EVOLVE ELSEVIER HESI MEDICAL-
SURGICAL EXAM 2025/2026:
Comprehensive Practice Questions
And Answers with 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
Answer: B. Furosemide
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
Answer: A. Broccoli
Rationale: Broccoli and other green leafy vegetables are high in
vitamin K, which antagonizes the effects of warfarin. Consistent
vitamin K intake is important for maintaining therapeutic INR
levels.
3. A 62-year-old male with a history of myocardial infarction
presents with chest pain and dyspnea. BP 150/90 mm Hg, HR
95 bpm, SpO₂ 93%. What is the nurse's priority action?
A. Administer nitroglycerin sublingually
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead ECG
D. Administer morphine sulfate IV
,Answer: B. Apply oxygen at 2 L/min via nasal cannula
Rationale: The priority is to address the SpO₂ of 93% by
administering oxygen to improve oxygenation. Airway and
breathing are always the first priority. Nitroglycerin and morphine
may be given after oxygen is established.
4. A client is receiving furosemide (Lasix) for heart failure.
Which laboratory value should the nurse monitor most
closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia can lead to serious cardiac arrhythmias,
especially in clients taking digoxin.
5. A client with heart failure is prescribed digoxin. Which
finding indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Serum potassium 4.2 mEq/L
, C. Nausea and vomiting
D. Blood pressure 120/80 mm Hg
Answer: C. Nausea and vomiting
Rationale: Nausea, vomiting, anorexia, and visual disturbances
(yellow-green halos) are early signs of digoxin toxicity.
Bradycardia (not a normal heart rate) is also a sign, but
nausea/vomiting are classic early indicators.
6. A client with chest pain is prescribed sublingual
nitroglycerin. Which instruction should the nurse include?
A. "Take one tablet every 15 minutes for up to 3 doses."
B. "Swallow the tablet with a full glass of water."
C. "Chew the tablet thoroughly before swallowing."
D. "Take one tablet and call 911 if pain is not relieved in 5
minutes."
Answer: D. "Take one tablet and call 911 if pain is not relieved
in 5 minutes."
Rationale: Nitroglycerin should be taken sublingually (not
swallowed or chewed) every 5 minutes for up to 3 doses. If pain
persists after the first dose, the client should call 911.
7. A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse monitor?
SURGICAL EXAM 2025/2026:
Comprehensive Practice Questions
And Answers with 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
Answer: B. Furosemide
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
Answer: A. Broccoli
Rationale: Broccoli and other green leafy vegetables are high in
vitamin K, which antagonizes the effects of warfarin. Consistent
vitamin K intake is important for maintaining therapeutic INR
levels.
3. A 62-year-old male with a history of myocardial infarction
presents with chest pain and dyspnea. BP 150/90 mm Hg, HR
95 bpm, SpO₂ 93%. What is the nurse's priority action?
A. Administer nitroglycerin sublingually
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead ECG
D. Administer morphine sulfate IV
,Answer: B. Apply oxygen at 2 L/min via nasal cannula
Rationale: The priority is to address the SpO₂ of 93% by
administering oxygen to improve oxygenation. Airway and
breathing are always the first priority. Nitroglycerin and morphine
may be given after oxygen is established.
4. A client is receiving furosemide (Lasix) for heart failure.
Which laboratory value should the nurse monitor most
closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia can lead to serious cardiac arrhythmias,
especially in clients taking digoxin.
5. A client with heart failure is prescribed digoxin. Which
finding indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Serum potassium 4.2 mEq/L
, C. Nausea and vomiting
D. Blood pressure 120/80 mm Hg
Answer: C. Nausea and vomiting
Rationale: Nausea, vomiting, anorexia, and visual disturbances
(yellow-green halos) are early signs of digoxin toxicity.
Bradycardia (not a normal heart rate) is also a sign, but
nausea/vomiting are classic early indicators.
6. A client with chest pain is prescribed sublingual
nitroglycerin. Which instruction should the nurse include?
A. "Take one tablet every 15 minutes for up to 3 doses."
B. "Swallow the tablet with a full glass of water."
C. "Chew the tablet thoroughly before swallowing."
D. "Take one tablet and call 911 if pain is not relieved in 5
minutes."
Answer: D. "Take one tablet and call 911 if pain is not relieved
in 5 minutes."
Rationale: Nitroglycerin should be taken sublingually (not
swallowed or chewed) every 5 minutes for up to 3 doses. If pain
persists after the first dose, the client should call 911.
7. A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse monitor?
