HESI Medical-Surgical Nursing Exit Exam
2026 |Questions and Answers Plus
Rationales Latest 2026/27 Academic Year
SECTION 1: CARDIOVASCULAR & RESPIRATORY (Questions 1-20)
QUESTION 1
A nurse is caring for a client with heart failure who has jugular vein
distention, 3+ pitting edema, and crackles in the lung bases. Which
dietary instruction is most important?
A) Increase fluid intake to 3 L/day
B) Restrict sodium to 2 g/day
C) Increase potassium-rich foods
D) Limit carbohydrates to 50 g/day
Answer: B) Restrict sodium to 2 g/day
Rationale: Sodium restriction reduces fluid retention, a key factor in
heart failure exacerbation. The client is showing signs of fluid
overload (JVD, edema, crackles). Fluid intake is typically restricted,
not increased. While potassium-rich foods may be encouraged if the
client is on diuretics, sodium restriction is the priority intervention .
,QUESTION 2
A nurse is assessing a client with right-sided heart failure. Which finding
should the nurse anticipate?
A) Decreased urinary output
B) Jugular vein distention
C) Pleural effusion
D) Bibasilar crackles
Answer: B) Jugular vein distention
Rationale: Right-sided heart failure causes fluid backup into the
venous system, leading to jugular vein distention (JVD), peripheral
edema, and hepatomegaly. Decreased urinary output, pleural
effusion, and bibasilar crackles are more characteristic of left-sided
heart failure .
QUESTION 3
A client with heart failure has a prescription for digoxin. The nurse is
aware that sufficient potassium should be included in the diet because
hypokalemia in combination with this medication:
A) Can predispose to dysrhythmias
B) May lead to oliguria
C) May cause irritability and anxiety
D) Sometimes alters consciousness
Answer: A) Can predispose to dysrhythmias
Rationale: Hypokalemia increases the risk of digoxin toxicity and
cardiac dysrhythmias. Digoxin and potassium compete for the same
binding sites on the sodium-potassium pump; low potassium levels
enhance digoxin's effects. This is a critical safety consideration for
clients on digoxin therapy .
,QUESTION 4
A nurse is caring for a client in an intensive care unit with hypertensive
crisis. The priority assessment in the first hour of care is:
A) Heart rate
B) Blood pressure
C) Respiratory rate
D) Level of consciousness
Answer: B) Blood pressure
Rationale: In hypertensive crisis, blood pressure monitoring is the
priority to prevent target organ damage. The immediate goal is to
reduce mean arterial pressure by no more than 25% within the first
hour. While other assessments are important, blood pressure is the
most critical parameter to monitor .
QUESTION 5
While caring for a client admitted with a myocardial infarction 2 days
ago, the nurse notes today's temperature is 101.1°F (38.4°C). The
appropriate nursing intervention is:
A) Call the healthcare provider immediately
B) Administer acetaminophen as ordered as this is normal at this time
C) Send blood, urine, and sputum for culture
D) Increase the client's fluid intake
Answer: B) Administer acetaminophen as ordered as this is normal
at this time
Rationale: Low-grade fever (up to 101°F/38.3°C) is common 24-48
hours after an MI due to the inflammatory response to myocardial
necrosis. This is an expected finding and should be managed with
, antipyretics. It does not require immediate provider notification,
cultures, or increased fluid intake as a primary intervention .
QUESTION 6
A nurse is assessing a client with coronary artery disease. Which finding
is most concerning?
A) Chest pressure unrelieved with rest
B) Fatigue after moderate activity
C) Mild shortness of breath with exertion
D) Occasional palpitations
Answer: A) Chest pressure unrelieved with rest
Rationale: Chest pressure unrelieved by rest is a hallmark of
unstable angina or acute myocardial infarction. This finding
requires immediate intervention. The other findings may indicate
stable angina or early heart failure but are less emergent .
QUESTION 7
A nurse is caring for a client with an acute exacerbation of COPD. Which
finding indicates the need for immediate intervention?
A) SpO₂ 88% on 2 L nasal cannula
B) Agitation and confusion
C) Productive cough with green sputum
D) Use of accessory muscles
Answer: B) Agitation and confusion
Rationale: Agitation and confusion in a client with COPD may
indicate hypoxemia or hypercapnia affecting cerebral perfusion.
2026 |Questions and Answers Plus
Rationales Latest 2026/27 Academic Year
SECTION 1: CARDIOVASCULAR & RESPIRATORY (Questions 1-20)
QUESTION 1
A nurse is caring for a client with heart failure who has jugular vein
distention, 3+ pitting edema, and crackles in the lung bases. Which
dietary instruction is most important?
A) Increase fluid intake to 3 L/day
B) Restrict sodium to 2 g/day
C) Increase potassium-rich foods
D) Limit carbohydrates to 50 g/day
Answer: B) Restrict sodium to 2 g/day
Rationale: Sodium restriction reduces fluid retention, a key factor in
heart failure exacerbation. The client is showing signs of fluid
overload (JVD, edema, crackles). Fluid intake is typically restricted,
not increased. While potassium-rich foods may be encouraged if the
client is on diuretics, sodium restriction is the priority intervention .
,QUESTION 2
A nurse is assessing a client with right-sided heart failure. Which finding
should the nurse anticipate?
A) Decreased urinary output
B) Jugular vein distention
C) Pleural effusion
D) Bibasilar crackles
Answer: B) Jugular vein distention
Rationale: Right-sided heart failure causes fluid backup into the
venous system, leading to jugular vein distention (JVD), peripheral
edema, and hepatomegaly. Decreased urinary output, pleural
effusion, and bibasilar crackles are more characteristic of left-sided
heart failure .
QUESTION 3
A client with heart failure has a prescription for digoxin. The nurse is
aware that sufficient potassium should be included in the diet because
hypokalemia in combination with this medication:
A) Can predispose to dysrhythmias
B) May lead to oliguria
C) May cause irritability and anxiety
D) Sometimes alters consciousness
Answer: A) Can predispose to dysrhythmias
Rationale: Hypokalemia increases the risk of digoxin toxicity and
cardiac dysrhythmias. Digoxin and potassium compete for the same
binding sites on the sodium-potassium pump; low potassium levels
enhance digoxin's effects. This is a critical safety consideration for
clients on digoxin therapy .
,QUESTION 4
A nurse is caring for a client in an intensive care unit with hypertensive
crisis. The priority assessment in the first hour of care is:
A) Heart rate
B) Blood pressure
C) Respiratory rate
D) Level of consciousness
Answer: B) Blood pressure
Rationale: In hypertensive crisis, blood pressure monitoring is the
priority to prevent target organ damage. The immediate goal is to
reduce mean arterial pressure by no more than 25% within the first
hour. While other assessments are important, blood pressure is the
most critical parameter to monitor .
QUESTION 5
While caring for a client admitted with a myocardial infarction 2 days
ago, the nurse notes today's temperature is 101.1°F (38.4°C). The
appropriate nursing intervention is:
A) Call the healthcare provider immediately
B) Administer acetaminophen as ordered as this is normal at this time
C) Send blood, urine, and sputum for culture
D) Increase the client's fluid intake
Answer: B) Administer acetaminophen as ordered as this is normal
at this time
Rationale: Low-grade fever (up to 101°F/38.3°C) is common 24-48
hours after an MI due to the inflammatory response to myocardial
necrosis. This is an expected finding and should be managed with
, antipyretics. It does not require immediate provider notification,
cultures, or increased fluid intake as a primary intervention .
QUESTION 6
A nurse is assessing a client with coronary artery disease. Which finding
is most concerning?
A) Chest pressure unrelieved with rest
B) Fatigue after moderate activity
C) Mild shortness of breath with exertion
D) Occasional palpitations
Answer: A) Chest pressure unrelieved with rest
Rationale: Chest pressure unrelieved by rest is a hallmark of
unstable angina or acute myocardial infarction. This finding
requires immediate intervention. The other findings may indicate
stable angina or early heart failure but are less emergent .
QUESTION 7
A nurse is caring for a client with an acute exacerbation of COPD. Which
finding indicates the need for immediate intervention?
A) SpO₂ 88% on 2 L nasal cannula
B) Agitation and confusion
C) Productive cough with green sputum
D) Use of accessory muscles
Answer: B) Agitation and confusion
Rationale: Agitation and confusion in a client with COPD may
indicate hypoxemia or hypercapnia affecting cerebral perfusion.
