HESI Med-Surg Final Exam Actual Exam 2026/2027 –
Comprehensive Medical-Surgical Nursing Assessment with
Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section 1: Cardiovascular Disorders
Q1: A 68-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 98/60, HR 110, RR 24. The 12-lead ECG
shows ST-segment elevation in leads V1-V4. Which intervention is the nurse's FIRST
priority?
A. Administer sublingual nitroglycerin
B. Prepare the patient for immediate percutaneous coronary intervention (PCI)
C. Establish IV access and administer morphine for pain
D. Obtain a detailed history of the chest pain
Correct Answer: B
Rationale: ST-elevation in anterior leads (V1-V4) indicates an anterior STEMI requiring
immediate reperfusion therapy. PCI is preferred within 90 minutes of first medical
contact. While pain management and IV access are important, "time is
muscle"—delaying reperfusion increases infarct size and mortality. Nitroglycerin is
contraindicated with hypotension (SBP <90).
Q2: A patient with heart failure is prescribed lisinopril (ACE inhibitor), metoprolol
(beta-blocker), and furosemide (loop diuretic). The nurse should monitor for which
potential adverse effect of the ACE inhibitor?
A. Hyperkalemia
B. Hypokalemia
C. Bradycardia
D. Hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors block aldosterone secretion, reducing potassium excretion and
causing hyperkalemia. Hypokalemia (B) is associated with loop diuretics like
furosemide. Bradycardia (C) is a beta-blocker effect, and hyperglycemia (D) is not
typical of ACE inhibitors.
,Q3: A patient with chronic hypertension has a blood pressure of 210/130 mmHg and
reports severe headache and blurred vision. The nurse recognizes this as:
A. Primary hypertension
B. Hypertensive urgency
C. Hypertensive emergency
D. Secondary hypertension
Correct Answer: C
Rationale: Hypertensive emergency is defined as severely elevated BP (≥180/120) with
evidence of acute target organ damage (headache, blurred vision indicating
encephalopathy/retinopathy). Hypertensive urgency lacks target organ damage.
Primary/secondary hypertension refer to etiology, not acuity.
Q4: A patient post-MI is prescribed nitroglycerin SL prn for chest pain. Before
administering, the nurse should FIRST:
A. Check the patient's blood pressure
B. Assess the patient's pain level on a 0-10 scale
C. Verify the medication administration record
D. Ask about current use of sildenafil (Viagra)
Correct Answer: A
Rationale: Nitroglycerin causes venous dilation and hypotension; checking BP before
each dose prevents administering to a hypotensive patient (SBP <90 or >30 mmHg
drop). While all steps are important, BP assessment is the safety priority because
hypotension can cause syncope or shock.
Q5: A patient with peripheral arterial disease (PAD) reports pain in the calves when
walking that resolves with rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Referred pain
D. Phantom pain
Correct Answer: B
Rationale: Intermittent claudication is reproducible ischemic muscle pain during
exercise that resolves with rest, classic for PAD. Rest pain (A) occurs at rest and
indicates severe disease. Referred pain (C) originates elsewhere, and phantom pain (D)
follows amputation.
,Q6: A patient with a history of rheumatic fever is diagnosed with mitral stenosis. The
nurse understands that this valvular disorder causes:
A. Backflow of blood into the left ventricle during diastole
B. Obstruction of blood flow from the left atrium to the left ventricle
C. Regurgitation of blood into the right atrium
D. Prolapse of the valve leaflets into the left atrium
Correct Answer: B
Rationale: Mitral stenosis narrows the mitral valve orifice, obstructing diastolic flow
from left atrium to left ventricle. This causes left atrial enlargement and pulmonary
congestion. Regurgitation (A, C) describes backflow, and prolapse (D) describes a
different pathology.
Q7: A patient with deep vein thrombosis (DVT) is started on enoxaparin (Lovenox) and
warfarin (Coumadin). The nurse understands that enoxaparin is continued until the INR
reaches:
A. 1.5
B. 2.0-3.0
C. 3.5-4.5
D. 4.0-5.0
Correct Answer: B
Rationale: Bridging therapy with enoxaparin continues until warfarin achieves
therapeutic INR of 2.0-3.0 for DVT/PE treatment. Below 2.0 (A) is subtherapeutic, and
higher ranges (C, D) increase bleeding risk without additional benefit for standard DVT
treatment.
Q8: A patient with an abdominal aortic aneurysm (AAA) reports sudden severe back
pain and hypotension. The nurse recognizes these findings as indicative of:
A. Stable aneurysm
B. Aneurysm thrombosis
C. Aneurysm rupture
D. Aneurysm infection
Correct Answer: C
Rationale: Sudden severe back/flank pain with hypotension is the classic triad of AAA
rupture—a surgical emergency with high mortality. Stable aneurysms (A) are
, asymptomatic, thrombosis (B) may be asymptomatic or cause emboli, and infection (D)
presents with fever and vague pain.
Q9: A patient with heart failure has the following assessment: dyspnea, orthopnea, JVD,
hepatomegaly, and peripheral edema. The nurse recognizes this as:
A. Left-sided heart failure
B. Right-sided heart failure
C. Biventricular failure
D. Cardiogenic shock
Correct Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion: JVD,
hepatomegaly (hepatojugular reflux), peripheral edema, and ascites. Left-sided failure
(A) causes pulmonary congestion (dyspnea, crackles). While dyspnea is present, the
systemic congestion pattern indicates right-sided failure.
Q10: A patient taking digoxin reports nausea, vomiting, and visual disturbances
(yellow-green halos). The serum digoxin level is 3.2 ng/mL. The nurse should:
A. Administer the next scheduled dose
B. Hold the dose and notify the provider immediately
C. Give potassium supplements
D. Increase the dose to achieve therapeutic levels
Correct Answer: B
Rationale: Digoxin toxicity presents with GI symptoms (nausea, vomiting) and visual
changes (xanthopsia) at levels >2.0 ng/mL. The level of 3.2 confirms toxicity. The nurse
must hold the dose and notify the provider. Potassium (C) is given only if hypokalemia
coexists, and increasing the dose (D) is lethal.
Q11: A patient with infective endocarditis is scheduled for dental work. The nurse
should ensure the patient receives:
A. No antibiotics are needed for dental procedures
B. Prophylactic antibiotics before the procedure
C. Antibiotics only if fever develops
D. Anticoagulation therapy before the procedure
Correct Answer: B
Comprehensive Medical-Surgical Nursing Assessment with
Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section 1: Cardiovascular Disorders
Q1: A 68-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 98/60, HR 110, RR 24. The 12-lead ECG
shows ST-segment elevation in leads V1-V4. Which intervention is the nurse's FIRST
priority?
A. Administer sublingual nitroglycerin
B. Prepare the patient for immediate percutaneous coronary intervention (PCI)
C. Establish IV access and administer morphine for pain
D. Obtain a detailed history of the chest pain
Correct Answer: B
Rationale: ST-elevation in anterior leads (V1-V4) indicates an anterior STEMI requiring
immediate reperfusion therapy. PCI is preferred within 90 minutes of first medical
contact. While pain management and IV access are important, "time is
muscle"—delaying reperfusion increases infarct size and mortality. Nitroglycerin is
contraindicated with hypotension (SBP <90).
Q2: A patient with heart failure is prescribed lisinopril (ACE inhibitor), metoprolol
(beta-blocker), and furosemide (loop diuretic). The nurse should monitor for which
potential adverse effect of the ACE inhibitor?
A. Hyperkalemia
B. Hypokalemia
C. Bradycardia
D. Hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors block aldosterone secretion, reducing potassium excretion and
causing hyperkalemia. Hypokalemia (B) is associated with loop diuretics like
furosemide. Bradycardia (C) is a beta-blocker effect, and hyperglycemia (D) is not
typical of ACE inhibitors.
,Q3: A patient with chronic hypertension has a blood pressure of 210/130 mmHg and
reports severe headache and blurred vision. The nurse recognizes this as:
A. Primary hypertension
B. Hypertensive urgency
C. Hypertensive emergency
D. Secondary hypertension
Correct Answer: C
Rationale: Hypertensive emergency is defined as severely elevated BP (≥180/120) with
evidence of acute target organ damage (headache, blurred vision indicating
encephalopathy/retinopathy). Hypertensive urgency lacks target organ damage.
Primary/secondary hypertension refer to etiology, not acuity.
Q4: A patient post-MI is prescribed nitroglycerin SL prn for chest pain. Before
administering, the nurse should FIRST:
A. Check the patient's blood pressure
B. Assess the patient's pain level on a 0-10 scale
C. Verify the medication administration record
D. Ask about current use of sildenafil (Viagra)
Correct Answer: A
Rationale: Nitroglycerin causes venous dilation and hypotension; checking BP before
each dose prevents administering to a hypotensive patient (SBP <90 or >30 mmHg
drop). While all steps are important, BP assessment is the safety priority because
hypotension can cause syncope or shock.
Q5: A patient with peripheral arterial disease (PAD) reports pain in the calves when
walking that resolves with rest. The nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Referred pain
D. Phantom pain
Correct Answer: B
Rationale: Intermittent claudication is reproducible ischemic muscle pain during
exercise that resolves with rest, classic for PAD. Rest pain (A) occurs at rest and
indicates severe disease. Referred pain (C) originates elsewhere, and phantom pain (D)
follows amputation.
,Q6: A patient with a history of rheumatic fever is diagnosed with mitral stenosis. The
nurse understands that this valvular disorder causes:
A. Backflow of blood into the left ventricle during diastole
B. Obstruction of blood flow from the left atrium to the left ventricle
C. Regurgitation of blood into the right atrium
D. Prolapse of the valve leaflets into the left atrium
Correct Answer: B
Rationale: Mitral stenosis narrows the mitral valve orifice, obstructing diastolic flow
from left atrium to left ventricle. This causes left atrial enlargement and pulmonary
congestion. Regurgitation (A, C) describes backflow, and prolapse (D) describes a
different pathology.
Q7: A patient with deep vein thrombosis (DVT) is started on enoxaparin (Lovenox) and
warfarin (Coumadin). The nurse understands that enoxaparin is continued until the INR
reaches:
A. 1.5
B. 2.0-3.0
C. 3.5-4.5
D. 4.0-5.0
Correct Answer: B
Rationale: Bridging therapy with enoxaparin continues until warfarin achieves
therapeutic INR of 2.0-3.0 for DVT/PE treatment. Below 2.0 (A) is subtherapeutic, and
higher ranges (C, D) increase bleeding risk without additional benefit for standard DVT
treatment.
Q8: A patient with an abdominal aortic aneurysm (AAA) reports sudden severe back
pain and hypotension. The nurse recognizes these findings as indicative of:
A. Stable aneurysm
B. Aneurysm thrombosis
C. Aneurysm rupture
D. Aneurysm infection
Correct Answer: C
Rationale: Sudden severe back/flank pain with hypotension is the classic triad of AAA
rupture—a surgical emergency with high mortality. Stable aneurysms (A) are
, asymptomatic, thrombosis (B) may be asymptomatic or cause emboli, and infection (D)
presents with fever and vague pain.
Q9: A patient with heart failure has the following assessment: dyspnea, orthopnea, JVD,
hepatomegaly, and peripheral edema. The nurse recognizes this as:
A. Left-sided heart failure
B. Right-sided heart failure
C. Biventricular failure
D. Cardiogenic shock
Correct Answer: B
Rationale: Right-sided heart failure causes systemic venous congestion: JVD,
hepatomegaly (hepatojugular reflux), peripheral edema, and ascites. Left-sided failure
(A) causes pulmonary congestion (dyspnea, crackles). While dyspnea is present, the
systemic congestion pattern indicates right-sided failure.
Q10: A patient taking digoxin reports nausea, vomiting, and visual disturbances
(yellow-green halos). The serum digoxin level is 3.2 ng/mL. The nurse should:
A. Administer the next scheduled dose
B. Hold the dose and notify the provider immediately
C. Give potassium supplements
D. Increase the dose to achieve therapeutic levels
Correct Answer: B
Rationale: Digoxin toxicity presents with GI symptoms (nausea, vomiting) and visual
changes (xanthopsia) at levels >2.0 ng/mL. The level of 3.2 confirms toxicity. The nurse
must hold the dose and notify the provider. Potassium (C) is given only if hypokalemia
coexists, and increasing the dose (D) is lethal.
Q11: A patient with infective endocarditis is scheduled for dental work. The nurse
should ensure the patient receives:
A. No antibiotics are needed for dental procedures
B. Prophylactic antibiotics before the procedure
C. Antibiotics only if fever develops
D. Anticoagulation therapy before the procedure
Correct Answer: B
