MED-SURG HESI FINAL 2026 COMPREHENSIVE
STUDY REVIEW | FULL PRACTICE FRAMEWORK
& LEARNING CONCEPTS || NEW VERSION
Section 1: Cardiovascular & Hematology (20 Questions)
1. A client with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance is
the priority for the nurse to monitor?
A. Hypokalemia
B. Hypernatremia
C. Hypercalcemia
D. Hypomagnesemia
2. The nurse is caring for a client with an acute myocardial infarction (MI) who is receiving tissue
plasminogen activator (tPA). Which assessment finding requires immediate intervention?
A. Blood pressure 138/86
B. Reports of mild headache
C. Sudden, severe headache with nausea
D. Occasional premature ventricular contractions (PVCs)
3. A client with atrial fibrillation has a CHA₂DS₂-VASc score of 4. The nurse anticipates the
administration of which medication for stroke prevention?
A. Aspirin
B. Warfarin (Coumadin)
C. Heparin IV drip
D. Clopidogrel (Plavix)
4. Which finding in a client with a deep vein thrombosis (DVT) in the left leg indicates a potential
pulmonary embolism (PE)?
A. Pitting edema of the left ankle
B. Sudden onset of dyspnea and pleuritic chest pain
C. Calf warmth and redness
D. Homans' sign
5. A client with aortic stenosis reports episodes of dizziness and syncope. The nurse
understands this is primarily due to:
A. Fluid volume overload
,B. Fixed cardiac output unable to meet demand
C. Ventricular dysrhythmias
D. Pulmonary hypertension
6. Post-operative teaching for a client with a mechanical heart valve replacement should
emphasize:
A. The need for annual valve replacements.
B. Lifelong anticoagulation therapy.
C. Restricting all physical activity.
D. A sodium-restricted diet indefinitely.
7. When assessing a client with suspected pericarditis, the nurse expects to hear which classic
finding upon auscultation?
A. A loud S3 gallop
B. A pericardial friction rub
C. Crackles in the lung bases
D. Harsh systolic murmur
8. The nurse is administering a blood transfusion. Within 15 minutes of initiation, the client
develops chills, flushing, and low back pain. The nurse's first action is to:
A. Slow the transfusion rate and monitor.
B. Administer prescribed antihistamines.
C. Stop the transfusion immediately and keep the line open with normal saline.
D. Check the client's identification band against the blood bag.
9. For a client with iron deficiency anemia, which instruction is most important?
A. "Drink orange juice with your iron supplement."
B. "Take the iron tablet with milk to avoid nausea."
C. "Limit green leafy vegetables in your diet."
D. "Your stools will be a clay color."
10. A client with sickle cell anemia is admitted with vaso-occlusive crisis. The priority nursing
intervention is:
A. Aggressive hydration and pain management.
B. Administering high-dose iron supplements.
C. Applying warm compresses to swollen joints.
D. Placing in protective isolation.
11. The nurse is reviewing telemetry and sees a pattern of a normal P wave, a PR interval that
progressively lengthens, then a dropped QRS complex. This is documented as:
,A. Atrial Fibrillation
B. Second-Degree Heart Block, Type I (Wenckebach)
C. Third-Degree Heart Block
D. Ventricular Tachycardia
12. A client with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse should teach
the client to report which potential side effect immediately?
A. Dry cough
B. Swelling of the lips or tongue (angioedema)
C. Frequent urination
D. Headache
13. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
B. Jugular venous distension (JVD) and peripheral edema
C. Orthopnea and paroxysmal nocturnal dyspnea
D. S3 heart sound
14. A client with a permanent pacemaker is scheduled for an MRI. The nurse should:
A. Proceed as normal; pacemakers are MRI-safe.
B. Notify the radiology team and physician immediately; MRI is typically
contraindicated.
C. Ensure the pacemaker is set to asynchronous mode.
D. Apply a magnet over the pacemaker generator.
15. The therapeutic effect of heparin is best monitored by which laboratory value?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
16. In which location would a myocardial infarction (MI) most likely present with ST-
segment depression on ECG?
A. Anterior wall
B. Inferior wall
C. Subendocardial (Non-ST Elevation MI - NSTEMI)
D. Lateral wall
17. A client with chronic arterial insufficiency of the lower extremities should be instructed to:
A. Keep legs in a dependent position to improve perfusion.
, B. Soak feet in hot water daily.
C. Wear tight-fitting socks for support.
D. Apply moisturizer between the toes.
18. After cardiac catheterization via the right femoral artery, it is essential for the nurse to:
A. Keep the client's head of bed elevated to 60 degrees.
B. Assess the insertion site for hematoma and the distal pulse, color, and temperature.
C. Encourage immediate ambulation to prevent stiffness.
D. Remove the pressure dressing after 2 hours.
19. A client with disseminated intravascular coagulation (DIC) has oozing from IV sites and
petechiae. Which lab result would the nurse anticipate?
A. Elevated D-dimer and decreased fibrinogen
B. Increased platelets and hemoglobin
C. Decreased PT and aPTT
D. Elevated hematocrit
20. The primary goal of administering beta-blockers (e.g., metoprolol) to a client after an MI is
to:
A. Reduce preload.
B. Decrease myocardial oxygen demand and prevent dysrhythmias.
C. Increase contractility.
D. Dilate coronary arteries.
Section 2: Respiratory (15 Questions)
21. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 5 L/min
via nasal cannula. The nurse assesses increased somnolence and a decreased respiratory rate.
The nurse suspects:
A. Improved oxygenation.
B. Oxygen-induced hypoventilation (CO2 narcosis).
C. Pneumothorax.
D. Anxiety attack.
22. The nurse is preparing to suction a client with a tracheostomy. The correct procedure
includes:
A. Applying suction during insertion of the catheter.
B. Using sterile technique and limiting suction time to 10-15 seconds.
STUDY REVIEW | FULL PRACTICE FRAMEWORK
& LEARNING CONCEPTS || NEW VERSION
Section 1: Cardiovascular & Hematology (20 Questions)
1. A client with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance is
the priority for the nurse to monitor?
A. Hypokalemia
B. Hypernatremia
C. Hypercalcemia
D. Hypomagnesemia
2. The nurse is caring for a client with an acute myocardial infarction (MI) who is receiving tissue
plasminogen activator (tPA). Which assessment finding requires immediate intervention?
A. Blood pressure 138/86
B. Reports of mild headache
C. Sudden, severe headache with nausea
D. Occasional premature ventricular contractions (PVCs)
3. A client with atrial fibrillation has a CHA₂DS₂-VASc score of 4. The nurse anticipates the
administration of which medication for stroke prevention?
A. Aspirin
B. Warfarin (Coumadin)
C. Heparin IV drip
D. Clopidogrel (Plavix)
4. Which finding in a client with a deep vein thrombosis (DVT) in the left leg indicates a potential
pulmonary embolism (PE)?
A. Pitting edema of the left ankle
B. Sudden onset of dyspnea and pleuritic chest pain
C. Calf warmth and redness
D. Homans' sign
5. A client with aortic stenosis reports episodes of dizziness and syncope. The nurse
understands this is primarily due to:
A. Fluid volume overload
,B. Fixed cardiac output unable to meet demand
C. Ventricular dysrhythmias
D. Pulmonary hypertension
6. Post-operative teaching for a client with a mechanical heart valve replacement should
emphasize:
A. The need for annual valve replacements.
B. Lifelong anticoagulation therapy.
C. Restricting all physical activity.
D. A sodium-restricted diet indefinitely.
7. When assessing a client with suspected pericarditis, the nurse expects to hear which classic
finding upon auscultation?
A. A loud S3 gallop
B. A pericardial friction rub
C. Crackles in the lung bases
D. Harsh systolic murmur
8. The nurse is administering a blood transfusion. Within 15 minutes of initiation, the client
develops chills, flushing, and low back pain. The nurse's first action is to:
A. Slow the transfusion rate and monitor.
B. Administer prescribed antihistamines.
C. Stop the transfusion immediately and keep the line open with normal saline.
D. Check the client's identification band against the blood bag.
9. For a client with iron deficiency anemia, which instruction is most important?
A. "Drink orange juice with your iron supplement."
B. "Take the iron tablet with milk to avoid nausea."
C. "Limit green leafy vegetables in your diet."
D. "Your stools will be a clay color."
10. A client with sickle cell anemia is admitted with vaso-occlusive crisis. The priority nursing
intervention is:
A. Aggressive hydration and pain management.
B. Administering high-dose iron supplements.
C. Applying warm compresses to swollen joints.
D. Placing in protective isolation.
11. The nurse is reviewing telemetry and sees a pattern of a normal P wave, a PR interval that
progressively lengthens, then a dropped QRS complex. This is documented as:
,A. Atrial Fibrillation
B. Second-Degree Heart Block, Type I (Wenckebach)
C. Third-Degree Heart Block
D. Ventricular Tachycardia
12. A client with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse should teach
the client to report which potential side effect immediately?
A. Dry cough
B. Swelling of the lips or tongue (angioedema)
C. Frequent urination
D. Headache
13. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
B. Jugular venous distension (JVD) and peripheral edema
C. Orthopnea and paroxysmal nocturnal dyspnea
D. S3 heart sound
14. A client with a permanent pacemaker is scheduled for an MRI. The nurse should:
A. Proceed as normal; pacemakers are MRI-safe.
B. Notify the radiology team and physician immediately; MRI is typically
contraindicated.
C. Ensure the pacemaker is set to asynchronous mode.
D. Apply a magnet over the pacemaker generator.
15. The therapeutic effect of heparin is best monitored by which laboratory value?
A. Prothrombin Time (PT)
B. Activated Partial Thromboplastin Time (aPTT)
C. International Normalized Ratio (INR)
D. Platelet count
16. In which location would a myocardial infarction (MI) most likely present with ST-
segment depression on ECG?
A. Anterior wall
B. Inferior wall
C. Subendocardial (Non-ST Elevation MI - NSTEMI)
D. Lateral wall
17. A client with chronic arterial insufficiency of the lower extremities should be instructed to:
A. Keep legs in a dependent position to improve perfusion.
, B. Soak feet in hot water daily.
C. Wear tight-fitting socks for support.
D. Apply moisturizer between the toes.
18. After cardiac catheterization via the right femoral artery, it is essential for the nurse to:
A. Keep the client's head of bed elevated to 60 degrees.
B. Assess the insertion site for hematoma and the distal pulse, color, and temperature.
C. Encourage immediate ambulation to prevent stiffness.
D. Remove the pressure dressing after 2 hours.
19. A client with disseminated intravascular coagulation (DIC) has oozing from IV sites and
petechiae. Which lab result would the nurse anticipate?
A. Elevated D-dimer and decreased fibrinogen
B. Increased platelets and hemoglobin
C. Decreased PT and aPTT
D. Elevated hematocrit
20. The primary goal of administering beta-blockers (e.g., metoprolol) to a client after an MI is
to:
A. Reduce preload.
B. Decrease myocardial oxygen demand and prevent dysrhythmias.
C. Increase contractility.
D. Dilate coronary arteries.
Section 2: Respiratory (15 Questions)
21. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 5 L/min
via nasal cannula. The nurse assesses increased somnolence and a decreased respiratory rate.
The nurse suspects:
A. Improved oxygenation.
B. Oxygen-induced hypoventilation (CO2 narcosis).
C. Pneumothorax.
D. Anxiety attack.
22. The nurse is preparing to suction a client with a tracheostomy. The correct procedure
includes:
A. Applying suction during insertion of the catheter.
B. Using sterile technique and limiting suction time to 10-15 seconds.
