HESI RN Med-Surg Comprehensive
Exam 2026/2027 | Complete Exam
with NGN (Next Generation NCLEX)
Questions & Correct Answers
Question 1
A client with heart failure reports sudden weight gain of 2.2 kg (5 lb) in 48 hours.
What is the nurse's priority action?
A. Encourage increased oral fluids
B. Document findings and reweigh in 24 hours
C. Restrict sodium intake immediately
D. Notify the healthcare provider
Correct Answer: D. Notify the healthcare provider
Rationale: Rapid weight gain indicates fluid overload and worsening heart failure
requiring prompt provider notification. A weight gain of 2+ lbs in 24 hours or 5 lbs in 1
week is significant for patients with heart failure . This may require medication
adjustment (diuretic dose increase) and further evaluation.
Question 2
A client with atrial fibrillation is prescribed warfarin. Which laboratory value
requires immediate action?
A. INR 1.2
B. INR 2.3
C. INR 4.5
D. INR 2.8
Correct Answer: C. INR 4.5
,Rationale: INR above therapeutic range (2-3 for atrial fibrillation) increases bleeding risk
significantly. An INR of 4.5 is supratherapeutic and requires holding the warfarin dose
and possibly administering vitamin K . An INR of 1.2 is subtherapeutic and increases
stroke risk.
Question 3
A client with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance is the priority for the nurse to monitor?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium excretion, leading to
hypokalemia, which can cause life-threatening dysrhythmias . Potassium levels should
be monitored and supplemented as needed.
Question 4
The nurse is caring for a client with an acute myocardial infarction (MI) who is
receiving tissue plasminogen activator (tPA). Which assessment finding requires
immediate intervention?
A. Blood pressure 138/86
B. Reports of mild headache
C. Sudden, severe headache with nausea
D. Occasional premature ventricular contractions (PVCs)
Correct Answer: C. Sudden, severe headache with nausea
Rationale: Sudden, severe neurological changes in a client on thrombolytics indicate a
potential intracranial hemorrhage, which is a medical emergency . tPA carries a
,significant risk of bleeding, and intracranial hemorrhage is the most serious
complication.
Question 5
A client with angina is prescribed a beta-blocker. What is the expected therapeutic
effect?
A. Increase heart rate
B. Increase blood pressure
C. Decrease myocardial oxygen demand
D. Dilate bronchi
Correct Answer: C. Decrease myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate and contractility, decreasing myocardial
oxygen demand and workload. This makes them effective for angina management .
They do not dilate bronchi (that is a side effect to monitor in asthma patients).
Question 6
A client with aortic stenosis reports episodes of dizziness and syncope. The nurse
understands this is primarily due to:
A. Fluid volume overload
B. Fixed cardiac output unable to meet demand
C. Ventricular dysrhythmias
D. Pulmonary hypertension
Correct Answer: B. Fixed cardiac output unable to meet demand
Rationale: Aortic stenosis creates a fixed obstruction, limiting the heart's ability to
increase output during activity, leading to dizziness and syncope . The classic triad of
aortic stenosis is syncope, angina, and dyspnea (SAD).
Question 7
, The nurse would be correct in withholding a dose of digoxin in a client with
congestive heart failure without specific instruction from the healthcare provider
if the client's:
A. Serum digoxin level is 1.5 ng/mL
B. Blood pressure is 104/68
C. Serum potassium level is 3.0 mEq/L
D. Apical pulse is 68/min
Correct Answer: C. Serum potassium level is 3.0 mEq/L
Rationale: Hypokalemia can precipitate digitalis toxicity in persons receiving digoxin,
which will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5
to 5.5 mEq/L) . The normal digoxin level is 0.5-2.0 ng/mL, and digoxin is typically held if
the apical pulse is <60 bpm.
Question 8
Following a cardiac catheterization and placement of a stent in the right coronary
artery, the nurse administers prasugrel, a platelet inhibitor, to the client. To
monitor for adverse effects from the medication, which assessment is most
important for the nurse to include in this client's plan of care?
A. Observe color of urine
B. Measure body temperature
C. Assess skin turgor
D. Check for pedal edema
Correct Answer: A. Observe color of urine
Rationale: Platelet inhibitors like prasugrel increase bleeding risk. Hematuria (blood in
urine) is a sign of bleeding that requires monitoring . The nurse should also monitor for
bruising, bleeding gums, and dark stools.
Question 9
Exam 2026/2027 | Complete Exam
with NGN (Next Generation NCLEX)
Questions & Correct Answers
Question 1
A client with heart failure reports sudden weight gain of 2.2 kg (5 lb) in 48 hours.
What is the nurse's priority action?
A. Encourage increased oral fluids
B. Document findings and reweigh in 24 hours
C. Restrict sodium intake immediately
D. Notify the healthcare provider
Correct Answer: D. Notify the healthcare provider
Rationale: Rapid weight gain indicates fluid overload and worsening heart failure
requiring prompt provider notification. A weight gain of 2+ lbs in 24 hours or 5 lbs in 1
week is significant for patients with heart failure . This may require medication
adjustment (diuretic dose increase) and further evaluation.
Question 2
A client with atrial fibrillation is prescribed warfarin. Which laboratory value
requires immediate action?
A. INR 1.2
B. INR 2.3
C. INR 4.5
D. INR 2.8
Correct Answer: C. INR 4.5
,Rationale: INR above therapeutic range (2-3 for atrial fibrillation) increases bleeding risk
significantly. An INR of 4.5 is supratherapeutic and requires holding the warfarin dose
and possibly administering vitamin K . An INR of 1.2 is subtherapeutic and increases
stroke risk.
Question 3
A client with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance is the priority for the nurse to monitor?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C. Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium excretion, leading to
hypokalemia, which can cause life-threatening dysrhythmias . Potassium levels should
be monitored and supplemented as needed.
Question 4
The nurse is caring for a client with an acute myocardial infarction (MI) who is
receiving tissue plasminogen activator (tPA). Which assessment finding requires
immediate intervention?
A. Blood pressure 138/86
B. Reports of mild headache
C. Sudden, severe headache with nausea
D. Occasional premature ventricular contractions (PVCs)
Correct Answer: C. Sudden, severe headache with nausea
Rationale: Sudden, severe neurological changes in a client on thrombolytics indicate a
potential intracranial hemorrhage, which is a medical emergency . tPA carries a
,significant risk of bleeding, and intracranial hemorrhage is the most serious
complication.
Question 5
A client with angina is prescribed a beta-blocker. What is the expected therapeutic
effect?
A. Increase heart rate
B. Increase blood pressure
C. Decrease myocardial oxygen demand
D. Dilate bronchi
Correct Answer: C. Decrease myocardial oxygen demand
Rationale: Beta-blockers reduce heart rate and contractility, decreasing myocardial
oxygen demand and workload. This makes them effective for angina management .
They do not dilate bronchi (that is a side effect to monitor in asthma patients).
Question 6
A client with aortic stenosis reports episodes of dizziness and syncope. The nurse
understands this is primarily due to:
A. Fluid volume overload
B. Fixed cardiac output unable to meet demand
C. Ventricular dysrhythmias
D. Pulmonary hypertension
Correct Answer: B. Fixed cardiac output unable to meet demand
Rationale: Aortic stenosis creates a fixed obstruction, limiting the heart's ability to
increase output during activity, leading to dizziness and syncope . The classic triad of
aortic stenosis is syncope, angina, and dyspnea (SAD).
Question 7
, The nurse would be correct in withholding a dose of digoxin in a client with
congestive heart failure without specific instruction from the healthcare provider
if the client's:
A. Serum digoxin level is 1.5 ng/mL
B. Blood pressure is 104/68
C. Serum potassium level is 3.0 mEq/L
D. Apical pulse is 68/min
Correct Answer: C. Serum potassium level is 3.0 mEq/L
Rationale: Hypokalemia can precipitate digitalis toxicity in persons receiving digoxin,
which will increase the chance of dangerous dysrhythmias (normal potassium level is 3.5
to 5.5 mEq/L) . The normal digoxin level is 0.5-2.0 ng/mL, and digoxin is typically held if
the apical pulse is <60 bpm.
Question 8
Following a cardiac catheterization and placement of a stent in the right coronary
artery, the nurse administers prasugrel, a platelet inhibitor, to the client. To
monitor for adverse effects from the medication, which assessment is most
important for the nurse to include in this client's plan of care?
A. Observe color of urine
B. Measure body temperature
C. Assess skin turgor
D. Check for pedal edema
Correct Answer: A. Observe color of urine
Rationale: Platelet inhibitors like prasugrel increase bleeding risk. Hematuria (blood in
urine) is a sign of bleeding that requires monitoring . The nurse should also monitor for
bruising, bleeding gums, and dark stools.
Question 9
