HESI Medical-Surgical Nursing Exam 2026/2027 Actual Exam with
Detailed Rationales | Complete Exam-Style Questions | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 60 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Cardiovascular & Peripheral Vascular Disorders | Q1 – Q12
Section 2 | Respiratory & Acid-Base Disorders | Q13 – Q24
Section 3 | Gastrointestinal & Nutritional Disorders | Q25 – Q36
Section 4 | Renal, Endocrine & Metabolic Disorders | Q37 – Q48
Section 5 | Neurological, Musculoskeletal, Integumentary & Immunologic Disorders |
Q49 – Q60
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR DISORDERS Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 72-year-old client with a history of heart failure is admitted with increasing shortness
of breath and a cough productive of pink, frothy sputum. Vital signs show blood
pressure 190/110 mmHg, heart rate 118/min, respiratory rate 32/min, and SpO2 84% on
room air. Crackles are audible bilaterally to the apices. After positioning the client
upright and applying oxygen, which assessment finding indicates the intervention is
working?
A. The client reports mild dizziness when sitting upright
B. The oxygen saturation improves to 92% on 6 L nasal cannula ✓ CORRECT
C. The heart rate increases to 130 beats per minute
D. The crackles become louder and more widespread
Correct Answer: B
,Rationale: Improving oxygen saturation demonstrates that upright positioning and
supplemental oxygen are reducing pulmonary congestion and improving gas exchange.
An increasing heart rate or worsening crackles would signal deterioration, not
improvement. Dizziness can occur with upright positioning but does not confirm
therapeutic effectiveness.
Question 2 of 60
A 64-year-old client returns to the unit after a cardiac catheterization via the right
femoral artery. The nurse notes the pressure dressing is intact, but the client reports
numbness and tingling in the right foot. The pedal pulse is weak, and the foot is cool to
the touch. Which action should the nurse take first?
A. Reinforce the pressure dressing to ensure hemostasis
B. Elevate the right leg on two pillows to promote venous return
C. Remove the dressing and assess the insertion site for hematoma ✓ CORRECT
D. Apply a warm compress to the foot to improve circulation
Correct Answer: C
Rationale: Numbness, coolness, and a weak pulse suggest compromised arterial flow,
most likely from a hematoma compressing the vessel under the dressing. Removing the
dressing allows visual assessment and relieves external pressure if a collection is
present. Elevating the leg or reinforcing the dressing could worsen ischemia, and
warmth is inappropriate when arterial supply is compromised.
Question 3 of 60
A 58-year-old client with atrial fibrillation has been taking digoxin 0.25 mg daily for six
months. During a routine clinic visit, the client mentions feeling nauseated and seeing
yellow-green halos around lights. The nurse checks the apical pulse and finds it to be 52
beats per minute and irregular. Which laboratory test should the nurse anticipate the
provider will order first?
,A. Serum digoxin level and serum potassium ✓ CORRECT
B. Complete blood count and thyroid panel
C. Liver function tests and coagulation studies
D. Brain natriuretic peptide and troponin
Correct Answer: A
Rationale: Nausea, visual disturbances, and bradycardia are classic early signs of
digoxin toxicity, which is potentiated by hypokalemia. Checking the digoxin level and
potassium priority guides immediate treatment decisions. Thyroid panels and liver
function tests do not explain this specific cluster of symptoms.
Question 4 of 60
A 70-year-old male is admitted with a 6 cm abdominal aortic aneurysm. He is
asymptomatic and hemodynamically stable. During the admission assessment, the
client asks why surgery is being recommended when he feels fine. Which response by
the nurse is most accurate?
A. Surgery is only necessary once you develop severe back pain
B. Medications can effectively shrink the aneurysm back to a normal size
C. Small aneurysms always remain stable and never require intervention
D. The risk of rupture increases significantly once the aneurysm reaches 5.5 cm ✓
CORRECT
Correct Answer: D
Rationale: Elective repair is typically recommended when an abdominal aortic aneurysm
reaches 5.5 cm because rupture risk rises sharply beyond that diameter. Medications
cannot reverse aneurysmal dilation, and waiting for pain risks catastrophic rupture.
Asymptomatic status does not eliminate the threat of sudden rupture.
Question 5 of 60
, A 55-year-old client with peripheral artery disease complains of severe cramping pain in
the left calf after walking two blocks. The pain resolves after resting for five minutes.
The client asks what can be done to improve walking distance. Which recommendation
should the nurse include?
A. Rest completely and avoid walking to prevent pain
B. Walk until the pain starts, rest until it resolves, then resume walking ✓ CORRECT
C. Apply a heating pad to the calf before walking to dilate vessels
D. Elevate your legs above heart level throughout the day
Correct Answer: B
Rationale: Supervised exercise therapy using start-stop walking trains collateral
circulation and gradually extends pain-free walking distance in PAD. Complete rest leads
to deconditioning, and heat application does not address the underlying flow limitation.
Leg elevation is helpful for venous disease but can worsen arterial perfusion.
Question 6 of 60
A 62-year-old client with chronic heart failure has an ejection fraction of 30%. The
provider prescribes lisinopril 10 mg daily and furosemide 40 mg daily. Which instruction
should the nurse emphasize to prevent complications?
A. Take the furosemide at bedtime to avoid daytime swelling
B. Stop taking the lisinopril if you develop a dry cough
C. Weigh yourself every morning and report a gain of 3 pounds in one day ✓ CORRECT
D. Increase your dietary sodium to maintain your blood pressure
Correct Answer: C
Rationale: Daily weights are the most sensitive early indicator of fluid retention in heart
failure, and a 2 to 3 pound gain in a day signals the need for prompt intervention. Taking
a diuretic at bedtime causes nocturia, and stopping an ACE inhibitor for a mild cough
can destabilize the condition. Sodium restriction, not increase, is essential in heart
failure management.
Detailed Rationales | Complete Exam-Style Questions | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 60 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Cardiovascular & Peripheral Vascular Disorders | Q1 – Q12
Section 2 | Respiratory & Acid-Base Disorders | Q13 – Q24
Section 3 | Gastrointestinal & Nutritional Disorders | Q25 – Q36
Section 4 | Renal, Endocrine & Metabolic Disorders | Q37 – Q48
Section 5 | Neurological, Musculoskeletal, Integumentary & Immunologic Disorders |
Q49 – Q60
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR DISORDERS Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 72-year-old client with a history of heart failure is admitted with increasing shortness
of breath and a cough productive of pink, frothy sputum. Vital signs show blood
pressure 190/110 mmHg, heart rate 118/min, respiratory rate 32/min, and SpO2 84% on
room air. Crackles are audible bilaterally to the apices. After positioning the client
upright and applying oxygen, which assessment finding indicates the intervention is
working?
A. The client reports mild dizziness when sitting upright
B. The oxygen saturation improves to 92% on 6 L nasal cannula ✓ CORRECT
C. The heart rate increases to 130 beats per minute
D. The crackles become louder and more widespread
Correct Answer: B
,Rationale: Improving oxygen saturation demonstrates that upright positioning and
supplemental oxygen are reducing pulmonary congestion and improving gas exchange.
An increasing heart rate or worsening crackles would signal deterioration, not
improvement. Dizziness can occur with upright positioning but does not confirm
therapeutic effectiveness.
Question 2 of 60
A 64-year-old client returns to the unit after a cardiac catheterization via the right
femoral artery. The nurse notes the pressure dressing is intact, but the client reports
numbness and tingling in the right foot. The pedal pulse is weak, and the foot is cool to
the touch. Which action should the nurse take first?
A. Reinforce the pressure dressing to ensure hemostasis
B. Elevate the right leg on two pillows to promote venous return
C. Remove the dressing and assess the insertion site for hematoma ✓ CORRECT
D. Apply a warm compress to the foot to improve circulation
Correct Answer: C
Rationale: Numbness, coolness, and a weak pulse suggest compromised arterial flow,
most likely from a hematoma compressing the vessel under the dressing. Removing the
dressing allows visual assessment and relieves external pressure if a collection is
present. Elevating the leg or reinforcing the dressing could worsen ischemia, and
warmth is inappropriate when arterial supply is compromised.
Question 3 of 60
A 58-year-old client with atrial fibrillation has been taking digoxin 0.25 mg daily for six
months. During a routine clinic visit, the client mentions feeling nauseated and seeing
yellow-green halos around lights. The nurse checks the apical pulse and finds it to be 52
beats per minute and irregular. Which laboratory test should the nurse anticipate the
provider will order first?
,A. Serum digoxin level and serum potassium ✓ CORRECT
B. Complete blood count and thyroid panel
C. Liver function tests and coagulation studies
D. Brain natriuretic peptide and troponin
Correct Answer: A
Rationale: Nausea, visual disturbances, and bradycardia are classic early signs of
digoxin toxicity, which is potentiated by hypokalemia. Checking the digoxin level and
potassium priority guides immediate treatment decisions. Thyroid panels and liver
function tests do not explain this specific cluster of symptoms.
Question 4 of 60
A 70-year-old male is admitted with a 6 cm abdominal aortic aneurysm. He is
asymptomatic and hemodynamically stable. During the admission assessment, the
client asks why surgery is being recommended when he feels fine. Which response by
the nurse is most accurate?
A. Surgery is only necessary once you develop severe back pain
B. Medications can effectively shrink the aneurysm back to a normal size
C. Small aneurysms always remain stable and never require intervention
D. The risk of rupture increases significantly once the aneurysm reaches 5.5 cm ✓
CORRECT
Correct Answer: D
Rationale: Elective repair is typically recommended when an abdominal aortic aneurysm
reaches 5.5 cm because rupture risk rises sharply beyond that diameter. Medications
cannot reverse aneurysmal dilation, and waiting for pain risks catastrophic rupture.
Asymptomatic status does not eliminate the threat of sudden rupture.
Question 5 of 60
, A 55-year-old client with peripheral artery disease complains of severe cramping pain in
the left calf after walking two blocks. The pain resolves after resting for five minutes.
The client asks what can be done to improve walking distance. Which recommendation
should the nurse include?
A. Rest completely and avoid walking to prevent pain
B. Walk until the pain starts, rest until it resolves, then resume walking ✓ CORRECT
C. Apply a heating pad to the calf before walking to dilate vessels
D. Elevate your legs above heart level throughout the day
Correct Answer: B
Rationale: Supervised exercise therapy using start-stop walking trains collateral
circulation and gradually extends pain-free walking distance in PAD. Complete rest leads
to deconditioning, and heat application does not address the underlying flow limitation.
Leg elevation is helpful for venous disease but can worsen arterial perfusion.
Question 6 of 60
A 62-year-old client with chronic heart failure has an ejection fraction of 30%. The
provider prescribes lisinopril 10 mg daily and furosemide 40 mg daily. Which instruction
should the nurse emphasize to prevent complications?
A. Take the furosemide at bedtime to avoid daytime swelling
B. Stop taking the lisinopril if you develop a dry cough
C. Weigh yourself every morning and report a gain of 3 pounds in one day ✓ CORRECT
D. Increase your dietary sodium to maintain your blood pressure
Correct Answer: C
Rationale: Daily weights are the most sensitive early indicator of fluid retention in heart
failure, and a 2 to 3 pound gain in a day signals the need for prompt intervention. Taking
a diuretic at bedtime causes nocturia, and stopping an ACE inhibitor for a mild cough
can destabilize the condition. Sodium restriction, not increase, is essential in heart
failure management.
