HESI MED-SURG RN PRACTICE EXAM
200 Questions with Answers & Rationales
CARDIOLOGY (Questions 1-30)
1. A client with heart failure is prescribed digoxin 0.25 mg daily. The nurse holds
the dose and notifies the healthcare provider based on which assessment finding?
A. Heart rate of 62 bpm
B. Serum potassium level of 3.1 mEq/L
C. Blood pressure of 130/78 mmHg
D. Respiratory rate of 20 breaths/min
Answer: B. Serum potassium level of 3.1 mEq/L
Rationale: Hypokalemia (normal K+ 3.5-5.0 mEq/L) increases the risk of digoxin toxicity
because potassium and digoxin compete for binding sites on the Na/K-ATPase pump.
With low potassium, more digoxin binds, potentiating its effects and toxicity risk. While
heart rate should be monitored (hold if <60 bpm), the potassium level is critically low
and requires correction before digoxin administration.
2. A client with acute coronary syndrome is receiving nitroglycerin IV. Which
assessment finding requires immediate action?
A. Headache rated 4/10
B. Blood pressure 88/50 mmHg
C. Flushing of the face and neck
D. Heart rate of 92 bpm
,Answer: B. Blood pressure 88/50 mmHg
Rationale: IV nitroglycerin causes venous and arterial vasodilation, which can lead to
significant hypotension. A systolic BP below 90 mmHg or a drop of >30 mmHg from
baseline compromises coronary artery perfusion and requires holding the infusion and
notifying the provider. Headache and flushing are common expected side effects.
3. The nurse is assessing a client 2 hours after cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Dried blood spot on the dressing
B. Right foot cool with capillary refill of 3 seconds
C. Client reports thirst
D. Small hematoma at the insertion site
Answer: B. Right foot cool with capillary refill of 3 seconds
Rationale: A cool extremity with delayed capillary refill suggests arterial insufficiency,
possibly from a thrombus or embolism at the catheterization site. This is a medical
emergency requiring immediate intervention. A small hematoma and dried blood are
expected. Thirst is common after contrast dye administration due to osmotic diuresis.
4. A client with atrial fibrillation is started on warfarin (Coumadin). The nurse
teaches the client to avoid which supplement?
A. Calcium carbonate
B. Vitamin C
C. Vitamin E
D. Vitamin B12
Answer: C. Vitamin E
Rationale: Vitamin E has anticoagulant properties and can increase the risk of bleeding
when taken with warfarin. It inhibits vitamin K-dependent carboxylation, potentiating
warfarin's effects. Clients should avoid high-dose vitamin E and other supplements that
affect coagulation (garlic, ginkgo, ginseng).
, 5. The nurse assesses a client with pericarditis. Which finding is most characteristic
of this condition?
A. Chest pain relieved by leaning forward
B. Substernal pain radiating to the left arm
C. Dyspnea on exertion
D. Syncopal episodes
Answer: A. Chest pain relieved by leaning forward
Rationale: Pericarditis pain is typically sharp, pleuritic, and improves with sitting up and
leaning forward (which relieves pressure on the inflamed pericardial sac). Pain worsens
when lying flat. This is a key distinguishing feature from angina or myocardial infarction.
6. A client with hypertension is prescribed lisinopril (Prinivil). Which instruction is
most important to include in the teaching plan?
A. "Take this medication with food to prevent stomach upset."
B. "Avoid salt substitutes containing potassium."
C. "Stop taking the medication if you develop a cough."
D. "Take the medication at bedtime to prevent dizziness."
Answer: B. "Avoid salt substitutes containing potassium."
Rationale: ACE inhibitors like lisinopril block aldosterone production, leading to
potassium retention (hyperkalemia). Using potassium-containing salt substitutes can
dangerously elevate potassium levels. While a dry cough is a common side effect, clients
should not stop the medication without consulting their provider.
7. The nurse is caring for a client 4 hours after thrombolytic therapy for an acute
myocardial infarction. Which assessment finding is most concerning?
A. Ecchymosis at the IV insertion site
B. Client report of mild back pain
200 Questions with Answers & Rationales
CARDIOLOGY (Questions 1-30)
1. A client with heart failure is prescribed digoxin 0.25 mg daily. The nurse holds
the dose and notifies the healthcare provider based on which assessment finding?
A. Heart rate of 62 bpm
B. Serum potassium level of 3.1 mEq/L
C. Blood pressure of 130/78 mmHg
D. Respiratory rate of 20 breaths/min
Answer: B. Serum potassium level of 3.1 mEq/L
Rationale: Hypokalemia (normal K+ 3.5-5.0 mEq/L) increases the risk of digoxin toxicity
because potassium and digoxin compete for binding sites on the Na/K-ATPase pump.
With low potassium, more digoxin binds, potentiating its effects and toxicity risk. While
heart rate should be monitored (hold if <60 bpm), the potassium level is critically low
and requires correction before digoxin administration.
2. A client with acute coronary syndrome is receiving nitroglycerin IV. Which
assessment finding requires immediate action?
A. Headache rated 4/10
B. Blood pressure 88/50 mmHg
C. Flushing of the face and neck
D. Heart rate of 92 bpm
,Answer: B. Blood pressure 88/50 mmHg
Rationale: IV nitroglycerin causes venous and arterial vasodilation, which can lead to
significant hypotension. A systolic BP below 90 mmHg or a drop of >30 mmHg from
baseline compromises coronary artery perfusion and requires holding the infusion and
notifying the provider. Headache and flushing are common expected side effects.
3. The nurse is assessing a client 2 hours after cardiac catheterization via the right
femoral artery. Which finding requires immediate intervention?
A. Dried blood spot on the dressing
B. Right foot cool with capillary refill of 3 seconds
C. Client reports thirst
D. Small hematoma at the insertion site
Answer: B. Right foot cool with capillary refill of 3 seconds
Rationale: A cool extremity with delayed capillary refill suggests arterial insufficiency,
possibly from a thrombus or embolism at the catheterization site. This is a medical
emergency requiring immediate intervention. A small hematoma and dried blood are
expected. Thirst is common after contrast dye administration due to osmotic diuresis.
4. A client with atrial fibrillation is started on warfarin (Coumadin). The nurse
teaches the client to avoid which supplement?
A. Calcium carbonate
B. Vitamin C
C. Vitamin E
D. Vitamin B12
Answer: C. Vitamin E
Rationale: Vitamin E has anticoagulant properties and can increase the risk of bleeding
when taken with warfarin. It inhibits vitamin K-dependent carboxylation, potentiating
warfarin's effects. Clients should avoid high-dose vitamin E and other supplements that
affect coagulation (garlic, ginkgo, ginseng).
, 5. The nurse assesses a client with pericarditis. Which finding is most characteristic
of this condition?
A. Chest pain relieved by leaning forward
B. Substernal pain radiating to the left arm
C. Dyspnea on exertion
D. Syncopal episodes
Answer: A. Chest pain relieved by leaning forward
Rationale: Pericarditis pain is typically sharp, pleuritic, and improves with sitting up and
leaning forward (which relieves pressure on the inflamed pericardial sac). Pain worsens
when lying flat. This is a key distinguishing feature from angina or myocardial infarction.
6. A client with hypertension is prescribed lisinopril (Prinivil). Which instruction is
most important to include in the teaching plan?
A. "Take this medication with food to prevent stomach upset."
B. "Avoid salt substitutes containing potassium."
C. "Stop taking the medication if you develop a cough."
D. "Take the medication at bedtime to prevent dizziness."
Answer: B. "Avoid salt substitutes containing potassium."
Rationale: ACE inhibitors like lisinopril block aldosterone production, leading to
potassium retention (hyperkalemia). Using potassium-containing salt substitutes can
dangerously elevate potassium levels. While a dry cough is a common side effect, clients
should not stop the medication without consulting their provider.
7. The nurse is caring for a client 4 hours after thrombolytic therapy for an acute
myocardial infarction. Which assessment finding is most concerning?
A. Ecchymosis at the IV insertion site
B. Client report of mild back pain
