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HESI Medical-Surgical Nursing Exam 2026 | Complete Question Bank
Cardiovascular
1. A client with heart failure has crackles in both lungs, 2+ pitting edema in the
lower extremities, and jugular vein distension. Which intervention should the
nurse implement first?
• A. Restrict oral fluids to 1500 mL/day
• B. Administer furosemide 40 mg IV push
-C. Place client in high Fowler's position
• D. Apply sequential compression devices
Answer: C
Rationale: High Fowler's position promotes lung expansion and reduces preload,
providing immediate relief of respiratory distress. Airway and breathing are
always first.
2. A client receiving digoxin reports nausea, blurred vision, and sees "yellow
halos" around lights. The telemetry shows heart rate 52 bpm. What is the nurse's
priority action?
• A. Give digoxin immune Fab (Digibind) immediately
• B. Withhold digoxin and obtain a serum digoxin level
• C. Administer atropine 0.5 mg IV push
• D. Reassure the client these are expected side effects
Answer: B
Rationale: Nausea, visual changes (yellow halos), and bradycardia are classic signs
of digoxin toxicity. The priority is to withhold the drug and check the digoxin level.
3. A client with unstable angina is started on heparin. The aPTT result is 110
seconds (normal 25-35). What should the nurse do?
• A. Continue heparin at the same rate
,2
• B. Increase the heparin infusion rate
• C. Stop the infusion and notify the provider
• D. Administer protamine sulfate immediately
Answer: C
Rationale: Therapeutic aPTT for heparin is usually 1.5–2.5 times normal (approx
50–80 sec). 110 seconds indicates excessive anticoagulation and high bleeding
risk. The infusion should be stopped.
4. A client 2 days post-MI reports sudden shortness of breath and audible crackles
halfway up the lung fields. Which complication should the nurse suspect?
• A. Cardiac tamponade
• B. Pulmonary embolism
• C. Heart failure (cardiogenic shock)
• D. Ventricular septal rupture
Answer: C
Rationale: Pulmonary crackles and dyspnea after MI suggest left ventricular
failure (cardiogenic pulmonary edema). This requires immediate diuretic and
oxygen therapy.
5. A client with hypertension is prescribed hydrochlorothiazide. Which lab value
requires the most immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.9 mEq/L
• C. Glucose 110 mg/dL
• D. Calcium 9.5 mg/dL
Answer: B
Rationale: Thiazide diuretics cause hypokalemia. Potassium 2.9 mEq/L is critical
,3
and increases the risk of cardiac arrhythmias, especially if the patient is on
digoxin.
6. A client with peripheral artery disease (PAD) complains of calf pain when
walking. The nurse identifies this as:
• A. Rest pain
• B. Intermittent claudication
• C. Venous stasis pain
• D. Neuropathic pain
Answer: B
Rationale: Intermittent claudication is muscle pain/cramping during exercise that
resolves with rest, caused by inadequate arterial blood flow.
7. A client with deep vein thrombosis (DVT) is on warfarin. Which INR indicates
therapeutic range for DVT treatment?
• A. 0.8
• B. 1.2
• C. 2.5
• D. 4.5
Answer: C
Rationale: Therapeutic INR for DVT treatment is 2.0–3.0. 2.5 is ideal.
8. The nurse is teaching a client with heart failure about daily weights. Which
statement indicates understanding?
• A. "I should weigh myself after breakfast each day"
• B. "A gain of 2 pounds overnight is normal"
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• C. "I'll weigh myself every morning before eating and after voiding"
• D. "I'll only call the doctor if I gain 5 pounds in a week"
Answer: C
Rationale: Daily weight should be at same time (morning), same scale, with same
clothing, after voiding, before breakfast. A gain of 2-3 lbs in 24 hours or 5 lbs in a
week indicates fluid retention.
9. A client has a blood pressure of 85/50 mmHg and heart rate 120 bpm after
receiving morphine 4 mg IV for chest pain. The nurse should first:
• A. Administer naloxone
• B. Place the client in Trendelenburg position
• C. Raise the foot of the bed and lower the head
• D. Elevate the legs while keeping the head flat
Answer: D
Rationale: Morphine can cause venodilation and hypotension. Elevating legs
(modified Trendelenburg) promotes venous return. Full Trendelenburg is no
longer recommended.
10. A client post-cardiac catheterization via femoral artery reports severe back
pain and a falling blood pressure. The nurse should suspect:
• A. Retroperitoneal bleeding
• B. Normal post-op discomfort
• C. Allergic contrast reaction
• D. Myocardial infarction
Answer: A
Rationale: Back/flank pain with hypotension after femoral cath suggests
retroperitoneal bleeding. Immediate provider notification is critical.
HESI Medical-Surgical Nursing Exam 2026 | Complete Question Bank
Cardiovascular
1. A client with heart failure has crackles in both lungs, 2+ pitting edema in the
lower extremities, and jugular vein distension. Which intervention should the
nurse implement first?
• A. Restrict oral fluids to 1500 mL/day
• B. Administer furosemide 40 mg IV push
-C. Place client in high Fowler's position
• D. Apply sequential compression devices
Answer: C
Rationale: High Fowler's position promotes lung expansion and reduces preload,
providing immediate relief of respiratory distress. Airway and breathing are
always first.
2. A client receiving digoxin reports nausea, blurred vision, and sees "yellow
halos" around lights. The telemetry shows heart rate 52 bpm. What is the nurse's
priority action?
• A. Give digoxin immune Fab (Digibind) immediately
• B. Withhold digoxin and obtain a serum digoxin level
• C. Administer atropine 0.5 mg IV push
• D. Reassure the client these are expected side effects
Answer: B
Rationale: Nausea, visual changes (yellow halos), and bradycardia are classic signs
of digoxin toxicity. The priority is to withhold the drug and check the digoxin level.
3. A client with unstable angina is started on heparin. The aPTT result is 110
seconds (normal 25-35). What should the nurse do?
• A. Continue heparin at the same rate
,2
• B. Increase the heparin infusion rate
• C. Stop the infusion and notify the provider
• D. Administer protamine sulfate immediately
Answer: C
Rationale: Therapeutic aPTT for heparin is usually 1.5–2.5 times normal (approx
50–80 sec). 110 seconds indicates excessive anticoagulation and high bleeding
risk. The infusion should be stopped.
4. A client 2 days post-MI reports sudden shortness of breath and audible crackles
halfway up the lung fields. Which complication should the nurse suspect?
• A. Cardiac tamponade
• B. Pulmonary embolism
• C. Heart failure (cardiogenic shock)
• D. Ventricular septal rupture
Answer: C
Rationale: Pulmonary crackles and dyspnea after MI suggest left ventricular
failure (cardiogenic pulmonary edema). This requires immediate diuretic and
oxygen therapy.
5. A client with hypertension is prescribed hydrochlorothiazide. Which lab value
requires the most immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.9 mEq/L
• C. Glucose 110 mg/dL
• D. Calcium 9.5 mg/dL
Answer: B
Rationale: Thiazide diuretics cause hypokalemia. Potassium 2.9 mEq/L is critical
,3
and increases the risk of cardiac arrhythmias, especially if the patient is on
digoxin.
6. A client with peripheral artery disease (PAD) complains of calf pain when
walking. The nurse identifies this as:
• A. Rest pain
• B. Intermittent claudication
• C. Venous stasis pain
• D. Neuropathic pain
Answer: B
Rationale: Intermittent claudication is muscle pain/cramping during exercise that
resolves with rest, caused by inadequate arterial blood flow.
7. A client with deep vein thrombosis (DVT) is on warfarin. Which INR indicates
therapeutic range for DVT treatment?
• A. 0.8
• B. 1.2
• C. 2.5
• D. 4.5
Answer: C
Rationale: Therapeutic INR for DVT treatment is 2.0–3.0. 2.5 is ideal.
8. The nurse is teaching a client with heart failure about daily weights. Which
statement indicates understanding?
• A. "I should weigh myself after breakfast each day"
• B. "A gain of 2 pounds overnight is normal"
, 4
• C. "I'll weigh myself every morning before eating and after voiding"
• D. "I'll only call the doctor if I gain 5 pounds in a week"
Answer: C
Rationale: Daily weight should be at same time (morning), same scale, with same
clothing, after voiding, before breakfast. A gain of 2-3 lbs in 24 hours or 5 lbs in a
week indicates fluid retention.
9. A client has a blood pressure of 85/50 mmHg and heart rate 120 bpm after
receiving morphine 4 mg IV for chest pain. The nurse should first:
• A. Administer naloxone
• B. Place the client in Trendelenburg position
• C. Raise the foot of the bed and lower the head
• D. Elevate the legs while keeping the head flat
Answer: D
Rationale: Morphine can cause venodilation and hypotension. Elevating legs
(modified Trendelenburg) promotes venous return. Full Trendelenburg is no
longer recommended.
10. A client post-cardiac catheterization via femoral artery reports severe back
pain and a falling blood pressure. The nurse should suspect:
• A. Retroperitoneal bleeding
• B. Normal post-op discomfort
• C. Allergic contrast reaction
• D. Myocardial infarction
Answer: A
Rationale: Back/flank pain with hypotension after femoral cath suggests
retroperitoneal bleeding. Immediate provider notification is critical.
