HESI MED SURG PRACTICE QUESTIONS 2026/2027 |
Questions & Answers | Verified w/ Rationales | Latest Update
| Exam Prep | Pass Guaranteed - A+ Graded
CARDIOVASCULAR SYSTEM (10 Questions)
Q1: Which blood pressure reading meets the criteria for Stage 2 hypertension according
to current ACC/AHA guidelines?
A. 128/82 mmHg
B. 134/84 mmHg
C. 142/92 mmHg
D. 118/78 mmHg
Correct Answer: C
Rationale: Stage 2 hypertension is defined as systolic ≥140 mmHg or diastolic ≥90
mmHg. Option C (142/92) meets this criteria.
● A is incorrect: 128/82 is elevated (systolic 120-129 and diastolic <80) but not
hypertensive.
● B is incorrect: 134/84 is Stage 1 hypertension (systolic 130-139 or diastolic
80-89).
● D is incorrect: 118/78 is normal blood pressure (<120/<80).
Memory Aid: "Stage 1 = 130s/80s, Stage 2 = 140s/90s, Crisis = 180s/120s"
Q2: A patient with heart failure is prescribed lisinopril 10 mg daily and furosemide 40
mg daily. The patient calls the clinic reporting a dry, persistent cough for two weeks.
What is the nurse's best response?
A. "This is likely a viral infection. Increase your fluid intake and rest."
,B. "Stop the furosemide immediately and come to the clinic today."
C. "This cough is a common side effect of lisinopril. We may need to switch you to a
different medication."
D. "Take an over-the-counter cough suppressant and continue your medications."
Correct Answer: C
Rationale: A dry, nonproductive cough is a well-documented side effect of ACE inhibitors
(lisinopril) occurring in 5-20% of patients. It results from accumulation of bradykinin and
substance P. The cough typically resolves within 1-4 weeks after discontinuation.
Switching to an ARB (angiotensin receptor blocker) like losartan usually resolves the
issue since ARBs do not affect bradykinin metabolism.
● A is incorrect: While possible, a new cough in a patient on ACE inhibitors should
first be evaluated as a drug side effect before attributing to viral illness.
● B is incorrect: Furosemide does not cause cough; stopping it could worsen heart
failure.
● D is incorrect: The cough will persist as long as the ACE inhibitor is continued;
masking symptoms delays appropriate treatment modification.
Q3: A patient with atrial fibrillation is started on warfarin therapy. Which instruction is
essential for the nurse to provide?
A. "Take aspirin daily in addition to warfarin for better stroke prevention."
B. "You can continue eating leafy green vegetables as long as you're consistent."
C. "Report any unusual bleeding, but nosebleeds are expected and normal."
D. "Your INR goal is 0.8-1.2, and we'll check it monthly."
Correct Answer: B
Rationale: Vitamin K (found in leafy greens) antagonizes warfarin's effect. The key is
consistency, not avoidance. Patients should maintain stable vitamin K intake rather than
suddenly increasing or decreasing it, which would destabilize INR. INR goal for atrial
fibrillation is 2.0-3.0.
, ● A is incorrect: Combining aspirin and warfarin increases bleeding risk
significantly and is only done under specific circumstances with close
monitoring.
● C is incorrect: Any bleeding, including nosebleeds, requires evaluation. While
minor bleeding may occur, it should never be dismissed as "normal."
● D is incorrect: Therapeutic INR for AFib is 2.0-3.0, not 0.8-1.2 (which is normal
without anticoagulation). INR is checked frequently at initiation (weekly), then
monthly when stable.
Q4: A patient with a history of angina reports chest pain while walking up stairs. The
pain is relieved after resting for 3 minutes and taking one nitroglycerin tablet
sublingually. This episode is most consistent with:
A. Unstable angina requiring emergency intervention
B. Stable angina with expected pattern
C. Myocardial infarction in evolution
D. Prinzmetal's variant angina
Correct Answer: B
Rationale: Stable angina is predictable, occurring with consistent exertion, relieved by
rest or nitroglycerin within 5-10 minutes, and follows a stable pattern for months. This
patient's presentation matches all criteria.
● A is incorrect: Unstable angina occurs at rest, with increasing frequency or
severity, or lasts >20 minutes despite treatment—medical emergency.
● C is incorrect: MI pain is unrelenting, not relieved by rest or nitroglycerin, and
typically accompanied by other symptoms (diaphoresis, nausea, radiation).
● D is incorrect: Prinzmetal's angina occurs at rest due to coronary vasospasm,
typically midnight to early morning, and responds to calcium channel blockers.
Q5: A patient with acute myocardial infarction develops cardiogenic shock. Which
hemodynamic finding is most consistent with this complication?
A. BP 88/50, CVP 2 mmHg, PCWP 8 mmHg
, B. BP 74/40, CVP 14 mmHg, PCWP 24 mmHg
C. BP 92/60, CVP 4 mmHg, PCWP 6 mmHg
D. BP 110/70, CVP 12 mmHg, PCWP 18 mmHg
Correct Answer: B
Rationale: Cardiogenic shock is characterized by inadequate tissue perfusion due to
cardiac pump failure. Hemodynamic profile shows: hypotension (SBP <90), elevated
CVP (right-sided failure/backup), and elevated PCWP (left-sided failure/pulmonary
congestion). Option B shows classic findings: low BP, high CVP (14, normal 2-6), high
PCWP (24, normal 6-12).
● A is incorrect: Low CVP and PCWP indicate hypovolemic shock, not cardiogenic.
● C is incorrect: Low CVP and PCWP with borderline BP suggest early hypovolemia
or sepsis with vasodilation.
● D is incorrect: Normal BP excludes shock; elevated pressures without
hypotension indicate compensated heart failure.
Q6: A nurse is caring for a patient with a new permanent pacemaker. Which discharge
instruction is the priority?
A. "You may resume all normal activities immediately, including swimming and golf."
B. "Avoid lifting your left arm above shoulder level for 4-6 weeks."
C. "You will need to have the battery changed surgically every year."
D. "Keep a magnet with you at all times to deactivate the pacemaker if needed."
Correct Answer: B
Rationale: For 4-6 weeks post-implantation, patients must avoid lifting the ipsilateral
arm above shoulder level to prevent lead dislodgement. The subclavian approach
creates a risk of lead displacement with excessive arm movement during the healing
period.
Questions & Answers | Verified w/ Rationales | Latest Update
| Exam Prep | Pass Guaranteed - A+ Graded
CARDIOVASCULAR SYSTEM (10 Questions)
Q1: Which blood pressure reading meets the criteria for Stage 2 hypertension according
to current ACC/AHA guidelines?
A. 128/82 mmHg
B. 134/84 mmHg
C. 142/92 mmHg
D. 118/78 mmHg
Correct Answer: C
Rationale: Stage 2 hypertension is defined as systolic ≥140 mmHg or diastolic ≥90
mmHg. Option C (142/92) meets this criteria.
● A is incorrect: 128/82 is elevated (systolic 120-129 and diastolic <80) but not
hypertensive.
● B is incorrect: 134/84 is Stage 1 hypertension (systolic 130-139 or diastolic
80-89).
● D is incorrect: 118/78 is normal blood pressure (<120/<80).
Memory Aid: "Stage 1 = 130s/80s, Stage 2 = 140s/90s, Crisis = 180s/120s"
Q2: A patient with heart failure is prescribed lisinopril 10 mg daily and furosemide 40
mg daily. The patient calls the clinic reporting a dry, persistent cough for two weeks.
What is the nurse's best response?
A. "This is likely a viral infection. Increase your fluid intake and rest."
,B. "Stop the furosemide immediately and come to the clinic today."
C. "This cough is a common side effect of lisinopril. We may need to switch you to a
different medication."
D. "Take an over-the-counter cough suppressant and continue your medications."
Correct Answer: C
Rationale: A dry, nonproductive cough is a well-documented side effect of ACE inhibitors
(lisinopril) occurring in 5-20% of patients. It results from accumulation of bradykinin and
substance P. The cough typically resolves within 1-4 weeks after discontinuation.
Switching to an ARB (angiotensin receptor blocker) like losartan usually resolves the
issue since ARBs do not affect bradykinin metabolism.
● A is incorrect: While possible, a new cough in a patient on ACE inhibitors should
first be evaluated as a drug side effect before attributing to viral illness.
● B is incorrect: Furosemide does not cause cough; stopping it could worsen heart
failure.
● D is incorrect: The cough will persist as long as the ACE inhibitor is continued;
masking symptoms delays appropriate treatment modification.
Q3: A patient with atrial fibrillation is started on warfarin therapy. Which instruction is
essential for the nurse to provide?
A. "Take aspirin daily in addition to warfarin for better stroke prevention."
B. "You can continue eating leafy green vegetables as long as you're consistent."
C. "Report any unusual bleeding, but nosebleeds are expected and normal."
D. "Your INR goal is 0.8-1.2, and we'll check it monthly."
Correct Answer: B
Rationale: Vitamin K (found in leafy greens) antagonizes warfarin's effect. The key is
consistency, not avoidance. Patients should maintain stable vitamin K intake rather than
suddenly increasing or decreasing it, which would destabilize INR. INR goal for atrial
fibrillation is 2.0-3.0.
, ● A is incorrect: Combining aspirin and warfarin increases bleeding risk
significantly and is only done under specific circumstances with close
monitoring.
● C is incorrect: Any bleeding, including nosebleeds, requires evaluation. While
minor bleeding may occur, it should never be dismissed as "normal."
● D is incorrect: Therapeutic INR for AFib is 2.0-3.0, not 0.8-1.2 (which is normal
without anticoagulation). INR is checked frequently at initiation (weekly), then
monthly when stable.
Q4: A patient with a history of angina reports chest pain while walking up stairs. The
pain is relieved after resting for 3 minutes and taking one nitroglycerin tablet
sublingually. This episode is most consistent with:
A. Unstable angina requiring emergency intervention
B. Stable angina with expected pattern
C. Myocardial infarction in evolution
D. Prinzmetal's variant angina
Correct Answer: B
Rationale: Stable angina is predictable, occurring with consistent exertion, relieved by
rest or nitroglycerin within 5-10 minutes, and follows a stable pattern for months. This
patient's presentation matches all criteria.
● A is incorrect: Unstable angina occurs at rest, with increasing frequency or
severity, or lasts >20 minutes despite treatment—medical emergency.
● C is incorrect: MI pain is unrelenting, not relieved by rest or nitroglycerin, and
typically accompanied by other symptoms (diaphoresis, nausea, radiation).
● D is incorrect: Prinzmetal's angina occurs at rest due to coronary vasospasm,
typically midnight to early morning, and responds to calcium channel blockers.
Q5: A patient with acute myocardial infarction develops cardiogenic shock. Which
hemodynamic finding is most consistent with this complication?
A. BP 88/50, CVP 2 mmHg, PCWP 8 mmHg
, B. BP 74/40, CVP 14 mmHg, PCWP 24 mmHg
C. BP 92/60, CVP 4 mmHg, PCWP 6 mmHg
D. BP 110/70, CVP 12 mmHg, PCWP 18 mmHg
Correct Answer: B
Rationale: Cardiogenic shock is characterized by inadequate tissue perfusion due to
cardiac pump failure. Hemodynamic profile shows: hypotension (SBP <90), elevated
CVP (right-sided failure/backup), and elevated PCWP (left-sided failure/pulmonary
congestion). Option B shows classic findings: low BP, high CVP (14, normal 2-6), high
PCWP (24, normal 6-12).
● A is incorrect: Low CVP and PCWP indicate hypovolemic shock, not cardiogenic.
● C is incorrect: Low CVP and PCWP with borderline BP suggest early hypovolemia
or sepsis with vasodilation.
● D is incorrect: Normal BP excludes shock; elevated pressures without
hypotension indicate compensated heart failure.
Q6: A nurse is caring for a patient with a new permanent pacemaker. Which discharge
instruction is the priority?
A. "You may resume all normal activities immediately, including swimming and golf."
B. "Avoid lifting your left arm above shoulder level for 4-6 weeks."
C. "You will need to have the battery changed surgically every year."
D. "Keep a magnet with you at all times to deactivate the pacemaker if needed."
Correct Answer: B
Rationale: For 4-6 weeks post-implantation, patients must avoid lifting the ipsilateral
arm above shoulder level to prevent lead dislodgement. The subclavian approach
creates a risk of lead displacement with excessive arm movement during the healing
period.
