HESI Medical-Surgical Nursing — Comprehensive
Advanced Practice Examination | 200 High-Yield
Questions with Verified Answers & Detailed
Rationales | Complete Study Guide for Advanced
Med-Surg Mastery
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–30)
1. A nurse is assessing a client with heart failure. Which finding indicates the client is
experiencing fluid overload?
A. Weight loss of 2 kg
B. Decreased urine output
C. Crackles in the lung bases
D. Dry mucous membranes
Correct Answer: C
Rationale: Crackles in the lung bases indicate pulmonary edema, a hallmark of fluid overload in
heart failure. Weight loss, decreased urine output, and dry mucous membranes are signs of
fluid deficit.
2. A client with atrial fibrillation has a new prescription for metoprolol. Which finding
indicates the medication is effective?
A. Heart rate decreases from 140 to 88 bpm
B. Blood pressure increases
C. Urine output increases
D. Respiratory rate decreases
Correct Answer: A
Rationale: Metoprolol is a beta-blocker used for rate control in atrial fibrillation. A decrease in
heart rate to 60–100 bpm indicates therapeutic effect.
,3. A nurse is caring for a client with acute coronary syndrome. Which finding requires
immediate intervention?
A. ST elevation on ECG
B. T wave inversion
C. Pain rating 4/10
D. Blood pressure 130/80 mmHg
Correct Answer: A
Rationale: ST elevation indicates STEMI, a life-threatening emergency requiring immediate
reperfusion therapy.
4. A client on digoxin reports nausea, vomiting, and visual disturbances. Which action should
the nurse take FIRST?
A. Administer the next dose
B. Check the serum digoxin level
C. Encourage oral fluids
D. Document the findings
Correct Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow halos) are classic signs of digoxin
toxicity. The nurse should check the serum digoxin level and hold the medication.
5. A nurse is administering furosemide to a client with heart failure. Which electrolyte should
be monitored?
A. Potassium
B. Calcium
C. Magnesium
D. Phosphorus
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia.
6. A client with a DVT is started on heparin. Which laboratory value should the nurse
monitor?
,A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B
Rationale: Heparin therapy is monitored using aPTT. INR is used for warfarin monitoring.
7. A nurse is assessing a client with cardiac tamponade. Which finding is characteristic?
A. Hypertension and tachycardia
B. Muffled heart sounds and hypotension
C. Clear lung sounds
D. Peripheral edema
Correct Answer: B
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) is characteristic of cardiac
tamponade.
8. A client with heart failure is prescribed carvedilol. Which finding indicates the medication
should be held?
A. Heart rate 52 bpm
B. Blood pressure 130/80 mmHg
C. Respiratory rate 16
D. Temperature 98.6°F
Correct Answer: A
Rationale: Beta-blockers should be held if heart rate is <60 bpm.
9. A nurse is assessing a client with an abdominal aortic aneurysm. Which finding requires
immediate intervention?
A. Pulsatile abdominal mass
B. Severe abdominal pain
C. Bruit over the mass
D. Mild discomfort
, Correct Answer: B
Rationale: Severe abdominal pain may indicate aneurysm rupture, a life-threatening emergency
requiring immediate intervention.
10. A client on warfarin has an INR of 5.2. Which action should the nurse take?
A. Continue the current dose
B. Hold warfarin and notify the provider
C. Increase the dose
D. Administer vitamin K immediately
Correct Answer: B
Rationale: An INR >5 is above the therapeutic range (2.0–3.0). The nurse should hold warfarin
and notify the provider. Vitamin K may be ordered if bleeding occurs.
11. A nurse is assessing a client with peripheral artery disease. Which finding is characteristic?
A. Intermittent claudication
B. Warm, red extremities
C. Bounding pulses
D. Edema
Correct Answer: A
Rationale: Intermittent claudication is characteristic of peripheral artery disease due to
decreased arterial blood flow.
12. A client with heart failure is prescribed spironolactone. Which finding indicates a
complication?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia.
Advanced Practice Examination | 200 High-Yield
Questions with Verified Answers & Detailed
Rationales | Complete Study Guide for Advanced
Med-Surg Mastery
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–30)
1. A nurse is assessing a client with heart failure. Which finding indicates the client is
experiencing fluid overload?
A. Weight loss of 2 kg
B. Decreased urine output
C. Crackles in the lung bases
D. Dry mucous membranes
Correct Answer: C
Rationale: Crackles in the lung bases indicate pulmonary edema, a hallmark of fluid overload in
heart failure. Weight loss, decreased urine output, and dry mucous membranes are signs of
fluid deficit.
2. A client with atrial fibrillation has a new prescription for metoprolol. Which finding
indicates the medication is effective?
A. Heart rate decreases from 140 to 88 bpm
B. Blood pressure increases
C. Urine output increases
D. Respiratory rate decreases
Correct Answer: A
Rationale: Metoprolol is a beta-blocker used for rate control in atrial fibrillation. A decrease in
heart rate to 60–100 bpm indicates therapeutic effect.
,3. A nurse is caring for a client with acute coronary syndrome. Which finding requires
immediate intervention?
A. ST elevation on ECG
B. T wave inversion
C. Pain rating 4/10
D. Blood pressure 130/80 mmHg
Correct Answer: A
Rationale: ST elevation indicates STEMI, a life-threatening emergency requiring immediate
reperfusion therapy.
4. A client on digoxin reports nausea, vomiting, and visual disturbances. Which action should
the nurse take FIRST?
A. Administer the next dose
B. Check the serum digoxin level
C. Encourage oral fluids
D. Document the findings
Correct Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow halos) are classic signs of digoxin
toxicity. The nurse should check the serum digoxin level and hold the medication.
5. A nurse is administering furosemide to a client with heart failure. Which electrolyte should
be monitored?
A. Potassium
B. Calcium
C. Magnesium
D. Phosphorus
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia.
6. A client with a DVT is started on heparin. Which laboratory value should the nurse
monitor?
,A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B
Rationale: Heparin therapy is monitored using aPTT. INR is used for warfarin monitoring.
7. A nurse is assessing a client with cardiac tamponade. Which finding is characteristic?
A. Hypertension and tachycardia
B. Muffled heart sounds and hypotension
C. Clear lung sounds
D. Peripheral edema
Correct Answer: B
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) is characteristic of cardiac
tamponade.
8. A client with heart failure is prescribed carvedilol. Which finding indicates the medication
should be held?
A. Heart rate 52 bpm
B. Blood pressure 130/80 mmHg
C. Respiratory rate 16
D. Temperature 98.6°F
Correct Answer: A
Rationale: Beta-blockers should be held if heart rate is <60 bpm.
9. A nurse is assessing a client with an abdominal aortic aneurysm. Which finding requires
immediate intervention?
A. Pulsatile abdominal mass
B. Severe abdominal pain
C. Bruit over the mass
D. Mild discomfort
, Correct Answer: B
Rationale: Severe abdominal pain may indicate aneurysm rupture, a life-threatening emergency
requiring immediate intervention.
10. A client on warfarin has an INR of 5.2. Which action should the nurse take?
A. Continue the current dose
B. Hold warfarin and notify the provider
C. Increase the dose
D. Administer vitamin K immediately
Correct Answer: B
Rationale: An INR >5 is above the therapeutic range (2.0–3.0). The nurse should hold warfarin
and notify the provider. Vitamin K may be ordered if bleeding occurs.
11. A nurse is assessing a client with peripheral artery disease. Which finding is characteristic?
A. Intermittent claudication
B. Warm, red extremities
C. Bounding pulses
D. Edema
Correct Answer: A
Rationale: Intermittent claudication is characteristic of peripheral artery disease due to
decreased arterial blood flow.
12. A client with heart failure is prescribed spironolactone. Which finding indicates a
complication?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia.
