HESI RN MED-SURG EXAM 2026/2027 | 200 VERIFIED QUESTIONS &
ANSWERS | ELSEVIER EVOLVE CLINICAL JUDGMENT | INSTANT
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Cardiovascular System (1–25)
1. A client with acute myocardial infarction develops chest pain unrelieved by nitroglycerin and a
blood pressure of 82/54 mmHg. Which action is the priority?
A. Administer additional nitroglycerin
B. Obtain a 12-lead ECG and notify the provider
C. Encourage ambulation
D. Administer oral fluids
Correct: B
Rationale: Unrelieved chest pain and hypotension after nitroglycerin suggest ongoing ischemia or a
complication such as right ventricular infarction or cardiogenic shock. Obtaining a 12-lead ECG and
notifying the provider is the priority to identify the rhythm and guide reperfusion or hemodynamic
support. Additional nitroglycerin is contraindicated with hypotension. Ambulation and oral fluids are not
appropriate in an acute ischemic event.
2. A client with heart failure is prescribed furosemide 40 mg IV push. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, increasing the risk of
hypokalemia. Hypokalemia can precipitate dysrhythmias and increases the risk of digoxin toxicity in
clients taking digoxin. Sodium, calcium, and magnesium are less directly affected by loop diuretics,
although magnesium loss can occur.
3. A client with atrial fibrillation and a ventricular rate of 128 beats/min has a new prescription for
metoprolol. The nurse knows this medication is primarily used for which purpose?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
,Correct: B
Rationale: Metoprolol is a beta-blocker that slows conduction through the AV node, controlling the
ventricular rate in atrial fibrillation. It does not convert the rhythm to normal sinus; antiarrhythmics or
cardioversion are used for rhythm control. Stroke prevention requires anticoagulation. Metoprolol does
not increase contractility.
4. A client with heart failure is started on carvedilol. Which finding would require the nurse to hold
the medication and notify the provider?
A. Heart rate 68 beats/min
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
Correct: B
Rationale: Carvedilol is a beta-blocker that can worsen hypotension. It should be held if the systolic
blood pressure is below 90 mmHg or signs of shock are present. A heart rate of 68 beats/min is
acceptable (beta-blockers are typically held for heart rate below 60 beats/min). A respiratory rate of 20
is normal, and weight gain of 0.5 kg should be monitored but does not warrant holding the medication.
5. A client who is 2 days post-myocardial infarction develops a pericardial friction rub and pleuritic
chest pain. The nurse should suspect which complication?
A. Recurrent MI
B. Pericarditis (Dressler's syndrome)
C. Pulmonary embolism
D. Cardiac tamponade
Correct: B
Rationale: A pericardial friction rub that develops 2 to 3 days post-MI suggests pericarditis (Dressler's
syndrome), an inflammatory complication involving the pericardium. Chest pain relieved by nitroglycerin
may suggest angina, but a friction rub is more specific for pericarditis. Pulmonary embolism and cardiac
tamponade have different presentations, such as sudden dyspnea, hypotension, and muffled heart
sounds.
6. A client with infective endocarditis has which assessment finding that is most concerning?
A. Fever of 101.2°F
B. Splinter hemorrhages
C. New-onset heart murmur
D. Joint pain
Correct: C
Rationale: A new or changing heart murmur indicates valvular damage from vegetations, a serious
complication that can lead to heart failure, valvular regurgitation, and embolic events. Fever and splinter
,hemorrhages are expected findings. Joint pain may indicate immune complex deposition but is not as
immediately concerning as valvular damage.
7. A client with peripheral artery disease reports leg pain when walking that resolves with rest. The
nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Venous stasis pain
D. Neuropathic pain
Correct: B
Rationale: Intermittent claudication is ischemic muscle pain that occurs with exercise and is relieved by
rest. It is the hallmark symptom of PAD. Rest pain occurs at rest and indicates more severe arterial
disease. Venous stasis pain is typically an aching sensation that improves with elevation. Neuropathic
pain is associated with nerve damage and presents with burning or tingling.
8. Which intervention should the nurse include in the plan of care for a client with PAD?
A. Elevate the legs above heart level
B. Apply heat to the affected extremity
C. Encourage walking until pain occurs, rest, then resume
D. Keep the legs in a dependent position only
Correct: C
Rationale: Structured walking exercise (walk until pain occurs, rest, then resume) improves collateral
circulation and walking distance in PAD. Elevating the legs above heart level worsens arterial perfusion.
Heat application can cause burns due to decreased sensation and should be avoided. Keeping the legs
dependent may provide comfort but does not promote collateral circulation.
9. A client receiving a blood transfusion develops hypotension, flushing, and back pain. Which is the
nurse's priority action?
A. Stop the transfusion
B. Slow the infusion rate
C. Administer antihistamine
D. Notify the healthcare provider
Correct: A
Rationale: These symptoms indicate an acute hemolytic transfusion reaction, typically caused by ABO
incompatibility. The immediate priority is to stop the transfusion to prevent further exposure to the
incompatible blood. The nurse should disconnect the blood tubing but keep the IV line open with
normal saline, notify the provider, and prepare to administer emergency medications. Slowing the
infusion is incorrect because the transfusion must be stopped entirely.
, 10. A patient with a history of MI is prescribed beta-blockers. What is the therapeutic effect?
A. Increase heart rate
B. Reduce myocardial oxygen demand
C. Promote vasodilation
D. Increase cardiac output
Correct: B
Rationale: Beta-blockers reduce heart rate and contractility, lowering myocardial oxygen demand and
preventing further ischemia. They do not increase heart rate or cardiac output. While some beta-
blockers have vasodilatory properties, the primary therapeutic effect post-MI is reduction of oxygen
demand.
11. A client with a DVT is prescribed warfarin. Which laboratory value should be monitored?
A. aPTT
B. INR
C. Platelets
D. Hemoglobin
Correct: B
Rationale: The INR monitors warfarin therapy, with a typical therapeutic range of 2 to 3 for most
indications. aPTT monitors unfractionated heparin. Platelets are monitored for heparin-induced
thrombocytopenia, and hemoglobin assesses for bleeding.
12. A patient with heart failure reports weight gain of 3 kg in 2 days. What should the nurse do first?
A. Assess for peripheral edema
B. Notify the provider
C. Review dietary sodium intake
D. Auscultate lung sounds
Correct: D
Rationale: Sudden weight gain suggests fluid retention and possible pulmonary congestion. Auscultating
lung sounds is the priority because it detects crackles or pulmonary edema, which indicates
decompensated heart failure and requires immediate intervention. Other assessments and
interventions follow.
13. Which symptom is expected in a patient with hypothyroidism?
A. Tachycardia
B. Diarrhea
C. Cold intolerance
D. Weight loss
ANSWERS | ELSEVIER EVOLVE CLINICAL JUDGMENT | INSTANT
DOWNLOAD PDF
Cardiovascular System (1–25)
1. A client with acute myocardial infarction develops chest pain unrelieved by nitroglycerin and a
blood pressure of 82/54 mmHg. Which action is the priority?
A. Administer additional nitroglycerin
B. Obtain a 12-lead ECG and notify the provider
C. Encourage ambulation
D. Administer oral fluids
Correct: B
Rationale: Unrelieved chest pain and hypotension after nitroglycerin suggest ongoing ischemia or a
complication such as right ventricular infarction or cardiogenic shock. Obtaining a 12-lead ECG and
notifying the provider is the priority to identify the rhythm and guide reperfusion or hemodynamic
support. Additional nitroglycerin is contraindicated with hypotension. Ambulation and oral fluids are not
appropriate in an acute ischemic event.
2. A client with heart failure is prescribed furosemide 40 mg IV push. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, increasing the risk of
hypokalemia. Hypokalemia can precipitate dysrhythmias and increases the risk of digoxin toxicity in
clients taking digoxin. Sodium, calcium, and magnesium are less directly affected by loop diuretics,
although magnesium loss can occur.
3. A client with atrial fibrillation and a ventricular rate of 128 beats/min has a new prescription for
metoprolol. The nurse knows this medication is primarily used for which purpose?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
,Correct: B
Rationale: Metoprolol is a beta-blocker that slows conduction through the AV node, controlling the
ventricular rate in atrial fibrillation. It does not convert the rhythm to normal sinus; antiarrhythmics or
cardioversion are used for rhythm control. Stroke prevention requires anticoagulation. Metoprolol does
not increase contractility.
4. A client with heart failure is started on carvedilol. Which finding would require the nurse to hold
the medication and notify the provider?
A. Heart rate 68 beats/min
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
Correct: B
Rationale: Carvedilol is a beta-blocker that can worsen hypotension. It should be held if the systolic
blood pressure is below 90 mmHg or signs of shock are present. A heart rate of 68 beats/min is
acceptable (beta-blockers are typically held for heart rate below 60 beats/min). A respiratory rate of 20
is normal, and weight gain of 0.5 kg should be monitored but does not warrant holding the medication.
5. A client who is 2 days post-myocardial infarction develops a pericardial friction rub and pleuritic
chest pain. The nurse should suspect which complication?
A. Recurrent MI
B. Pericarditis (Dressler's syndrome)
C. Pulmonary embolism
D. Cardiac tamponade
Correct: B
Rationale: A pericardial friction rub that develops 2 to 3 days post-MI suggests pericarditis (Dressler's
syndrome), an inflammatory complication involving the pericardium. Chest pain relieved by nitroglycerin
may suggest angina, but a friction rub is more specific for pericarditis. Pulmonary embolism and cardiac
tamponade have different presentations, such as sudden dyspnea, hypotension, and muffled heart
sounds.
6. A client with infective endocarditis has which assessment finding that is most concerning?
A. Fever of 101.2°F
B. Splinter hemorrhages
C. New-onset heart murmur
D. Joint pain
Correct: C
Rationale: A new or changing heart murmur indicates valvular damage from vegetations, a serious
complication that can lead to heart failure, valvular regurgitation, and embolic events. Fever and splinter
,hemorrhages are expected findings. Joint pain may indicate immune complex deposition but is not as
immediately concerning as valvular damage.
7. A client with peripheral artery disease reports leg pain when walking that resolves with rest. The
nurse documents this as:
A. Rest pain
B. Intermittent claudication
C. Venous stasis pain
D. Neuropathic pain
Correct: B
Rationale: Intermittent claudication is ischemic muscle pain that occurs with exercise and is relieved by
rest. It is the hallmark symptom of PAD. Rest pain occurs at rest and indicates more severe arterial
disease. Venous stasis pain is typically an aching sensation that improves with elevation. Neuropathic
pain is associated with nerve damage and presents with burning or tingling.
8. Which intervention should the nurse include in the plan of care for a client with PAD?
A. Elevate the legs above heart level
B. Apply heat to the affected extremity
C. Encourage walking until pain occurs, rest, then resume
D. Keep the legs in a dependent position only
Correct: C
Rationale: Structured walking exercise (walk until pain occurs, rest, then resume) improves collateral
circulation and walking distance in PAD. Elevating the legs above heart level worsens arterial perfusion.
Heat application can cause burns due to decreased sensation and should be avoided. Keeping the legs
dependent may provide comfort but does not promote collateral circulation.
9. A client receiving a blood transfusion develops hypotension, flushing, and back pain. Which is the
nurse's priority action?
A. Stop the transfusion
B. Slow the infusion rate
C. Administer antihistamine
D. Notify the healthcare provider
Correct: A
Rationale: These symptoms indicate an acute hemolytic transfusion reaction, typically caused by ABO
incompatibility. The immediate priority is to stop the transfusion to prevent further exposure to the
incompatible blood. The nurse should disconnect the blood tubing but keep the IV line open with
normal saline, notify the provider, and prepare to administer emergency medications. Slowing the
infusion is incorrect because the transfusion must be stopped entirely.
, 10. A patient with a history of MI is prescribed beta-blockers. What is the therapeutic effect?
A. Increase heart rate
B. Reduce myocardial oxygen demand
C. Promote vasodilation
D. Increase cardiac output
Correct: B
Rationale: Beta-blockers reduce heart rate and contractility, lowering myocardial oxygen demand and
preventing further ischemia. They do not increase heart rate or cardiac output. While some beta-
blockers have vasodilatory properties, the primary therapeutic effect post-MI is reduction of oxygen
demand.
11. A client with a DVT is prescribed warfarin. Which laboratory value should be monitored?
A. aPTT
B. INR
C. Platelets
D. Hemoglobin
Correct: B
Rationale: The INR monitors warfarin therapy, with a typical therapeutic range of 2 to 3 for most
indications. aPTT monitors unfractionated heparin. Platelets are monitored for heparin-induced
thrombocytopenia, and hemoglobin assesses for bleeding.
12. A patient with heart failure reports weight gain of 3 kg in 2 days. What should the nurse do first?
A. Assess for peripheral edema
B. Notify the provider
C. Review dietary sodium intake
D. Auscultate lung sounds
Correct: D
Rationale: Sudden weight gain suggests fluid retention and possible pulmonary congestion. Auscultating
lung sounds is the priority because it detects crackles or pulmonary edema, which indicates
decompensated heart failure and requires immediate intervention. Other assessments and
interventions follow.
13. Which symptom is expected in a patient with hypothyroidism?
A. Tachycardia
B. Diarrhea
C. Cold intolerance
D. Weight loss
