HESI MED-SURG – High-Yield Practice Questions
(Chamberlain Nursing | 2026)
Complete 180-Question Exam Prep with Rationales, NCLEX-Style
Scenarios & Critical Care Review
SECTION 1: CARDIOVASCULAR & RESPIRATORY DISORDERS (35 Questions)
Question 1
A patient with acute decompensated heart failure presents with severe dyspnea,
crackles in all lung fields, and an SpO₂ of 84% on room air. Which intervention should
the nurse implement FIRST?
A. Administer IV furosemide
B. Apply non-invasive positive pressure ventilation (NIPPV)
C. Place the patient in High-Fowler’s position
D. Prepare for endotracheal intubation
✓ CORRECT ANSWER: C
Rationale: High-Fowler’s position uses gravity to reduce venous return (preload) and
shift fluid to the lower extremities, immediately improving ventilation. This is the fastest
non-invasive intervention. NIPPV (B) may be used after positioning if oxygenation does
not improve. Furosemide (A) takes time to work. Intubation (D) is a last resort.
Question 2
A nurse is caring for a patient 2 hours after a percutaneous coronary intervention (PCI)
via the femoral artery. The patient reports severe pain in the groin and the nurse notes
a rapidly expanding hematoma. What is the priority action?
,A. Apply firm pressure 1-2 cm above the femoral insertion site
B. Remove the femoral sheath immediately
C. Elevate the head of the bed to 45 degrees
D. Administer IV morphine for pain
✓ CORRECT ANSWER: A
Rationale: Expanding hematoma indicates bleeding at the arterial access site. Applying
firm pressure above the site can control bleeding while maintaining distal perfusion.
Removing the sheath (B) would worsen bleeding. Elevating HOB (C) increases hip
flexion and may dislodge the clot. Morphine (D) does not address bleeding.
Question 3
A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing: pH 7.31, PaCO₂ 68 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 32 mEq/L. Which
oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% FiO₂
C. Nasal cannula at 6 L/min
D. Simple face mask at 10 L/min
✓ CORRECT ANSWER: B
Rationale: The patient has chronic hypercapnia (PaCO₂ 68) with metabolic compensation
(HCO₃⁻ 32). High oxygen can suppress hypoxic drive. A Venturi mask delivers precise, low
FiO₂ (24-28%) to maintain SpO₂ 88-92% without worsening hypercapnia. Non-rebreather
(A) and high-flow nasal cannula (C) may oversuppress ventilation.
Question 4
A patient with stable angina reports chest pressure while walking up stairs. The pain
subsides after 2 minutes of rest. Which medication should the nurse administer?
,A. Nitroglycerin 0.4 mg sublingual
B. Aspirin 324 mg chewed
C. Morphine 2 mg IV
D. Metoprolol 25 mg oral
✓ CORRECT ANSWER: A
Rationale: Stable angina relieved by rest indicates exertion-induced ischemia. Sublingual
nitroglycerin is first-line for acute symptom relief. Aspirin (B) is for secondary prevention,
not acute relief. Morphine (C) is for unstable angina/MI. Metoprolol (D) is chronic
management.
Question 5
A nurse auscultates a high-pitched, blowing diastolic murmur at the left sternal border
in a patient with a history of IV drug use. Which valvular disorder is most likely?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
✓ CORRECT ANSWER: B
Rationale: Aortic regurgitation causes a high-pitched, blowing diastolic murmur at the
left sternal border (Erb’s point). IV drug use can cause infective endocarditis damaging
the aortic valve. Mitral stenosis (C) is diastolic but low- pitched and at the apex.
Tricuspid regurgitation (D) is systolic.
Question 6
A patient with atrial fibrillation (AF) is prescribed warfarin. The INR today is 1.2. The nurse
should anticipate which order from the provider?
A. Increase warfarin dose
B. Administer vitamin K 10 mg oral
, C. Hold warfarin and give enoxaparin
D. Continue same warfarin dose
✓ CORRECT ANSWER: A
Rationale: Target INR for AF is 2-3. INR 1.2 is subtherapeutic, increasing stroke risk. The
provider will likely increase warfarin dose. Vitamin K (B) is for supratherapeutic INR with
bleeding. Enoxaparin (C) may be used for bridging but not as first-line for low INR
without procedure.
Question 7
A patient with pneumonia has a fever of 39.4°C (103°F), productive cough with green
sputum, and respiratory rate of 28 breaths/min. Which assessment finding is most
concerning?
A. Crackles in the right lower lobe
B. Oxygen saturation of 89% on room air
C. White blood cell count of 18,000/mm³
D. Heart rate of 110 bpm
✓ CORRECT ANSWER: B
Rationale: SpO₂ 89% indicates hypoxemia and risk for respiratory failure. While crackles
(A), elevated WBC (C), and tachycardia (D) are expected in pneumonia, hypoxemia
requires immediate oxygen therapy and may indicate severe disease or sepsis.
Question 8
A nurse is teaching a patient with hypertension about lifestyle changes. Which statement
by the patient indicates a need for further teaching?
A. "I will limit my sodium intake to less than 2,300 mg per day."
B. "I should aim for at least 150 minutes of moderate exercise weekly."
C. "I can stop my medication once my blood pressure is normal."
D. "I will try to maintain a BMI below 25."
(Chamberlain Nursing | 2026)
Complete 180-Question Exam Prep with Rationales, NCLEX-Style
Scenarios & Critical Care Review
SECTION 1: CARDIOVASCULAR & RESPIRATORY DISORDERS (35 Questions)
Question 1
A patient with acute decompensated heart failure presents with severe dyspnea,
crackles in all lung fields, and an SpO₂ of 84% on room air. Which intervention should
the nurse implement FIRST?
A. Administer IV furosemide
B. Apply non-invasive positive pressure ventilation (NIPPV)
C. Place the patient in High-Fowler’s position
D. Prepare for endotracheal intubation
✓ CORRECT ANSWER: C
Rationale: High-Fowler’s position uses gravity to reduce venous return (preload) and
shift fluid to the lower extremities, immediately improving ventilation. This is the fastest
non-invasive intervention. NIPPV (B) may be used after positioning if oxygenation does
not improve. Furosemide (A) takes time to work. Intubation (D) is a last resort.
Question 2
A nurse is caring for a patient 2 hours after a percutaneous coronary intervention (PCI)
via the femoral artery. The patient reports severe pain in the groin and the nurse notes
a rapidly expanding hematoma. What is the priority action?
,A. Apply firm pressure 1-2 cm above the femoral insertion site
B. Remove the femoral sheath immediately
C. Elevate the head of the bed to 45 degrees
D. Administer IV morphine for pain
✓ CORRECT ANSWER: A
Rationale: Expanding hematoma indicates bleeding at the arterial access site. Applying
firm pressure above the site can control bleeding while maintaining distal perfusion.
Removing the sheath (B) would worsen bleeding. Elevating HOB (C) increases hip
flexion and may dislodge the clot. Morphine (D) does not address bleeding.
Question 3
A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing: pH 7.31, PaCO₂ 68 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 32 mEq/L. Which
oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% FiO₂
C. Nasal cannula at 6 L/min
D. Simple face mask at 10 L/min
✓ CORRECT ANSWER: B
Rationale: The patient has chronic hypercapnia (PaCO₂ 68) with metabolic compensation
(HCO₃⁻ 32). High oxygen can suppress hypoxic drive. A Venturi mask delivers precise, low
FiO₂ (24-28%) to maintain SpO₂ 88-92% without worsening hypercapnia. Non-rebreather
(A) and high-flow nasal cannula (C) may oversuppress ventilation.
Question 4
A patient with stable angina reports chest pressure while walking up stairs. The pain
subsides after 2 minutes of rest. Which medication should the nurse administer?
,A. Nitroglycerin 0.4 mg sublingual
B. Aspirin 324 mg chewed
C. Morphine 2 mg IV
D. Metoprolol 25 mg oral
✓ CORRECT ANSWER: A
Rationale: Stable angina relieved by rest indicates exertion-induced ischemia. Sublingual
nitroglycerin is first-line for acute symptom relief. Aspirin (B) is for secondary prevention,
not acute relief. Morphine (C) is for unstable angina/MI. Metoprolol (D) is chronic
management.
Question 5
A nurse auscultates a high-pitched, blowing diastolic murmur at the left sternal border
in a patient with a history of IV drug use. Which valvular disorder is most likely?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
✓ CORRECT ANSWER: B
Rationale: Aortic regurgitation causes a high-pitched, blowing diastolic murmur at the
left sternal border (Erb’s point). IV drug use can cause infective endocarditis damaging
the aortic valve. Mitral stenosis (C) is diastolic but low- pitched and at the apex.
Tricuspid regurgitation (D) is systolic.
Question 6
A patient with atrial fibrillation (AF) is prescribed warfarin. The INR today is 1.2. The nurse
should anticipate which order from the provider?
A. Increase warfarin dose
B. Administer vitamin K 10 mg oral
, C. Hold warfarin and give enoxaparin
D. Continue same warfarin dose
✓ CORRECT ANSWER: A
Rationale: Target INR for AF is 2-3. INR 1.2 is subtherapeutic, increasing stroke risk. The
provider will likely increase warfarin dose. Vitamin K (B) is for supratherapeutic INR with
bleeding. Enoxaparin (C) may be used for bridging but not as first-line for low INR
without procedure.
Question 7
A patient with pneumonia has a fever of 39.4°C (103°F), productive cough with green
sputum, and respiratory rate of 28 breaths/min. Which assessment finding is most
concerning?
A. Crackles in the right lower lobe
B. Oxygen saturation of 89% on room air
C. White blood cell count of 18,000/mm³
D. Heart rate of 110 bpm
✓ CORRECT ANSWER: B
Rationale: SpO₂ 89% indicates hypoxemia and risk for respiratory failure. While crackles
(A), elevated WBC (C), and tachycardia (D) are expected in pneumonia, hypoxemia
requires immediate oxygen therapy and may indicate severe disease or sepsis.
Question 8
A nurse is teaching a patient with hypertension about lifestyle changes. Which statement
by the patient indicates a need for further teaching?
A. "I will limit my sodium intake to less than 2,300 mg per day."
B. "I should aim for at least 150 minutes of moderate exercise weekly."
C. "I can stop my medication once my blood pressure is normal."
D. "I will try to maintain a BMI below 25."
