SN HESI 266 Med Surg Exam Nightingale
B
College Medical-Surgical HESI Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
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Question 1 of 50
A 72-year-old client with heart failure is admitted with dyspnea, 3+ pitting edema, and a
potassium level of 3.1 mEq/L. The morning medication list includes furosemide 40 mg
PO, digoxin 0.25 mg PO, and potassium chloride 20 mEq PO. What is the priority nursing
action before administering the medications?
. Hold the digoxin and notify the provider of the potassium level. ✓ CORRECT
A
B. Administer the furosemide and potassium chloride together as prescribed.
C. Administer the digoxin first, followed by the potassium chloride.
D. Hold the furosemide and administer the digoxin and potassium chloride.
orrect Answer: A
C
Rationale: Furosemide is a loop diuretic that causes potassium wasting, and
administering digoxin in the presence of hypokalemia significantly increases the risk of
digoxin toxicity and lethal cardiac dysrhythmias. Administering the furosemide would
worsen the hypokalemia, making it dangerous to give the digoxin even with potassium
,supplementation. On the HESI exam, always check potassium levels before giving
digoxin, as hypokalemia potentiates digoxin toxicity.
Question 2 of 50
A 68-year-old client is admitted with a suspected myocardial infarction and reports
severe chest pain rated 8 out of 10. Vital signs are BP 90/60, HR 110, RR 22. The
provider orders morphine 2 mg IV push for pain. What is the most appropriate nursing
action?
. Administer the morphine as ordered to reduce myocardial oxygen demand.
A
B. Administer a half dose of morphine and reassess the blood pressure. ✓ CORRECT
C. Hold the morphine and administer nitroglycerin sublingually instead.
D. Hold the morphine and notify the provider of the vital signs immediately.
orrect Answer: B
C
Rationale: Morphine reduces preload and pain in myocardial infarction, but the client is
hypotensive, making a full dose unsafe; therefore, consulting the provider for a dose
adjustment or administering a smaller dose is the standard of care to balance pain relief
with hemodynamic stability. Holding the medication entirely leaves the client in severe
pain, increasing myocardial oxygen demand, and administering a vasodilator like
nitroglycerin would worsen the hypotension. In HESI questions, if a prescribed dose is
unsafe due to vitals, modify the intervention and notify the provider rather than just
holding the drug if pain is severe.
Question 3 of 50
,A 55-year-old client with atrial fibrillation is receiving a continuous heparin infusion. The
morning aPTT result is 120 seconds, and the control value is 35 seconds. The client has
no signs of active bleeding. What is the nurse's priority action?
. Increase the infusion rate to achieve a therapeutic aPTT.
A
B. Administer protamine sulfate as an emergency reversal agent.
C. Stop the heparin infusion and notify the provider immediately. ✓ CORRECT
D. Reassess the client and recheck the aPTT in six hours.
orrect Answer: C
C
Rationale: The therapeutic aPTT range for heparin is 1.5 to 2.5 times the control,
meaning the desired range is roughly 52 to 88 seconds; an aPTT of 120 seconds
indicates a critical risk for bleeding, requiring the infusion to be stopped immediately.
Protamine sulfate is the reversal agent, but it is reserved for active bleeding or
extremely high overdoses, and simply rechecking in six hours leaves the client at risk for
a hemorrhagic event. On the HESI exam, always stop the infusion first when a critical
lab value places the client at immediate risk.
Question 4 of 50
A 60-year-old client with a deep vein thrombosis is being discharged on warfarin
therapy. The nurse is providing discharge teaching regarding diet and medication
interactions. What statement by the client indicates the teaching has been effective?
. I will increase my intake of dark green leafy vegetables to improve my blood levels.
A
B. I should take an over-the-counter ibuprofen if I experience any muscle aches.
C. I will notify my dentist that I am taking this medication before any procedures. ✓
CORRECT
D. I can expect my urine to turn a reddish-orange color while taking this medication.
, orrect Answer: C
C
Rationale: Warfarin increases the risk of bleeding, and clients must inform all healthcare
providers, including dentists, prior to procedures to allow for safe bridging or dose
adjustment. Dark green leafy vegetables are high in vitamin K, which antagonizes
warfarin and should be kept consistent rather than increased, and ibuprofen increases
the risk of gastrointestinal bleeding. Reddish-orange urine is a side effect of rifampin or
phenazopyridine, not warfarin, so HESI expects you to know specific drug side effect
profiles.
Question 5 of 50
A 45-year-old client with a history of hypertension presents to the emergency
department with a severe headache, blurred vision, and a blood pressure of 210/120
mmHg. The client reports running out of metoprolol five days ago. What is the priority
pathophysiological concern for this client?
. Rebound cardiac failure due to sudden beta-blocker withdrawal. ✓ CORRECT
A
B. Development of a hemorrhagic stroke due to uncontrolled hypertension.
C. Orthostatic hypotension resulting from medication non-compliance.
D. Acute renal failure secondary to prolonged decreased renal perfusion.
orrect Answer: A
C
Rationale: Sudden withdrawal of beta-blockers like metoprolol causes sympathetic
overactivity, leading to rebound tachycardia, severe hypertension, and potentially acute
myocardial ischemia or failure. While a hemorrhagic stroke is a complication of severe
hypertension, the immediate physiological mechanism driving this specific rapid onset
is the beta-blocker withdrawal phenomenon. The HESI exam frequently tests the
B
College Medical-Surgical HESI Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
═════════════════════════════════════
═
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old client with heart failure is admitted with dyspnea, 3+ pitting edema, and a
potassium level of 3.1 mEq/L. The morning medication list includes furosemide 40 mg
PO, digoxin 0.25 mg PO, and potassium chloride 20 mEq PO. What is the priority nursing
action before administering the medications?
. Hold the digoxin and notify the provider of the potassium level. ✓ CORRECT
A
B. Administer the furosemide and potassium chloride together as prescribed.
C. Administer the digoxin first, followed by the potassium chloride.
D. Hold the furosemide and administer the digoxin and potassium chloride.
orrect Answer: A
C
Rationale: Furosemide is a loop diuretic that causes potassium wasting, and
administering digoxin in the presence of hypokalemia significantly increases the risk of
digoxin toxicity and lethal cardiac dysrhythmias. Administering the furosemide would
worsen the hypokalemia, making it dangerous to give the digoxin even with potassium
,supplementation. On the HESI exam, always check potassium levels before giving
digoxin, as hypokalemia potentiates digoxin toxicity.
Question 2 of 50
A 68-year-old client is admitted with a suspected myocardial infarction and reports
severe chest pain rated 8 out of 10. Vital signs are BP 90/60, HR 110, RR 22. The
provider orders morphine 2 mg IV push for pain. What is the most appropriate nursing
action?
. Administer the morphine as ordered to reduce myocardial oxygen demand.
A
B. Administer a half dose of morphine and reassess the blood pressure. ✓ CORRECT
C. Hold the morphine and administer nitroglycerin sublingually instead.
D. Hold the morphine and notify the provider of the vital signs immediately.
orrect Answer: B
C
Rationale: Morphine reduces preload and pain in myocardial infarction, but the client is
hypotensive, making a full dose unsafe; therefore, consulting the provider for a dose
adjustment or administering a smaller dose is the standard of care to balance pain relief
with hemodynamic stability. Holding the medication entirely leaves the client in severe
pain, increasing myocardial oxygen demand, and administering a vasodilator like
nitroglycerin would worsen the hypotension. In HESI questions, if a prescribed dose is
unsafe due to vitals, modify the intervention and notify the provider rather than just
holding the drug if pain is severe.
Question 3 of 50
,A 55-year-old client with atrial fibrillation is receiving a continuous heparin infusion. The
morning aPTT result is 120 seconds, and the control value is 35 seconds. The client has
no signs of active bleeding. What is the nurse's priority action?
. Increase the infusion rate to achieve a therapeutic aPTT.
A
B. Administer protamine sulfate as an emergency reversal agent.
C. Stop the heparin infusion and notify the provider immediately. ✓ CORRECT
D. Reassess the client and recheck the aPTT in six hours.
orrect Answer: C
C
Rationale: The therapeutic aPTT range for heparin is 1.5 to 2.5 times the control,
meaning the desired range is roughly 52 to 88 seconds; an aPTT of 120 seconds
indicates a critical risk for bleeding, requiring the infusion to be stopped immediately.
Protamine sulfate is the reversal agent, but it is reserved for active bleeding or
extremely high overdoses, and simply rechecking in six hours leaves the client at risk for
a hemorrhagic event. On the HESI exam, always stop the infusion first when a critical
lab value places the client at immediate risk.
Question 4 of 50
A 60-year-old client with a deep vein thrombosis is being discharged on warfarin
therapy. The nurse is providing discharge teaching regarding diet and medication
interactions. What statement by the client indicates the teaching has been effective?
. I will increase my intake of dark green leafy vegetables to improve my blood levels.
A
B. I should take an over-the-counter ibuprofen if I experience any muscle aches.
C. I will notify my dentist that I am taking this medication before any procedures. ✓
CORRECT
D. I can expect my urine to turn a reddish-orange color while taking this medication.
, orrect Answer: C
C
Rationale: Warfarin increases the risk of bleeding, and clients must inform all healthcare
providers, including dentists, prior to procedures to allow for safe bridging or dose
adjustment. Dark green leafy vegetables are high in vitamin K, which antagonizes
warfarin and should be kept consistent rather than increased, and ibuprofen increases
the risk of gastrointestinal bleeding. Reddish-orange urine is a side effect of rifampin or
phenazopyridine, not warfarin, so HESI expects you to know specific drug side effect
profiles.
Question 5 of 50
A 45-year-old client with a history of hypertension presents to the emergency
department with a severe headache, blurred vision, and a blood pressure of 210/120
mmHg. The client reports running out of metoprolol five days ago. What is the priority
pathophysiological concern for this client?
. Rebound cardiac failure due to sudden beta-blocker withdrawal. ✓ CORRECT
A
B. Development of a hemorrhagic stroke due to uncontrolled hypertension.
C. Orthostatic hypotension resulting from medication non-compliance.
D. Acute renal failure secondary to prolonged decreased renal perfusion.
orrect Answer: A
C
Rationale: Sudden withdrawal of beta-blockers like metoprolol causes sympathetic
overactivity, leading to rebound tachycardia, severe hypertension, and potentially acute
myocardial ischemia or failure. While a hemorrhagic stroke is a complication of severe
hypertension, the immediate physiological mechanism driving this specific rapid onset
is the beta-blocker withdrawal phenomenon. The HESI exam frequently tests the
