NURSING • MEDICAL-SURGICAL
EVOLVE ELSEVIER
HESI MED SURG
2026/2027 Official Exam
A+ Verified Questions with Complete Rationales
A+ 6 100%
QUESTIONS EXAM DOMAINS RATIONALES
VERIFIED COVERED INCLUDED
CATEGORIES
■ Cardiovascular & Hematologic Disorders
■ Respiratory Disorders
■ Neurological & Musculoskeletal Disorders
■ Gastrointestinal & Endocrine Disorders
■ Renal, Fluid & Electrolyte Disorders
■ Perioperative, Integumentary, Infection & Multisystem Care
STUVIAACTUALEXAM
Aligned to HESI Medical-Surgical Nursing Content Domains
, SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS
Q1. A 68-year-old client with a history of hypertension is admitted with acute chest pain radiating to the left arm. The nurse notes
diaphoresis and a blood pressure of 92/58 mm Hg. The cardiac monitor shows sinus tachycardia at 118 beats/min. After placing
the client on oxygen and obtaining a 12-lead ECG, which action should the nurse take next?
A. Administer a prescribed beta-blocker to lower the heart rate
B. Encourage the client to ambulate to relieve anxiety
C. Prepare for possible nitroglycerin administration while continuously monitoring blood pressure
D. Obtain a complete blood count before any further intervention
Correct Answer: C
Rationale: Hypotension contraindicates nitroglycerin until blood pressure stabilizes; however, the priority after oxygen and ECG is careful
assessment for possible nitroglycerin once BP is adequate, while preparing for reperfusion. Immediate beta-blocker without addressing potential
cardiogenic shock or BP is unsafe. Ambulation is contraindicated in acute coronary syndrome.
Q2. A client recovering from a myocardial infarction develops crackles in the lower lung fields, an S3 gallop, and mild dyspnea.
The nurse recognizes these findings as early indicators of which complication?
A. Pulmonary embolism
B. Dressler syndrome
C. Ventricular septal rupture
D. Left-sided heart failure
Correct Answer: D
Rationale: Crackles, S3, and dyspnea after MI classically signal left ventricular dysfunction and early pulmonary congestion. Pulmonary
embolism typically presents with sudden dyspnea and pleuritic pain; Dressler is a later autoimmune pericarditis; septal rupture causes a new
harsh murmur and rapid deterioration.
Q3. A client with atrial fibrillation is started on warfarin. The nurse is teaching about dietary considerations. Which statement by
the client indicates a need for further teaching?
A. I will keep my intake of green leafy vegetables consistent from week to week
B. I can take extra vitamin K supplements if I feel tired
C. I should report any unusual bruising or bleeding to my provider
D. I will have my INR checked regularly as ordered
Correct Answer: B
Rationale: Vitamin K antagonizes warfarin. Clients should maintain consistent vitamin K intake, not increase it with supplements. Consistent
greens, reporting bleeding, and INR monitoring are correct teaching points.
Q4. A client with chronic heart failure has a serum potassium of 5.8 mEq/L while taking digoxin and a potassium-sparing diuretic.
The nurse should prioritize assessment for which finding?
A. Bradycardia, visual changes, and nausea that may indicate digoxin toxicity potentiated by hyperkalemia
B. Hyporeflexia and muscle weakness only
C. Immediate signs of dehydration
D. Elevated blood glucose
Correct Answer: A
Rationale: Hyperkalemia can increase the risk of digoxin-related arrhythmias and toxicity manifestations. Classic digoxin toxicity signs include GI
symptoms, visual changes (halos), and conduction abnormalities. The combination requires close cardiac monitoring.
Q5. A nurse is caring for a client after cardiac catheterization via the right femoral artery. Four hours later the client reports back
pain and the nurse notes a firm, expanding mass at the puncture site with a drop in blood pressure. What is the priority nursing
action?
A. Apply a warm compress to the site
B. Encourage the client to flex the hip to relieve discomfort
C. Administer the scheduled anticoagulant dose
D. Notify the provider immediately and maintain pressure while preparing for possible intervention
Correct Answer: D
Rationale: An expanding hematoma with hemodynamic change suggests arterial bleeding or retroperitoneal bleed. Immediate notification,
pressure, and preparation for intervention are required. Warm compresses, hip flexion, or anticoagulants would worsen bleeding.
STUVIAACTUALEXAM | Page 2 of 20
, Q6. A client with peripheral arterial disease reports leg pain that occurs with walking and is relieved by rest. The nurse documents
this as intermittent claudication. Which additional teaching point is most important?
A. Elevate the legs above heart level whenever sitting
B. Walk to the point of pain, rest, then continue walking as tolerated to improve collateral circulation
C. Apply heating pads directly to the feet for comfort
D. Cross the legs frequently to improve venous return
Correct Answer: B
Rationale: Supervised walking programs that push to mild-moderate claudication and then rest improve collateral flow. Elevation and crossing
legs worsen arterial perfusion; direct heat risks burns in ischemic tissue.
Q7. A client receiving a blood transfusion develops chills, fever, and low back pain 20 minutes after the infusion starts. The nurse
stops the transfusion and keeps the line open with normal saline. Which action should follow immediately?
A. Notify the provider and blood bank, and send the blood bag and tubing for analysis
B. Administer acetaminophen and continue the transfusion at a slower rate
C. Flush the IV with heparin and restart the same unit
D. Place the client in Trendelenburg position and increase the infusion rate
Correct Answer: A
Rationale: Signs of acute hemolytic reaction require stopping the blood, maintaining IV access with saline, notifying the provider and blood bank,
and returning the remaining blood and tubing for investigation. Continuing or accelerating the transfusion is dangerous.
Q8. A client with deep-vein thrombosis is receiving continuous IV heparin. The aPTT returns at 110 seconds (control 30
seconds). The nurse should anticipate which order?
A. Increase the heparin infusion rate by 200 units/hour
B. Administer an intramuscular injection of vitamin K
C. Hold the heparin infusion and notify the provider for possible dose adjustment or reversal
D. Continue the current rate and recheck aPTT in 24 hours
Correct Answer: C
Rationale: An aPTT more than 2–2.5 times control indicates excessive anticoagulation and bleeding risk. Holding the infusion and contacting the
provider is appropriate; vitamin K is for warfarin, not heparin.
Q9. A client with anemia secondary to chronic kidney disease is prescribed epoetin alfa. The nurse teaches that the medication
will be effective when which laboratory value improves?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin and hematocrit
D. Blood urea nitrogen
Correct Answer: C
Rationale: Epoetin alfa stimulates red-blood-cell production; the expected response is a rise in hemoglobin and hematocrit. It does not directly
correct creatinine, potassium, or BUN.
Q10. A client develops sudden severe chest pain, dyspnea, and a feeling of impending doom after orthopedic surgery. Oxygen
saturation drops to 88% on room air. The nurse suspects pulmonary embolism. After applying oxygen, which action has the
highest priority?
A. Administer a prescribed oral anticoagulant immediately
B. Place the client in high Fowler position and notify the rapid response team or provider
C. Encourage deep breathing and coughing only
D. Obtain a stool sample for occult blood
Correct Answer: B
Rationale: Suspected PE with hypoxia requires high-flow oxygen, upright positioning if tolerated, and immediate medical evaluation for possible
thrombolysis or anticoagulation. Oral anticoagulants are not the acute rescue intervention.
Q11. A client with hypertension is prescribed lisinopril. The nurse should emphasize monitoring for which common adverse effect
that may require discontinuation?
A. Excessive salivation
B. Weight gain of 1 lb per month
C. Increased appetite
D. Dry, persistent cough
STUVIAACTUALEXAM | Page 3 of 20
EVOLVE ELSEVIER
HESI MED SURG
2026/2027 Official Exam
A+ Verified Questions with Complete Rationales
A+ 6 100%
QUESTIONS EXAM DOMAINS RATIONALES
VERIFIED COVERED INCLUDED
CATEGORIES
■ Cardiovascular & Hematologic Disorders
■ Respiratory Disorders
■ Neurological & Musculoskeletal Disorders
■ Gastrointestinal & Endocrine Disorders
■ Renal, Fluid & Electrolyte Disorders
■ Perioperative, Integumentary, Infection & Multisystem Care
STUVIAACTUALEXAM
Aligned to HESI Medical-Surgical Nursing Content Domains
, SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS
Q1. A 68-year-old client with a history of hypertension is admitted with acute chest pain radiating to the left arm. The nurse notes
diaphoresis and a blood pressure of 92/58 mm Hg. The cardiac monitor shows sinus tachycardia at 118 beats/min. After placing
the client on oxygen and obtaining a 12-lead ECG, which action should the nurse take next?
A. Administer a prescribed beta-blocker to lower the heart rate
B. Encourage the client to ambulate to relieve anxiety
C. Prepare for possible nitroglycerin administration while continuously monitoring blood pressure
D. Obtain a complete blood count before any further intervention
Correct Answer: C
Rationale: Hypotension contraindicates nitroglycerin until blood pressure stabilizes; however, the priority after oxygen and ECG is careful
assessment for possible nitroglycerin once BP is adequate, while preparing for reperfusion. Immediate beta-blocker without addressing potential
cardiogenic shock or BP is unsafe. Ambulation is contraindicated in acute coronary syndrome.
Q2. A client recovering from a myocardial infarction develops crackles in the lower lung fields, an S3 gallop, and mild dyspnea.
The nurse recognizes these findings as early indicators of which complication?
A. Pulmonary embolism
B. Dressler syndrome
C. Ventricular septal rupture
D. Left-sided heart failure
Correct Answer: D
Rationale: Crackles, S3, and dyspnea after MI classically signal left ventricular dysfunction and early pulmonary congestion. Pulmonary
embolism typically presents with sudden dyspnea and pleuritic pain; Dressler is a later autoimmune pericarditis; septal rupture causes a new
harsh murmur and rapid deterioration.
Q3. A client with atrial fibrillation is started on warfarin. The nurse is teaching about dietary considerations. Which statement by
the client indicates a need for further teaching?
A. I will keep my intake of green leafy vegetables consistent from week to week
B. I can take extra vitamin K supplements if I feel tired
C. I should report any unusual bruising or bleeding to my provider
D. I will have my INR checked regularly as ordered
Correct Answer: B
Rationale: Vitamin K antagonizes warfarin. Clients should maintain consistent vitamin K intake, not increase it with supplements. Consistent
greens, reporting bleeding, and INR monitoring are correct teaching points.
Q4. A client with chronic heart failure has a serum potassium of 5.8 mEq/L while taking digoxin and a potassium-sparing diuretic.
The nurse should prioritize assessment for which finding?
A. Bradycardia, visual changes, and nausea that may indicate digoxin toxicity potentiated by hyperkalemia
B. Hyporeflexia and muscle weakness only
C. Immediate signs of dehydration
D. Elevated blood glucose
Correct Answer: A
Rationale: Hyperkalemia can increase the risk of digoxin-related arrhythmias and toxicity manifestations. Classic digoxin toxicity signs include GI
symptoms, visual changes (halos), and conduction abnormalities. The combination requires close cardiac monitoring.
Q5. A nurse is caring for a client after cardiac catheterization via the right femoral artery. Four hours later the client reports back
pain and the nurse notes a firm, expanding mass at the puncture site with a drop in blood pressure. What is the priority nursing
action?
A. Apply a warm compress to the site
B. Encourage the client to flex the hip to relieve discomfort
C. Administer the scheduled anticoagulant dose
D. Notify the provider immediately and maintain pressure while preparing for possible intervention
Correct Answer: D
Rationale: An expanding hematoma with hemodynamic change suggests arterial bleeding or retroperitoneal bleed. Immediate notification,
pressure, and preparation for intervention are required. Warm compresses, hip flexion, or anticoagulants would worsen bleeding.
STUVIAACTUALEXAM | Page 2 of 20
, Q6. A client with peripheral arterial disease reports leg pain that occurs with walking and is relieved by rest. The nurse documents
this as intermittent claudication. Which additional teaching point is most important?
A. Elevate the legs above heart level whenever sitting
B. Walk to the point of pain, rest, then continue walking as tolerated to improve collateral circulation
C. Apply heating pads directly to the feet for comfort
D. Cross the legs frequently to improve venous return
Correct Answer: B
Rationale: Supervised walking programs that push to mild-moderate claudication and then rest improve collateral flow. Elevation and crossing
legs worsen arterial perfusion; direct heat risks burns in ischemic tissue.
Q7. A client receiving a blood transfusion develops chills, fever, and low back pain 20 minutes after the infusion starts. The nurse
stops the transfusion and keeps the line open with normal saline. Which action should follow immediately?
A. Notify the provider and blood bank, and send the blood bag and tubing for analysis
B. Administer acetaminophen and continue the transfusion at a slower rate
C. Flush the IV with heparin and restart the same unit
D. Place the client in Trendelenburg position and increase the infusion rate
Correct Answer: A
Rationale: Signs of acute hemolytic reaction require stopping the blood, maintaining IV access with saline, notifying the provider and blood bank,
and returning the remaining blood and tubing for investigation. Continuing or accelerating the transfusion is dangerous.
Q8. A client with deep-vein thrombosis is receiving continuous IV heparin. The aPTT returns at 110 seconds (control 30
seconds). The nurse should anticipate which order?
A. Increase the heparin infusion rate by 200 units/hour
B. Administer an intramuscular injection of vitamin K
C. Hold the heparin infusion and notify the provider for possible dose adjustment or reversal
D. Continue the current rate and recheck aPTT in 24 hours
Correct Answer: C
Rationale: An aPTT more than 2–2.5 times control indicates excessive anticoagulation and bleeding risk. Holding the infusion and contacting the
provider is appropriate; vitamin K is for warfarin, not heparin.
Q9. A client with anemia secondary to chronic kidney disease is prescribed epoetin alfa. The nurse teaches that the medication
will be effective when which laboratory value improves?
A. Serum creatinine
B. Serum potassium
C. Hemoglobin and hematocrit
D. Blood urea nitrogen
Correct Answer: C
Rationale: Epoetin alfa stimulates red-blood-cell production; the expected response is a rise in hemoglobin and hematocrit. It does not directly
correct creatinine, potassium, or BUN.
Q10. A client develops sudden severe chest pain, dyspnea, and a feeling of impending doom after orthopedic surgery. Oxygen
saturation drops to 88% on room air. The nurse suspects pulmonary embolism. After applying oxygen, which action has the
highest priority?
A. Administer a prescribed oral anticoagulant immediately
B. Place the client in high Fowler position and notify the rapid response team or provider
C. Encourage deep breathing and coughing only
D. Obtain a stool sample for occult blood
Correct Answer: B
Rationale: Suspected PE with hypoxia requires high-flow oxygen, upright positioning if tolerated, and immediate medical evaluation for possible
thrombolysis or anticoagulation. Oral anticoagulants are not the acute rescue intervention.
Q11. A client with hypertension is prescribed lisinopril. The nurse should emphasize monitoring for which common adverse effect
that may require discontinuation?
A. Excessive salivation
B. Weight gain of 1 lb per month
C. Increased appetite
D. Dry, persistent cough
STUVIAACTUALEXAM | Page 3 of 20
