HESI Medical-Surgical Exam:
Comprehensive Topic Test (2026
Edition)||| questions and answers
with rationales/graded A+/2026
update/100% correct /instant
download
Total Questions: 85
Instructions: Select the best answer. Correct answers are highlighted in bold with
a rationale provided.
Section 1: Cardiovascular Disorders (Questions 1–15)
1. A client with heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which assessment finding requires immediate intervention?
• A. Urine output of 200 mL in 4 hours
• B. Serum potassium of 3.1 mEq/L
• C. Blood pressure of 130/80 mm Hg
• D. Heart rate of 78 bpm
Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity, leading
to life-threatening dysrhythmias. Low urine output and stable vitals are not
immediate priorities.
2. A client with unstable angina receives nitroglycerin sublingual. After three
doses 5 minutes apart, chest pain persists. What is the priority action?
• A. Administer aspirin 324 mg
• B. Prepare for emergency percutaneous coronary intervention (PCI)
, • C. Obtain a 12-lead ECG
• D. Recheck blood pressure
Rationale: Unrelieved pain after 3 nitroglycerin doses indicates possible acute
myocardial infarction; immediate reperfusion (PCI) is standard of care.
3. A nurse assesses a client post-cardiac catheterization via the right femoral
artery. The right foot is pale and cool with diminished pulses. What should the
nurse do first?
• A. Notify the healthcare provider immediately
• B. Apply warm blankets to the right foot
• C. Elevate the head of the bed to 45 degrees
• D. Document the findings and reassess in 30 minutes
Rationale: Pale, cool extremity with diminished pulses suggests arterial occlusion
(e.g., thrombus). Immediate intervention is required to prevent limb loss.
4. Which laboratory value is most concerning in a client with suspected left-
sided heart failure?
• A. BNP 100 pg/mL
• B. BNP 1200 pg/mL
• C. Troponin I 0.03 ng/mL
• D. Hemoglobin 12 g/dL
Rationale: BNP >500 pg/mL strongly indicates heart failure; 1200 pg/mL suggests
acute decompensation. Troponin rules out MI; anemia is unrelated here.
5. A client with hypertension is prescribed hydrochlorothiazide. Which
instruction should the nurse include?
• A. Take the medication at bedtime
• B. Monitor for muscle weakness or cramps
• C. Restrict fluids to 1.5 L/day
• D. Avoid foods high in potassium
, Rationale: Thiazides cause hypokalemia and hyponatremia, leading to muscle
weakness/cramps. Morning dosing is typical to avoid nocturia.
6–8. Select all that apply: A client with infective endocarditis should be
monitored for which complications? (Select 3)
• A. Splinter hemorrhages
• B. Osler’s nodes
• C. Heart failure
• D. Decreased JVP
• E. Bradycardia
Rationale: Endocarditis causes peripheral emboli (splinter hemorrhages, Osler’s
nodes) and valvular damage leading to heart failure. JVP increases, and
fever/tachycardia are typical.
9. Priority question (NGN style): A client post-MI has HR 120, BP 85/50, cool
clammy skin, and urine output 15 mL/hr for 2 hours. What condition is most
likely?
• A. Cardiogenic shock (Correct)
• B. Anaphylactic shock
• C. Septic shock
• D. Hypovolemic shock
Rationale: Post-MI decreased contractility → low BP, tachycardia, poor perfusion
→ cardiogenic shock.
10. A client with atrial fibrillation (rate 140 bpm) is prescribed diltiazem IV.
What is the expected therapeutic outcome?
• A. Conversion to sinus rhythm
• B. Slowing of ventricular rate to <100 bpm
• C. Increase in blood pressure
• D. Prevention of stroke
Comprehensive Topic Test (2026
Edition)||| questions and answers
with rationales/graded A+/2026
update/100% correct /instant
download
Total Questions: 85
Instructions: Select the best answer. Correct answers are highlighted in bold with
a rationale provided.
Section 1: Cardiovascular Disorders (Questions 1–15)
1. A client with heart failure is prescribed furosemide (Lasix) and digoxin
(Lanoxin). Which assessment finding requires immediate intervention?
• A. Urine output of 200 mL in 4 hours
• B. Serum potassium of 3.1 mEq/L
• C. Blood pressure of 130/80 mm Hg
• D. Heart rate of 78 bpm
Rationale: Hypokalemia (K+ <3.5) increases the risk of digoxin toxicity, leading
to life-threatening dysrhythmias. Low urine output and stable vitals are not
immediate priorities.
2. A client with unstable angina receives nitroglycerin sublingual. After three
doses 5 minutes apart, chest pain persists. What is the priority action?
• A. Administer aspirin 324 mg
• B. Prepare for emergency percutaneous coronary intervention (PCI)
, • C. Obtain a 12-lead ECG
• D. Recheck blood pressure
Rationale: Unrelieved pain after 3 nitroglycerin doses indicates possible acute
myocardial infarction; immediate reperfusion (PCI) is standard of care.
3. A nurse assesses a client post-cardiac catheterization via the right femoral
artery. The right foot is pale and cool with diminished pulses. What should the
nurse do first?
• A. Notify the healthcare provider immediately
• B. Apply warm blankets to the right foot
• C. Elevate the head of the bed to 45 degrees
• D. Document the findings and reassess in 30 minutes
Rationale: Pale, cool extremity with diminished pulses suggests arterial occlusion
(e.g., thrombus). Immediate intervention is required to prevent limb loss.
4. Which laboratory value is most concerning in a client with suspected left-
sided heart failure?
• A. BNP 100 pg/mL
• B. BNP 1200 pg/mL
• C. Troponin I 0.03 ng/mL
• D. Hemoglobin 12 g/dL
Rationale: BNP >500 pg/mL strongly indicates heart failure; 1200 pg/mL suggests
acute decompensation. Troponin rules out MI; anemia is unrelated here.
5. A client with hypertension is prescribed hydrochlorothiazide. Which
instruction should the nurse include?
• A. Take the medication at bedtime
• B. Monitor for muscle weakness or cramps
• C. Restrict fluids to 1.5 L/day
• D. Avoid foods high in potassium
, Rationale: Thiazides cause hypokalemia and hyponatremia, leading to muscle
weakness/cramps. Morning dosing is typical to avoid nocturia.
6–8. Select all that apply: A client with infective endocarditis should be
monitored for which complications? (Select 3)
• A. Splinter hemorrhages
• B. Osler’s nodes
• C. Heart failure
• D. Decreased JVP
• E. Bradycardia
Rationale: Endocarditis causes peripheral emboli (splinter hemorrhages, Osler’s
nodes) and valvular damage leading to heart failure. JVP increases, and
fever/tachycardia are typical.
9. Priority question (NGN style): A client post-MI has HR 120, BP 85/50, cool
clammy skin, and urine output 15 mL/hr for 2 hours. What condition is most
likely?
• A. Cardiogenic shock (Correct)
• B. Anaphylactic shock
• C. Septic shock
• D. Hypovolemic shock
Rationale: Post-MI decreased contractility → low BP, tachycardia, poor perfusion
→ cardiogenic shock.
10. A client with atrial fibrillation (rate 140 bpm) is prescribed diltiazem IV.
What is the expected therapeutic outcome?
• A. Conversion to sinus rhythm
• B. Slowing of ventricular rate to <100 bpm
• C. Increase in blood pressure
• D. Prevention of stroke
