1
Evolve HESI Medical Surgical Latest Exam (Brand New!!) — 100 Practice Questions &
Verified Answers
Study Guide Note: This practice exam is aligned with the 2026/2027 HESI Medical-Surgical
Nursing Examination blueprint, covering the most tested content domains including
cardiovascular, respiratory, neurological, endocrine, gastrointestinal, renal, musculoskeletal,
and perioperative care. Each question includes the correct answer and a well-elaborated
rationale grounded in evidence-based practice.
Section 1: Cardiovascular Disorders (Questions 1–15)
1. A client with heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which
action is most important for the nurse to implement?
A. Give 20 mEq of potassium chloride
B. Initiate continuous cardiac monitoring
C. Arrange a consultation with the dietitian
D. Teach about the side effects of diuretics
Answer: B. Hypokalemia causes changes in myocardial irritability and ECG waveform. It is
most important to initiate continuous cardiac monitoring to identify ventricular ectopy or
other life-threatening dysrhythmias. After cardiac monitoring is initiated, potassium chloride
should be given so the effects of potassium replacement on the cardiac rhythm can be
monitored .
2. A client with atrial fibrillation and a ventricular rate of 128 beats/min has a new
prescription for metoprolol. The nurse knows this medication is primarily used for which
purpose?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
Answer: B. Metoprolol is a beta-blocker that slows conduction through the AV node, thereby
controlling the ventricular rate in atrial fibrillation. Rate control is the first-line approach for
many patients with atrial fibrillation, particularly those who are hemodynamically stable .
3. A client with heart failure reports increased shortness of breath and notices a 3-pound
weight gain over 2 days. Which nursing intervention is the PRIORITY?
A. Restrict fluid intake to 1500 mL/day
B. Assess the client for jugular venous distension
C. Assess current weight and compare with baseline
D. Administer the prescribed diuretic
,2
Answer: B. The 3-pound weight gain in 2 days indicates fluid volume overload. Assessment is
the priority nursing action before intervening. Assessing for jugular venous distension (JVD)
and other signs of fluid overload provides data needed to guide intervention .
4. A patient with chronic atrial fibrillation is prescribed warfarin. Which laboratory value is
most important to monitor?
A. Serum potassium
B. Serum creatinine
C. International Normalized Ratio (INR)
D. Platelet count
Answer: C. Warfarin is an anticoagulant that requires close monitoring of the INR to
maintain therapeutic levels (typically 2.0–3.0 for atrial fibrillation). This ensures adequate
anticoagulation while minimizing bleeding risk .
5. A patient with a history of deep vein thrombosis (DVT) is prescribed enoxaparin
subcutaneously. Which action is correct when administering this medication?
A. Massage the injection site after administration
B. Administer the injection in the deltoid muscle
C. Inject the medication into the subcutaneous tissue of the abdomen
D. Aspirate before injecting to ensure no blood return
Answer: C. Enoxaparin is a low-molecular-weight heparin administered subcutaneously in
the abdomen. The injection site should not be massaged (to prevent bruising/hematoma).
Aspiration is not required for subcutaneous injections. It is not given intramuscularly .
6. A patient is prescribed digoxin for heart failure. Which finding indicates digoxin toxicity?
A. Heart rate of 62 bpm
B. Anorexia, nausea, and visual disturbances (halos around lights)
C. Blood pressure of 110/70 mmHg
D. Serum potassium level of 4.0 mEq/L
Answer: B. Digoxin toxicity presents with GI symptoms (anorexia, nausea, vomiting), visual
disturbances (yellow-green halos, blurred vision), and cardiac dysrhythmias (bradycardia,
heart block). Hypokalemia potentiates digoxin toxicity .
7. A patient presents with jugular venous distention, peripheral edema, and
hepatomegaly. These findings are most consistent with which type of heart failure?
A. Left-sided heart failure
B. Right-sided heart failure
C. High-output heart failure
D. Pulmonary edema
, 3
Answer: B. Right-sided heart failure causes systemic venous congestion, leading to jugular
venous distention (JVD), peripheral edema, hepatomegaly, and ascites. Left-sided heart
failure primarily causes pulmonary congestion (dyspnea, crackles, orthopnea) .
8. A client with heart failure is started on carvedilol. Which finding would require the
nurse to hold the medication and notify the healthcare provider?
A. Heart rate 68 bpm
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
Answer: B. Carvedilol is a beta-blocker that can worsen hypotension. The medication should
be held if the systolic blood pressure is < 90 mmHg or signs of shock are present.
Hypotension can reduce cardiac perfusion and worsen heart failure. Beta-blockers should
also be held if the heart rate is < 60 bpm, but a heart rate of 68 bpm is within acceptable
limits .
9. A patient is 2 days post-operative following coronary artery bypass graft (CABG) surgery.
The nurse notes new-onset atrial fibrillation with a ventricular rate of 140 bpm. The
patient is hemodynamically stable. Which intervention should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of amiodarone or beta-blocker for rate control
C. Administration of adenosine 6 mg IV push
D. Notification of the provider for possible pacemaker insertion
Answer: B. Post-operative atrial fibrillation is common after CABG. For a hemodynamically
stable patient, rate control with medications such as amiodarone or beta-blockers is the
initial approach. Synchronized cardioversion is reserved for unstable patients .
10. A male client with chronic atrial fibrillation and a slow ventricular response is
scheduled for surgical placement of a permanent pacemaker. The client asks how this
device will help him. How should the nurse explain the action of a synchronous
pacemaker?
A. Ventricular irritability is prevented by the constant rate setting of pacemaker
B. Ectopic stimulus in the atria is suppressed by the device usurping depolarization
C. An impulse is fired every second to maintain a heart rate of 60 beats per minute
D. An electrical stimulus is discharged when no ventricular response is sensed
Answer: D. The artificial cardiac pacemaker is an electronic device used to pace the heart
when the normal conduction pathway is damaged or diseased. Synchronous pacing modes
generate an impulse on demand or as needed according to the client's intrinsic rhythm .
11. A patient with infective endocarditis is started on intravenous antibiotics. Which
nursing intervention is a priority?
Evolve HESI Medical Surgical Latest Exam (Brand New!!) — 100 Practice Questions &
Verified Answers
Study Guide Note: This practice exam is aligned with the 2026/2027 HESI Medical-Surgical
Nursing Examination blueprint, covering the most tested content domains including
cardiovascular, respiratory, neurological, endocrine, gastrointestinal, renal, musculoskeletal,
and perioperative care. Each question includes the correct answer and a well-elaborated
rationale grounded in evidence-based practice.
Section 1: Cardiovascular Disorders (Questions 1–15)
1. A client with heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which
action is most important for the nurse to implement?
A. Give 20 mEq of potassium chloride
B. Initiate continuous cardiac monitoring
C. Arrange a consultation with the dietitian
D. Teach about the side effects of diuretics
Answer: B. Hypokalemia causes changes in myocardial irritability and ECG waveform. It is
most important to initiate continuous cardiac monitoring to identify ventricular ectopy or
other life-threatening dysrhythmias. After cardiac monitoring is initiated, potassium chloride
should be given so the effects of potassium replacement on the cardiac rhythm can be
monitored .
2. A client with atrial fibrillation and a ventricular rate of 128 beats/min has a new
prescription for metoprolol. The nurse knows this medication is primarily used for which
purpose?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
Answer: B. Metoprolol is a beta-blocker that slows conduction through the AV node, thereby
controlling the ventricular rate in atrial fibrillation. Rate control is the first-line approach for
many patients with atrial fibrillation, particularly those who are hemodynamically stable .
3. A client with heart failure reports increased shortness of breath and notices a 3-pound
weight gain over 2 days. Which nursing intervention is the PRIORITY?
A. Restrict fluid intake to 1500 mL/day
B. Assess the client for jugular venous distension
C. Assess current weight and compare with baseline
D. Administer the prescribed diuretic
,2
Answer: B. The 3-pound weight gain in 2 days indicates fluid volume overload. Assessment is
the priority nursing action before intervening. Assessing for jugular venous distension (JVD)
and other signs of fluid overload provides data needed to guide intervention .
4. A patient with chronic atrial fibrillation is prescribed warfarin. Which laboratory value is
most important to monitor?
A. Serum potassium
B. Serum creatinine
C. International Normalized Ratio (INR)
D. Platelet count
Answer: C. Warfarin is an anticoagulant that requires close monitoring of the INR to
maintain therapeutic levels (typically 2.0–3.0 for atrial fibrillation). This ensures adequate
anticoagulation while minimizing bleeding risk .
5. A patient with a history of deep vein thrombosis (DVT) is prescribed enoxaparin
subcutaneously. Which action is correct when administering this medication?
A. Massage the injection site after administration
B. Administer the injection in the deltoid muscle
C. Inject the medication into the subcutaneous tissue of the abdomen
D. Aspirate before injecting to ensure no blood return
Answer: C. Enoxaparin is a low-molecular-weight heparin administered subcutaneously in
the abdomen. The injection site should not be massaged (to prevent bruising/hematoma).
Aspiration is not required for subcutaneous injections. It is not given intramuscularly .
6. A patient is prescribed digoxin for heart failure. Which finding indicates digoxin toxicity?
A. Heart rate of 62 bpm
B. Anorexia, nausea, and visual disturbances (halos around lights)
C. Blood pressure of 110/70 mmHg
D. Serum potassium level of 4.0 mEq/L
Answer: B. Digoxin toxicity presents with GI symptoms (anorexia, nausea, vomiting), visual
disturbances (yellow-green halos, blurred vision), and cardiac dysrhythmias (bradycardia,
heart block). Hypokalemia potentiates digoxin toxicity .
7. A patient presents with jugular venous distention, peripheral edema, and
hepatomegaly. These findings are most consistent with which type of heart failure?
A. Left-sided heart failure
B. Right-sided heart failure
C. High-output heart failure
D. Pulmonary edema
, 3
Answer: B. Right-sided heart failure causes systemic venous congestion, leading to jugular
venous distention (JVD), peripheral edema, hepatomegaly, and ascites. Left-sided heart
failure primarily causes pulmonary congestion (dyspnea, crackles, orthopnea) .
8. A client with heart failure is started on carvedilol. Which finding would require the
nurse to hold the medication and notify the healthcare provider?
A. Heart rate 68 bpm
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
Answer: B. Carvedilol is a beta-blocker that can worsen hypotension. The medication should
be held if the systolic blood pressure is < 90 mmHg or signs of shock are present.
Hypotension can reduce cardiac perfusion and worsen heart failure. Beta-blockers should
also be held if the heart rate is < 60 bpm, but a heart rate of 68 bpm is within acceptable
limits .
9. A patient is 2 days post-operative following coronary artery bypass graft (CABG) surgery.
The nurse notes new-onset atrial fibrillation with a ventricular rate of 140 bpm. The
patient is hemodynamically stable. Which intervention should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of amiodarone or beta-blocker for rate control
C. Administration of adenosine 6 mg IV push
D. Notification of the provider for possible pacemaker insertion
Answer: B. Post-operative atrial fibrillation is common after CABG. For a hemodynamically
stable patient, rate control with medications such as amiodarone or beta-blockers is the
initial approach. Synchronized cardioversion is reserved for unstable patients .
10. A male client with chronic atrial fibrillation and a slow ventricular response is
scheduled for surgical placement of a permanent pacemaker. The client asks how this
device will help him. How should the nurse explain the action of a synchronous
pacemaker?
A. Ventricular irritability is prevented by the constant rate setting of pacemaker
B. Ectopic stimulus in the atria is suppressed by the device usurping depolarization
C. An impulse is fired every second to maintain a heart rate of 60 beats per minute
D. An electrical stimulus is discharged when no ventricular response is sensed
Answer: D. The artificial cardiac pacemaker is an electronic device used to pace the heart
when the normal conduction pathway is damaged or diseased. Synchronous pacing modes
generate an impulse on demand or as needed according to the client's intrinsic rhythm .
11. A patient with infective endocarditis is started on intravenous antibiotics. Which
nursing intervention is a priority?
