HESI Med Surg Exam Study Guide
2026/2027: Practice Questions & Nursing
Care Priorities
Question 1: A client who underwent cardiac stent placement 4 days ago arrives to the
emergency department reporting sudden onset chest pressure and shortness of breath.
Which action should the nurse take NEXT?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead ECG and begin continuous cardiac monitoring
C) Give oxygen at 2 L/min via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure and shortness of breath after recent
stenting is at high risk for acute stent thrombosis or myocardial infarction. Obtaining an
ECG is the priority to rapidly assess for ischemic changes .
Question 2: A client with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lung bases. Which medication should the nurse prepare to
administer FIRST?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion. Digoxin and beta-blockers are chronic therapies; spironolactone
is a potassium-sparing diuretic used as an adjunct .
,Question 3: A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor MOST closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
can lead to cardiac dysrhythmias and increases the risk of digoxin toxicity .
Question 4: A client is prescribed digoxin 0.25 mg daily. Which finding would
indicate digoxin toxicity?
A) Heart rate 72 bpm
B) Yellow-green halos around vision
C) Blood pressure 120/80 mmHg
D) Urine output 50 mL/hour
Answer: B
Rationale: Visual disturbances (yellow-green halos, blurred vision) are classic signs of
digoxin toxicity. Other signs include nausea, vomiting, anorexia, and bradycardia .
Question 5: A client with hypertension is prescribed hydrochlorothiazide. The nurse
should monitor for which adverse effect?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypoglycemia
Answer: B
Rationale: Thiazide diuretics cause potassium loss, leading to hypokalemia. Signs
include muscle weakness, fatigue, and ECG changes .
,Question 6: Which ECG finding is most concerning in a client with chest pain after
cardiac stenting?
A) ST-segment depression
B) Normal troponin
C) ST-segment elevation
D) Sinus bradycardia
Answer: C
Rationale: ST-segment elevation indicates acute myocardial injury, which is highly
concerning in a client with recent stenting. ST depression suggests ischemia but is less
immediately life-threatening .
Question 7: A client with hypertension has a blood pressure of 180/110 mmHg and
reports headache and blurred vision. What is the nurse's priority action?
A) Administer prescribed antihypertensive medication
B) Recheck blood pressure in 15 minutes
C) Notify the healthcare provider immediately
D) Place the client in a supine position
Answer: C
Rationale: A blood pressure of 180/110 mmHg with symptoms indicates hypertensive
urgency/emergency requiring immediate medical intervention to prevent target organ
damage .
Question 8: A client with angina is prescribed sublingual nitroglycerin. The nurse should
instruct the client to:
A) Swallow the tablet with water
B) Place the tablet under the tongue and let it dissolve
C) Chew the tablet for faster effect
D) Apply the tablet to the chest wall
, Answer: B
Rationale: Sublingual nitroglycerin should be placed under the tongue and allowed to
dissolve for rapid absorption through the sublingual mucosa .
Question 9: A client with angina is prescribed nitroglycerin sublingual. The nurse should
instruct the client to:
A) Take one tablet daily at bedtime
B) Take up to 3 tablets 5 minutes apart; seek emergency care if no relief after 1
tablet
C) Swallow the tablet with water
D) Chew the tablet for faster absorption
Answer: B
Rationale: Standard instructions: take one tablet at onset of pain, repeat every 5
minutes for up to 3 doses. If no relief after first tablet, call 911 .
Question 10: A client is receiving a blood transfusion and develops fever, chills, and
hypotension. This is most likely:
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Allergic reaction
D) Bacterial contamination
Answer: B
Rationale: Hypotension + fever/chills suggests acute hemolytic reaction (ABO
incompatibility), a medical emergency requiring immediate transfusion termination .
Question 11: The nurse is caring for a client receiving the second unit of whole blood
for GI bleeding. Which parameter indicates fluid overload?
A) Bounding pulse, hypertension, distended neck veins
B) Thready pulse, hypotension, chest/back pain
2026/2027: Practice Questions & Nursing
Care Priorities
Question 1: A client who underwent cardiac stent placement 4 days ago arrives to the
emergency department reporting sudden onset chest pressure and shortness of breath.
Which action should the nurse take NEXT?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead ECG and begin continuous cardiac monitoring
C) Give oxygen at 2 L/min via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure and shortness of breath after recent
stenting is at high risk for acute stent thrombosis or myocardial infarction. Obtaining an
ECG is the priority to rapidly assess for ischemic changes .
Question 2: A client with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lung bases. Which medication should the nurse prepare to
administer FIRST?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion. Digoxin and beta-blockers are chronic therapies; spironolactone
is a potassium-sparing diuretic used as an adjunct .
,Question 3: A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor MOST closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
can lead to cardiac dysrhythmias and increases the risk of digoxin toxicity .
Question 4: A client is prescribed digoxin 0.25 mg daily. Which finding would
indicate digoxin toxicity?
A) Heart rate 72 bpm
B) Yellow-green halos around vision
C) Blood pressure 120/80 mmHg
D) Urine output 50 mL/hour
Answer: B
Rationale: Visual disturbances (yellow-green halos, blurred vision) are classic signs of
digoxin toxicity. Other signs include nausea, vomiting, anorexia, and bradycardia .
Question 5: A client with hypertension is prescribed hydrochlorothiazide. The nurse
should monitor for which adverse effect?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypoglycemia
Answer: B
Rationale: Thiazide diuretics cause potassium loss, leading to hypokalemia. Signs
include muscle weakness, fatigue, and ECG changes .
,Question 6: Which ECG finding is most concerning in a client with chest pain after
cardiac stenting?
A) ST-segment depression
B) Normal troponin
C) ST-segment elevation
D) Sinus bradycardia
Answer: C
Rationale: ST-segment elevation indicates acute myocardial injury, which is highly
concerning in a client with recent stenting. ST depression suggests ischemia but is less
immediately life-threatening .
Question 7: A client with hypertension has a blood pressure of 180/110 mmHg and
reports headache and blurred vision. What is the nurse's priority action?
A) Administer prescribed antihypertensive medication
B) Recheck blood pressure in 15 minutes
C) Notify the healthcare provider immediately
D) Place the client in a supine position
Answer: C
Rationale: A blood pressure of 180/110 mmHg with symptoms indicates hypertensive
urgency/emergency requiring immediate medical intervention to prevent target organ
damage .
Question 8: A client with angina is prescribed sublingual nitroglycerin. The nurse should
instruct the client to:
A) Swallow the tablet with water
B) Place the tablet under the tongue and let it dissolve
C) Chew the tablet for faster effect
D) Apply the tablet to the chest wall
, Answer: B
Rationale: Sublingual nitroglycerin should be placed under the tongue and allowed to
dissolve for rapid absorption through the sublingual mucosa .
Question 9: A client with angina is prescribed nitroglycerin sublingual. The nurse should
instruct the client to:
A) Take one tablet daily at bedtime
B) Take up to 3 tablets 5 minutes apart; seek emergency care if no relief after 1
tablet
C) Swallow the tablet with water
D) Chew the tablet for faster absorption
Answer: B
Rationale: Standard instructions: take one tablet at onset of pain, repeat every 5
minutes for up to 3 doses. If no relief after first tablet, call 911 .
Question 10: A client is receiving a blood transfusion and develops fever, chills, and
hypotension. This is most likely:
A) Febrile non-hemolytic reaction
B) Acute hemolytic reaction
C) Allergic reaction
D) Bacterial contamination
Answer: B
Rationale: Hypotension + fever/chills suggests acute hemolytic reaction (ABO
incompatibility), a medical emergency requiring immediate transfusion termination .
Question 11: The nurse is caring for a client receiving the second unit of whole blood
for GI bleeding. Which parameter indicates fluid overload?
A) Bounding pulse, hypertension, distended neck veins
B) Thready pulse, hypotension, chest/back pain
