EVOLVE ELSEVIER HESI MED SURG LATEST 2026/2027
TEST BANK
150 Practice Questions with Verified Answers and Detailed
Rationales
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. Digoxin and beta-blockers are
chronic therapies that do not provide immediate relief of fluid overload symptoms.
Spironolactone is a potassium-sparing diuretic used as an adjunct therapy. Crackles
indicate pulmonary congestion requiring immediate intervention .
2. A client with hypertension has been receiving ramipril 5 mg PO daily for 2
weeks and is scheduled to receive a dose at 0900. At 0830, the client's blood
pressure is 120/70 mm Hg. Which action should the nurse take?
,A. Hold the dose and contact the healthcare provider
B. Administer the prescribed dose at the scheduled time
C. Hold the dose and recheck blood pressure in 1 hour
D. Check the provider's prescription to clarify the dose
Correct Answer: B
Rationale: The client's blood pressure is within normal limits, indicating that the ramipril
(an ACE inhibitor) is having the desired effect and should be administered. Options A and
C would be appropriate if the client's blood pressure was excessively low (systolic <100
mm Hg) or if the client exhibited signs of hypotension such as dizziness .
3. A client with atrial fibrillation is prescribed warfarin. The nurse should teach the
client to avoid which food?
A. Apples
B. Broccoli
C. Chicken
D. Rice
Correct Answer: B
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which can
antagonize warfarin's effect and lower the INR. Clients taking warfarin should maintain
consistent vitamin K intake rather than avoiding these foods entirely, but large variations
in intake should be avoided .
4. A client with 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. This finding guides treatment decisions for heart failure with reduced
ejection fraction (HFrEF) .
5. A client is receiving IV heparin. The nurse notes that the aPTT is 110 seconds
(control 30 seconds). What should the nurse do?
A. Continue the heparin at the same rate
B. Increase the heparin rate
C. Hold the heparin and notify the provider
D. Administer protamine sulfate immediately
Correct Answer: C
Rationale: Therapeutic aPTT for heparin is 1.5-2.5 times control (approximately 45-75
seconds). An aPTT of 110 seconds is supratherapeutic, indicating a high bleeding risk. The
nurse should hold the heparin and notify the provider. Protamine sulfate is the antidote
but is reserved for severe bleeding [citation:10, 11].
6. A client with angina is prescribed a transdermal nitroglycerin patch. Which
instruction should the nurse include?
A. Apply the patch to the same site daily for consistent absorption
B. Remove the patch for 10-12 hours each day to prevent tolerance
C. Apply the patch directly over the sternum
D. Use the patch immediately if chest pain occurs
Correct Answer: B
Rationale: To prevent nitrate tolerance, the patch should be removed for 10-12 hours each
day (usually at night). The site should be rotated to prevent skin irritation. The patch is not
for acute pain relief; sublingual nitroglycerin is used for that purpose .
, 7. A client with deep vein thrombosis is started on a heparin infusion. The nurse
should have which antidote available?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote for heparin. Vitamin K reverses
warfarin. Naloxone reverses opioids. Flumazenil reverses benzodiazepines. The antidote
should be readily available when a client is receiving heparin therapy .
8. A client who had a myocardial infarction 2 days ago reports sudden onset of
shortness of breath and crackles in both lungs. What should the nurse do first?
A. Administer sublingual nitroglycerin as prescribed
B. Raise the head of the bed to high Fowler's position
C. Notify the healthcare provider immediately
D. Check the client's telemetry monitor for arrhythmias
Correct Answer: B
Rationale: Raising the head of the bed reduces venous return (preload) to the heart and
decreases pulmonary congestion. This is a rapid, independent nursing intervention that
alleviates breathing difficulty. After positioning, the nurse should notify the provider .
9. 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. Intermittent claudication
C. Venous stasis
D. Neuropathy
TEST BANK
150 Practice Questions with Verified Answers and Detailed
Rationales
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. Digoxin and beta-blockers are
chronic therapies that do not provide immediate relief of fluid overload symptoms.
Spironolactone is a potassium-sparing diuretic used as an adjunct therapy. Crackles
indicate pulmonary congestion requiring immediate intervention .
2. A client with hypertension has been receiving ramipril 5 mg PO daily for 2
weeks and is scheduled to receive a dose at 0900. At 0830, the client's blood
pressure is 120/70 mm Hg. Which action should the nurse take?
,A. Hold the dose and contact the healthcare provider
B. Administer the prescribed dose at the scheduled time
C. Hold the dose and recheck blood pressure in 1 hour
D. Check the provider's prescription to clarify the dose
Correct Answer: B
Rationale: The client's blood pressure is within normal limits, indicating that the ramipril
(an ACE inhibitor) is having the desired effect and should be administered. Options A and
C would be appropriate if the client's blood pressure was excessively low (systolic <100
mm Hg) or if the client exhibited signs of hypotension such as dizziness .
3. A client with atrial fibrillation is prescribed warfarin. The nurse should teach the
client to avoid which food?
A. Apples
B. Broccoli
C. Chicken
D. Rice
Correct Answer: B
Rationale: Broccoli and other green leafy vegetables are high in vitamin K, which can
antagonize warfarin's effect and lower the INR. Clients taking warfarin should maintain
consistent vitamin K intake rather than avoiding these foods entirely, but large variations
in intake should be avoided .
4. A client with 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. This finding guides treatment decisions for heart failure with reduced
ejection fraction (HFrEF) .
5. A client is receiving IV heparin. The nurse notes that the aPTT is 110 seconds
(control 30 seconds). What should the nurse do?
A. Continue the heparin at the same rate
B. Increase the heparin rate
C. Hold the heparin and notify the provider
D. Administer protamine sulfate immediately
Correct Answer: C
Rationale: Therapeutic aPTT for heparin is 1.5-2.5 times control (approximately 45-75
seconds). An aPTT of 110 seconds is supratherapeutic, indicating a high bleeding risk. The
nurse should hold the heparin and notify the provider. Protamine sulfate is the antidote
but is reserved for severe bleeding [citation:10, 11].
6. A client with angina is prescribed a transdermal nitroglycerin patch. Which
instruction should the nurse include?
A. Apply the patch to the same site daily for consistent absorption
B. Remove the patch for 10-12 hours each day to prevent tolerance
C. Apply the patch directly over the sternum
D. Use the patch immediately if chest pain occurs
Correct Answer: B
Rationale: To prevent nitrate tolerance, the patch should be removed for 10-12 hours each
day (usually at night). The site should be rotated to prevent skin irritation. The patch is not
for acute pain relief; sublingual nitroglycerin is used for that purpose .
, 7. A client with deep vein thrombosis is started on a heparin infusion. The nurse
should have which antidote available?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote for heparin. Vitamin K reverses
warfarin. Naloxone reverses opioids. Flumazenil reverses benzodiazepines. The antidote
should be readily available when a client is receiving heparin therapy .
8. A client who had a myocardial infarction 2 days ago reports sudden onset of
shortness of breath and crackles in both lungs. What should the nurse do first?
A. Administer sublingual nitroglycerin as prescribed
B. Raise the head of the bed to high Fowler's position
C. Notify the healthcare provider immediately
D. Check the client's telemetry monitor for arrhythmias
Correct Answer: B
Rationale: Raising the head of the bed reduces venous return (preload) to the heart and
decreases pulmonary congestion. This is a rapid, independent nursing intervention that
alleviates breathing difficulty. After positioning, the nurse should notify the provider .
9. 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. Intermittent claudication
C. Venous stasis
D. Neuropathy
