HESI MEDICAL-SURGICAL NEW
COMPREHENSIVE ACTUAL EXAM
PRACTICE QUESTION WITH ANSWERS
AND RATIONALE LATEST UPDATE
1. A patient with hypertension is prescribed lisinopril. Which instruction should the nurse include
in the teaching plan?
A. Take the medication with food to prevent gastric upset.
B. Avoid salt substitutes containing potassium.
C. Expect a dry, hacking cough that will subside over time.
D. Discontinue the medication if blood pressure normalizes.
Answer: B
*Rationale: * ACE inhibitors like lisinopril can cause hyperkalemia by reducing aldosterone.
Patients should avoid potassium-rich foods and salt substitutes containing potassium chloride. A
dry cough (C) is a side effect but may require changing the medication, as it does not always
subside.
2. A patient with infective endocarditis is being discharged. Which statement by the patient
indicates a need for further teaching? A. "I need to let my dentist know about this
infection."
B. "I will need antibiotics before any dental procedures."
C. "I can stop antibiotics when my fever is gone."
D. "I should monitor my temperature daily."
,Answer: C
*Rationale: * *Antibiotic therapy for endocarditis must be completed entirely, typically for 4-6
weeks, even if symptoms resolve. Stopping early can lead to relapse or resistant organisms. *
3. A patient with unstable angina is admitted to the telemetry unit. The nurse observes a new
irregular heart rhythm and sudden shortness of breath. What should the nurse assess for first? A.
Carotid bruit
B. Pulse deficit
C. Jugular vein distention
D. Hepatojugular reflux
Answer: B
*Rationale: * A patient with a history of atrial fibrillation may revert to that rhythm. Sudden
shortness of breath with an irregular rhythm requires assessment for a pulse deficit (difference
between apical and radial rates), which occurs with atrial fibrillation.
4. A patient with peripheral arterial disease (PAD) asks about sexual dysfunction. Which
response by the nurse is most accurate?
A. "This is unrelated to your circulation problem."
B. "Peripheral arterial disease can reduce blood flow to the penis, causing erectile dysfunction."
C. "This is a common side effect of aging and not a medical concern."
D. "You should discuss this with a urologist after your arteries are treated."
Answer: B
*Rationale: * PAD is a systemic atherosclerotic condition. Reduced blood flow to the penile
artery is a known cause of erectile dysfunction. The nurse should provide accurate education
linking the disease process to this complication.
5. A 40-year-old female with a history of smoking is started on oral contraceptives. The nurse
identifies this patient is at increased risk for:
A. Pulmonary embolism
B. Myocardial infarction
,C. Ovarian cancer
D. Bacterial endocarditis
Answer: B
*Rationale: * Women over 35 who smoke and take oral contraceptives have a significantly
increased risk of myocardial infarction and stroke due to synergistic effects on thrombosis and
vasoconstriction.
6. A patient with heart failure has a daily weight order. The nurse notes a 2 kg (4.4 lb) weight
gain since yesterday. What is the priority action? A. Document the finding as expected.
B. Increase the patient's fluid intake.
C. Assess for peripheral edema and lung sounds.
D. Encourage the patient to ambulate to promote diuresis.
Answer: C
*Rationale: * A 2 kg weight gain in 24 hours represents approximately 2 liters of fluid retention.
The nurse must assess for worsening failure (edema, crackles, JVD) before notifying the provider
for potential diuretic adjustment.
7. A patient with heart failure is admitted with shortness of breath, crackles in the lungs, and
peripheral edema. What is the priority nursing intervention? A. Administer furosemide as
prescribed.
B. Place the patient in a high Fowler's position.
C. Restrict oral fluids to 1500 mL per day.
D. Draw blood for laboratory testing.
Answer: B
*Rationale: * The priority is to optimize oxygenation. Placing the patient in high Fowler's
position uses gravity to redistribute fluid from the lungs, decreasing preload and improving
breathing. While diuretics (A) are critical, positioning is the fastest independent nursing action.
, 8. A patient with atrial fibrillation is prescribed warfarin. Which laboratory value should the
nurse monitor to evaluate therapeutic effect?
A. Prothrombin time (PT) and International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. Bleeding time
Answer: A
*Rationale: * *Warfarin inhibits vitamin K-dependent clotting factors, and its effect is
monitored by PT/INR. For atrial fibrillation, the therapeutic INR goal is typically 2.0–3.0. aPTT
(B) is used to monitor heparin therapy. *
9. A patient develops chest pain unrelieved by three doses of sublingual nitroglycerin, each 5
minutes apart. What should the nurse do next? A. Wait 15 minutes and repeat the
nitroglycerin.
B. Administer a fourth dose of nitroglycerin.
C. Activate the emergency response system.
D. Document the finding as unstable angina.
Answer: C
*Rationale: * Chest pain unrelieved by three nitroglycerin doses suggests an acute myocardial
infarction. The nurse must activate the emergency response system immediately for further
intervention (oxygen, aspirin, ECG, and possible reperfusion therapy).
10. A 77-year-old female client is admitted confused, nauseated, and vomiting, with a headache
and a pulse rate of 43 beats per minute. It is most important for the nurse to assess for which
finding?
A. Wearing dentures
B. Use of aspirin prior to admit
C. History of nitroglycerin use
D. Current digoxin use
COMPREHENSIVE ACTUAL EXAM
PRACTICE QUESTION WITH ANSWERS
AND RATIONALE LATEST UPDATE
1. A patient with hypertension is prescribed lisinopril. Which instruction should the nurse include
in the teaching plan?
A. Take the medication with food to prevent gastric upset.
B. Avoid salt substitutes containing potassium.
C. Expect a dry, hacking cough that will subside over time.
D. Discontinue the medication if blood pressure normalizes.
Answer: B
*Rationale: * ACE inhibitors like lisinopril can cause hyperkalemia by reducing aldosterone.
Patients should avoid potassium-rich foods and salt substitutes containing potassium chloride. A
dry cough (C) is a side effect but may require changing the medication, as it does not always
subside.
2. A patient with infective endocarditis is being discharged. Which statement by the patient
indicates a need for further teaching? A. "I need to let my dentist know about this
infection."
B. "I will need antibiotics before any dental procedures."
C. "I can stop antibiotics when my fever is gone."
D. "I should monitor my temperature daily."
,Answer: C
*Rationale: * *Antibiotic therapy for endocarditis must be completed entirely, typically for 4-6
weeks, even if symptoms resolve. Stopping early can lead to relapse or resistant organisms. *
3. A patient with unstable angina is admitted to the telemetry unit. The nurse observes a new
irregular heart rhythm and sudden shortness of breath. What should the nurse assess for first? A.
Carotid bruit
B. Pulse deficit
C. Jugular vein distention
D. Hepatojugular reflux
Answer: B
*Rationale: * A patient with a history of atrial fibrillation may revert to that rhythm. Sudden
shortness of breath with an irregular rhythm requires assessment for a pulse deficit (difference
between apical and radial rates), which occurs with atrial fibrillation.
4. A patient with peripheral arterial disease (PAD) asks about sexual dysfunction. Which
response by the nurse is most accurate?
A. "This is unrelated to your circulation problem."
B. "Peripheral arterial disease can reduce blood flow to the penis, causing erectile dysfunction."
C. "This is a common side effect of aging and not a medical concern."
D. "You should discuss this with a urologist after your arteries are treated."
Answer: B
*Rationale: * PAD is a systemic atherosclerotic condition. Reduced blood flow to the penile
artery is a known cause of erectile dysfunction. The nurse should provide accurate education
linking the disease process to this complication.
5. A 40-year-old female with a history of smoking is started on oral contraceptives. The nurse
identifies this patient is at increased risk for:
A. Pulmonary embolism
B. Myocardial infarction
,C. Ovarian cancer
D. Bacterial endocarditis
Answer: B
*Rationale: * Women over 35 who smoke and take oral contraceptives have a significantly
increased risk of myocardial infarction and stroke due to synergistic effects on thrombosis and
vasoconstriction.
6. A patient with heart failure has a daily weight order. The nurse notes a 2 kg (4.4 lb) weight
gain since yesterday. What is the priority action? A. Document the finding as expected.
B. Increase the patient's fluid intake.
C. Assess for peripheral edema and lung sounds.
D. Encourage the patient to ambulate to promote diuresis.
Answer: C
*Rationale: * A 2 kg weight gain in 24 hours represents approximately 2 liters of fluid retention.
The nurse must assess for worsening failure (edema, crackles, JVD) before notifying the provider
for potential diuretic adjustment.
7. A patient with heart failure is admitted with shortness of breath, crackles in the lungs, and
peripheral edema. What is the priority nursing intervention? A. Administer furosemide as
prescribed.
B. Place the patient in a high Fowler's position.
C. Restrict oral fluids to 1500 mL per day.
D. Draw blood for laboratory testing.
Answer: B
*Rationale: * The priority is to optimize oxygenation. Placing the patient in high Fowler's
position uses gravity to redistribute fluid from the lungs, decreasing preload and improving
breathing. While diuretics (A) are critical, positioning is the fastest independent nursing action.
, 8. A patient with atrial fibrillation is prescribed warfarin. Which laboratory value should the
nurse monitor to evaluate therapeutic effect?
A. Prothrombin time (PT) and International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. Bleeding time
Answer: A
*Rationale: * *Warfarin inhibits vitamin K-dependent clotting factors, and its effect is
monitored by PT/INR. For atrial fibrillation, the therapeutic INR goal is typically 2.0–3.0. aPTT
(B) is used to monitor heparin therapy. *
9. A patient develops chest pain unrelieved by three doses of sublingual nitroglycerin, each 5
minutes apart. What should the nurse do next? A. Wait 15 minutes and repeat the
nitroglycerin.
B. Administer a fourth dose of nitroglycerin.
C. Activate the emergency response system.
D. Document the finding as unstable angina.
Answer: C
*Rationale: * Chest pain unrelieved by three nitroglycerin doses suggests an acute myocardial
infarction. The nurse must activate the emergency response system immediately for further
intervention (oxygen, aspirin, ECG, and possible reperfusion therapy).
10. A 77-year-old female client is admitted confused, nauseated, and vomiting, with a headache
and a pulse rate of 43 beats per minute. It is most important for the nurse to assess for which
finding?
A. Wearing dentures
B. Use of aspirin prior to admit
C. History of nitroglycerin use
D. Current digoxin use
