EVOLVE ELSEVIER HESI MED SURG EXAM
150 Practice Questions with Detailed Rationales
2026/2027 Updated Edition
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
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
Correct Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion in acute heart failure exacerbation. The signs of JVD, edema, and
crackles indicate fluid volume overload requiring immediate diuresis. Digoxin and beta-
blockers are chronic therapies; spironolactone is a potassium-sparing diuretic used as an
adjunct rather than for acute management .
2. A client with atrial fibrillation is prescribed warfarin. Which food should the nurse
teach the client to avoid?
A. Broccoli
B. Apples
C. Rice
D. Chicken
,Correct Answer: A
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which can
antagonize warfarin's effect and lower the INR, increasing the risk of clot formation.
Consistent vitamin K intake is more important than complete avoidance, but patients
should be educated to maintain a consistent dietary intake of vitamin K-rich foods .
3. A client presents with chest pain radiating to the jaw, diaphoresis, and nausea. The
ECG shows ST-segment elevation. Which intervention should the nurse implement first?
A. Administer sublingual nitroglycerin
B. Obtain a troponin level
C. Apply oxygen
D. Prepare for percutaneous coronary intervention (PCI)
Correct Answer: C
Rationale: Oxygen is the priority to increase myocardial oxygenation in a client with ST-
elevation myocardial infarction (STEMI). Ensuring adequate oxygenation precedes other
interventions. Nitroglycerin, pain management, and rapid transfer for PCI follow, but
airway and oxygenation come first .
4. A client with chronic heart failure has an ejection fraction of 25%. The nurse
understands this indicates:
A. Normal cardiac function
B. Mildly reduced systolic function
C. Severely reduced systolic function
D. Preserved ejection fraction heart failure
Correct Answer: C
Rationale: Normal ejection fraction is 55–70%. An EF of 25% indicates severely impaired
systolic function. The heart is pumping less than half the normal amount of blood with
each contraction, classifying this as heart failure with reduced ejection fraction (HFrEF) .
,5. A client with peripheral artery disease (PAD) reports leg pain when walking that
resolves with rest. The nurse documents this as:
A. Rest pain
B. Claudication
C. Venous stasis
D. Neuropathy
Correct Answer: B
Rationale: Intermittent claudication is pain in the lower extremities that occurs with
exercise and is relieved by rest. It is a classic symptom of PAD caused by inadequate blood
flow to meet metabolic demands during activity. Rest pain indicates more severe disease
and occurs at night .
6. A client on a heparin infusion has an aPTT of 110 seconds. Which action should the
nurse take?
A. Continue the infusion as prescribed
B. Decrease the infusion rate
C. Stop the infusion and notify the provider
D. Increase the infusion rate
Correct Answer: C
Rationale: An aPTT of 110 seconds is significantly above the therapeutic range (typically
1.5–2.5 times control, approximately 60–80 seconds), indicating excessive anticoagulation
and increased bleeding risk. The nurse should stop the infusion and notify the provider for
dose adjustment .
7. A client with a pacemaker is being discharged. Which statement indicates a need for
further teaching?
, A. "I can use a microwave oven."
B. "I will avoid close contact with large motors."
C. "I will keep my cell phone in my chest pocket."
D. "I will carry my pacemaker identification card."
Correct Answer: C
Rationale: Cell phones should be kept at least 6 inches away from the pacemaker,
preferably on the opposite ear. Microwave ovens are safe. Large motors and industrial
equipment can cause interference. The client should always carry the pacemaker
identification card .
8. A client with acute decompensated heart failure has a blood pressure of 85/50 mm
Hg and is dyspneic. Which medication should the nurse anticipate administering?
A. Dobutamine
B. Metoprolol
C. Furosemide
D. Spironolactone
Correct Answer: A
Rationale: Dobutamine is an inotropic agent that increases cardiac output and blood
pressure in cardiogenic shock. Metoprolol is contraindicated in acute decompensation;
furosemide may further drop blood pressure. Inotropic support is needed to improve
cardiac contractility and perfusion .
9. A client with unstable angina is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A. INR
B. aPTT
C. Platelet count
D. PT
150 Practice Questions with Detailed Rationales
2026/2027 Updated Edition
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
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
Correct Answer: B
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and relieves
pulmonary congestion in acute heart failure exacerbation. The signs of JVD, edema, and
crackles indicate fluid volume overload requiring immediate diuresis. Digoxin and beta-
blockers are chronic therapies; spironolactone is a potassium-sparing diuretic used as an
adjunct rather than for acute management .
2. A client with atrial fibrillation is prescribed warfarin. Which food should the nurse
teach the client to avoid?
A. Broccoli
B. Apples
C. Rice
D. Chicken
,Correct Answer: A
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which can
antagonize warfarin's effect and lower the INR, increasing the risk of clot formation.
Consistent vitamin K intake is more important than complete avoidance, but patients
should be educated to maintain a consistent dietary intake of vitamin K-rich foods .
3. A client presents with chest pain radiating to the jaw, diaphoresis, and nausea. The
ECG shows ST-segment elevation. Which intervention should the nurse implement first?
A. Administer sublingual nitroglycerin
B. Obtain a troponin level
C. Apply oxygen
D. Prepare for percutaneous coronary intervention (PCI)
Correct Answer: C
Rationale: Oxygen is the priority to increase myocardial oxygenation in a client with ST-
elevation myocardial infarction (STEMI). Ensuring adequate oxygenation precedes other
interventions. Nitroglycerin, pain management, and rapid transfer for PCI follow, but
airway and oxygenation come first .
4. A client with chronic heart failure has an ejection fraction of 25%. The nurse
understands this indicates:
A. Normal cardiac function
B. Mildly reduced systolic function
C. Severely reduced systolic function
D. Preserved ejection fraction heart failure
Correct Answer: C
Rationale: Normal ejection fraction is 55–70%. An EF of 25% indicates severely impaired
systolic function. The heart is pumping less than half the normal amount of blood with
each contraction, classifying this as heart failure with reduced ejection fraction (HFrEF) .
,5. A client with peripheral artery disease (PAD) reports leg pain when walking that
resolves with rest. The nurse documents this as:
A. Rest pain
B. Claudication
C. Venous stasis
D. Neuropathy
Correct Answer: B
Rationale: Intermittent claudication is pain in the lower extremities that occurs with
exercise and is relieved by rest. It is a classic symptom of PAD caused by inadequate blood
flow to meet metabolic demands during activity. Rest pain indicates more severe disease
and occurs at night .
6. A client on a heparin infusion has an aPTT of 110 seconds. Which action should the
nurse take?
A. Continue the infusion as prescribed
B. Decrease the infusion rate
C. Stop the infusion and notify the provider
D. Increase the infusion rate
Correct Answer: C
Rationale: An aPTT of 110 seconds is significantly above the therapeutic range (typically
1.5–2.5 times control, approximately 60–80 seconds), indicating excessive anticoagulation
and increased bleeding risk. The nurse should stop the infusion and notify the provider for
dose adjustment .
7. A client with a pacemaker is being discharged. Which statement indicates a need for
further teaching?
, A. "I can use a microwave oven."
B. "I will avoid close contact with large motors."
C. "I will keep my cell phone in my chest pocket."
D. "I will carry my pacemaker identification card."
Correct Answer: C
Rationale: Cell phones should be kept at least 6 inches away from the pacemaker,
preferably on the opposite ear. Microwave ovens are safe. Large motors and industrial
equipment can cause interference. The client should always carry the pacemaker
identification card .
8. A client with acute decompensated heart failure has a blood pressure of 85/50 mm
Hg and is dyspneic. Which medication should the nurse anticipate administering?
A. Dobutamine
B. Metoprolol
C. Furosemide
D. Spironolactone
Correct Answer: A
Rationale: Dobutamine is an inotropic agent that increases cardiac output and blood
pressure in cardiogenic shock. Metoprolol is contraindicated in acute decompensation;
furosemide may further drop blood pressure. Inotropic support is needed to improve
cardiac contractility and perfusion .
9. A client with unstable angina is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A. INR
B. aPTT
C. Platelet count
D. PT
