adjuncts, they must not
delay the primary intervention, and sending this unstable patient to a step-down unit would be
dangerous given his hypotension and hypoxemia. HESI often tests the "time is muscle"
principle — look for the action that most directly restores coronary perfusion.
Question 2 of 60
,A 54-year-old female with newly diagnosed heart failure is prescribed lisinopril 10 mg daily,
furosemide 40 mg daily, and carvedilol 3.125 mg twice daily. During the discharge teaching
session, she states, "I feel much better now, so I can stop these diuretics once my swelling
goes down." Which response by the nurse best addresses this misconception?
A. "You should never stop any medication without asking your cardiologist first."
B. "The diuretic is only temporary until your heart fully recovers."
C. "Heart failure requires lifelong therapy; stopping furosemide will cause fluid to
reaccumulate and worsen your symptoms." ✓ CORRECT
D. "Your blood pressure will drop too low if you stop the diuretic suddenly."
Correct Answer: C
Rationale: Heart failure is a chronic, progressive condition managed with lifelong
pharmacotherapy, and diuretics control fluid volume to prevent pulmonary congestion and
peripheral edema. Stopping furosemide abruptly leads to fluid retention, increased preload,
and acute decompensation. While involving the cardiologist is wise, option C directly
corrects the misconception with a clear physiologic explanation, whereas option B falsely
implies recovery is possible and option D confuses the mechanism with antihypertensive
withdrawal. HESI Med-Surg frequently tests patient education around chronic disease
self-management and the consequences of nonadherence.
Question 3 of 60
A 72-year-old male with atrial fibrillation on warfarin therapy presents to the emergency
department after a fall. His INR is 6.8, and a CT scan reveals a small subdural hematoma. The
provider orders vitamin K 10 mg subcutaneously and fresh frozen plasma. Which assessment
finding during the FFP infusion requires the most immediate nursing intervention?
A. The patient reports mild itching at the IV insertion site
B. The blood pressure rises from 118/72 to 136/84 mmHg
C. The patient develops dyspnea, wheezing, and a drop in SpO2 to 88% ✓ CORRECT
D. The heart rate increases from 78 to 96 beats per minute
Correct Answer: C
Rationale: Dyspnea, wheezing, and hypoxemia during plasma infusion are classic signs of a
transfusion-related acute lung injury or anaphylactic reaction, which is life-threatening and
requires immediate cessation of the infusion, airway support, and provider notification. Mild
itching may indicate a minor allergic reaction but is not emergent, while modest changes in
blood pressure or heart rate are expected physiologic responses to volume expansion. HESI
prioritization questions reward recognition of respiratory compromise during blood product
administration, as TRALI and TACO are high-yield exam topics.
Question 4 of 60
,A 61-year-old female is admitted with severe anemia secondary to menorrhagia. Her
hemoglobin is 6.2 g/dL, hematocrit is 19%, and she reports dyspnea on exertion and
palpitations when climbing stairs. Two units of packed red blood cells are ordered. Before
initiating the transfusion, which action is most essential for the nurse to perform?
A. Verify that the patient has signed a consent form for blood administration
B. Assess the patient's temperature and compare it to the baseline reading
C. Ensure two licensed nurses independently check the blood product at the bedside with the
patient ✓ CORRECT
D. Document the blood type and crossmatch results in the electronic health record
Correct Answer: C
Rationale: The Joint Commission and AABB standards mandate that two qualified healthcare
providers verify the blood product, patient identity, and compatibility at the bedside before any
transfusion begins, as this is the final critical safety check to prevent a hemolytic transfusion
reaction. While informed consent and documentation are required, they do not directly
prevent the immediate lethal risk of a mismatched transfusion, and a temperature check
alone is insufficient pre-transfusion assessment. HESI often embeds this safety protocol in
clinical scenarios where the nurse must identify the action that most directly prevents a
catastrophic error.
Question 5 of 60
A 58-year-old male with a history of hypertension reports to the clinic for a follow-up visit.
His home blood pressure log shows readings consistently between 158/96 and 164/100
mmHg over the past three weeks. He currently takes hydrochlorothiazide 25 mg daily. Which
modification to his plan of care is most appropriate at this time?
A. Add a beta-blocker and instruct the patient to restrict sodium intake to less than 3 grams
daily
B. Initiate a second antihypertensive agent from a different pharmacologic class and
schedule a return visit in 2–4 weeks ✓ CORRECT
C. Increase the hydrochlorothiazide dose to 50 mg daily and add a calcium channel blocker
D. Recommend lifestyle modifications only and reassess blood pressure in 6 months
Correct Answer: B
Rationale: According to JNC-8 and current hypertension guidelines, uncontrolled stage 2
hypertension on a single thiazide diuretic warrants combination therapy with an agent from a
complementary class, such as an ACE inhibitor, ARB, or calcium channel blocker, with close
follow-up to evaluate response and adherence. Lifestyle modifications alone are insufficient
for sustained stage 2 readings, and doubling the diuretic dose without adding a second
mechanism is less effective than guideline-directed combination therapy. HESI Med-Surg
questions often test stepwise hypertension management and the importance of timely
pharmacologic escalation rather than passive observation.
, Question 6 of 60
A 49-year-old female with mitral valve prolapse is scheduled for valve replacement surgery.
During the preoperative assessment, she asks the nurse why she must take prophylactic
antibiotics before certain dental procedures. Which explanation by the nurse is most
accurate?
A. "The antibiotics will boost your immune system before the dentist begins working."
B. "Bacteria from the mouth can enter your bloodstream during dental work and infect the
artificial valve." ✓ CORRECT
C. "Antibiotics are required to prevent a fungal infection from developing in your surgical
wound."
D. "Your surgeon wants to make sure you do not develop a postoperative pneumonia."
Correct Answer: B
Rationale: Patients with prosthetic heart valves or certain native valve disorders are at high
risk for infective endocarditis, which can occur when transient bacteremia from dental
instrumentation seeds the valve tissue. Prophylactic antibiotics target viridans group
streptococci and other oral flora, not fungi or respiratory pathogens, and they do not enhance
systemic immunity. HESI frequently tests endocarditis prophylaxis indications in the context
of cardiac surgery, and the correct answer must reflect the specific mechanism of
hematogenous bacterial seeding rather than generalized infection prevention.
Question 7 of 60
A 76-year-old male with chronic heart failure is admitted with a 3-pound weight gain over two
days, increasing dyspnea, and bilateral crackles on auscultation. He is receiving furosemide
80 mg IV twice daily. During the morning assessment, the nurse notes that his urine output
over the past 8 hours was 1800 mL. Which laboratory value should the nurse monitor most
closely during this aggressive diuresis?
A. Serum potassium ✓ CORRECT
B. Hemoglobin
C. Serum albumin
D. Prothrombin time
Correct Answer: A
Rationale: Loop diuretics such as furosemide promote potassium wasting in the distal
nephron, and aggressive diuresis in heart failure patients places them at high risk for
hypokalemia, which can precipitate life-threatening ventricular dysrhythmias. While
hemoglobin and albumin reflect nutritional and oxygen-carrying status, and coagulation
studies are relevant in anticoagulated patients, potassium is the most immediately
dangerous electrolyte to lose during high-dose loop diuretic therapy. HESI Med-Surg
questions often pair heart failure exacerbations with electrolyte monitoring priorities,
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 – Q12
══════════════════════════════════════
Question 1 of 60
A 68-year-old male with a history of hypertension and hyperlipidemia is admitted with
crushing substernal chest pain radiating to his left jaw. Vital signs are BP 92/58, HR 112, RR
24, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in leads V1–V4.
After initiating oxygen and establishing IV access, which intervention is the nurse's
immediate priority?
A. Administer morphine sulfate 2 mg IV push for pain relief
B. Assist the provider with obtaining informed consent for emergent percutaneous coronary
intervention ✓ CORRECT
C. Give aspirin 325 mg chewable and sublingual nitroglycerin 0.4 mg
D. Insert a urinary catheter and prepare the patient for transfer to the step-down unit
Correct Answer: B
Rationale: In a patient with STEMI and hemodynamic instability, the priority is rapid
reperfusion therapy, and PCI is the preferred strategy when available within 90 minutes of first
medical contact. Delays in obtaining consent or mobilizing the cath lab directly increase
mortality and infarct size. While morphine and aspirin are appropriate adjuncts, they must not
delay the primary intervention, and sending this unstable patient to a step-down unit would be
dangerous given his hypotension and hypoxemia. HESI often tests the "time is muscle"
principle — look for the action that most directly restores coronary perfusion.
Question 2 of 60
,A 54-year-old female with newly diagnosed heart failure is prescribed lisinopril 10 mg daily,
furosemide 40 mg daily, and carvedilol 3.125 mg twice daily. During the discharge teaching
session, she states, "I feel much better now, so I can stop these diuretics once my swelling
goes down." Which response by the nurse best addresses this misconception?
A. "You should never stop any medication without asking your cardiologist first."
B. "The diuretic is only temporary until your heart fully recovers."
C. "Heart failure requires lifelong therapy; stopping furosemide will cause fluid to
reaccumulate and worsen your symptoms." ✓ CORRECT
D. "Your blood pressure will drop too low if you stop the diuretic suddenly."
Correct Answer: C
Rationale: Heart failure is a chronic, progressive condition managed with lifelong
pharmacotherapy, and diuretics control fluid volume to prevent pulmonary congestion and
peripheral edema. Stopping furosemide abruptly leads to fluid retention, increased preload,
and acute decompensation. While involving the cardiologist is wise, option C directly
corrects the misconception with a clear physiologic explanation, whereas option B falsely
implies recovery is possible and option D confuses the mechanism with antihypertensive
withdrawal. HESI Med-Surg frequently tests patient education around chronic disease
self-management and the consequences of nonadherence.
Question 3 of 60
A 72-year-old male with atrial fibrillation on warfarin therapy presents to the emergency
department after a fall. His INR is 6.8, and a CT scan reveals a small subdural hematoma. The
provider orders vitamin K 10 mg subcutaneously and fresh frozen plasma. Which assessment
finding during the FFP infusion requires the most immediate nursing intervention?
A. The patient reports mild itching at the IV insertion site
B. The blood pressure rises from 118/72 to 136/84 mmHg
C. The patient develops dyspnea, wheezing, and a drop in SpO2 to 88% ✓ CORRECT
D. The heart rate increases from 78 to 96 beats per minute
Correct Answer: C
Rationale: Dyspnea, wheezing, and hypoxemia during plasma infusion are classic signs of a
transfusion-related acute lung injury or anaphylactic reaction, which is life-threatening and
requires immediate cessation of the infusion, airway support, and provider notification. Mild
itching may indicate a minor allergic reaction but is not emergent, while modest changes in
blood pressure or heart rate are expected physiologic responses to volume expansion. HESI
prioritization questions reward recognition of respiratory compromise during blood product
administration, as TRALI and TACO are high-yield exam topics.
Question 4 of 60
,A 61-year-old female is admitted with severe anemia secondary to menorrhagia. Her
hemoglobin is 6.2 g/dL, hematocrit is 19%, and she reports dyspnea on exertion and
palpitations when climbing stairs. Two units of packed red blood cells are ordered. Before
initiating the transfusion, which action is most essential for the nurse to perform?
A. Verify that the patient has signed a consent form for blood administration
B. Assess the patient's temperature and compare it to the baseline reading
C. Ensure two licensed nurses independently check the blood product at the bedside with the
patient ✓ CORRECT
D. Document the blood type and crossmatch results in the electronic health record
Correct Answer: C
Rationale: The Joint Commission and AABB standards mandate that two qualified healthcare
providers verify the blood product, patient identity, and compatibility at the bedside before any
transfusion begins, as this is the final critical safety check to prevent a hemolytic transfusion
reaction. While informed consent and documentation are required, they do not directly
prevent the immediate lethal risk of a mismatched transfusion, and a temperature check
alone is insufficient pre-transfusion assessment. HESI often embeds this safety protocol in
clinical scenarios where the nurse must identify the action that most directly prevents a
catastrophic error.
Question 5 of 60
A 58-year-old male with a history of hypertension reports to the clinic for a follow-up visit.
His home blood pressure log shows readings consistently between 158/96 and 164/100
mmHg over the past three weeks. He currently takes hydrochlorothiazide 25 mg daily. Which
modification to his plan of care is most appropriate at this time?
A. Add a beta-blocker and instruct the patient to restrict sodium intake to less than 3 grams
daily
B. Initiate a second antihypertensive agent from a different pharmacologic class and
schedule a return visit in 2–4 weeks ✓ CORRECT
C. Increase the hydrochlorothiazide dose to 50 mg daily and add a calcium channel blocker
D. Recommend lifestyle modifications only and reassess blood pressure in 6 months
Correct Answer: B
Rationale: According to JNC-8 and current hypertension guidelines, uncontrolled stage 2
hypertension on a single thiazide diuretic warrants combination therapy with an agent from a
complementary class, such as an ACE inhibitor, ARB, or calcium channel blocker, with close
follow-up to evaluate response and adherence. Lifestyle modifications alone are insufficient
for sustained stage 2 readings, and doubling the diuretic dose without adding a second
mechanism is less effective than guideline-directed combination therapy. HESI Med-Surg
questions often test stepwise hypertension management and the importance of timely
pharmacologic escalation rather than passive observation.
, Question 6 of 60
A 49-year-old female with mitral valve prolapse is scheduled for valve replacement surgery.
During the preoperative assessment, she asks the nurse why she must take prophylactic
antibiotics before certain dental procedures. Which explanation by the nurse is most
accurate?
A. "The antibiotics will boost your immune system before the dentist begins working."
B. "Bacteria from the mouth can enter your bloodstream during dental work and infect the
artificial valve." ✓ CORRECT
C. "Antibiotics are required to prevent a fungal infection from developing in your surgical
wound."
D. "Your surgeon wants to make sure you do not develop a postoperative pneumonia."
Correct Answer: B
Rationale: Patients with prosthetic heart valves or certain native valve disorders are at high
risk for infective endocarditis, which can occur when transient bacteremia from dental
instrumentation seeds the valve tissue. Prophylactic antibiotics target viridans group
streptococci and other oral flora, not fungi or respiratory pathogens, and they do not enhance
systemic immunity. HESI frequently tests endocarditis prophylaxis indications in the context
of cardiac surgery, and the correct answer must reflect the specific mechanism of
hematogenous bacterial seeding rather than generalized infection prevention.
Question 7 of 60
A 76-year-old male with chronic heart failure is admitted with a 3-pound weight gain over two
days, increasing dyspnea, and bilateral crackles on auscultation. He is receiving furosemide
80 mg IV twice daily. During the morning assessment, the nurse notes that his urine output
over the past 8 hours was 1800 mL. Which laboratory value should the nurse monitor most
closely during this aggressive diuresis?
A. Serum potassium ✓ CORRECT
B. Hemoglobin
C. Serum albumin
D. Prothrombin time
Correct Answer: A
Rationale: Loop diuretics such as furosemide promote potassium wasting in the distal
nephron, and aggressive diuresis in heart failure patients places them at high risk for
hypokalemia, which can precipitate life-threatening ventricular dysrhythmias. While
hemoglobin and albumin reflect nutritional and oxygen-carrying status, and coagulation
studies are relevant in anticoagulated patients, potassium is the most immediately
dangerous electrolyte to lose during high-dose loop diuretic therapy. HESI Med-Surg
questions often pair heart failure exacerbations with electrolyte monitoring priorities,
