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MED SURG HESI V1 ACTUAL EXAM 2026/2027 | Version 1
Verified Q&A | Complete Test Bank | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Core Concepts (Q1-16)
Q1. A 58-year-old patient with newly diagnosed Stage 1 hypertension (BP 142/88
mmHg) asks about first-line lifestyle modifications. Which recommendation aligns
with current JNC guidelines as the initial nonpharmacologic intervention?
A. Begin a low-sodium DASH diet and restrict alcohol to no more than 2 drinks daily
B. Adopt the DASH eating plan, reduce sodium to <2,300 mg/day, and engage in
regular aerobic activity
C. Initiate a ketogenic diet and eliminate all dietary sodium immediately
D. Focus exclusively on stress reduction through meditation without dietary changes
B. Adopt the DASH eating plan, reduce sodium to <2,300 mg/day, and engage in
regular aerobic activity [CORRECT]
Rationale: JNC guidelines emphasize weight reduction, DASH diet, sodium restriction,
and regular physical activity as first-line lifestyle modifications for Stage 1
hypertension. Option A incorrectly permits 2 drinks daily (limit is ≤1 for women, ≤2
for men). Option C is unsafe and not guideline-supported. Option D is incomplete.
Correct Answer: B
Q2. A patient prescribed lisinopril for hypertension returns for a follow-up visit and
reports a persistent dry cough. Which statement by the nurse is most accurate
regarding this adverse effect?
A. "This cough indicates an allergic reaction; you must stop the medication
immediately."
,2
B. "A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation and is not life-threatening."
C. "The cough will resolve if you take the medication with a full glass of water."
D. "This side effect is rare and usually indicates the dose is too high."
B. "A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation and is not life-threatening." [CORRECT]
Rationale: ACE inhibitor-induced cough occurs in 5-20% of patients due to
bradykinin and substance P accumulation; it is not an allergic reaction. Option A is
incorrect because angioedema—not cough—signals immediate discontinuation.
Option C is false; water does not prevent the cough. Option D is incorrect because
the cough is dose-independent.
Correct Answer: B
Q3. A 67-year-old male presents to the emergency department with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. His 12-lead
ECG shows ST-segment elevation in leads V1-V4. Which cardiac enzyme rises first
and is the most sensitive early indicator of myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate dehydrogenase (LDH)
C. Myoglobin [CORRECT]
Rationale: Myoglobin rises within 1-3 hours after MI onset, making it the earliest
marker, though it lacks cardiac specificity. Troponin I (Option B) is the most specific
and rises within 3-6 hours but is not the first. CK-MB (Option A) rises within 4-6
hours. LDH (Option D) is a late marker and no longer used for acute diagnosis.
Correct Answer: C
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Q4. A diabetic patient presents with acute MI. Which atypical symptom presentation
is most commonly seen in female and older adult patients during myocardial
infarction?
A. Sharp, stabbing chest pain that worsens with inspiration
B. Dyspnea, fatigue, indigestion, and back or jaw pain without classic chest pain
C. Continuous, tearing pain radiating to the abdomen
D. Pleuritic chest pain accompanied by a friction rub
B. Dyspnea, fatigue, indigestion, and back or jaw pain without classic chest pain
[CORRECT]
Rationale: Women and older adults frequently present with atypical MI symptoms
including dyspnea, fatigue, nausea, and back or jaw discomfort rather than classic
crushing chest pain. Option A describes pleuritic pain (pericarditis). Option C
suggests aortic dissection. Option D indicates pericarditis.
Correct Answer: B
Q5. Which ECG change is most characteristic of an acute anterior wall myocardial
infarction?
A. ST-segment elevation in leads II, III, and aVF
B. ST-segment depression in leads V1-V4 with reciprocal changes
C. ST-segment elevation in leads V1-V4
D. Pathological Q waves in leads I and aVL
C. ST-segment elevation in leads V1-V4 [CORRECT]
Rationale: Leads V1-V4 view the anterior wall of the left ventricle; ST elevation in
these leads is diagnostic of anterior STEMI. Option A indicates an inferior MI. Option
B describes ischemia rather than infarction. Option D indicates a lateral MI.
Correct Answer: C
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Q6. A patient with hypertension is prescribed hydrochlorothiazide. Which laboratory
value should the nurse monitor closely during therapy?
A. Serum potassium
B. Serum calcium
C. Serum magnesium
D. Serum chloride
A. Serum potassium [CORRECT]
Rationale: Thiazide diuretics promote potassium wasting through increased distal
tubular delivery of sodium and water, risking hypokalemia. While magnesium (Option
C) and calcium (Option B) may be affected, potassium is the priority monitoring
parameter. Option D is incorrect because chloride typically follows sodium.
Correct Answer: A
Q7. A nurse is caring for a patient post-MI who is prescribed atorvastatin. Which
instruction is essential regarding statin therapy?
A. "Take the medication in the morning for maximum effectiveness."
B. "Report any unexplained muscle pain, tenderness, or weakness immediately."
C. "It is safe to drink grapefruit juice daily while taking this medication."
D. "You can stop this medication once your cholesterol reaches normal levels."
B. "Report any unexplained muscle pain, tenderness, or weakness immediately."
[CORRECT]
Rationale: Statins can cause myopathy and rhabdomyolysis; early recognition of
muscle symptoms is critical. Option A is incorrect because statins may be taken at
any time (though some providers prefer evening dosing). Option C is dangerous
because grapefruit inhibits CYP3A4 metabolism. Option D is false; statins require
continued therapy for secondary prevention.
Correct Answer: B
MED SURG HESI V1 ACTUAL EXAM 2026/2027 | Version 1
Verified Q&A | Complete Test Bank | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Core Concepts (Q1-16)
Q1. A 58-year-old patient with newly diagnosed Stage 1 hypertension (BP 142/88
mmHg) asks about first-line lifestyle modifications. Which recommendation aligns
with current JNC guidelines as the initial nonpharmacologic intervention?
A. Begin a low-sodium DASH diet and restrict alcohol to no more than 2 drinks daily
B. Adopt the DASH eating plan, reduce sodium to <2,300 mg/day, and engage in
regular aerobic activity
C. Initiate a ketogenic diet and eliminate all dietary sodium immediately
D. Focus exclusively on stress reduction through meditation without dietary changes
B. Adopt the DASH eating plan, reduce sodium to <2,300 mg/day, and engage in
regular aerobic activity [CORRECT]
Rationale: JNC guidelines emphasize weight reduction, DASH diet, sodium restriction,
and regular physical activity as first-line lifestyle modifications for Stage 1
hypertension. Option A incorrectly permits 2 drinks daily (limit is ≤1 for women, ≤2
for men). Option C is unsafe and not guideline-supported. Option D is incomplete.
Correct Answer: B
Q2. A patient prescribed lisinopril for hypertension returns for a follow-up visit and
reports a persistent dry cough. Which statement by the nurse is most accurate
regarding this adverse effect?
A. "This cough indicates an allergic reaction; you must stop the medication
immediately."
,2
B. "A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation and is not life-threatening."
C. "The cough will resolve if you take the medication with a full glass of water."
D. "This side effect is rare and usually indicates the dose is too high."
B. "A dry cough is a common side effect of ACE inhibitors caused by bradykinin
accumulation and is not life-threatening." [CORRECT]
Rationale: ACE inhibitor-induced cough occurs in 5-20% of patients due to
bradykinin and substance P accumulation; it is not an allergic reaction. Option A is
incorrect because angioedema—not cough—signals immediate discontinuation.
Option C is false; water does not prevent the cough. Option D is incorrect because
the cough is dose-independent.
Correct Answer: B
Q3. A 67-year-old male presents to the emergency department with crushing
substernal chest pain radiating to the left arm, diaphoresis, and nausea. His 12-lead
ECG shows ST-segment elevation in leads V1-V4. Which cardiac enzyme rises first
and is the most sensitive early indicator of myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate dehydrogenase (LDH)
C. Myoglobin [CORRECT]
Rationale: Myoglobin rises within 1-3 hours after MI onset, making it the earliest
marker, though it lacks cardiac specificity. Troponin I (Option B) is the most specific
and rises within 3-6 hours but is not the first. CK-MB (Option A) rises within 4-6
hours. LDH (Option D) is a late marker and no longer used for acute diagnosis.
Correct Answer: C
,3
Q4. A diabetic patient presents with acute MI. Which atypical symptom presentation
is most commonly seen in female and older adult patients during myocardial
infarction?
A. Sharp, stabbing chest pain that worsens with inspiration
B. Dyspnea, fatigue, indigestion, and back or jaw pain without classic chest pain
C. Continuous, tearing pain radiating to the abdomen
D. Pleuritic chest pain accompanied by a friction rub
B. Dyspnea, fatigue, indigestion, and back or jaw pain without classic chest pain
[CORRECT]
Rationale: Women and older adults frequently present with atypical MI symptoms
including dyspnea, fatigue, nausea, and back or jaw discomfort rather than classic
crushing chest pain. Option A describes pleuritic pain (pericarditis). Option C
suggests aortic dissection. Option D indicates pericarditis.
Correct Answer: B
Q5. Which ECG change is most characteristic of an acute anterior wall myocardial
infarction?
A. ST-segment elevation in leads II, III, and aVF
B. ST-segment depression in leads V1-V4 with reciprocal changes
C. ST-segment elevation in leads V1-V4
D. Pathological Q waves in leads I and aVL
C. ST-segment elevation in leads V1-V4 [CORRECT]
Rationale: Leads V1-V4 view the anterior wall of the left ventricle; ST elevation in
these leads is diagnostic of anterior STEMI. Option A indicates an inferior MI. Option
B describes ischemia rather than infarction. Option D indicates a lateral MI.
Correct Answer: C
, 4
Q6. A patient with hypertension is prescribed hydrochlorothiazide. Which laboratory
value should the nurse monitor closely during therapy?
A. Serum potassium
B. Serum calcium
C. Serum magnesium
D. Serum chloride
A. Serum potassium [CORRECT]
Rationale: Thiazide diuretics promote potassium wasting through increased distal
tubular delivery of sodium and water, risking hypokalemia. While magnesium (Option
C) and calcium (Option B) may be affected, potassium is the priority monitoring
parameter. Option D is incorrect because chloride typically follows sodium.
Correct Answer: A
Q7. A nurse is caring for a patient post-MI who is prescribed atorvastatin. Which
instruction is essential regarding statin therapy?
A. "Take the medication in the morning for maximum effectiveness."
B. "Report any unexplained muscle pain, tenderness, or weakness immediately."
C. "It is safe to drink grapefruit juice daily while taking this medication."
D. "You can stop this medication once your cholesterol reaches normal levels."
B. "Report any unexplained muscle pain, tenderness, or weakness immediately."
[CORRECT]
Rationale: Statins can cause myopathy and rhabdomyolysis; early recognition of
muscle symptoms is critical. Option A is incorrect because statins may be taken at
any time (though some providers prefer evening dosing). Option C is dangerous
because grapefruit inhibits CYP3A4 metabolism. Option D is false; statins require
continued therapy for secondary prevention.
Correct Answer: B
