HESI MED-SURG RETAKE REVIEW 2026/2027 | Verified Q&A
for Retake Success | Complete Remediation Guide | Pass
Guaranteed - A+ Graded
Section 1: High-Failure Cardiovascular Concepts (Q1-20)
Q1. A client with heart failure is being discharged. The nurse reviews daily weights and
when to call the provider. Which statement by the client indicates correct understanding
of early decompensation signs?
A. "I should call if I gain 1 pound in one day."
B. "I should call if I gain 3 pounds in one week or 2 pounds in one day."
C. "I only need to weigh myself once a week."
D. "A 5-pound weight gain in 3 days is normal for me."
B. "I should call if I gain 3 pounds in one week or 2 pounds in one day." [CORRECT]
Rationale: Rapid weight gain indicates fluid retention before pulmonary edema
develops; the standard threshold is 2-3 lb (1-1.5 kg) in 24 hours or 3-5 lb in one week.
Option A is too sensitive, C misses early detection, and D normalizes dangerous fluid
overload.
Correct Answer: B
Q2. A client receiving digoxin 0.25 mg daily has a potassium of 2.8 mEq/L. The nurse
should prioritize which action?
A. Administer the digoxin as scheduled because the dose is within normal limits
B. Hold the digoxin and notify the provider immediately due to increased risk of toxicity
C. Give the digoxin with a potassium supplement without checking the provider's orders
D. Recheck the potassium in 4 hours and administer the digoxin now
,B. Hold the digoxin and notify the provider immediately due to increased risk of toxicity
[CORRECT]
Rationale: Hypokalemia potentiates digoxin toxicity by displacing digoxin from tissue
binding sites and increasing myocardial sensitivity; holding the dose and notifying the
provider prevents life-threatening arrhythmias. Administering digoxin with low
potassium (A, C) is unsafe, and waiting (D) delays critical intervention.
Correct Answer: B
Q3. A client on heparin therapy has a platelet count that dropped from 180,000 to
82,000 on day 7 of therapy. The next appropriate nursing action is:
A. Continue heparin and increase the dose to compensate for platelet consumption
B. Stop heparin immediately, notify the provider, and anticipate switching to a
non-heparin anticoagulant such as argatroban or fondaparinux
C. Administer a platelet transfusion and continue heparin at the current dose
D. Switch to warfarin alone without bridging therapy
B. Stop heparin immediately, notify the provider, and anticipate switching to a
non-heparin anticoagulant such as argatroban or fondaparinux [CORRECT]
Rationale: A >50% platelet drop or count <100,000 suggests heparin-induced
thrombocytopenia (HIT), an immune-mediated prothrombotic condition; all heparin
must be stopped immediately and a direct thrombin inhibitor (argatroban) or
fondaparinux initiated. Continuing heparin (A) worsens thrombosis risk, and platelet
transfusion (C) is contraindicated in HIT.
Correct Answer: B
,Q4. A client with acute pulmonary embolism has a blood pressure of 82/50 mmHg,
heart rate 128, and oxygen saturation 86% on 6L nasal cannula. The nurse recognizes
this as:
A. A stable PE that can be managed with heparin alone
B. A massive PE with hemodynamic compromise requiring immediate intervention
including possible systemic thrombolysis
C. A submassive PE that only requires supplemental oxygen and observation
D. A chronic PE that should be treated with warfarin alone
B. A massive PE with hemodynamic compromise requiring immediate intervention
including possible systemic thrombolysis [CORRECT]
Rationale: Massive PE is defined by hemodynamic instability (SBP <90 mmHg or drop
>40 mmHg), persistent hypotension, or shock; this client meets criteria and requires
immediate resuscitation, oxygenation support, and consideration of systemic
thrombolytics or embolectomy. Heparin alone (A) is insufficient, and submassive PE (C)
lacks hypotension.
Correct Answer: B
Q5. A client with a new onset of atrial fibrillation is started on warfarin. The nurse knows
that bridging with heparin or LMWH is necessary until the INR is therapeutic because:
A. Warfarin causes a transient hypercoagulable state by depleting protein C and S
before fully inhibiting vitamin K-dependent clotting factors
B. Warfarin immediately inhibits all clotting factors upon administration
C. Heparin is only needed for clients with mechanical heart valves
D. Warfarin increases platelet aggregation during the first week
A. Warfarin causes a transient hypercoagulable state by depleting protein C and S
before fully inhibiting vitamin K-dependent clotting factors [CORRECT]
, Rationale: Protein C and S have shorter half-lives than factors II, VII, IX, and X; warfarin
initially depletes these natural anticoagulants faster than it inhibits procoagulant
factors, creating a transient hypercoagulable window that requires heparin bridging until
INR is therapeutic for at least 24 hours.
Correct Answer: A
Q6. A client with heart failure has an S3 gallop auscultated at the apex. The nurse
understands that this sound indicates:
A. A normal finding in healthy adults
B. Turbulent blood flow into a stiff, noncompliant ventricle during atrial contraction
C. Rapid ventricular filling into a volume-overloaded, compliant ventricle
D. Aortic stenosis with delayed aortic valve closure
C. Rapid ventricular filling into a volume-overloaded, compliant ventricle [CORRECT]
Rationale: An S3 gallop occurs during early diastole when blood rushes into a dilated,
volume-overloaded ventricle (as in systolic heart failure); it is not normal in adults over
age 40. An S4 (not S3) indicates a stiff ventricle (B), and aortic stenosis produces a
systolic murmur (D).
Correct Answer: C
Q7. A client post-cardiac catheterization via the femoral artery has a sandbag placed on
the insertion site. Two hours later, the nurse notes the client has a cold, pale right foot
with diminished pedal pulses. The priority nursing action is:
A. Elevate the leg above heart level to reduce swelling
B. Assess the client for pain and document the findings
C. Notify the provider immediately because this indicates arterial occlusion from a
thrombus or hematoma
for Retake Success | Complete Remediation Guide | Pass
Guaranteed - A+ Graded
Section 1: High-Failure Cardiovascular Concepts (Q1-20)
Q1. A client with heart failure is being discharged. The nurse reviews daily weights and
when to call the provider. Which statement by the client indicates correct understanding
of early decompensation signs?
A. "I should call if I gain 1 pound in one day."
B. "I should call if I gain 3 pounds in one week or 2 pounds in one day."
C. "I only need to weigh myself once a week."
D. "A 5-pound weight gain in 3 days is normal for me."
B. "I should call if I gain 3 pounds in one week or 2 pounds in one day." [CORRECT]
Rationale: Rapid weight gain indicates fluid retention before pulmonary edema
develops; the standard threshold is 2-3 lb (1-1.5 kg) in 24 hours or 3-5 lb in one week.
Option A is too sensitive, C misses early detection, and D normalizes dangerous fluid
overload.
Correct Answer: B
Q2. A client receiving digoxin 0.25 mg daily has a potassium of 2.8 mEq/L. The nurse
should prioritize which action?
A. Administer the digoxin as scheduled because the dose is within normal limits
B. Hold the digoxin and notify the provider immediately due to increased risk of toxicity
C. Give the digoxin with a potassium supplement without checking the provider's orders
D. Recheck the potassium in 4 hours and administer the digoxin now
,B. Hold the digoxin and notify the provider immediately due to increased risk of toxicity
[CORRECT]
Rationale: Hypokalemia potentiates digoxin toxicity by displacing digoxin from tissue
binding sites and increasing myocardial sensitivity; holding the dose and notifying the
provider prevents life-threatening arrhythmias. Administering digoxin with low
potassium (A, C) is unsafe, and waiting (D) delays critical intervention.
Correct Answer: B
Q3. A client on heparin therapy has a platelet count that dropped from 180,000 to
82,000 on day 7 of therapy. The next appropriate nursing action is:
A. Continue heparin and increase the dose to compensate for platelet consumption
B. Stop heparin immediately, notify the provider, and anticipate switching to a
non-heparin anticoagulant such as argatroban or fondaparinux
C. Administer a platelet transfusion and continue heparin at the current dose
D. Switch to warfarin alone without bridging therapy
B. Stop heparin immediately, notify the provider, and anticipate switching to a
non-heparin anticoagulant such as argatroban or fondaparinux [CORRECT]
Rationale: A >50% platelet drop or count <100,000 suggests heparin-induced
thrombocytopenia (HIT), an immune-mediated prothrombotic condition; all heparin
must be stopped immediately and a direct thrombin inhibitor (argatroban) or
fondaparinux initiated. Continuing heparin (A) worsens thrombosis risk, and platelet
transfusion (C) is contraindicated in HIT.
Correct Answer: B
,Q4. A client with acute pulmonary embolism has a blood pressure of 82/50 mmHg,
heart rate 128, and oxygen saturation 86% on 6L nasal cannula. The nurse recognizes
this as:
A. A stable PE that can be managed with heparin alone
B. A massive PE with hemodynamic compromise requiring immediate intervention
including possible systemic thrombolysis
C. A submassive PE that only requires supplemental oxygen and observation
D. A chronic PE that should be treated with warfarin alone
B. A massive PE with hemodynamic compromise requiring immediate intervention
including possible systemic thrombolysis [CORRECT]
Rationale: Massive PE is defined by hemodynamic instability (SBP <90 mmHg or drop
>40 mmHg), persistent hypotension, or shock; this client meets criteria and requires
immediate resuscitation, oxygenation support, and consideration of systemic
thrombolytics or embolectomy. Heparin alone (A) is insufficient, and submassive PE (C)
lacks hypotension.
Correct Answer: B
Q5. A client with a new onset of atrial fibrillation is started on warfarin. The nurse knows
that bridging with heparin or LMWH is necessary until the INR is therapeutic because:
A. Warfarin causes a transient hypercoagulable state by depleting protein C and S
before fully inhibiting vitamin K-dependent clotting factors
B. Warfarin immediately inhibits all clotting factors upon administration
C. Heparin is only needed for clients with mechanical heart valves
D. Warfarin increases platelet aggregation during the first week
A. Warfarin causes a transient hypercoagulable state by depleting protein C and S
before fully inhibiting vitamin K-dependent clotting factors [CORRECT]
, Rationale: Protein C and S have shorter half-lives than factors II, VII, IX, and X; warfarin
initially depletes these natural anticoagulants faster than it inhibits procoagulant
factors, creating a transient hypercoagulable window that requires heparin bridging until
INR is therapeutic for at least 24 hours.
Correct Answer: A
Q6. A client with heart failure has an S3 gallop auscultated at the apex. The nurse
understands that this sound indicates:
A. A normal finding in healthy adults
B. Turbulent blood flow into a stiff, noncompliant ventricle during atrial contraction
C. Rapid ventricular filling into a volume-overloaded, compliant ventricle
D. Aortic stenosis with delayed aortic valve closure
C. Rapid ventricular filling into a volume-overloaded, compliant ventricle [CORRECT]
Rationale: An S3 gallop occurs during early diastole when blood rushes into a dilated,
volume-overloaded ventricle (as in systolic heart failure); it is not normal in adults over
age 40. An S4 (not S3) indicates a stiff ventricle (B), and aortic stenosis produces a
systolic murmur (D).
Correct Answer: C
Q7. A client post-cardiac catheterization via the femoral artery has a sandbag placed on
the insertion site. Two hours later, the nurse notes the client has a cold, pale right foot
with diminished pedal pulses. The priority nursing action is:
A. Elevate the leg above heart level to reduce swelling
B. Assess the client for pain and document the findings
C. Notify the provider immediately because this indicates arterial occlusion from a
thrombus or hematoma
