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HESI MEDICAL-SURGICAL EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
HESI MEDICAL-SURGICAL EXAM — 250 Practice Questions
10-Point Summary of HESI Medical-Surgical Exam Coverage
Cardiovascular Disorders: Heart failure, myocardial infarction, hypertension, coronary
artery disease, dysrhythmias, valvular disorders, and peripheral vascular disease.
Respiratory Disorders: COPD, asthma, pneumonia, tuberculosis, pulmonary embolism,
ARDS, and respiratory failure.
Neurological Disorders: Stroke, seizures, head injuries, meningitis, Parkinson's disease,
Alzheimer's disease, and multiple sclerosis.
Gastrointestinal Disorders: Peptic ulcer disease, GERD, diverticulitis, inflammatory bowel
disease, hepatitis, cirrhosis, pancreatitis, and cholecystitis.
Endocrine Disorders: Diabetes mellitus (type 1 and type 2), thyroid disorders, adrenal
disorders, and diabetes insipidus.
Renal & Urinary Disorders: Acute kidney injury, chronic kidney disease, pyelonephritis,
glomerulonephritis, and urolithiasis.
Musculoskeletal Disorders: Osteoporosis, osteoarthritis, rheumatoid arthritis, fractures, and
joint replacements.
Hematological Disorders: Anemia, sickle cell disease, coagulopathies, and leukemia.
Integumentary Disorders: Pressure injuries, burns, wound care, and skin infections.
Immunological Disorders: HIV/AIDS, lupus, and transplant rejection.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
1. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
A. Serum potassium level increases to 4.5 mEq/L.
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B. Urine output increases to 1,500 mL per 24 hours.
C. Blood pressure decreases from 160/90 to 130/80 mm Hg.
D. Heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Furosemide is a loop diuretic that reduces fluid volume, decreasing
blood pressure and workload on the heart. A decrease in blood pressure indicates a positive
therapeutic response.
2. The nurse is caring for a client who is 2 days post-operative from a total hip
replacement. Which finding requires immediate intervention?
A. Pain at the surgical site rated 6/10.
B. Low-grade fever of 100.2°F (37.9°C).
C. Warm foot with palpable dorsalis pedis pulse.
D. Shortness of breath and sudden chest pain.
Answer: D. Rationale: Sudden shortness of breath and chest pain are classic symptoms of a
pulmonary embolism (PE), a life-threatening complication of lower extremity surgeries. This
requires immediate intervention.
3. The nurse is providing teaching to a client who has a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Ibuprofen (an NSAID) increases the risk of bleeding and should be
avoided with warfarin. Clients should use acetaminophen for pain instead.
4. A client with hypertension is prescribed lisinopril. The client develops a persistent
dry cough. What is the most appropriate nursing action?
A. Reassure the client that this is a temporary side effect.
B. Advise the client to take an over-the-counter cough suppressant.
C. Instruct the client to stop the medication immediately.
D. Document and notify the healthcare provider for a possible medication change.
Answer: D. Rationale: A persistent dry cough is a known side effect of ACE inhibitors.
While not life-threatening, it is often bothersome and the primary reason for medication
discontinuation. The provider should be notified.
5. The nurse is caring for a client with a diagnosis of heart failure. Which finding is the
earliest sign of left-sided heart failure?
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A. Peripheral edema.
B. Jugular venous distension.
C. Dyspnea on exertion.
D. Hepatomegaly.
Answer: C. Rationale: Left-sided heart failure causes pulmonary congestion. Dyspnea on
exertion is often the earliest symptom. Peripheral edema, JVD, and hepatomegaly are signs of
right-sided heart failure.
6. The nurse is caring for a client who is receiving a continuous heparin infusion. Which
lab value is most important to monitor?
A. Prothrombin time (PT) and INR.
B. Activated partial thromboplastin time (aPTT).
C. Platelet count.
D. Hemoglobin and hematocrit.
Answer: B. Rationale: The aPTT monitors the therapeutic effect of unfractionated heparin.
The goal is to maintain the aPTT at 1.5 to 2.5 times the control value.
7. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: The standard protocol is to hold digoxin and notify the provider if the
apical pulse is below 60 beats per minute. Bradycardia can be a sign of digoxin toxicity.
8. The nurse is caring for a client with a diagnosis of deep vein thrombosis (DVT).
Which intervention is most important to prevent a life-threatening complication?
A. Massage the affected leg to improve circulation.
B. Apply a heating pad to the affected leg.
C. Elevate the affected leg and monitor for signs of pulmonary embolism.
D. Encourage the client to walk frequently.
Answer: C. Rationale: The most serious complication of a DVT is a pulmonary embolism.
The nurse should elevate the leg and monitor for signs of a PE. Massaging or applying heat
can dislodge the clot.
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9. The nurse is caring for a client with a chest tube. Continuous bubbling in the water
seal chamber indicates:
A. Normal functioning of the system.
B. An air leak in the system.
C. The suction is set too high.
D. The chest tube is occluded.
Answer: B. Rationale: In a closed chest drainage system, the water seal chamber should have
tidaling but not continuous bubbling. Continuous bubbling indicates an air leak that must be
assessed.
10. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client's oxygen saturation is 90%, but they appear
drowsy. What is the most important action?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
C. Assess the client's arterial blood gases (ABGs).
D. Notify the healthcare provider immediately.
Answer: C. Rationale: In clients with COPD, drowsiness can indicate carbon dioxide
retention (hypercapnia). The priority is to assess ABGs before making changes to oxygen
therapy.
11. The nurse is providing teaching to a client who is starting a new prescription for an
ACE inhibitor. Which side effect should the nurse instruct the client to report?
A. A persistent, dry cough.
B. Mild headache.
C. Weight gain of 1-2 pounds.
D. Dizziness when standing up.
Answer: A. Rationale: A persistent, dry cough is a common side effect of ACE inhibitors
and the primary reason for medication discontinuation.
12. The nurse is caring for a client who has a prescription for a low-sodium diet for
heart failure. Which food item should the nurse remove from the tray?
A. A fresh apple.
B. A cup of steamed broccoli.
C. A grilled chicken breast.
D. A bowl of tomato soup.
HESI MEDICAL-SURGICAL EXAM 2026
QUESTIONS LATEST VERSION QUESTIONS AND
ANSWERS
HESI MEDICAL-SURGICAL EXAM — 250 Practice Questions
10-Point Summary of HESI Medical-Surgical Exam Coverage
Cardiovascular Disorders: Heart failure, myocardial infarction, hypertension, coronary
artery disease, dysrhythmias, valvular disorders, and peripheral vascular disease.
Respiratory Disorders: COPD, asthma, pneumonia, tuberculosis, pulmonary embolism,
ARDS, and respiratory failure.
Neurological Disorders: Stroke, seizures, head injuries, meningitis, Parkinson's disease,
Alzheimer's disease, and multiple sclerosis.
Gastrointestinal Disorders: Peptic ulcer disease, GERD, diverticulitis, inflammatory bowel
disease, hepatitis, cirrhosis, pancreatitis, and cholecystitis.
Endocrine Disorders: Diabetes mellitus (type 1 and type 2), thyroid disorders, adrenal
disorders, and diabetes insipidus.
Renal & Urinary Disorders: Acute kidney injury, chronic kidney disease, pyelonephritis,
glomerulonephritis, and urolithiasis.
Musculoskeletal Disorders: Osteoporosis, osteoarthritis, rheumatoid arthritis, fractures, and
joint replacements.
Hematological Disorders: Anemia, sickle cell disease, coagulopathies, and leukemia.
Integumentary Disorders: Pressure injuries, burns, wound care, and skin infections.
Immunological Disorders: HIV/AIDS, lupus, and transplant rejection.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
1. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
A. Serum potassium level increases to 4.5 mEq/L.
, Page 2 of 59
B. Urine output increases to 1,500 mL per 24 hours.
C. Blood pressure decreases from 160/90 to 130/80 mm Hg.
D. Heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Furosemide is a loop diuretic that reduces fluid volume, decreasing
blood pressure and workload on the heart. A decrease in blood pressure indicates a positive
therapeutic response.
2. The nurse is caring for a client who is 2 days post-operative from a total hip
replacement. Which finding requires immediate intervention?
A. Pain at the surgical site rated 6/10.
B. Low-grade fever of 100.2°F (37.9°C).
C. Warm foot with palpable dorsalis pedis pulse.
D. Shortness of breath and sudden chest pain.
Answer: D. Rationale: Sudden shortness of breath and chest pain are classic symptoms of a
pulmonary embolism (PE), a life-threatening complication of lower extremity surgeries. This
requires immediate intervention.
3. The nurse is providing teaching to a client who has a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Ibuprofen (an NSAID) increases the risk of bleeding and should be
avoided with warfarin. Clients should use acetaminophen for pain instead.
4. A client with hypertension is prescribed lisinopril. The client develops a persistent
dry cough. What is the most appropriate nursing action?
A. Reassure the client that this is a temporary side effect.
B. Advise the client to take an over-the-counter cough suppressant.
C. Instruct the client to stop the medication immediately.
D. Document and notify the healthcare provider for a possible medication change.
Answer: D. Rationale: A persistent dry cough is a known side effect of ACE inhibitors.
While not life-threatening, it is often bothersome and the primary reason for medication
discontinuation. The provider should be notified.
5. The nurse is caring for a client with a diagnosis of heart failure. Which finding is the
earliest sign of left-sided heart failure?
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A. Peripheral edema.
B. Jugular venous distension.
C. Dyspnea on exertion.
D. Hepatomegaly.
Answer: C. Rationale: Left-sided heart failure causes pulmonary congestion. Dyspnea on
exertion is often the earliest symptom. Peripheral edema, JVD, and hepatomegaly are signs of
right-sided heart failure.
6. The nurse is caring for a client who is receiving a continuous heparin infusion. Which
lab value is most important to monitor?
A. Prothrombin time (PT) and INR.
B. Activated partial thromboplastin time (aPTT).
C. Platelet count.
D. Hemoglobin and hematocrit.
Answer: B. Rationale: The aPTT monitors the therapeutic effect of unfractionated heparin.
The goal is to maintain the aPTT at 1.5 to 2.5 times the control value.
7. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: The standard protocol is to hold digoxin and notify the provider if the
apical pulse is below 60 beats per minute. Bradycardia can be a sign of digoxin toxicity.
8. The nurse is caring for a client with a diagnosis of deep vein thrombosis (DVT).
Which intervention is most important to prevent a life-threatening complication?
A. Massage the affected leg to improve circulation.
B. Apply a heating pad to the affected leg.
C. Elevate the affected leg and monitor for signs of pulmonary embolism.
D. Encourage the client to walk frequently.
Answer: C. Rationale: The most serious complication of a DVT is a pulmonary embolism.
The nurse should elevate the leg and monitor for signs of a PE. Massaging or applying heat
can dislodge the clot.
, Page 4 of 59
9. The nurse is caring for a client with a chest tube. Continuous bubbling in the water
seal chamber indicates:
A. Normal functioning of the system.
B. An air leak in the system.
C. The suction is set too high.
D. The chest tube is occluded.
Answer: B. Rationale: In a closed chest drainage system, the water seal chamber should have
tidaling but not continuous bubbling. Continuous bubbling indicates an air leak that must be
assessed.
10. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client's oxygen saturation is 90%, but they appear
drowsy. What is the most important action?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
C. Assess the client's arterial blood gases (ABGs).
D. Notify the healthcare provider immediately.
Answer: C. Rationale: In clients with COPD, drowsiness can indicate carbon dioxide
retention (hypercapnia). The priority is to assess ABGs before making changes to oxygen
therapy.
11. The nurse is providing teaching to a client who is starting a new prescription for an
ACE inhibitor. Which side effect should the nurse instruct the client to report?
A. A persistent, dry cough.
B. Mild headache.
C. Weight gain of 1-2 pounds.
D. Dizziness when standing up.
Answer: A. Rationale: A persistent, dry cough is a common side effect of ACE inhibitors
and the primary reason for medication discontinuation.
12. The nurse is caring for a client who has a prescription for a low-sodium diet for
heart failure. Which food item should the nurse remove from the tray?
A. A fresh apple.
B. A cup of steamed broccoli.
C. A grilled chicken breast.
D. A bowl of tomato soup.
