HESI Med-Surg V1 Questions and Answers
(2025/2026) (Verified Answers)
OVERVIEW
Each section will contain the exact number and mix of traditional + NGN item types (15 items
per section × 4 sections = 60 total).
All clinical data, drug doses, lab values, and rationales reflect current, evidence-based practice
and the Clinical Judgment Measurement Model (CJMM).
SECTION 1 – CARDIOVASCULAR & HEMATOLOGY (15 items)
1. (MC – Single)
A client is admitted with BP 88/50, HR 110, RR 24, SpO₂ 94 % on 2 L NC. Current meds
include metoprolol 50 mg PO BID. Which action should the nurse take first?
A. Hold next metoprolol dose
B. Start 2nd IV line
C. Increase O₂ to 4 L
D. Obtain 12-lead ECG
Correct: A
Rationale: Hypotension + tachycardia suggests hypoperfusion; holding a negative
chronotrope/inotrope (metoprolol) prevents further BP drop (CJMM: recognize cues →
take action). ECG is important but not priority vs. removing causative drug. Increasing O₂
will not fix perfusion; 2nd IV is premature.
2. (MC) The nurse is caring for a client with new-onset AFib (HR 150). Which finding
requires immediate intervention?
A. Complaints of palpitations
B. SBP 180 mmHg
C. Loss of speech
D. Urine output 30 mL/h
Correct: C
Rationale: Sudden speech loss suggests embolic stroke (loss of perfusion to MCA).
Palpitations & HTN are expected with rapid AFib; 30 mL/h UOP is low-normal.
3. (MC) Post-cardiac cath via R femoral artery, the client reports “warm, wet” feeling in
groin. Nurse notes 8 cm ecchymosis. Vital signs stable. Priority action?
A. Apply sandbag
, B. Check site & mark borders
C. Remove dressing
D. Call physician
Correct: B
Rationale: Warm wet feeling + expanding ecchymosis = possible hematoma. First assess
extent (mark borders), then apply direct pressure; sandbags are outdated. Calling MD
comes after assessment.
4. (MC) Which lab value best reflects effectiveness of heparin therapy for PE?
A. aPTT 60 sec (control 30)
B. INR 2.5
C. Platelets 90 k
D. D-dimer 0.2 mg/L
Correct: A
Rationale: aPTT goal 1.5–2.5 × control (45–75 s) correlates with therapeutic heparin. INR
monitors warfarin; low platelets may signal HIT; D-dimer confirms clot presence, not
therapy.
5. (MC) Client with HF (EF 30 %) is started on sacubitril/valsartan. Which teaching point is
most important?
A. “Take with food to reduce GI upset.”
B. “Change positions slowly to avoid dizziness.”
C. “Monitor for dry cough every night.”
D. “Weigh yourself weekly.”
Correct: B
Rationale: ARNI causes vasodilation → first-dose hypotension; orthostatic precautions
are key. Dry cough is less common than with ACE; daily weights (not weekly) are
standard.
6. (MC) A client with pericarditis develops pulsus paradoxus >20 mmHg. Nurse anticipates
which order?
A. Increase IV morphine
B. Prepare for pericardiocentesis
C. Start dopamine drip
D. Administer colloid bolus
Correct: B
Rationale: Pulsus paradoxus >20 mmHg signals cardiac tamponade (impaired filling) →
emergency pericardiocentesis. Morphine won’t fix compression; inotropes/boluses are
ineffective.
, 7. (MC) Which statement by a client with newly implanted ICD indicates need for further
teaching?
A. “I’ll avoid strong magnetic fields.”
B. “I can still microwave my food.”
C. “If I feel a shock, I’ll call 911 if it’s the second shock.”
D. “I’ll lift my left arm above shoulder for stretching.”
Correct: D
Rationale: Arm abduction >90° before lead maturation (4–6 wk) risks lead dislodgement.
Microwaves are safe; magnets & 2-shock rule are correct.
8. (MC) Lab results post 4-unit PRBC transfusion: K⁺ 6.8, Ca²⁺ 7.5 mg/dL, HR 48. First
medication?
A. Regular insulin 10 units IV push
B. Calcium gluconate 1 g IV
C. Furosemide 40 mg IV
D. Albuterol nebulizer
Correct: B
Rationale: Severe hyperkalemia + hypocalcemia → risk of VF; calcium gluconate
stabilizes cardiac membranes immediately (CJMM: take immediate action). Insulin shifts
K⁺ but takes 10–20 min.
9. (MC) Nurse notes new loud holosystolic murmur at apex radiating to axilla in MI client.
Priority?
A. Obtain stat chest X-ray
B. Give O₂ 6 L via mask
C. Call for stat echocardiogram
D. Administer furosemide
Correct: C
Rationale: Murmur timing & location suggest acute mitral regurgitation from papillary-
muscle rupture → needs stat echo for surgical planning. O₂ is supportive; furosemide is
premature.
10. (MC) Which finding supports diagnosis of chronic arterial insufficiency?
A. 3+ pitting edema bilaterally
B. Brownish pigmentation above ankles
C. Cool foot with 5-second capillary refill
D. Dilated superficial veins
Correct: C
(2025/2026) (Verified Answers)
OVERVIEW
Each section will contain the exact number and mix of traditional + NGN item types (15 items
per section × 4 sections = 60 total).
All clinical data, drug doses, lab values, and rationales reflect current, evidence-based practice
and the Clinical Judgment Measurement Model (CJMM).
SECTION 1 – CARDIOVASCULAR & HEMATOLOGY (15 items)
1. (MC – Single)
A client is admitted with BP 88/50, HR 110, RR 24, SpO₂ 94 % on 2 L NC. Current meds
include metoprolol 50 mg PO BID. Which action should the nurse take first?
A. Hold next metoprolol dose
B. Start 2nd IV line
C. Increase O₂ to 4 L
D. Obtain 12-lead ECG
Correct: A
Rationale: Hypotension + tachycardia suggests hypoperfusion; holding a negative
chronotrope/inotrope (metoprolol) prevents further BP drop (CJMM: recognize cues →
take action). ECG is important but not priority vs. removing causative drug. Increasing O₂
will not fix perfusion; 2nd IV is premature.
2. (MC) The nurse is caring for a client with new-onset AFib (HR 150). Which finding
requires immediate intervention?
A. Complaints of palpitations
B. SBP 180 mmHg
C. Loss of speech
D. Urine output 30 mL/h
Correct: C
Rationale: Sudden speech loss suggests embolic stroke (loss of perfusion to MCA).
Palpitations & HTN are expected with rapid AFib; 30 mL/h UOP is low-normal.
3. (MC) Post-cardiac cath via R femoral artery, the client reports “warm, wet” feeling in
groin. Nurse notes 8 cm ecchymosis. Vital signs stable. Priority action?
A. Apply sandbag
, B. Check site & mark borders
C. Remove dressing
D. Call physician
Correct: B
Rationale: Warm wet feeling + expanding ecchymosis = possible hematoma. First assess
extent (mark borders), then apply direct pressure; sandbags are outdated. Calling MD
comes after assessment.
4. (MC) Which lab value best reflects effectiveness of heparin therapy for PE?
A. aPTT 60 sec (control 30)
B. INR 2.5
C. Platelets 90 k
D. D-dimer 0.2 mg/L
Correct: A
Rationale: aPTT goal 1.5–2.5 × control (45–75 s) correlates with therapeutic heparin. INR
monitors warfarin; low platelets may signal HIT; D-dimer confirms clot presence, not
therapy.
5. (MC) Client with HF (EF 30 %) is started on sacubitril/valsartan. Which teaching point is
most important?
A. “Take with food to reduce GI upset.”
B. “Change positions slowly to avoid dizziness.”
C. “Monitor for dry cough every night.”
D. “Weigh yourself weekly.”
Correct: B
Rationale: ARNI causes vasodilation → first-dose hypotension; orthostatic precautions
are key. Dry cough is less common than with ACE; daily weights (not weekly) are
standard.
6. (MC) A client with pericarditis develops pulsus paradoxus >20 mmHg. Nurse anticipates
which order?
A. Increase IV morphine
B. Prepare for pericardiocentesis
C. Start dopamine drip
D. Administer colloid bolus
Correct: B
Rationale: Pulsus paradoxus >20 mmHg signals cardiac tamponade (impaired filling) →
emergency pericardiocentesis. Morphine won’t fix compression; inotropes/boluses are
ineffective.
, 7. (MC) Which statement by a client with newly implanted ICD indicates need for further
teaching?
A. “I’ll avoid strong magnetic fields.”
B. “I can still microwave my food.”
C. “If I feel a shock, I’ll call 911 if it’s the second shock.”
D. “I’ll lift my left arm above shoulder for stretching.”
Correct: D
Rationale: Arm abduction >90° before lead maturation (4–6 wk) risks lead dislodgement.
Microwaves are safe; magnets & 2-shock rule are correct.
8. (MC) Lab results post 4-unit PRBC transfusion: K⁺ 6.8, Ca²⁺ 7.5 mg/dL, HR 48. First
medication?
A. Regular insulin 10 units IV push
B. Calcium gluconate 1 g IV
C. Furosemide 40 mg IV
D. Albuterol nebulizer
Correct: B
Rationale: Severe hyperkalemia + hypocalcemia → risk of VF; calcium gluconate
stabilizes cardiac membranes immediately (CJMM: take immediate action). Insulin shifts
K⁺ but takes 10–20 min.
9. (MC) Nurse notes new loud holosystolic murmur at apex radiating to axilla in MI client.
Priority?
A. Obtain stat chest X-ray
B. Give O₂ 6 L via mask
C. Call for stat echocardiogram
D. Administer furosemide
Correct: C
Rationale: Murmur timing & location suggest acute mitral regurgitation from papillary-
muscle rupture → needs stat echo for surgical planning. O₂ is supportive; furosemide is
premature.
10. (MC) Which finding supports diagnosis of chronic arterial insufficiency?
A. 3+ pitting edema bilaterally
B. Brownish pigmentation above ankles
C. Cool foot with 5-second capillary refill
D. Dilated superficial veins
Correct: C
