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HESI RN Medical-Surgical Exam Pack 2024–2025 | 280 NCLEX-Style Questions with
Detailed Rationales | Med-Surg Mastery QBank
Question 1:
A nurse is caring for a client with acute decompensated heart failure who reports increasing
shortness of breath, cough with frothy sputum, and anxiety. Which action should the nurse take
first?
A. Notify the healthcare provider
B. Apply oxygen via nasal cannula
C. Place the client in high Fowler’s position
D. Administer a prescribed loop diuretic
Correct Answer: C
Rationale: High Fowler’s position helps decrease venous return and improve oxygenation in
pulmonary edema. Although oxygen and diuretics are critical, positioning the patient is an
immediate action that facilitates respiratory effort while other interventions are prepared.
Question 2:
A client recovering from a myocardial infarction is being discharged with a prescription for
metoprolol. Which instruction should the nurse emphasize?
, 2
A. Take the medication at bedtime to reduce dizziness
B. Check your pulse daily and hold if under 60 bpm
C. Stop the drug once chest pain resolves
D. Avoid potassium-rich foods
Correct Answer: B
Rationale: Beta-blockers like metoprolol reduce heart rate and workload. Clients must monitor
their pulse and avoid taking the drug if the pulse is too low. Abrupt discontinuation can worsen
cardiac symptoms.
Question 3:
A nurse is caring for a client with infective endocarditis. Which assessment finding is most
concerning?
A. Sudden onset left-sided weakness
B. Fatigue and malaise
C. Petechiae on the conjunctiva
D. Low-grade fever
Correct Answer: A
Rationale: New neurologic deficits such as left-sided weakness may indicate embolization to the
brain, a serious complication of infective endocarditis. This finding requires immediate
intervention.
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Question 4:
A client is admitted for management of hypertensive crisis. The nurse should question which
physician order?
A. Continuous cardiac monitoring
B. Administer labetalol IV push every 10 minutes as needed without BP limits
C. Frequent blood pressure assessments
D. Maintain IV access with normal saline
Correct Answer: B
Rationale: Labetalol can cause hypotension and bradycardia. Giving repeated IV pushes without
specific blood pressure parameters is unsafe and could lead to complications. Orders must
include guidelines for administration.
Question 5:
A nurse is preparing to administer digoxin to a client with heart failure. Which lab value requires
action?
A. Hemoglobin 11.2 g/dL
B. Serum potassium 4.2 mEq/L
C. Digoxin level 2.6 ng/mL
D. Sodium 135 mEq/L
Correct Answer: C
Rationale: A digoxin level above 2.0 ng/mL indicates toxicity, which can lead to arrhythmias.
The nurse should hold the medication and notify the provider immediately.
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Question 6:
A client is scheduled for cardiac catheterization. Which statement by the client requires follow-
up?
A. "I know I’ll need to lie flat after the procedure."
B. "I’m allergic to shrimp and lobster."
C. "I haven’t eaten anything since midnight."
D. "I’ve arranged for someone to drive me home."
Correct Answer: B
Rationale: Shellfish allergies may indicate a sensitivity to iodine or contrast dye used in cardiac
catheterization. This should be reported and managed before the procedure.
Question 7:
A client who had coronary artery bypass graft surgery yesterday is confused and restless. What is
the nurse’s priority action?
A. Apply soft restraints
B. Assess oxygen saturation and ABG values
C. Notify the family of behavior change
D. Offer reorientation and stimulation
HESI RN Medical-Surgical Exam Pack 2024–2025 | 280 NCLEX-Style Questions with
Detailed Rationales | Med-Surg Mastery QBank
Question 1:
A nurse is caring for a client with acute decompensated heart failure who reports increasing
shortness of breath, cough with frothy sputum, and anxiety. Which action should the nurse take
first?
A. Notify the healthcare provider
B. Apply oxygen via nasal cannula
C. Place the client in high Fowler’s position
D. Administer a prescribed loop diuretic
Correct Answer: C
Rationale: High Fowler’s position helps decrease venous return and improve oxygenation in
pulmonary edema. Although oxygen and diuretics are critical, positioning the patient is an
immediate action that facilitates respiratory effort while other interventions are prepared.
Question 2:
A client recovering from a myocardial infarction is being discharged with a prescription for
metoprolol. Which instruction should the nurse emphasize?
, 2
A. Take the medication at bedtime to reduce dizziness
B. Check your pulse daily and hold if under 60 bpm
C. Stop the drug once chest pain resolves
D. Avoid potassium-rich foods
Correct Answer: B
Rationale: Beta-blockers like metoprolol reduce heart rate and workload. Clients must monitor
their pulse and avoid taking the drug if the pulse is too low. Abrupt discontinuation can worsen
cardiac symptoms.
Question 3:
A nurse is caring for a client with infective endocarditis. Which assessment finding is most
concerning?
A. Sudden onset left-sided weakness
B. Fatigue and malaise
C. Petechiae on the conjunctiva
D. Low-grade fever
Correct Answer: A
Rationale: New neurologic deficits such as left-sided weakness may indicate embolization to the
brain, a serious complication of infective endocarditis. This finding requires immediate
intervention.
, 3
Question 4:
A client is admitted for management of hypertensive crisis. The nurse should question which
physician order?
A. Continuous cardiac monitoring
B. Administer labetalol IV push every 10 minutes as needed without BP limits
C. Frequent blood pressure assessments
D. Maintain IV access with normal saline
Correct Answer: B
Rationale: Labetalol can cause hypotension and bradycardia. Giving repeated IV pushes without
specific blood pressure parameters is unsafe and could lead to complications. Orders must
include guidelines for administration.
Question 5:
A nurse is preparing to administer digoxin to a client with heart failure. Which lab value requires
action?
A. Hemoglobin 11.2 g/dL
B. Serum potassium 4.2 mEq/L
C. Digoxin level 2.6 ng/mL
D. Sodium 135 mEq/L
Correct Answer: C
Rationale: A digoxin level above 2.0 ng/mL indicates toxicity, which can lead to arrhythmias.
The nurse should hold the medication and notify the provider immediately.
, 4
Question 6:
A client is scheduled for cardiac catheterization. Which statement by the client requires follow-
up?
A. "I know I’ll need to lie flat after the procedure."
B. "I’m allergic to shrimp and lobster."
C. "I haven’t eaten anything since midnight."
D. "I’ve arranged for someone to drive me home."
Correct Answer: B
Rationale: Shellfish allergies may indicate a sensitivity to iodine or contrast dye used in cardiac
catheterization. This should be reported and managed before the procedure.
Question 7:
A client who had coronary artery bypass graft surgery yesterday is confused and restless. What is
the nurse’s priority action?
A. Apply soft restraints
B. Assess oxygen saturation and ABG values
C. Notify the family of behavior change
D. Offer reorientation and stimulation
