MedSurg 1 HESI Practice Questions
Q&A with Complete Solutions
SECTION 1: CARDIAC AND VASCULAR CONDITIONS
Question 1: A nurse is caring for a client with heart failure who reports
increasing shortness of breath and orthopnea. Which assessment finding
requires immediate intervention?
A) Bilateral crackles in the lung bases
B) Weight gain of 2 kg in 24 hours
C) Serum potassium of 3.8 mEq/L
D) Jugular venous distension
Answer: B) Weight gain of 2 kg in 24 hours
Rationale: A weight gain of 2 kg (4.4 lbs) in 24 hours indicates significant
fluid retention and worsening heart failure. This requires immediate
intervention as it precedes more severe symptoms. Crackles, JVD, and
potassium levels should be monitored but the rapid weight gain is the most
urgent finding.
Question 2: A client is admitted with an acute myocardial infarction. Which
laboratory value should the nurse monitor as the most specific indicator of
cardiac muscle damage?
A) Creatine kinase-MB (CK-MB)
B) Troponin I
C) Myoglobin
D) Lactate dehydrogenase (LDH)
Answer: B) Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac marker for
myocardial injury. It begins to rise 3-4 hours after MI and remains elevated for
,up to 10-14 days. CK-MB is less specific, myoglobin is early but non-specific,
and LDH is no longer routinely used.
Question 3: A nurse is preparing to administer digoxin to a client with heart
failure. Which finding indicates the client may be experiencing digoxin
toxicity?
A) Heart rate of 62 beats per minute
B) Serum digoxin level of 1.2 ng/mL
C) Visual disturbances with yellow-green halos
D) Blood pressure of 140/90 mmHg
Answer: C) Visual disturbances with yellow-green halos
Rationale: Visual disturbances, including yellow-green halos or blurred
vision, are classic signs of digoxin toxicity. Therapeutic digoxin level is 0.8-2.0
ng/mL; a level of 1.2 ng/mL is within therapeutic range. Bradycardia may
occur but heart rate of 62 is normal.
Question 4: A client with hypertension is prescribed lisinopril. Which
instruction should the nurse include in the teaching plan?
A) "Take this medication with a high-potassium banana"
B) "Report any persistent dry cough to your provider"
C) "This medication works immediately to lower blood pressure"
D) "You may discontinue this medication once blood pressure normalizes"
Answer: B) "Report any persistent dry cough to your provider"
Rationale: Lisinopril (an ACE inhibitor) commonly causes a persistent dry
cough due to bradykinin accumulation. Clients should be instructed to report
this to their provider. ACE inhibitors can increase potassium levels, so
potassium-rich foods should not be emphasized. The medication takes weeks
for full effect and should not be discontinued without provider guidance.
Question 5: A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is characteristic of this condition?
,A) Bilateral edema of the lower extremities
B) Shiny, hairless skin on the lower legs
C) Brownish discoloration around the ankles
D) Thick, hardened skin with ulcers on the medial malleolus
Answer: B) Shiny, hairless skin on the lower legs
Rationale: PAD causes decreased blood flow, leading to trophic changes
including shiny, hairless skin, thickened toenails, and diminished pulses.
Edema and brownish discoloration around the ankles are characteristic of
venous insufficiency, not arterial disease.
Question 6: A client who had an abdominal aortic aneurysm repair 24 hours
ago has decreased urine output of 20 mL/hour. Which action should the nurse
take first?
A) Increase the IV fluid rate
B) Notify the healthcare provider
C) Check the client's bladder for distension
D) Assess the client's blood pressure and heart rate
Answer: D) Assess the client's blood pressure and heart rate
Rationale: Decreased urine output may indicate hypovolemia or renal
compromise. The nurse should first assess vital signs to evaluate
hemodynamic status. Hypotension and tachycardia may indicate hypovolemia,
while hypertension may indicate renal artery occlusion. Assessment precedes
notification and interventions.
Question 7: A nurse is caring for a client receiving heparin therapy for deep
vein thrombosis. Which laboratory value should the nurse monitor to evaluate
therapeutic effectiveness?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
, Answer: C) Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal
of 1.5-2.5 times the normal control. PT and INR are used to monitor warfarin
therapy. Platelet count is monitored to assess for heparin-induced
thrombocytopenia (HIT).
Question 8: A client with heart failure is prescribed furosemide. Which
finding indicates the medication is effective?
A) Decreased peripheral edema
B) Increased blood pressure
C) Weight gain of 1 kg
D) Increased heart rate
Answer: A) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart
failure. Effectiveness is evidenced by decreased edema, weight loss, and
improved breath sounds. Blood pressure should decrease, not increase, with
diuresis.
Question 9: A nurse is assessing a client who is 2 days post-cardiac
catheterization via the femoral artery. Which finding requires immediate
intervention?
A) Bruising at the insertion site
B) Pedal pulse palpable bilaterally
C) Hematoma formation at the site
D) Mild discomfort at the insertion site
Answer: C) Hematoma formation at the site
Rationale: A hematoma at the femoral insertion site indicates active bleeding,
requiring immediate intervention including pressure application and provider
notification. Bruising and mild discomfort are expected; palpable pulses
indicate adequate circulation.
Q&A with Complete Solutions
SECTION 1: CARDIAC AND VASCULAR CONDITIONS
Question 1: A nurse is caring for a client with heart failure who reports
increasing shortness of breath and orthopnea. Which assessment finding
requires immediate intervention?
A) Bilateral crackles in the lung bases
B) Weight gain of 2 kg in 24 hours
C) Serum potassium of 3.8 mEq/L
D) Jugular venous distension
Answer: B) Weight gain of 2 kg in 24 hours
Rationale: A weight gain of 2 kg (4.4 lbs) in 24 hours indicates significant
fluid retention and worsening heart failure. This requires immediate
intervention as it precedes more severe symptoms. Crackles, JVD, and
potassium levels should be monitored but the rapid weight gain is the most
urgent finding.
Question 2: A client is admitted with an acute myocardial infarction. Which
laboratory value should the nurse monitor as the most specific indicator of
cardiac muscle damage?
A) Creatine kinase-MB (CK-MB)
B) Troponin I
C) Myoglobin
D) Lactate dehydrogenase (LDH)
Answer: B) Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac marker for
myocardial injury. It begins to rise 3-4 hours after MI and remains elevated for
,up to 10-14 days. CK-MB is less specific, myoglobin is early but non-specific,
and LDH is no longer routinely used.
Question 3: A nurse is preparing to administer digoxin to a client with heart
failure. Which finding indicates the client may be experiencing digoxin
toxicity?
A) Heart rate of 62 beats per minute
B) Serum digoxin level of 1.2 ng/mL
C) Visual disturbances with yellow-green halos
D) Blood pressure of 140/90 mmHg
Answer: C) Visual disturbances with yellow-green halos
Rationale: Visual disturbances, including yellow-green halos or blurred
vision, are classic signs of digoxin toxicity. Therapeutic digoxin level is 0.8-2.0
ng/mL; a level of 1.2 ng/mL is within therapeutic range. Bradycardia may
occur but heart rate of 62 is normal.
Question 4: A client with hypertension is prescribed lisinopril. Which
instruction should the nurse include in the teaching plan?
A) "Take this medication with a high-potassium banana"
B) "Report any persistent dry cough to your provider"
C) "This medication works immediately to lower blood pressure"
D) "You may discontinue this medication once blood pressure normalizes"
Answer: B) "Report any persistent dry cough to your provider"
Rationale: Lisinopril (an ACE inhibitor) commonly causes a persistent dry
cough due to bradykinin accumulation. Clients should be instructed to report
this to their provider. ACE inhibitors can increase potassium levels, so
potassium-rich foods should not be emphasized. The medication takes weeks
for full effect and should not be discontinued without provider guidance.
Question 5: A nurse is assessing a client with peripheral arterial disease
(PAD). Which finding is characteristic of this condition?
,A) Bilateral edema of the lower extremities
B) Shiny, hairless skin on the lower legs
C) Brownish discoloration around the ankles
D) Thick, hardened skin with ulcers on the medial malleolus
Answer: B) Shiny, hairless skin on the lower legs
Rationale: PAD causes decreased blood flow, leading to trophic changes
including shiny, hairless skin, thickened toenails, and diminished pulses.
Edema and brownish discoloration around the ankles are characteristic of
venous insufficiency, not arterial disease.
Question 6: A client who had an abdominal aortic aneurysm repair 24 hours
ago has decreased urine output of 20 mL/hour. Which action should the nurse
take first?
A) Increase the IV fluid rate
B) Notify the healthcare provider
C) Check the client's bladder for distension
D) Assess the client's blood pressure and heart rate
Answer: D) Assess the client's blood pressure and heart rate
Rationale: Decreased urine output may indicate hypovolemia or renal
compromise. The nurse should first assess vital signs to evaluate
hemodynamic status. Hypotension and tachycardia may indicate hypovolemia,
while hypertension may indicate renal artery occlusion. Assessment precedes
notification and interventions.
Question 7: A nurse is caring for a client receiving heparin therapy for deep
vein thrombosis. Which laboratory value should the nurse monitor to evaluate
therapeutic effectiveness?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
, Answer: C) Activated Partial Thromboplastin Time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal
of 1.5-2.5 times the normal control. PT and INR are used to monitor warfarin
therapy. Platelet count is monitored to assess for heparin-induced
thrombocytopenia (HIT).
Question 8: A client with heart failure is prescribed furosemide. Which
finding indicates the medication is effective?
A) Decreased peripheral edema
B) Increased blood pressure
C) Weight gain of 1 kg
D) Increased heart rate
Answer: A) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart
failure. Effectiveness is evidenced by decreased edema, weight loss, and
improved breath sounds. Blood pressure should decrease, not increase, with
diuresis.
Question 9: A nurse is assessing a client who is 2 days post-cardiac
catheterization via the femoral artery. Which finding requires immediate
intervention?
A) Bruising at the insertion site
B) Pedal pulse palpable bilaterally
C) Hematoma formation at the site
D) Mild discomfort at the insertion site
Answer: C) Hematoma formation at the site
Rationale: A hematoma at the femoral insertion site indicates active bleeding,
requiring immediate intervention including pressure application and provider
notification. Bruising and mild discomfort are expected; palpable pulses
indicate adequate circulation.
