HESI Medical-Surgical Nursing 2
Comprehensive Exam with 100
questions and verified answers
with rationale graded A+NEW!!
Cardiovascular Disorders
1. A client with acute heart failure is severely dyspneic and coughing pink, frothy sputum. Which
action should the nurse take first?
A. Administer prescribed oral furosemide
B. Place the client in high-Fowler’s position
C. Obtain the client’s daily weight
D. Encourage oral fluid intake
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning decreases venous return and improves lung expansion, helping
relieve acute pulmonary congestion. Medications and other interventions follow immediate support
of breathing.
2. A client taking digoxin reports nausea, anorexia, and seeing yellow halos around lights. What is
the nurse’s priority action?
A. Administer the medication with food
B. Hold the digoxin and notify the provider
C. Encourage foods high in potassium
D. Recheck the client’s temperature
Answer: B. Hold the digoxin and notify the provider
,Rationale: Nausea, anorexia, visual disturbances, and dysrhythmias are signs of digoxin toxicity. The
medication should be withheld and the provider notified. The apical pulse and serum digoxin level
are commonly assessed.
3. Which assessment finding is most concerning in a client with left-sided heart failure?
A. Dependent ankle edema
B. Jugular venous distention
C. Crackles throughout both lungs
D. Weight gain of 1 kg in a week
Answer: C. Crackles throughout both lungs
Rationale: Left-sided heart failure causes pulmonary congestion. Diffuse crackles suggest worsening
pulmonary edema and impaired gas exchange.
4. A client taking warfarin has an international normalized ratio (INR) of 5.8. Which action should the
nurse anticipate?
A. Administer the scheduled dose
B. Hold warfarin and notify the provider
C. Encourage increased intake of leafy green vegetables
D. Give aspirin for additional anticoagulation
Answer: B. Hold warfarin and notify the provider
Rationale: An INR of 5.8 indicates excessive anticoagulation and increased bleeding risk. Warfarin is
generally held, and further treatment depends on bleeding status and provider orders.
5. A client reports crushing substernal chest pain radiating to the left arm. Which prescribed
medication should the nurse administer first, if the client’s blood pressure is adequate?
A. Sublingual nitroglycerin
B. Oral furosemide
C. Warfarin
D. Digoxin
,Answer: A. Sublingual nitroglycerin
Rationale: Nitroglycerin dilates coronary arteries and decreases cardiac workload, relieving ischemic
chest pain. The nurse should first assess vital signs and ensure the client has not recently taken a
phosphodiesterase-5 inhibitor.
6. Which finding is most characteristic of an arterial ulcer?
A. Located near the medial malleolus
B. Irregular, shallow wound with heavy drainage
C. Pain relieved by leg elevation
D. Punched-out lesion with a pale wound bed
Answer: D. Punched-out lesion with a pale wound bed
Rationale: Arterial ulcers are often painful, well-defined, and “punched out,” with a pale or necrotic
base. Pain typically worsens with elevation and improves when the leg is dependent.
7. A client is admitted with suspected infective endocarditis. Which prescription should the nurse
implement first?
A. Administer antibiotics before collecting cultures
B. Obtain blood cultures from separate sites
C. Restrict all oral fluids
D. Place the client on strict bedrest for 2 weeks
Answer: B. Obtain blood cultures from separate sites
Rationale: Blood cultures should be obtained before antibiotics when possible to identify the
causative organism and guide therapy.
8. A client with peripheral arterial disease reports severe foot pain. Which intervention is
appropriate?
A. Elevate the legs above the heart
, B. Apply cold packs to the feet
C. Allow the legs to remain dependent
D. Massage the affected extremity
Answer: C. Allow the legs to remain dependent
Rationale: Dependency improves arterial blood flow to the feet. Elevation and cold can worsen
ischemia. Massage may injure compromised tissue.
9. A client with atrial fibrillation is prescribed apixaban. Which statement indicates understanding?
A. “I should stop the medication if I bruise.”
B. “I should report black, tarry stools.”
C. “I need to increase my vitamin K intake.”
D. “This medication will permanently correct my rhythm.”
Answer: B. “I should report black, tarry stools.”
Rationale: Black, tarry stools may indicate gastrointestinal bleeding. Apixaban reduces
thromboembolic risk but does not permanently correct atrial fibrillation.
10. Which laboratory value is most important to monitor in a client receiving unfractionated
heparin?
A. INR
B. Activated partial thromboplastin time
C. Hemoglobin A1c
D. Serum sodium
Answer: B. Activated partial thromboplastin time
Rationale: The aPTT is used to monitor the therapeutic effect of unfractionated heparin. INR is
primarily used for warfarin therapy.
Comprehensive Exam with 100
questions and verified answers
with rationale graded A+NEW!!
Cardiovascular Disorders
1. A client with acute heart failure is severely dyspneic and coughing pink, frothy sputum. Which
action should the nurse take first?
A. Administer prescribed oral furosemide
B. Place the client in high-Fowler’s position
C. Obtain the client’s daily weight
D. Encourage oral fluid intake
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning decreases venous return and improves lung expansion, helping
relieve acute pulmonary congestion. Medications and other interventions follow immediate support
of breathing.
2. A client taking digoxin reports nausea, anorexia, and seeing yellow halos around lights. What is
the nurse’s priority action?
A. Administer the medication with food
B. Hold the digoxin and notify the provider
C. Encourage foods high in potassium
D. Recheck the client’s temperature
Answer: B. Hold the digoxin and notify the provider
,Rationale: Nausea, anorexia, visual disturbances, and dysrhythmias are signs of digoxin toxicity. The
medication should be withheld and the provider notified. The apical pulse and serum digoxin level
are commonly assessed.
3. Which assessment finding is most concerning in a client with left-sided heart failure?
A. Dependent ankle edema
B. Jugular venous distention
C. Crackles throughout both lungs
D. Weight gain of 1 kg in a week
Answer: C. Crackles throughout both lungs
Rationale: Left-sided heart failure causes pulmonary congestion. Diffuse crackles suggest worsening
pulmonary edema and impaired gas exchange.
4. A client taking warfarin has an international normalized ratio (INR) of 5.8. Which action should the
nurse anticipate?
A. Administer the scheduled dose
B. Hold warfarin and notify the provider
C. Encourage increased intake of leafy green vegetables
D. Give aspirin for additional anticoagulation
Answer: B. Hold warfarin and notify the provider
Rationale: An INR of 5.8 indicates excessive anticoagulation and increased bleeding risk. Warfarin is
generally held, and further treatment depends on bleeding status and provider orders.
5. A client reports crushing substernal chest pain radiating to the left arm. Which prescribed
medication should the nurse administer first, if the client’s blood pressure is adequate?
A. Sublingual nitroglycerin
B. Oral furosemide
C. Warfarin
D. Digoxin
,Answer: A. Sublingual nitroglycerin
Rationale: Nitroglycerin dilates coronary arteries and decreases cardiac workload, relieving ischemic
chest pain. The nurse should first assess vital signs and ensure the client has not recently taken a
phosphodiesterase-5 inhibitor.
6. Which finding is most characteristic of an arterial ulcer?
A. Located near the medial malleolus
B. Irregular, shallow wound with heavy drainage
C. Pain relieved by leg elevation
D. Punched-out lesion with a pale wound bed
Answer: D. Punched-out lesion with a pale wound bed
Rationale: Arterial ulcers are often painful, well-defined, and “punched out,” with a pale or necrotic
base. Pain typically worsens with elevation and improves when the leg is dependent.
7. A client is admitted with suspected infective endocarditis. Which prescription should the nurse
implement first?
A. Administer antibiotics before collecting cultures
B. Obtain blood cultures from separate sites
C. Restrict all oral fluids
D. Place the client on strict bedrest for 2 weeks
Answer: B. Obtain blood cultures from separate sites
Rationale: Blood cultures should be obtained before antibiotics when possible to identify the
causative organism and guide therapy.
8. A client with peripheral arterial disease reports severe foot pain. Which intervention is
appropriate?
A. Elevate the legs above the heart
, B. Apply cold packs to the feet
C. Allow the legs to remain dependent
D. Massage the affected extremity
Answer: C. Allow the legs to remain dependent
Rationale: Dependency improves arterial blood flow to the feet. Elevation and cold can worsen
ischemia. Massage may injure compromised tissue.
9. A client with atrial fibrillation is prescribed apixaban. Which statement indicates understanding?
A. “I should stop the medication if I bruise.”
B. “I should report black, tarry stools.”
C. “I need to increase my vitamin K intake.”
D. “This medication will permanently correct my rhythm.”
Answer: B. “I should report black, tarry stools.”
Rationale: Black, tarry stools may indicate gastrointestinal bleeding. Apixaban reduces
thromboembolic risk but does not permanently correct atrial fibrillation.
10. Which laboratory value is most important to monitor in a client receiving unfractionated
heparin?
A. INR
B. Activated partial thromboplastin time
C. Hemoglobin A1c
D. Serum sodium
Answer: B. Activated partial thromboplastin time
Rationale: The aPTT is used to monitor the therapeutic effect of unfractionated heparin. INR is
primarily used for warfarin therapy.
