HESI Med Surg I 2026/2027 | HESI RN Medical-Surgical
Nursing I Study Guide, Practice Questions & Answers, HESI
Medical-Surgical Exam Prep, Adult Health Nursing, Clinical
Judgment, Cardiovascular, Respiratory, Neurologic,
Gastrointestinal, Renal & Urinary, Endocrine, Hematologic,
Musculoskeletal, Integumentary, Immune & Infectious
Disorders, Fluid & Electrolytes, Acid-Base Balance,
Pharmacology, Prioritization, Delegation & Detailed
Rationales
Question 1: A client with acute decompensated heart failure has
bilateral crackles to the apices, SpO₂ 86% on room air, and RR 32.
Which action should the nurse take FIRST?
A. Administer IV furosemide as prescribed
B. Apply high-flow oxygen via non-rebreather mask
C. Insert a Foley catheter for strict output monitoring
D. Obtain a 12-lead ECG
CORRECT ANSWER: B. Apply high-flow oxygen via non-rebreather mask
Rationale: Using the ABC priority framework, the client has severe
hypoxemia (SpO₂ 86%) indicating impaired gas exchange. Oxygenation
must be restored before addressing fluid overload with diuretics or
monitoring interventions.
Question 2: A client receiving continuous IV heparin has an aPTT of 110
seconds (control 30 seconds) and blood-tinged urine. Which action
should the nurse take FIRST?
A. Increase the heparin infusion rate
B. Hold the infusion and notify the provider
C. Administer vitamin K IV push
D. Document findings and reassess in 4 hours
CORRECT ANSWER: B. Hold the infusion and notify the provider
Rationale: An aPTT greater than 2.5–3 times the control indicates excessive
anticoagulation with active bleeding. The infusion must be stopped
immediately, and protamine sulfate may be ordered as the reversal agent.
,Question 3: A client with severe aortic stenosis reports episodes of
fainting when standing. The nurse recognizes this symptom as
indicating:
A. Mild disease requiring routine follow-up
B. Critical stenosis requiring urgent intervention
C. A benign vasovagal response
D. Adequate compensation of the stenosis
CORRECT ANSWER: B. Critical stenosis requiring urgent intervention
Rationale: Exertional or positional syncope in aortic stenosis indicates
fixed cardiac output that cannot meet cerebral perfusion demands. This is
a classic symptom of critical stenosis requiring valve replacement
evaluation.
Question 4: A client on a continuous heparin infusion develops a
platelet count drop from 250,000 to 85,000/mm³. Which complication
should the nurse suspect?
A. Heparin-induced thrombocytopenia (HIT)
B. Vitamin K deficiency
C. Disseminated intravascular coagulation
D. Aplastic anemia
CORRECT ANSWER: A. Heparin-induced thrombocytopenia (HIT)
Rationale: HIT is an immune-mediated reaction causing platelet activation
and destruction. The hallmark is a >50% drop in platelets, paradoxically
increasing thrombosis risk. All heparin must be stopped immediately.
Question 5: A client with atrial fibrillation of unknown duration is
scheduled for cardioversion. Which pre-procedure verification is
essential?
A. The client has been NPO for 2 hours
B. Therapeutic anticoagulation for at least 3 weeks or TEE has excluded
thrombus
C. All rate-control medications have been held for 48 hours
D. A temporary pacemaker has been placed prophylactically
,CORRECT ANSWER: B. Therapeutic anticoagulation for at least 3 weeks
or TEE has excluded thrombus
Rationale: Cardioversion in AF lasting >48 hours risks embolizing a left
atrial thrombus. Anticoagulation or TEE clearance is mandatory to prevent
stroke.
Question 6: A client with heart failure and ejection fraction of 25% is
prescribed carvedilol. The nurse teaches that the primary benefit is:
A. Immediate diuresis of excess fluid
B. Reduced sympathetic stimulation and slowed adverse remodeling
C. Increased myocardial contractility
D. Prevention of all future myocardial infarctions
CORRECT ANSWER: B. Reduced sympathetic stimulation and slowed
adverse remodeling
Rationale: Beta-blockers in HFrEF reduce catecholamine effects, decrease
myocardial oxygen demand, and improve long-term outcomes by limiting
ventricular remodeling.
Question 7: A client receiving IV nitroglycerin for unstable angina
develops BP 84/50 and lightheadedness. Which action should the
nurse take FIRST?
A. Increase the infusion rate to improve coronary perfusion
B. Stop or decrease the infusion, place supine, and notify the provider
C. Administer a 1 L normal saline bolus without orders
D. Document and reassess in 30 minutes
CORRECT ANSWER: B. Stop or decrease the infusion, place supine, and
notify the provider
Rationale: Nitroglycerin is a potent vasodilator. Hypotension requires
immediate reduction or cessation of infusion, supportive positioning, and
provider notification.
, Question 8: A client with acute coronary syndrome reports sudden
severe chest pain radiating to the left arm and jaw. Which action should
the nurse take FIRST?
A. Obtain a detailed dietary history
B. Place on cardiac monitor, administer oxygen if hypoxic, establish IV
access, and obtain 12-lead ECG within 10 minutes
C. Encourage ambulation to relieve anxiety
D. Give a full meal to rule out GI causes
CORRECT ANSWER: B. Place on cardiac monitor, administer oxygen if
hypoxic, establish IV access, and obtain 12-lead ECG within 10 minutes
Rationale: Time is muscle in ACS. The priority is rapid assessment with 12-
lead ECG within 10 minutes of presentation, continuous monitoring, and
oxygenation if hypoxic.
Question 9: A client with hypertension and new-onset headache,
blurred vision, and BP 220/130 should receive which priority
intervention?
A. Sublingual nitroglycerin
B. IV antihypertensive per protocol with gradual BP reduction
C. Vagal maneuvers
D. Rapid BP reduction to normal range
CORRECT ANSWER: B. IV antihypertensive per protocol with gradual BP
reduction
Rationale: Hypertensive emergency requires controlled BP reduction (10–
20% in first hour) to prevent cerebral, cardiac, and renal ischemia. Rapid
normalization can cause organ hypoperfusion.
Question 10: A patient post-MI day 3 develops a new holosystolic
murmur at the apex, hypotension, and pulmonary edema. Which
complication should the nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture with acute mitral regurgitation
Nursing I Study Guide, Practice Questions & Answers, HESI
Medical-Surgical Exam Prep, Adult Health Nursing, Clinical
Judgment, Cardiovascular, Respiratory, Neurologic,
Gastrointestinal, Renal & Urinary, Endocrine, Hematologic,
Musculoskeletal, Integumentary, Immune & Infectious
Disorders, Fluid & Electrolytes, Acid-Base Balance,
Pharmacology, Prioritization, Delegation & Detailed
Rationales
Question 1: A client with acute decompensated heart failure has
bilateral crackles to the apices, SpO₂ 86% on room air, and RR 32.
Which action should the nurse take FIRST?
A. Administer IV furosemide as prescribed
B. Apply high-flow oxygen via non-rebreather mask
C. Insert a Foley catheter for strict output monitoring
D. Obtain a 12-lead ECG
CORRECT ANSWER: B. Apply high-flow oxygen via non-rebreather mask
Rationale: Using the ABC priority framework, the client has severe
hypoxemia (SpO₂ 86%) indicating impaired gas exchange. Oxygenation
must be restored before addressing fluid overload with diuretics or
monitoring interventions.
Question 2: A client receiving continuous IV heparin has an aPTT of 110
seconds (control 30 seconds) and blood-tinged urine. Which action
should the nurse take FIRST?
A. Increase the heparin infusion rate
B. Hold the infusion and notify the provider
C. Administer vitamin K IV push
D. Document findings and reassess in 4 hours
CORRECT ANSWER: B. Hold the infusion and notify the provider
Rationale: An aPTT greater than 2.5–3 times the control indicates excessive
anticoagulation with active bleeding. The infusion must be stopped
immediately, and protamine sulfate may be ordered as the reversal agent.
,Question 3: A client with severe aortic stenosis reports episodes of
fainting when standing. The nurse recognizes this symptom as
indicating:
A. Mild disease requiring routine follow-up
B. Critical stenosis requiring urgent intervention
C. A benign vasovagal response
D. Adequate compensation of the stenosis
CORRECT ANSWER: B. Critical stenosis requiring urgent intervention
Rationale: Exertional or positional syncope in aortic stenosis indicates
fixed cardiac output that cannot meet cerebral perfusion demands. This is
a classic symptom of critical stenosis requiring valve replacement
evaluation.
Question 4: A client on a continuous heparin infusion develops a
platelet count drop from 250,000 to 85,000/mm³. Which complication
should the nurse suspect?
A. Heparin-induced thrombocytopenia (HIT)
B. Vitamin K deficiency
C. Disseminated intravascular coagulation
D. Aplastic anemia
CORRECT ANSWER: A. Heparin-induced thrombocytopenia (HIT)
Rationale: HIT is an immune-mediated reaction causing platelet activation
and destruction. The hallmark is a >50% drop in platelets, paradoxically
increasing thrombosis risk. All heparin must be stopped immediately.
Question 5: A client with atrial fibrillation of unknown duration is
scheduled for cardioversion. Which pre-procedure verification is
essential?
A. The client has been NPO for 2 hours
B. Therapeutic anticoagulation for at least 3 weeks or TEE has excluded
thrombus
C. All rate-control medications have been held for 48 hours
D. A temporary pacemaker has been placed prophylactically
,CORRECT ANSWER: B. Therapeutic anticoagulation for at least 3 weeks
or TEE has excluded thrombus
Rationale: Cardioversion in AF lasting >48 hours risks embolizing a left
atrial thrombus. Anticoagulation or TEE clearance is mandatory to prevent
stroke.
Question 6: A client with heart failure and ejection fraction of 25% is
prescribed carvedilol. The nurse teaches that the primary benefit is:
A. Immediate diuresis of excess fluid
B. Reduced sympathetic stimulation and slowed adverse remodeling
C. Increased myocardial contractility
D. Prevention of all future myocardial infarctions
CORRECT ANSWER: B. Reduced sympathetic stimulation and slowed
adverse remodeling
Rationale: Beta-blockers in HFrEF reduce catecholamine effects, decrease
myocardial oxygen demand, and improve long-term outcomes by limiting
ventricular remodeling.
Question 7: A client receiving IV nitroglycerin for unstable angina
develops BP 84/50 and lightheadedness. Which action should the
nurse take FIRST?
A. Increase the infusion rate to improve coronary perfusion
B. Stop or decrease the infusion, place supine, and notify the provider
C. Administer a 1 L normal saline bolus without orders
D. Document and reassess in 30 minutes
CORRECT ANSWER: B. Stop or decrease the infusion, place supine, and
notify the provider
Rationale: Nitroglycerin is a potent vasodilator. Hypotension requires
immediate reduction or cessation of infusion, supportive positioning, and
provider notification.
, Question 8: A client with acute coronary syndrome reports sudden
severe chest pain radiating to the left arm and jaw. Which action should
the nurse take FIRST?
A. Obtain a detailed dietary history
B. Place on cardiac monitor, administer oxygen if hypoxic, establish IV
access, and obtain 12-lead ECG within 10 minutes
C. Encourage ambulation to relieve anxiety
D. Give a full meal to rule out GI causes
CORRECT ANSWER: B. Place on cardiac monitor, administer oxygen if
hypoxic, establish IV access, and obtain 12-lead ECG within 10 minutes
Rationale: Time is muscle in ACS. The priority is rapid assessment with 12-
lead ECG within 10 minutes of presentation, continuous monitoring, and
oxygenation if hypoxic.
Question 9: A client with hypertension and new-onset headache,
blurred vision, and BP 220/130 should receive which priority
intervention?
A. Sublingual nitroglycerin
B. IV antihypertensive per protocol with gradual BP reduction
C. Vagal maneuvers
D. Rapid BP reduction to normal range
CORRECT ANSWER: B. IV antihypertensive per protocol with gradual BP
reduction
Rationale: Hypertensive emergency requires controlled BP reduction (10–
20% in first hour) to prevent cerebral, cardiac, and renal ischemia. Rapid
normalization can cause organ hypoperfusion.
Question 10: A patient post-MI day 3 develops a new holosystolic
murmur at the apex, hypotension, and pulmonary edema. Which
complication should the nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture with acute mitral regurgitation
