HESI PN MedSurg Test Bank | Latest Update 2026/2027
| 200 Practice Questions & Detailed Answers |
NGNStyle Q&A with Case Scenarios | A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
1. A client with heart failure reports a weight gain of 5 pounds in 3 days. What is the nurse's priority
action?
A. Encourage the client to restrict oral fluids
B. Assess for peripheral edema and crackles
C. Notify the healthcare provider immediately
D. Increase the dose of furosemide
Answer: C. Notify the healthcare provider immediately
Explanation: A rapid weight gain of 2–3 pounds in 24 hours or 5 pounds in 1 week is a sign of worsening
fluid overload. The provider should be notified for potential adjustment of diuretic therapy. While
assessing for edema and crackles is important, immediate notification is the priority.
2. A practical nurse is caring for a client with heart failure. Which assessment finding requires immediate
intervention?
A. Weight gain of 2 pounds in 24 hours
B. Crackles in the lung bases
C. 2+ pitting edema in the lower extremities
D. Jugular vein distention when sitting upright
,Answer: B. Crackles in the lung bases
Explanation: Crackles in the lung bases indicate pulmonary congestion (fluid in the alveoli), a sign of
worsening heart failure that requires immediate intervention (e.g., diuretics, oxygen) to prevent
respiratory failure. Weight gain and edema are signs of fluid overload but are less emergent.
3. A client with hypertension is prescribed hydrochlorothiazide (HCTZ). Which instruction should the PN
include in discharge teaching?
A. Take the medication at bedtime to avoid dizziness
B. Increase intake of potassiumrich foods (bananas, oranges)
C. Limit fluid intake to 1 liter per day
D. Take the medication with a highfat meal
Answer: B. Increase intake of potassiumrich foods (bananas, oranges)
Explanation: HCTZ is a thiazide diuretic that can cause hypokalemia (low potassium). Clients should
increase intake of potassiumrich foods (bananas, oranges, potatoes, spinach). HCTZ should be taken in
the morning to avoid nocturia.
4. A client with angina is prescribed a transdermal nitroglycerin patch. Which instruction should the PN
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 chest bone (sternum)
,D. Use the patch immediately if chest pain occurs
Answer: B. Remove the patch for 10–12 hours each day to prevent tolerance
Explanation: To prevent nitrate tolerance, the patch should be removed for 10–12 hours each day
(usually overnight) to provide a nitratefree interval. Sites should be rotated to prevent skin irritation.
5. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response.
Based on this finding, the nurse anticipates assisting the physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client as soon as possible
D. Administer atropine, 0.4 mg intravenous push
Answer: B. Perform synchronized cardioversion
Explanation: With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion
to convert the cardiac rhythm back to normal sinus rhythm. Lidocaine is used for ventricular
dysrhythmias. Defibrillation is for lifethreatening dysrhythmias like ventricular fibrillation.
6. A client with heart failure reports shortness of breath when lying flat. The nurse should document this
finding as:
A. Orthopnea
B. Dyspnea on exertion
, C. Paroxysmal nocturnal dyspnea
D. Tachypnea
Answer: A. Orthopnea
Explanation: Orthopnea is shortness of breath when lying flat that is relieved by sitting or standing. It is a
classic sign of heart failure due to fluid redistribution.
7. A client with deep vein thrombosis (DVT) is receiving a heparin infusion. Which laboratory value
should the nurse use to monitor the effectiveness of the therapy?
A. INR (International Normalized Ratio)
B. aPTT (activated partial thromboplastin time)
C. Platelet count
D. PT (Prothrombin time)
Answer: B. aPTT (activated partial thromboplastin time)
Explanation: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5–2.5 times the
normal control value. INR monitors warfarin therapy.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse instruct the
client to report immediately?
A. Dry cough
B. Dizziness when standing
| 200 Practice Questions & Detailed Answers |
NGNStyle Q&A with Case Scenarios | A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
1. A client with heart failure reports a weight gain of 5 pounds in 3 days. What is the nurse's priority
action?
A. Encourage the client to restrict oral fluids
B. Assess for peripheral edema and crackles
C. Notify the healthcare provider immediately
D. Increase the dose of furosemide
Answer: C. Notify the healthcare provider immediately
Explanation: A rapid weight gain of 2–3 pounds in 24 hours or 5 pounds in 1 week is a sign of worsening
fluid overload. The provider should be notified for potential adjustment of diuretic therapy. While
assessing for edema and crackles is important, immediate notification is the priority.
2. A practical nurse is caring for a client with heart failure. Which assessment finding requires immediate
intervention?
A. Weight gain of 2 pounds in 24 hours
B. Crackles in the lung bases
C. 2+ pitting edema in the lower extremities
D. Jugular vein distention when sitting upright
,Answer: B. Crackles in the lung bases
Explanation: Crackles in the lung bases indicate pulmonary congestion (fluid in the alveoli), a sign of
worsening heart failure that requires immediate intervention (e.g., diuretics, oxygen) to prevent
respiratory failure. Weight gain and edema are signs of fluid overload but are less emergent.
3. A client with hypertension is prescribed hydrochlorothiazide (HCTZ). Which instruction should the PN
include in discharge teaching?
A. Take the medication at bedtime to avoid dizziness
B. Increase intake of potassiumrich foods (bananas, oranges)
C. Limit fluid intake to 1 liter per day
D. Take the medication with a highfat meal
Answer: B. Increase intake of potassiumrich foods (bananas, oranges)
Explanation: HCTZ is a thiazide diuretic that can cause hypokalemia (low potassium). Clients should
increase intake of potassiumrich foods (bananas, oranges, potatoes, spinach). HCTZ should be taken in
the morning to avoid nocturia.
4. A client with angina is prescribed a transdermal nitroglycerin patch. Which instruction should the PN
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 chest bone (sternum)
,D. Use the patch immediately if chest pain occurs
Answer: B. Remove the patch for 10–12 hours each day to prevent tolerance
Explanation: To prevent nitrate tolerance, the patch should be removed for 10–12 hours each day
(usually overnight) to provide a nitratefree interval. Sites should be rotated to prevent skin irritation.
5. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response.
Based on this finding, the nurse anticipates assisting the physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client as soon as possible
D. Administer atropine, 0.4 mg intravenous push
Answer: B. Perform synchronized cardioversion
Explanation: With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion
to convert the cardiac rhythm back to normal sinus rhythm. Lidocaine is used for ventricular
dysrhythmias. Defibrillation is for lifethreatening dysrhythmias like ventricular fibrillation.
6. A client with heart failure reports shortness of breath when lying flat. The nurse should document this
finding as:
A. Orthopnea
B. Dyspnea on exertion
, C. Paroxysmal nocturnal dyspnea
D. Tachypnea
Answer: A. Orthopnea
Explanation: Orthopnea is shortness of breath when lying flat that is relieved by sitting or standing. It is a
classic sign of heart failure due to fluid redistribution.
7. A client with deep vein thrombosis (DVT) is receiving a heparin infusion. Which laboratory value
should the nurse use to monitor the effectiveness of the therapy?
A. INR (International Normalized Ratio)
B. aPTT (activated partial thromboplastin time)
C. Platelet count
D. PT (Prothrombin time)
Answer: B. aPTT (activated partial thromboplastin time)
Explanation: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5–2.5 times the
normal control value. INR monitors warfarin therapy.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse instruct the
client to report immediately?
A. Dry cough
B. Dizziness when standing
