HESI RN MED-SURG EXAM
2026/2027 | 200 VERIFIED
QUESTIONS & ANSWERS WITH
DETAILED RATIONALES | ELSEVIER
NCLEX-RN READINESS & TEST
BANK | INSTANT DOWNLOAD
Cardiovascular System
1. A client with heart failure is prescribed furosemide. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Weight gain of 2 kg in 24 hours
B. Decreased urine output
C. Clear lung sounds bilaterally
D. Increased peripheral edema
Answer: C. Clear lung sounds bilaterally
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Clear lung sounds
indicate resolution of pulmonary congestion, which is the desired therapeutic effect.
Weight gain, decreased urine output, and increased edema would indicate worsening
fluid retention.
2. A nurse is caring for a client with atrial fibrillation. Which medication does
the nurse anticipate will be prescribed to reduce the risk of stroke?
A. Digoxin
B. Warfarin
C. Amiodarone
D. Metoprolol
Answer: B. Warfarin
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of
thrombus formation and stroke. Warfarin is an anticoagulant that prevents clot
formation. Digoxin, amiodarone, and metoprolol control rate or rhythm but do not
directly reduce stroke risk as effectively as anticoagulation.
,3. A client is admitted with acute decompensated heart failure. Which position
should the nurse place the client in to promote comfort and breathing?
A. Supine with legs elevated
B. High Fowler's position
C. Trendelenburg position
D. Left lateral recumbent position
Answer: B. High Fowler's position
Rationale: High Fowler's position facilitates breathing by allowing maximum chest
expansion and reducing venous return to the heart, which decreases pulmonary
congestion. Supine and Trendelenburg positions would worsen pulmonary edema by
increasing venous return.
4. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is most consistent with this condition?
A. Dependent rubor and cool extremities
B. Warm, swollen extremities
C. Strong pedal pulses
D. Improved pain with elevation
Answer: A. Dependent rubor and cool extremities
Rationale: PAD results from arterial insufficiency, leading to cool extremities,
dependent rubor (redness when the leg is dependent), and diminished pulses. Pain
worsens with elevation and improves with dependency. Warm, swollen extremities and
strong pulses are more consistent with venous insufficiency.
5. A client with a history of myocardial infarction is prescribed aspirin. The
nurse understands that the primary purpose of this medication is to:
A. Relieve pain
B. Lower blood pressure
C. Inhibit platelet aggregation
D. Reduce cholesterol levels
Answer: C. Inhibit platelet aggregation
Rationale: Aspirin inhibits cyclooxygenase, reducing thromboxane A2 production and
platelet aggregation. This prevents thrombus formation in clients with coronary artery
disease. It is not primarily used for pain relief, blood pressure control, or cholesterol
reduction in this context.
6. A nurse is monitoring a client receiving digoxin. Which finding should the
nurse report immediately?
A. Heart rate of 72 beats per minute
B. Serum potassium of 4.0 mEq/L
C. Heart rate of 52 beats per minute
D. Blood pressure of 118/76 mm Hg
,Answer: C. Heart rate of 52 beats per minute
Rationale: Digoxin slows the heart rate and can cause bradycardia. A heart rate below
60 beats per minute may indicate digoxin toxicity and should be reported immediately.
The other findings are within normal limits.
7. A client is scheduled for a cardiac catheterization. Which assessment is most
important for the nurse to perform before the procedure?
A. Assess for allergies to shellfish or contrast dye
B. Check the client's blood glucose level
C. Perform a comprehensive skin assessment
D. Assess the client's hearing acuity
Answer: A. Assess for allergies to shellfish or contrast dye
Rationale: Cardiac catheterization uses iodinated contrast dye, which can cause
anaphylactic reactions in clients with allergies to shellfish or contrast media. This
assessment is critical for safety. Blood glucose and skin assessments are routine but less
immediately critical.
8. A nurse is teaching a client about lifestyle modifications to manage
hypertension. Which statement by the client indicates a need for further
teaching?
A. "I will limit my sodium intake to less than 2 grams per day."
B. "I will exercise for 30 minutes most days of the week."
C. "I will drink alcohol daily to help relax my blood vessels."
D. "I will monitor my blood pressure at home regularly."
Answer: C. "I will drink alcohol daily to help relax my blood vessels."
Rationale: Alcohol consumption can increase blood pressure and should be limited, not
encouraged. The other statements reflect appropriate lifestyle modifications for
hypertension management, including sodium restriction, regular exercise, and home
blood pressure monitoring.
9. A client with heart failure is prescribed a low-sodium diet. Which food should
the nurse instruct the client to avoid?
A. Fresh fruit
B. Canned soup
C. Grilled chicken
D. Steamed vegetables
Answer: B. Canned soup
Rationale: Canned soups are high in sodium due to preservatives and added salt.
Clients with heart failure should avoid high-sodium foods to prevent fluid retention.
Fresh fruits, grilled chicken, and steamed vegetables are low in sodium and appropriate
choices.
, Respiratory System
10. A 55-year-old male client has been admitted to the hospital with a medical
diagnosis of chronic obstructive pulmonary disease (COPD). Which risk factor is
the most significant in the development of this client's COPD?
A. The client's father was diagnosed with COPD in his 50s.
B. A close family member contracted tuberculosis last year.
C. The client smokes one to two packs of cigarettes per day.
D. The client has been 40 pounds overweight for 15 years.
Answer: C. The client smokes one to two packs of cigarettes per day.
Rationale: Smoking, considered to be a modifiable risk factor, is the most significant
risk factor for the development of COPD. The exact mechanism of genetic and
hereditary implications for the development of COPD is still under investigation,
although exposure to similar predisposing factors (e.g., smoking or inhaling
secondhand smoke) may increase the likelihood of COPD incidence among family
members. Options B and D do not exceed the risks associated with cigarette smoking in
the development of COPD.
11. A family member was taught to suction a client's tracheostomy prior to the
client's discharge from the hospital. Which observation by the nurse indicates
that the family member is capable of correctly performing the suctioning
technique?
A. Turns on the continuous wall suction to 190 mm Hg.
B. Inserts the catheter until resistance or coughing occurs.
C. Withdraws the catheter while maintaining suctioning.
D. Reclears the tracheostomy after suctioning the mouth.
Answer: B. Inserts the catheter until resistance or coughing occurs.
Rationale: Option B indicates correct technique for performing suctioning. Suction
pressure should be between 80 and 120 mm Hg, not 190 mm Hg. The catheter should
be withdrawn 1 to 2 cm at a time with intermittent, not continuous, suction. Option D
introduces pathogens unnecessarily into the tracheobronchial tree.
12. A 74-year-old male client is admitted to the intensive care unit (ICU) with a
diagnosis of respiratory failure secondary to pneumonia. Currently, he is
ventilator-dependent, with settings of tidal volume (VT) of 750 mL and an
intermittent mandatory ventilation (IMV) rate of 10 breaths/min. Arterial blood
gas (ABG) results are as follows: pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg;
HCO3, 25 mEq/L; and FiO2, 0.80. Which intervention should the nurse
implement first?
A. Increase the ventilator VT to 850 mL.
2026/2027 | 200 VERIFIED
QUESTIONS & ANSWERS WITH
DETAILED RATIONALES | ELSEVIER
NCLEX-RN READINESS & TEST
BANK | INSTANT DOWNLOAD
Cardiovascular System
1. A client with heart failure is prescribed furosemide. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Weight gain of 2 kg in 24 hours
B. Decreased urine output
C. Clear lung sounds bilaterally
D. Increased peripheral edema
Answer: C. Clear lung sounds bilaterally
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Clear lung sounds
indicate resolution of pulmonary congestion, which is the desired therapeutic effect.
Weight gain, decreased urine output, and increased edema would indicate worsening
fluid retention.
2. A nurse is caring for a client with atrial fibrillation. Which medication does
the nurse anticipate will be prescribed to reduce the risk of stroke?
A. Digoxin
B. Warfarin
C. Amiodarone
D. Metoprolol
Answer: B. Warfarin
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of
thrombus formation and stroke. Warfarin is an anticoagulant that prevents clot
formation. Digoxin, amiodarone, and metoprolol control rate or rhythm but do not
directly reduce stroke risk as effectively as anticoagulation.
,3. A client is admitted with acute decompensated heart failure. Which position
should the nurse place the client in to promote comfort and breathing?
A. Supine with legs elevated
B. High Fowler's position
C. Trendelenburg position
D. Left lateral recumbent position
Answer: B. High Fowler's position
Rationale: High Fowler's position facilitates breathing by allowing maximum chest
expansion and reducing venous return to the heart, which decreases pulmonary
congestion. Supine and Trendelenburg positions would worsen pulmonary edema by
increasing venous return.
4. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is most consistent with this condition?
A. Dependent rubor and cool extremities
B. Warm, swollen extremities
C. Strong pedal pulses
D. Improved pain with elevation
Answer: A. Dependent rubor and cool extremities
Rationale: PAD results from arterial insufficiency, leading to cool extremities,
dependent rubor (redness when the leg is dependent), and diminished pulses. Pain
worsens with elevation and improves with dependency. Warm, swollen extremities and
strong pulses are more consistent with venous insufficiency.
5. A client with a history of myocardial infarction is prescribed aspirin. The
nurse understands that the primary purpose of this medication is to:
A. Relieve pain
B. Lower blood pressure
C. Inhibit platelet aggregation
D. Reduce cholesterol levels
Answer: C. Inhibit platelet aggregation
Rationale: Aspirin inhibits cyclooxygenase, reducing thromboxane A2 production and
platelet aggregation. This prevents thrombus formation in clients with coronary artery
disease. It is not primarily used for pain relief, blood pressure control, or cholesterol
reduction in this context.
6. A nurse is monitoring a client receiving digoxin. Which finding should the
nurse report immediately?
A. Heart rate of 72 beats per minute
B. Serum potassium of 4.0 mEq/L
C. Heart rate of 52 beats per minute
D. Blood pressure of 118/76 mm Hg
,Answer: C. Heart rate of 52 beats per minute
Rationale: Digoxin slows the heart rate and can cause bradycardia. A heart rate below
60 beats per minute may indicate digoxin toxicity and should be reported immediately.
The other findings are within normal limits.
7. A client is scheduled for a cardiac catheterization. Which assessment is most
important for the nurse to perform before the procedure?
A. Assess for allergies to shellfish or contrast dye
B. Check the client's blood glucose level
C. Perform a comprehensive skin assessment
D. Assess the client's hearing acuity
Answer: A. Assess for allergies to shellfish or contrast dye
Rationale: Cardiac catheterization uses iodinated contrast dye, which can cause
anaphylactic reactions in clients with allergies to shellfish or contrast media. This
assessment is critical for safety. Blood glucose and skin assessments are routine but less
immediately critical.
8. A nurse is teaching a client about lifestyle modifications to manage
hypertension. Which statement by the client indicates a need for further
teaching?
A. "I will limit my sodium intake to less than 2 grams per day."
B. "I will exercise for 30 minutes most days of the week."
C. "I will drink alcohol daily to help relax my blood vessels."
D. "I will monitor my blood pressure at home regularly."
Answer: C. "I will drink alcohol daily to help relax my blood vessels."
Rationale: Alcohol consumption can increase blood pressure and should be limited, not
encouraged. The other statements reflect appropriate lifestyle modifications for
hypertension management, including sodium restriction, regular exercise, and home
blood pressure monitoring.
9. A client with heart failure is prescribed a low-sodium diet. Which food should
the nurse instruct the client to avoid?
A. Fresh fruit
B. Canned soup
C. Grilled chicken
D. Steamed vegetables
Answer: B. Canned soup
Rationale: Canned soups are high in sodium due to preservatives and added salt.
Clients with heart failure should avoid high-sodium foods to prevent fluid retention.
Fresh fruits, grilled chicken, and steamed vegetables are low in sodium and appropriate
choices.
, Respiratory System
10. A 55-year-old male client has been admitted to the hospital with a medical
diagnosis of chronic obstructive pulmonary disease (COPD). Which risk factor is
the most significant in the development of this client's COPD?
A. The client's father was diagnosed with COPD in his 50s.
B. A close family member contracted tuberculosis last year.
C. The client smokes one to two packs of cigarettes per day.
D. The client has been 40 pounds overweight for 15 years.
Answer: C. The client smokes one to two packs of cigarettes per day.
Rationale: Smoking, considered to be a modifiable risk factor, is the most significant
risk factor for the development of COPD. The exact mechanism of genetic and
hereditary implications for the development of COPD is still under investigation,
although exposure to similar predisposing factors (e.g., smoking or inhaling
secondhand smoke) may increase the likelihood of COPD incidence among family
members. Options B and D do not exceed the risks associated with cigarette smoking in
the development of COPD.
11. A family member was taught to suction a client's tracheostomy prior to the
client's discharge from the hospital. Which observation by the nurse indicates
that the family member is capable of correctly performing the suctioning
technique?
A. Turns on the continuous wall suction to 190 mm Hg.
B. Inserts the catheter until resistance or coughing occurs.
C. Withdraws the catheter while maintaining suctioning.
D. Reclears the tracheostomy after suctioning the mouth.
Answer: B. Inserts the catheter until resistance or coughing occurs.
Rationale: Option B indicates correct technique for performing suctioning. Suction
pressure should be between 80 and 120 mm Hg, not 190 mm Hg. The catheter should
be withdrawn 1 to 2 cm at a time with intermittent, not continuous, suction. Option D
introduces pathogens unnecessarily into the tracheobronchial tree.
12. A 74-year-old male client is admitted to the intensive care unit (ICU) with a
diagnosis of respiratory failure secondary to pneumonia. Currently, he is
ventilator-dependent, with settings of tidal volume (VT) of 750 mL and an
intermittent mandatory ventilation (IMV) rate of 10 breaths/min. Arterial blood
gas (ABG) results are as follows: pH, 7.48; PaCO2, 30 mm Hg; PaO2, 64 mm Hg;
HCO3, 25 mEq/L; and FiO2, 0.80. Which intervention should the nurse
implement first?
A. Increase the ventilator VT to 850 mL.
