Med-Surg HESI Practice Test : Key Concepts &
Clinical Scenarios
This comprehensive practice exam is designed to mirror the content and difficulty
of the HESI Medical-Surgical examination. Questions cover cardiology,
pulmonology, neurology, renal, gastrointestinal, endocrine, infectious disease,
oncology, and emergency nursing . Each question includes the correct answer with
a detailed rationale to reinforce clinical reasoning and prioritization skills.
Instructions
• Select the best answer for each question.
• Correct answers are bolded with rationales in italics.
• Questions are organized by body system for focused review.
Section 1: Cardiovascular Disorders
1. A client with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lung bases. Which medication should the nurse prepare to
administer FIRST?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion. Digoxin and beta-blockers are chronic therapies;
,spironolactone is a potassium-sparing diuretic used as an adjunct. In acute
decompensated heart failure, reducing fluid volume is the priority to improve
oxygenation .
2. A client with heart failure reports a 3-pound weight gain in 24 hours. What
should the nurse do FIRST?
• A) Administer furosemide as prescribed
• B) Assess for peripheral edema
• C) Restrict fluid intake
• D) Notify the healthcare provider
Rationale: Rapid weight gain in heart failure suggests fluid retention. Assessing for
peripheral edema provides data to guide further action and determine the severity
of fluid overload before implementing interventions .
3. A client with heart failure is experiencing dyspnea and has a respiratory rate
of 28 breaths per minute. What is the nurse's PRIORITY action?
• A) Administer a diuretic
• B) Encourage deep breathing exercises
• C) Position the patient in high Fowler's position
• D) Obtain a chest X-ray
Rationale: Positioning the patient in high Fowler's position facilitates lung
expansion and improves oxygenation, which is the priority for a patient with
dyspnea due to heart failure. This aligns with current nursing standards for
managing acute respiratory distress .
,4. A client with heart failure has crackles in both lung bases and peripheral
edema. Which nursing intervention should the nurse implement FIRST?
• A) Administer digoxin as ordered
• B) Check blood pressure
• C) Obtain daily weight
• D) Elevate the head of the bed
Rationale: The priority intervention for a client with pulmonary congestion is to
elevate the head of the bed to improve breathing and oxygenation. Airway and
breathing always take priority. After positioning, the nurse can administer
medications and assess further .
5. The nurse notes that a client's telemetry monitor indicates the sudden onset
of ventricular fibrillation. Which assessment finding should the nurse anticipate?
• A) Bounding erratic pulse
• B) Regularly irregular pulse
• C) Thready irregular pulse
• D) No palpable pulse
Rationale: Ventricular fibrillation results in no effective cardiac output. The nurse
should anticipate no palpable pulse, unresponsiveness, and apnea. Immediate
defibrillation is the priority intervention .
6. A client with atrial fibrillation is prescribed warfarin. The nurse should teach
the client to avoid which food?
• A) Broccoli
• B) Apples
• C) Rice
, • D) Chicken
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which
can antagonize warfarin's effect and lower the INR. Consistent intake is more
important than avoidance, but large variations should be avoided .
7. A client with atrial fibrillation has a new prescription for warfarin. The nurse
should prepare the client for which therapy?
• A) Cardioversion
• B) Pacemaker implantation
• C) Anticoagulation therapy
• D) Cardiac catheterization
Rationale: The client is experiencing atrial fibrillation, and the nurse should
prepare the client for anticoagulation therapy which should be prescribed before
rhythm control therapies to prevent cardioembolic events which result from blood
pooling in the fibrillating atria .
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse teach the client to report IMMEDIATELY?
• A) Dry cough
• B) Headache
• C) Swelling of the face, lips, or tongue
• D) Dizziness
Rationale: Angioedema (swelling of the face, lips, tongue, or airway) is a serious
adverse effect of ACE inhibitors that can compromise the airway. Clients should be
instructed to seek emergency care immediately if this occurs .
Clinical Scenarios
This comprehensive practice exam is designed to mirror the content and difficulty
of the HESI Medical-Surgical examination. Questions cover cardiology,
pulmonology, neurology, renal, gastrointestinal, endocrine, infectious disease,
oncology, and emergency nursing . Each question includes the correct answer with
a detailed rationale to reinforce clinical reasoning and prioritization skills.
Instructions
• Select the best answer for each question.
• Correct answers are bolded with rationales in italics.
• Questions are organized by body system for focused review.
Section 1: Cardiovascular Disorders
1. A client with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lung bases. Which medication should the nurse prepare to
administer FIRST?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion. Digoxin and beta-blockers are chronic therapies;
,spironolactone is a potassium-sparing diuretic used as an adjunct. In acute
decompensated heart failure, reducing fluid volume is the priority to improve
oxygenation .
2. A client with heart failure reports a 3-pound weight gain in 24 hours. What
should the nurse do FIRST?
• A) Administer furosemide as prescribed
• B) Assess for peripheral edema
• C) Restrict fluid intake
• D) Notify the healthcare provider
Rationale: Rapid weight gain in heart failure suggests fluid retention. Assessing for
peripheral edema provides data to guide further action and determine the severity
of fluid overload before implementing interventions .
3. A client with heart failure is experiencing dyspnea and has a respiratory rate
of 28 breaths per minute. What is the nurse's PRIORITY action?
• A) Administer a diuretic
• B) Encourage deep breathing exercises
• C) Position the patient in high Fowler's position
• D) Obtain a chest X-ray
Rationale: Positioning the patient in high Fowler's position facilitates lung
expansion and improves oxygenation, which is the priority for a patient with
dyspnea due to heart failure. This aligns with current nursing standards for
managing acute respiratory distress .
,4. A client with heart failure has crackles in both lung bases and peripheral
edema. Which nursing intervention should the nurse implement FIRST?
• A) Administer digoxin as ordered
• B) Check blood pressure
• C) Obtain daily weight
• D) Elevate the head of the bed
Rationale: The priority intervention for a client with pulmonary congestion is to
elevate the head of the bed to improve breathing and oxygenation. Airway and
breathing always take priority. After positioning, the nurse can administer
medications and assess further .
5. The nurse notes that a client's telemetry monitor indicates the sudden onset
of ventricular fibrillation. Which assessment finding should the nurse anticipate?
• A) Bounding erratic pulse
• B) Regularly irregular pulse
• C) Thready irregular pulse
• D) No palpable pulse
Rationale: Ventricular fibrillation results in no effective cardiac output. The nurse
should anticipate no palpable pulse, unresponsiveness, and apnea. Immediate
defibrillation is the priority intervention .
6. A client with atrial fibrillation is prescribed warfarin. The nurse should teach
the client to avoid which food?
• A) Broccoli
• B) Apples
• C) Rice
, • D) Chicken
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which
can antagonize warfarin's effect and lower the INR. Consistent intake is more
important than avoidance, but large variations should be avoided .
7. A client with atrial fibrillation has a new prescription for warfarin. The nurse
should prepare the client for which therapy?
• A) Cardioversion
• B) Pacemaker implantation
• C) Anticoagulation therapy
• D) Cardiac catheterization
Rationale: The client is experiencing atrial fibrillation, and the nurse should
prepare the client for anticoagulation therapy which should be prescribed before
rhythm control therapies to prevent cardioembolic events which result from blood
pooling in the fibrillating atria .
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse teach the client to report IMMEDIATELY?
• A) Dry cough
• B) Headache
• C) Swelling of the face, lips, or tongue
• D) Dizziness
Rationale: Angioedema (swelling of the face, lips, tongue, or airway) is a serious
adverse effect of ACE inhibitors that can compromise the airway. Clients should be
instructed to seek emergency care immediately if this occurs .
