HESI MED SURG PRACTICE QUESTIONS BANK 2026/2027 |
Verified Answers | Complete Q&A for Med-Surg Exam | Pass
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Section 1: Cardiac & Vascular Disorders (Q1-20)
Q1. A patient with heart failure calls the clinic reporting a 3-pound weight gain in 1 day
and increased dyspnea with exertion. Which instruction is most appropriate?
A. Continue current medications and increase fluid intake to 3 liters daily
B. Take an additional dose of metoprolol and rest for 24 hours
C. Increase the dose of furosemide by double for 2 days and notify the provider if
symptoms persist [CORRECT]
D. Schedule an appointment for next week and avoid all physical activity
Rationale: A 3-pound gain in 24 hours or 5 pounds in a week indicates fluid retention
requiring diuretic adjustment per protocol; delaying care risks pulmonary edema.
Increasing fluids worsens overload and metoprolol does not address volume.
Correct Answer: C
Q2. A patient taking digoxin reports nausea, vomiting, and seeing yellow-green halos
around lights. The apical pulse is 52 bpm. Which action is priority?
A. Administer the scheduled dose of digoxin and obtain a serum potassium level
B. Hold the digoxin dose, assess serum digoxin and potassium levels, and notify the
provider [CORRECT]
C. Administer atropine 0.5 mg IV and continue the digoxin as prescribed
D. Increase the patient's oral fluid intake to flush the drug from the system
Rationale: Bradycardia <60 bpm, visual disturbances, and GI symptoms are classic
digoxin toxicity; the dose must be held pending labs. Atropine is for symptomatic
bradycardia but does not address toxicity, and fluids do not treat digitalis excess.
,Correct Answer: B
Q3. A patient weighs 70 kg and is prescribed a heparin infusion at 18 units/kg/hr. The
pharmacy supplies 25,000 units in 500 mL D5W. How many mL/hr should the nurse set
the infusion pump?
A. 15.2 mL/hr
B. 20.2 mL/hr
C. 25.2 mL/hr [CORRECT]
D. 30.4 mL/hr
Rationale: 70 kg × 18 units/kg/hr = 1,260 units/hr; 25,000 units/500 mL = 50 units/mL;
1,260 ÷ 50 = 25.2 mL/hr. Option A uses incorrect weight, B miscalculates concentration,
and D doubles the dose.
Correct Answer: C
Q4. A patient is 24 hours post-MI and hemodynamically stable. Which activity
progression is most appropriate?
A. Complete bed rest with bathroom privileges only for 48 hours
B. Ambulate in the hallway for 30 minutes twice daily
C. Sit in a chair for 30 minutes three times daily and perform self-care activities
[CORRECT]
D. Jog on the unit treadmill to build cardiac endurance
Rationale: Early progressive mobilization prevents deconditioning and complications;
prolonged bed rest increases DVT risk. Overexertion with jogging is contraindicated and
30-minute hallway walks are excessive at 24 hours.
Correct Answer: C
Q5. A patient with non-valvular atrial fibrillation has a CHA2DS2-VASc score of 4. Which
medication and education are most appropriate?
A. Aspirin 81 mg daily; monitor for GI bleeding
B. Apixaban 5 mg BID; avoid NSAIDs and report unusual bruising or bleeding [CORRECT]
C. Clopidogrel 75 mg daily; monitor for neutropenia
D. Warfarin 5 mg daily; target INR 1.5-2.0 and restrict all green vegetables
,Rationale: DOACs are first-line for stroke prevention in non-valvular AF with
CHA2DS2-VASc ≥2; bleeding precautions are essential. Aspirin/clopidogrel are
insufficient, warfarin requires INR 2-3, and vitamin K consistency—not restriction—is key.
Correct Answer: B
Q6. A patient presents with BP 210/130, severe headache, and papilledema. Which
intervention is priority?
A. Reduce MAP by 25% within the first hour using IV nicardipine or labetalol [CORRECT]
B. Administer sublingual nifedipine to achieve normotension within 15 minutes
C. Administer oral clonidine 0.2 mg and discharge home after 2 hours
D. Place the patient in Trendelenburg to improve cerebral perfusion
Rationale: Hypertensive emergency requires controlled reduction to prevent cerebral
ischemia; sublingual nifedipine causes precipitous drops, oral agents are for urgency
without end-organ damage, and Trendelenburg increases intracranial pressure.
Correct Answer: A
Q7. A patient with peripheral arterial disease has an ankle-brachial index (ABI) of 0.62.
Which education and intervention are most appropriate?
A. Perform Buerger's exercises, strict smoking cessation, and wound care with moist
dressings [CORRECT]
B. Apply compression stockings to improve venous return and reduce edema
C. Encourage high-impact aerobics to stimulate collateral circulation
D. Elevate legs above the heart level for 8 hours daily to improve perfusion
Rationale: ABI <0.9 indicates PAD; management includes exercise, smoking cessation,
and protective wound care. Compression stockings are contraindicated in PAD,
high-impact exercise causes trauma, and leg elevation reduces arterial perfusion.
Correct Answer: A
Q8. A patient returns from cardiac catheterization with the femoral approach. Which
assessment is priority in the first hour?
, A. Assess the puncture site for hematoma, check distal pulses, and maintain the leg
straight [CORRECT]
B. Encourage ambulation to the bathroom to prevent back pain and stiffness
C. Remove the pressure dressing to inspect the site for infection
D. Administer aspirin and clopidogrel immediately to prevent stent thrombosis
Rationale: Post-cath monitoring focuses on vascular access complications and bed rest
with the leg straight; early ambulation risks bleeding, removing dressings too early is
unsafe, and antiplatelet timing follows orders.
Correct Answer: A
Q9. A patient with heart failure is being discharged. The nurse is teaching
self-management. Select all that apply: Which statements by the patient indicate
understanding? (1. Weigh daily at the same time; 2. Take furosemide at bedtime; 3.
Limit sodium to 2 grams daily; 4. Report weight gain of 3 pounds in 1 day)
A. 1 and 3 only
B. 2 and 4 only
C. 1, 3, and 4 only [CORRECT]
D. 1, 2, 3, and 4
Rationale: Daily weights, sodium restriction, and reporting rapid weight gain are correct;
diuretics should be taken in the morning to prevent nocturia, making statement 2
incorrect.
Correct Answer: C
Q10. A patient with acute decompensated heart failure has the following arterial blood
gas: pH 7.30, PaCO2 58 mmHg, HCO3 28 mEq/L, PaO2 62 mmHg. Which interpretation
is correct?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
Verified Answers | Complete Q&A for Med-Surg Exam | Pass
Guaranteed - A+ Graded
Section 1: Cardiac & Vascular Disorders (Q1-20)
Q1. A patient with heart failure calls the clinic reporting a 3-pound weight gain in 1 day
and increased dyspnea with exertion. Which instruction is most appropriate?
A. Continue current medications and increase fluid intake to 3 liters daily
B. Take an additional dose of metoprolol and rest for 24 hours
C. Increase the dose of furosemide by double for 2 days and notify the provider if
symptoms persist [CORRECT]
D. Schedule an appointment for next week and avoid all physical activity
Rationale: A 3-pound gain in 24 hours or 5 pounds in a week indicates fluid retention
requiring diuretic adjustment per protocol; delaying care risks pulmonary edema.
Increasing fluids worsens overload and metoprolol does not address volume.
Correct Answer: C
Q2. A patient taking digoxin reports nausea, vomiting, and seeing yellow-green halos
around lights. The apical pulse is 52 bpm. Which action is priority?
A. Administer the scheduled dose of digoxin and obtain a serum potassium level
B. Hold the digoxin dose, assess serum digoxin and potassium levels, and notify the
provider [CORRECT]
C. Administer atropine 0.5 mg IV and continue the digoxin as prescribed
D. Increase the patient's oral fluid intake to flush the drug from the system
Rationale: Bradycardia <60 bpm, visual disturbances, and GI symptoms are classic
digoxin toxicity; the dose must be held pending labs. Atropine is for symptomatic
bradycardia but does not address toxicity, and fluids do not treat digitalis excess.
,Correct Answer: B
Q3. A patient weighs 70 kg and is prescribed a heparin infusion at 18 units/kg/hr. The
pharmacy supplies 25,000 units in 500 mL D5W. How many mL/hr should the nurse set
the infusion pump?
A. 15.2 mL/hr
B. 20.2 mL/hr
C. 25.2 mL/hr [CORRECT]
D. 30.4 mL/hr
Rationale: 70 kg × 18 units/kg/hr = 1,260 units/hr; 25,000 units/500 mL = 50 units/mL;
1,260 ÷ 50 = 25.2 mL/hr. Option A uses incorrect weight, B miscalculates concentration,
and D doubles the dose.
Correct Answer: C
Q4. A patient is 24 hours post-MI and hemodynamically stable. Which activity
progression is most appropriate?
A. Complete bed rest with bathroom privileges only for 48 hours
B. Ambulate in the hallway for 30 minutes twice daily
C. Sit in a chair for 30 minutes three times daily and perform self-care activities
[CORRECT]
D. Jog on the unit treadmill to build cardiac endurance
Rationale: Early progressive mobilization prevents deconditioning and complications;
prolonged bed rest increases DVT risk. Overexertion with jogging is contraindicated and
30-minute hallway walks are excessive at 24 hours.
Correct Answer: C
Q5. A patient with non-valvular atrial fibrillation has a CHA2DS2-VASc score of 4. Which
medication and education are most appropriate?
A. Aspirin 81 mg daily; monitor for GI bleeding
B. Apixaban 5 mg BID; avoid NSAIDs and report unusual bruising or bleeding [CORRECT]
C. Clopidogrel 75 mg daily; monitor for neutropenia
D. Warfarin 5 mg daily; target INR 1.5-2.0 and restrict all green vegetables
,Rationale: DOACs are first-line for stroke prevention in non-valvular AF with
CHA2DS2-VASc ≥2; bleeding precautions are essential. Aspirin/clopidogrel are
insufficient, warfarin requires INR 2-3, and vitamin K consistency—not restriction—is key.
Correct Answer: B
Q6. A patient presents with BP 210/130, severe headache, and papilledema. Which
intervention is priority?
A. Reduce MAP by 25% within the first hour using IV nicardipine or labetalol [CORRECT]
B. Administer sublingual nifedipine to achieve normotension within 15 minutes
C. Administer oral clonidine 0.2 mg and discharge home after 2 hours
D. Place the patient in Trendelenburg to improve cerebral perfusion
Rationale: Hypertensive emergency requires controlled reduction to prevent cerebral
ischemia; sublingual nifedipine causes precipitous drops, oral agents are for urgency
without end-organ damage, and Trendelenburg increases intracranial pressure.
Correct Answer: A
Q7. A patient with peripheral arterial disease has an ankle-brachial index (ABI) of 0.62.
Which education and intervention are most appropriate?
A. Perform Buerger's exercises, strict smoking cessation, and wound care with moist
dressings [CORRECT]
B. Apply compression stockings to improve venous return and reduce edema
C. Encourage high-impact aerobics to stimulate collateral circulation
D. Elevate legs above the heart level for 8 hours daily to improve perfusion
Rationale: ABI <0.9 indicates PAD; management includes exercise, smoking cessation,
and protective wound care. Compression stockings are contraindicated in PAD,
high-impact exercise causes trauma, and leg elevation reduces arterial perfusion.
Correct Answer: A
Q8. A patient returns from cardiac catheterization with the femoral approach. Which
assessment is priority in the first hour?
, A. Assess the puncture site for hematoma, check distal pulses, and maintain the leg
straight [CORRECT]
B. Encourage ambulation to the bathroom to prevent back pain and stiffness
C. Remove the pressure dressing to inspect the site for infection
D. Administer aspirin and clopidogrel immediately to prevent stent thrombosis
Rationale: Post-cath monitoring focuses on vascular access complications and bed rest
with the leg straight; early ambulation risks bleeding, removing dressings too early is
unsafe, and antiplatelet timing follows orders.
Correct Answer: A
Q9. A patient with heart failure is being discharged. The nurse is teaching
self-management. Select all that apply: Which statements by the patient indicate
understanding? (1. Weigh daily at the same time; 2. Take furosemide at bedtime; 3.
Limit sodium to 2 grams daily; 4. Report weight gain of 3 pounds in 1 day)
A. 1 and 3 only
B. 2 and 4 only
C. 1, 3, and 4 only [CORRECT]
D. 1, 2, 3, and 4
Rationale: Daily weights, sodium restriction, and reporting rapid weight gain are correct;
diuretics should be taken in the morning to prevent nocturia, making statement 2
incorrect.
Correct Answer: C
Q10. A patient with acute decompensated heart failure has the following arterial blood
gas: pH 7.30, PaCO2 58 mmHg, HCO3 28 mEq/L, PaO2 62 mmHg. Which interpretation
is correct?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with respiratory compensation
