HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
Cardiovascular & Hematology (Questions 1–25)
Question 1
A nurse is caring for a client who underwent a percutaneous coronary intervention (PCI)
through the right femoral artery 2 hours ago. Which assessment finding requires immediate
notification to the healthcare provider? A) A palpable dorsal pedis pulse in the right foot that
matches the baseline.
B) A 4 cm area of firm, elevated ecchymosis at the arterial puncture site.
C) Client reports of mild back pain and a blood pressure drop from 120/80 to 94/56 mmHg.
D) A target heart rate of 82 beats/min with occasional premature ventricular contractions
(PVCs).
Correct Answer: C — Client reports of mild back pain and a blood pressure drop from
120/80 to 94/56 mmHg.
Rationale: Retroperitoneal bleeding is a serious complication of femoral arterial punctures. It
typically manifests as back or flank pain, hypotension, and tachycardia. A firm hematoma
(Option B) needs monitoring but a systemic drop in pressure indicates active internal
bleeding.
Question 2
A client with a history of deep vein thrombosis (DVT) is receiving a continuous intravenous
heparin infusion. The client's baseline activated partial thromboplastin time (aPTT) was 30
seconds. The current aPTT result is 120 seconds. Which action should the nurse take first? A)
Increase the infusion rate by 10% to hit target parameters.
B) Stop the heparin infusion immediately and prepare to administer protamine sulfate if
ordered.
C) Draw an immediate repeat blood sample to verify the lab value.
D) Document the finding and reassess the client in 4 hours.
Correct Answer: B — Stop the heparin infusion immediately and prepare to administer
protamine sulfate if ordered.
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times
the normal baseline (around 45 to 75 seconds). An aPTT of 120 seconds indicates a critical
risk for spontaneous bleeding. The infusion must be stopped immediately.
Question 3
,HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
The nurse prepares to administer the morning dose of Digoxin ($0.25\text{ mg}$ PO) to a
client with chronic heart failure. The client’s apical pulse is 54 beats/min and the serum
potassium level is $3.1\text{ mEq/L}$. What is the priority nursing action? A) Administer the
medication as scheduled and document the pulse.
B) Administer the medication alongside a potassium-restricted snack.
C) Hold the dose, notify the provider, and monitor for signs of digoxin toxicity.
D) Request an immediate electrocardiogram (ECG) from the telemetry tech.
Correct Answer: C — Hold the dose, notify the provider, and monitor for signs of digoxin
toxicity.
Rationale: Digoxin should be held if the apical pulse is less than 60 beats/min in an adult.
Furthermore, hypokalemia ($<3.5\text{ mEq/L}$) drastically increases the risk of digoxin
toxicity. The nurse must hold the medication and report both findings.
Question 4
A client with an acute myocardial infarction develops a sudden burst of ventricular
tachycardia (VT) on the telemetry monitor. The nurse enters the room and notes the client is
awake, talking, and reports feeling "a little dizzy." Which action should the nurse take first?
A) Immediately deliver a precordial thump to the chest wall.
B) Prepare for immediate unsynchronized cardioversion (defibrillation).
C) Assess the client's airway, obtain a blood pressure reading, and check oxygen saturation.
D) Administer high-dose intravenous epinephrine.
Correct Answer: C — Assess the client's airway, obtain a blood pressure reading, and check
oxygen saturation.
Rationale: Ventricular tachycardia with a pulse is treated differently than pulseless VT.
Because the client is conscious and speaking, the first step is to assess hemodynamic stability
(vitals, perfusion) before implementing pharmacological or electrical interventions.
Question 5
The nurse is reviewing laboratory results for a client diagnosed with polycythemia vera.
Which laboratory parameter should the nurse anticipate as a hallmark characteristic of this
condition? A) Serum hemoglobin of $8.2\text{ g/dL}$.
B) Hematocrit level of 62%.
C) Total white blood cell count of $1,500/\mu\text{L}$.
,HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
D) Platelet count of $45,000/\mu\text{L}$.
Correct Answer: B — Hematocrit level of 62%.
Rationale: Polycythemia vera is a bone marrow disorder characterized by the overproduction
of red blood cells, leading to a highly elevated hematocrit. This thickens the blood, drastically
increasing the risk of thrombotic events.
Question 6
A client with chronic peripheral arterial disease (PAD) reports severe, burning pain in the
bilateral lower extremities that worsens when the legs are elevated in bed. Which
instruction should the nurse provide to help alleviate the client's discomfort? A) Place the
legs in a highly elevated position using three pillows.
B) Apply a commercial heating pad set to high directly to both feet.
C) Allow the legs to dangle over the side of the bed in a dependent position.
D) Perform vigorous deep-tissue calf massages twice daily.
Correct Answer: C — Allow the legs to dangle over the side of the bed in a dependent
position.
Rationale: In PAD, blood flow to the lower extremities is impaired. Elevating the legs reduces
arterial perfusion, worsening ischemia and pain. Allowing the legs to dangle relies on gravity
to improve blood flow to the distal tissues.
Question 7
The nurse is caring for a client admitted with an acute exacerbation of left-sided heart
failure. Which clinical manifestation should the nurse expect to find during the physical
assessment? A) Marked jugular venous distention and splenomegaly.
B) Bilateral $3+$ pitting ankle edema and abdominal ascites.
C) Dyspnea, orthopnea, and crackles audible upon lung auscultation.
D) Significant weight gain with clear lung sounds.
Correct Answer: C — Dyspnea, orthopnea, and crackles audible upon lung auscultation.
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion (crackles, dyspnea, tachypnea, orthopnea). Right-sided
failure leads to systemic venous congestion (JVD, edema, ascites).
Question 8
, HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
A client who has been taking Warfarin daily for chronic atrial fibrillation presents to the clinic
for a routine evaluation. The client's International Normalized Ratio (INR) result is reported
as 7.5. The nurse notes no visible signs of bleeding or bruising. Which intervention should
the nurse anticipate? A) Instructing the client to double their next dose of Warfarin.
B) Withholding the next doses of Warfarin and preparing to administer Vitamin K if ordered.
C) Preparing the client for an immediate emergency blood transfusion.
D) Administering a bolus of intravenous heparin.
Correct Answer: B — Withholding the next doses of Warfarin and preparing to administer
Vitamin K if ordered.
Rationale: The target therapeutic INR for a client with atrial fibrillation is 2.0 to 3.0. An INR
of 7.5 significantly elevates the risk of spontaneous hemorrhage. Warfarin must be held, and
Vitamin K (the antidote) may be prescribed to reverse the coagulation profile safely.
Question 9
A nurse is assessing a client with a suspected abdominal aortic aneurysm (AAA). Which
physical assessment finding is classically associated with this condition? A) A loud friction
rub heard over the left upper quadrant.
B) A palpable, pulsating mass located in the periumbilical area accompanied by a systolic
bruit.
C) Severe tenderness elicited upon light palpation of the right lower quadrant.
D) Absence of bowel sounds across all four quadrants.
Correct Answer: B — A palpable, pulsating mass located in the periumbilical area
accompanied by a systolic bruit.
Rationale: An abdominal aortic aneurysm typically presents as a prominent, pulsating mass
in the midline or left upper abdomen, often with an audible bruit. Deep palpation should be
avoided to prevent rupture.
Question 10
The nurse is providing discharge teaching to a client diagnosed with Raynaud's
phenomenon. Which lifestyle modification is most important for the nurse to emphasize to
prevent vasospastic attacks? A) Maintain a completely low-protein diet.
B) Avoid exposure to sudden cold temperatures and wear gloves when handling frozen
items.
C) Take an over-the-counter vasoconstrictor medication at the first sign of finger pallor.
Comprehensive Medical-Surgical Nursing. Graded A+.
Cardiovascular & Hematology (Questions 1–25)
Question 1
A nurse is caring for a client who underwent a percutaneous coronary intervention (PCI)
through the right femoral artery 2 hours ago. Which assessment finding requires immediate
notification to the healthcare provider? A) A palpable dorsal pedis pulse in the right foot that
matches the baseline.
B) A 4 cm area of firm, elevated ecchymosis at the arterial puncture site.
C) Client reports of mild back pain and a blood pressure drop from 120/80 to 94/56 mmHg.
D) A target heart rate of 82 beats/min with occasional premature ventricular contractions
(PVCs).
Correct Answer: C — Client reports of mild back pain and a blood pressure drop from
120/80 to 94/56 mmHg.
Rationale: Retroperitoneal bleeding is a serious complication of femoral arterial punctures. It
typically manifests as back or flank pain, hypotension, and tachycardia. A firm hematoma
(Option B) needs monitoring but a systemic drop in pressure indicates active internal
bleeding.
Question 2
A client with a history of deep vein thrombosis (DVT) is receiving a continuous intravenous
heparin infusion. The client's baseline activated partial thromboplastin time (aPTT) was 30
seconds. The current aPTT result is 120 seconds. Which action should the nurse take first? A)
Increase the infusion rate by 10% to hit target parameters.
B) Stop the heparin infusion immediately and prepare to administer protamine sulfate if
ordered.
C) Draw an immediate repeat blood sample to verify the lab value.
D) Document the finding and reassess the client in 4 hours.
Correct Answer: B — Stop the heparin infusion immediately and prepare to administer
protamine sulfate if ordered.
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5 to 2.5 times
the normal baseline (around 45 to 75 seconds). An aPTT of 120 seconds indicates a critical
risk for spontaneous bleeding. The infusion must be stopped immediately.
Question 3
,HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
The nurse prepares to administer the morning dose of Digoxin ($0.25\text{ mg}$ PO) to a
client with chronic heart failure. The client’s apical pulse is 54 beats/min and the serum
potassium level is $3.1\text{ mEq/L}$. What is the priority nursing action? A) Administer the
medication as scheduled and document the pulse.
B) Administer the medication alongside a potassium-restricted snack.
C) Hold the dose, notify the provider, and monitor for signs of digoxin toxicity.
D) Request an immediate electrocardiogram (ECG) from the telemetry tech.
Correct Answer: C — Hold the dose, notify the provider, and monitor for signs of digoxin
toxicity.
Rationale: Digoxin should be held if the apical pulse is less than 60 beats/min in an adult.
Furthermore, hypokalemia ($<3.5\text{ mEq/L}$) drastically increases the risk of digoxin
toxicity. The nurse must hold the medication and report both findings.
Question 4
A client with an acute myocardial infarction develops a sudden burst of ventricular
tachycardia (VT) on the telemetry monitor. The nurse enters the room and notes the client is
awake, talking, and reports feeling "a little dizzy." Which action should the nurse take first?
A) Immediately deliver a precordial thump to the chest wall.
B) Prepare for immediate unsynchronized cardioversion (defibrillation).
C) Assess the client's airway, obtain a blood pressure reading, and check oxygen saturation.
D) Administer high-dose intravenous epinephrine.
Correct Answer: C — Assess the client's airway, obtain a blood pressure reading, and check
oxygen saturation.
Rationale: Ventricular tachycardia with a pulse is treated differently than pulseless VT.
Because the client is conscious and speaking, the first step is to assess hemodynamic stability
(vitals, perfusion) before implementing pharmacological or electrical interventions.
Question 5
The nurse is reviewing laboratory results for a client diagnosed with polycythemia vera.
Which laboratory parameter should the nurse anticipate as a hallmark characteristic of this
condition? A) Serum hemoglobin of $8.2\text{ g/dL}$.
B) Hematocrit level of 62%.
C) Total white blood cell count of $1,500/\mu\text{L}$.
,HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
D) Platelet count of $45,000/\mu\text{L}$.
Correct Answer: B — Hematocrit level of 62%.
Rationale: Polycythemia vera is a bone marrow disorder characterized by the overproduction
of red blood cells, leading to a highly elevated hematocrit. This thickens the blood, drastically
increasing the risk of thrombotic events.
Question 6
A client with chronic peripheral arterial disease (PAD) reports severe, burning pain in the
bilateral lower extremities that worsens when the legs are elevated in bed. Which
instruction should the nurse provide to help alleviate the client's discomfort? A) Place the
legs in a highly elevated position using three pillows.
B) Apply a commercial heating pad set to high directly to both feet.
C) Allow the legs to dangle over the side of the bed in a dependent position.
D) Perform vigorous deep-tissue calf massages twice daily.
Correct Answer: C — Allow the legs to dangle over the side of the bed in a dependent
position.
Rationale: In PAD, blood flow to the lower extremities is impaired. Elevating the legs reduces
arterial perfusion, worsening ischemia and pain. Allowing the legs to dangle relies on gravity
to improve blood flow to the distal tissues.
Question 7
The nurse is caring for a client admitted with an acute exacerbation of left-sided heart
failure. Which clinical manifestation should the nurse expect to find during the physical
assessment? A) Marked jugular venous distention and splenomegaly.
B) Bilateral $3+$ pitting ankle edema and abdominal ascites.
C) Dyspnea, orthopnea, and crackles audible upon lung auscultation.
D) Significant weight gain with clear lung sounds.
Correct Answer: C — Dyspnea, orthopnea, and crackles audible upon lung auscultation.
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion (crackles, dyspnea, tachypnea, orthopnea). Right-sided
failure leads to systemic venous congestion (JVD, edema, ascites).
Question 8
, HESI Med-Surg RN Custom Exam (2026/2027)
Comprehensive Medical-Surgical Nursing. Graded A+.
A client who has been taking Warfarin daily for chronic atrial fibrillation presents to the clinic
for a routine evaluation. The client's International Normalized Ratio (INR) result is reported
as 7.5. The nurse notes no visible signs of bleeding or bruising. Which intervention should
the nurse anticipate? A) Instructing the client to double their next dose of Warfarin.
B) Withholding the next doses of Warfarin and preparing to administer Vitamin K if ordered.
C) Preparing the client for an immediate emergency blood transfusion.
D) Administering a bolus of intravenous heparin.
Correct Answer: B — Withholding the next doses of Warfarin and preparing to administer
Vitamin K if ordered.
Rationale: The target therapeutic INR for a client with atrial fibrillation is 2.0 to 3.0. An INR
of 7.5 significantly elevates the risk of spontaneous hemorrhage. Warfarin must be held, and
Vitamin K (the antidote) may be prescribed to reverse the coagulation profile safely.
Question 9
A nurse is assessing a client with a suspected abdominal aortic aneurysm (AAA). Which
physical assessment finding is classically associated with this condition? A) A loud friction
rub heard over the left upper quadrant.
B) A palpable, pulsating mass located in the periumbilical area accompanied by a systolic
bruit.
C) Severe tenderness elicited upon light palpation of the right lower quadrant.
D) Absence of bowel sounds across all four quadrants.
Correct Answer: B — A palpable, pulsating mass located in the periumbilical area
accompanied by a systolic bruit.
Rationale: An abdominal aortic aneurysm typically presents as a prominent, pulsating mass
in the midline or left upper abdomen, often with an audible bruit. Deep palpation should be
avoided to prevent rupture.
Question 10
The nurse is providing discharge teaching to a client diagnosed with Raynaud's
phenomenon. Which lifestyle modification is most important for the nurse to emphasize to
prevent vasospastic attacks? A) Maintain a completely low-protein diet.
B) Avoid exposure to sudden cold temperatures and wear gloves when handling frozen
items.
C) Take an over-the-counter vasoconstrictor medication at the first sign of finger pallor.
