HESI RN EXAMINATION PREPARATION
2026/2027 HESI RN MEDICAL SURGICAL
ALL 55 CORRECT ANSWERS - VERSION 1
Aligned with the HESI RN Medical-Surgical Exam Blueprint, the NCLEX-RN Test Plan, and Medical-Surgical
Nursing Core Competencies (2026/2027 Edition)
55 Multiple-Choice Questions | Single Best Answer (A-D) | Correct Answers Marked and Fully Rationaled
Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | 80% Scenario-Based Content | Includes 10
Priority-Setting, 10 Pharmacology, and 5 Laboratory-Interpretation Items
Section 1: Cardiovascular Disorders
Questions 1-10
Q1: The nurse is assigned to four clients on a telemetry unit. Which client should the nurse assess first?
A. A client with heart failure who has 2+ pitting edema of the ankles and reports mild dyspnea on exertion
B. A client with controlled atrial fibrillation whose apical pulse is 88 beats/min and who is asymptomatic
C. A client with heart failure who suddenly reports dyspnea at rest and is coughing up pink, frothy sputum
[CORRECT]
D. A client one day after cardiac catheterization who asks for assistance to ambulate to the bathroom
Correct Answer: C
Rationale: Pink, frothy sputum with dyspnea at rest signals acute pulmonary edema, a life-threatening complication
of heart failure that compromises oxygenation; the ABC priority framework directs the nurse to this client first. The
other clients have stable or expected findings that pose no immediate threat to airway, breathing, or circulation. Rapid
response notification and upright positioning with oxygen should immediately follow this assessment.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Management of Care | Cognitive Level: Analysis
Q2: A client admitted with crushing chest pain has serial cardiac markers drawn. The initial troponin I level is
0.02 ng/mL, and a repeat level 6 hours later is 2.4 ng/mL (reference: less than 0.04 ng/mL). How should the
nurse interpret these findings?
A. The values are within normal limits and effectively rule out myocardial infarction
B. The rising value indicates myocardial injury consistent with acute myocardial infarction [CORRECT]
C. The levels should be disregarded because CK-MB is a more specific marker of cardiac injury
D. The elevation is an expected response to skeletal muscle trauma from repeated venipuncture
HESI RN Medical-Surgical Examination Preparation Page 1
,2026/2027 HESI RN Medical-Surgical Examination - All 55 Correct Answers - Version 1 Questions 1-55
Correct Answer: B
Rationale: Troponin I begins to rise within 3 to 4 hours of myocardial injury, peaks at 18 to 24 hours, and stays
elevated for up to 10 days, so a rising trend far above the reference range confirms myocardial injury. A normal early
value does not rule out infarction, and troponin is more specific for cardiac muscle than CK-MB. Skeletal muscle
trauma does not elevate troponin I to this degree.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Reduction of Risk Potential | Cognitive Level: Application
Q3: The nurse is providing discharge teaching for a client with a new prescription for lisinopril. Which client
statement indicates a correct understanding of the teaching?
A. I will eat more bananas and drink orange juice to prevent leg cramps from this medicine
B. If I develop a dry, hacking cough, I will stop the medication until my next clinic visit
C. I will contact my provider right away if my lips, face, or tongue begin to swell [CORRECT]
D. I can take over-the-counter ibuprofen for headaches without any interaction concerns
Correct Answer: C
Rationale: Swelling of the lips, face, or tongue signals angioedema, a life-threatening adverse effect of ACE
inhibitors that requires emergency treatment and permanent discontinuation. ACE inhibitors promote potassium
retention, so extra dietary potassium is unsafe, and a persistent dry cough should be reported rather than self-treated by
stopping the drug. NSAIDs such as ibuprofen reduce antihypertensive effectiveness and increase the risk of acute
kidney injury.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Pharmacological Therapies | Cognitive Level: Application
Q4: Which electrocardiographic rhythm pattern is characteristic of atrial flutter?
A. An irregularly irregular rhythm with no identifiable P waves and a wavy fibrillatory baseline
B. A progressively lengthening PR interval followed by a dropped QRS complex
C. A regular rhythm with no P waves and wide, slurred QRS complexes
D. A regular rhythm with sawtooth-shaped flutter waves between the QRS complexes [CORRECT]
Correct Answer: D
Rationale: Atrial flutter produces rapid, regular atrial depolarizations that create the classic sawtooth (flutter-wave)
pattern, usually at an atrial rate near 300 beats/min, best seen in leads II, III, and aVF. An irregularly irregular rhythm
without P waves describes atrial fibrillation, progressive PR lengthening with dropped beats describes second-degree
AV block type I, and wide, slurred complexes describe ventricular rhythms.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Recall
Q5: The nurse is reviewing medications with a client with atrial fibrillation who takes warfarin. Which client
statement requires immediate follow-up by the nurse?
A. I try to keep my intake of leafy green vegetables about the same every day
B. I take my warfarin at the same time every evening and keep all my lab appointments
C. I started taking aspirin every day for my arthritis pain [CORRECT]
D. I call my provider if I notice unusual bruising or bleeding from my gums
Correct Answer: C
Rationale: Aspirin adds an antiplatelet effect to warfarin anticoagulation and greatly increases the risk of serious
bleeding, so it must not be started without provider approval. Keeping vitamin K intake consistent, adhering to timing
and INR monitoring, and reporting bleeding signs are all correct safety behaviors. NSAIDs and aspirin are classic
pharmacological pitfalls combined with warfarin therapy.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Pharmacological Therapies | Cognitive Level: Application
HESI RN Medical-Surgical Examination Preparation Page 2
, 2026/2027 HESI RN Medical-Surgical Examination - All 55 Correct Answers - Version 1 Questions 1-55
Q6: A client is one day postoperative after coronary artery bypass graft surgery. Which assessment finding
should the nurse report to the provider immediately?
A. Sternal incision pain rated 4 on a scale of 0 to 10, controlled with prescribed analgesia
B. Temperature of 100.2 °F with a small amount of clear drainage on the dressing
C. Hypoactive bowel sounds with mild abdominal distention
D. Sudden fall in blood pressure with distended neck veins and muffled heart sounds [CORRECT]
Correct Answer: D
Rationale: Hypotension, distended neck veins, and muffled heart sounds constitute Beck's triad of cardiac
tamponade, a surgical emergency after cardiac surgery caused by blood or fluid compressing the heart. The other
findings are common, expected postoperative occurrences managed with routine interventions. Tamponade requires
immediate notification and preparation for pericardiocentesis or return to the operating room.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Reduction of Risk Potential | Cognitive Level: Application
Q7: Two hours after an acute myocardial infarction, a client has blood pressure 84/52 mmHg, heart rate 118
beats/min, cold clammy skin, crackles at the lung bases, distended neck veins, and urine output of 20 mL/hr.
Which type of shock should the nurse suspect?
A. Hypovolemic shock from an absolute loss of intravascular volume
B. Cardiogenic shock from impaired pumping ability of the heart [CORRECT]
C. Septic shock from a systemic inflammatory response to infection
D. Anaphylactic shock from a severe hypersensitivity reaction
Correct Answer: B
Rationale: Pump failure after extensive infarction produces cardiogenic shock: hypotension, tachycardia, oliguria,
pulmonary crackles, and distended neck veins. Hypovolemic shock presents with flat neck veins and no crackles,
septic shock usually causes warm flushed skin early, and anaphylactic shock follows allergen exposure with
bronchospasm and urticaria. Management centers on improving cardiac output rather than aggressive fluid loading.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Analysis
Q8: The nurse is preparing a client with a new permanent pacemaker for discharge. Which instruction should be
included in the teaching plan?
A. You will need to avoid all airport security screening equipment permanently
B. Check your pulse daily and report a sustained rate lower than the rate set for your pacemaker
[CORRECT]
C. You should no longer use microwave ovens because they will interfere with the device
D. You may resume heavy contact sports and full shoulder exercises within one week
Correct Answer: B
Rationale: Daily pulse checking verifies pacemaker capture, and a sustained rate below the set rate indicates loss of
sensing or capture that must be reported promptly. Brief passage through security detectors is generally safe when
carrying the device identification card, modern microwave ovens do not interfere with pacemakers, and strenuous use
of the ipsilateral arm is restricted for several weeks to prevent lead displacement.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Recall
HESI RN Medical-Surgical Examination Preparation Page 3
2026/2027 HESI RN MEDICAL SURGICAL
ALL 55 CORRECT ANSWERS - VERSION 1
Aligned with the HESI RN Medical-Surgical Exam Blueprint, the NCLEX-RN Test Plan, and Medical-Surgical
Nursing Core Competencies (2026/2027 Edition)
55 Multiple-Choice Questions | Single Best Answer (A-D) | Correct Answers Marked and Fully Rationaled
Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | 80% Scenario-Based Content | Includes 10
Priority-Setting, 10 Pharmacology, and 5 Laboratory-Interpretation Items
Section 1: Cardiovascular Disorders
Questions 1-10
Q1: The nurse is assigned to four clients on a telemetry unit. Which client should the nurse assess first?
A. A client with heart failure who has 2+ pitting edema of the ankles and reports mild dyspnea on exertion
B. A client with controlled atrial fibrillation whose apical pulse is 88 beats/min and who is asymptomatic
C. A client with heart failure who suddenly reports dyspnea at rest and is coughing up pink, frothy sputum
[CORRECT]
D. A client one day after cardiac catheterization who asks for assistance to ambulate to the bathroom
Correct Answer: C
Rationale: Pink, frothy sputum with dyspnea at rest signals acute pulmonary edema, a life-threatening complication
of heart failure that compromises oxygenation; the ABC priority framework directs the nurse to this client first. The
other clients have stable or expected findings that pose no immediate threat to airway, breathing, or circulation. Rapid
response notification and upright positioning with oxygen should immediately follow this assessment.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Management of Care | Cognitive Level: Analysis
Q2: A client admitted with crushing chest pain has serial cardiac markers drawn. The initial troponin I level is
0.02 ng/mL, and a repeat level 6 hours later is 2.4 ng/mL (reference: less than 0.04 ng/mL). How should the
nurse interpret these findings?
A. The values are within normal limits and effectively rule out myocardial infarction
B. The rising value indicates myocardial injury consistent with acute myocardial infarction [CORRECT]
C. The levels should be disregarded because CK-MB is a more specific marker of cardiac injury
D. The elevation is an expected response to skeletal muscle trauma from repeated venipuncture
HESI RN Medical-Surgical Examination Preparation Page 1
,2026/2027 HESI RN Medical-Surgical Examination - All 55 Correct Answers - Version 1 Questions 1-55
Correct Answer: B
Rationale: Troponin I begins to rise within 3 to 4 hours of myocardial injury, peaks at 18 to 24 hours, and stays
elevated for up to 10 days, so a rising trend far above the reference range confirms myocardial injury. A normal early
value does not rule out infarction, and troponin is more specific for cardiac muscle than CK-MB. Skeletal muscle
trauma does not elevate troponin I to this degree.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Reduction of Risk Potential | Cognitive Level: Application
Q3: The nurse is providing discharge teaching for a client with a new prescription for lisinopril. Which client
statement indicates a correct understanding of the teaching?
A. I will eat more bananas and drink orange juice to prevent leg cramps from this medicine
B. If I develop a dry, hacking cough, I will stop the medication until my next clinic visit
C. I will contact my provider right away if my lips, face, or tongue begin to swell [CORRECT]
D. I can take over-the-counter ibuprofen for headaches without any interaction concerns
Correct Answer: C
Rationale: Swelling of the lips, face, or tongue signals angioedema, a life-threatening adverse effect of ACE
inhibitors that requires emergency treatment and permanent discontinuation. ACE inhibitors promote potassium
retention, so extra dietary potassium is unsafe, and a persistent dry cough should be reported rather than self-treated by
stopping the drug. NSAIDs such as ibuprofen reduce antihypertensive effectiveness and increase the risk of acute
kidney injury.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Pharmacological Therapies | Cognitive Level: Application
Q4: Which electrocardiographic rhythm pattern is characteristic of atrial flutter?
A. An irregularly irregular rhythm with no identifiable P waves and a wavy fibrillatory baseline
B. A progressively lengthening PR interval followed by a dropped QRS complex
C. A regular rhythm with no P waves and wide, slurred QRS complexes
D. A regular rhythm with sawtooth-shaped flutter waves between the QRS complexes [CORRECT]
Correct Answer: D
Rationale: Atrial flutter produces rapid, regular atrial depolarizations that create the classic sawtooth (flutter-wave)
pattern, usually at an atrial rate near 300 beats/min, best seen in leads II, III, and aVF. An irregularly irregular rhythm
without P waves describes atrial fibrillation, progressive PR lengthening with dropped beats describes second-degree
AV block type I, and wide, slurred complexes describe ventricular rhythms.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Recall
Q5: The nurse is reviewing medications with a client with atrial fibrillation who takes warfarin. Which client
statement requires immediate follow-up by the nurse?
A. I try to keep my intake of leafy green vegetables about the same every day
B. I take my warfarin at the same time every evening and keep all my lab appointments
C. I started taking aspirin every day for my arthritis pain [CORRECT]
D. I call my provider if I notice unusual bruising or bleeding from my gums
Correct Answer: C
Rationale: Aspirin adds an antiplatelet effect to warfarin anticoagulation and greatly increases the risk of serious
bleeding, so it must not be started without provider approval. Keeping vitamin K intake consistent, adhering to timing
and INR monitoring, and reporting bleeding signs are all correct safety behaviors. NSAIDs and aspirin are classic
pharmacological pitfalls combined with warfarin therapy.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Pharmacological Therapies | Cognitive Level: Application
HESI RN Medical-Surgical Examination Preparation Page 2
, 2026/2027 HESI RN Medical-Surgical Examination - All 55 Correct Answers - Version 1 Questions 1-55
Q6: A client is one day postoperative after coronary artery bypass graft surgery. Which assessment finding
should the nurse report to the provider immediately?
A. Sternal incision pain rated 4 on a scale of 0 to 10, controlled with prescribed analgesia
B. Temperature of 100.2 °F with a small amount of clear drainage on the dressing
C. Hypoactive bowel sounds with mild abdominal distention
D. Sudden fall in blood pressure with distended neck veins and muffled heart sounds [CORRECT]
Correct Answer: D
Rationale: Hypotension, distended neck veins, and muffled heart sounds constitute Beck's triad of cardiac
tamponade, a surgical emergency after cardiac surgery caused by blood or fluid compressing the heart. The other
findings are common, expected postoperative occurrences managed with routine interventions. Tamponade requires
immediate notification and preparation for pericardiocentesis or return to the operating room.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Reduction of Risk Potential | Cognitive Level: Application
Q7: Two hours after an acute myocardial infarction, a client has blood pressure 84/52 mmHg, heart rate 118
beats/min, cold clammy skin, crackles at the lung bases, distended neck veins, and urine output of 20 mL/hr.
Which type of shock should the nurse suspect?
A. Hypovolemic shock from an absolute loss of intravascular volume
B. Cardiogenic shock from impaired pumping ability of the heart [CORRECT]
C. Septic shock from a systemic inflammatory response to infection
D. Anaphylactic shock from a severe hypersensitivity reaction
Correct Answer: B
Rationale: Pump failure after extensive infarction produces cardiogenic shock: hypotension, tachycardia, oliguria,
pulmonary crackles, and distended neck veins. Hypovolemic shock presents with flat neck veins and no crackles,
septic shock usually causes warm flushed skin early, and anaphylactic shock follows allergen exposure with
bronchospasm and urticaria. Management centers on improving cardiac output rather than aggressive fluid loading.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Analysis
Q8: The nurse is preparing a client with a new permanent pacemaker for discharge. Which instruction should be
included in the teaching plan?
A. You will need to avoid all airport security screening equipment permanently
B. Check your pulse daily and report a sustained rate lower than the rate set for your pacemaker
[CORRECT]
C. You should no longer use microwave ovens because they will interfere with the device
D. You may resume heavy contact sports and full shoulder exercises within one week
Correct Answer: B
Rationale: Daily pulse checking verifies pacemaker capture, and a sustained rate below the set rate indicates loss of
sensing or capture that must be reported promptly. Brief passage through security detectors is generally safe when
carrying the device identification card, modern microwave ovens do not interfere with pacemakers, and strenuous use
of the ipsilateral arm is restricted for several weeks to prevent lead displacement.
HESI Content Domain: Cardiovascular Disorders | NCLEX Client Need: Physiological Adaptation | Cognitive Level: Recall
HESI RN Medical-Surgical Examination Preparation Page 3
