HESI MEDICAL-SURGICAL NURSING
TEST BANK 2026/2027: COMPLETE WITH
VERIFIED ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 68-year-old with crushing substernal chest pain radiating to the left arm is admitted. Vital
signs: BP 88/50, HR 112, RR 26, SpO₂ 89%. Which action should the nurse take FIRST?
A. Obtain a stat 12-lead ECG.
B. Administer oxygen 4 L/min via nasal cannula.
C. Draw blood for cardiac enzymes & lactate.
D. Give sublingual nitroglycerin 0.4 mg.
Correct Answer: B
Rationale: The patient is hypoxemic (SpO₂ 89%) and hypotensive—oxygen is the immediate
priority to improve myocardial oxygenation. ECG (A) is next, but hypoxemia must be corrected
first. Labs (C) are important but not emergent before oxygen. Nitroglycerin (D) is
contraindicated with systolic BP <90 mmHg because it worsens hypotension and reduces
coronary perfusion.
Q2: Four days after coronary artery bypass graft (CABG), a client’s temperature spikes to 38.9
°C (102 °F) and chest-tube drainage is suddenly 20 mL/h less than the previous 4 h. What is the
nurse’s priority action?
A. Increase oral fluid intake.
B. Milk the chest tube toward the collection chamber.
C. Administer acetaminophen 650 mg PO.
D. Obtain stat chest x-ray.
Correct Answer: B
Rationale: Decreased output plus fever suggests chest-tube occlusion; milking prevents clot
obstruction and cardiac tamponade risk. Increasing fluids (A) does not address the occlusive
problem. Acetaminophen (C) treats symptom, not cause. Chest x-ray (D) is useful but only after
ensuring tube patency.
Q3: A client with HF is receiving digoxin 0.25 mg PO daily and furosemide 40 mg IV BID.
Which serum finding warrants immediate intervention?
A. Potassium 3.1 mEq/L
B. Creatinine 1.3 mg/dL
C. BNP 450 pg/mL
D. Sodium 138 mEq/L
Correct Answer: A
Rationale: Hypokalemia increases digoxin toxicity risk (ventricular ectopy). Normal K 3.5–5.0
mEq/L; 3.1 is dangerously low. Creatinine 1.3 (B) is mildly elevated but not emergent. BNP 450
,(C) confirms HF but is not an immediate safety issue. Sodium 138 (D) is normal.
Q4: A patient with DVT is started on enoxaparin 1 mg/kg subcutaneous q12h. Two hours after
the first dose, the patient reports sudden severe back pain and hypotension (BP 74/48). Which
action is most appropriate?
A. Apply warm compresses to the back.
B. Administer protamine sulfate per protocol.
C. Increase the rate of the maintenance IV fluids.
D. Hold the next enoxaparin dose and notify provider.
Correct Answer: B
Rationale: Sudden back pain plus shock suggests retroperitoneal hemorrhage; protamine reverses
enoxaparin’s anticoagulant effect. Warm compresses (A) are contraindicated with active
bleeding. IV fluids (C) support perfusion but do not stop bleeding. Holding the next dose (D) is
insufficient for life-threatening hemorrhage.
Q5: The nurse is caring for a client with microcytic anemia (Hb 8.2 g/dL). Which dietary
selection best supports the prescribed iron replacement?
A. Spinach salad with strawberries and iced tea
B. Oatmeal with milk and orange slices
C. Whole-grain toast with jelly and coffee
D. Cheese omelet with tomatoes and water
Correct Answer: B
Rationale: Non-heme iron in oatmeal is enhanced by vitamin C in oranges; milk calcium is
modest and does not significantly inhibit absorption. Spinach (A) contains oxalates that bind
iron, and tea polyphenols inhibit absorption. Coffee (C) and calcium-rich cheese (D) reduce iron
uptake.
Q6: A client in hypovolemic shock has a BP 72/50 and HR 130. Current order: infuse 1 L 0.9%
saline wide open. After 30 min, 600 mL has infused and BP is 80/54. What should the nurse do?
A. Slow the infusion to 125 mL/h to avoid fluid overload.
B. Continue rapid infusion and prepare to give packed RBCs.
C. Administer IV furosemide to prevent pulmonary edema.
D. Change fluid to D5W to supply free water.
Correct Answer: B
Rationale: Blood pressure remains low after partial response—ongoing hemorrhage or severe
fluid loss is likely; continue isotonic crystalloid and prepare blood products. Slowing (A) risks
irreversible shock. Diuretics (C) are contraindicated. D5W (D) is hypotonic and redistributes
intracellularly, worsening hypotension.
Q7: Post-MI client develops ventricular tachycardia at 160 bpm, BP 86/50, and is alert. Which
medication is the priority?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV over 10 min
C. Atropine 0.5 mg IV
, D. Digoxin 0.25 mg IV
Correct Answer: B
Rationale: Amiodarone is first-line for stable monomorphic VT with hypotension. Adenosine (A)
is for supraventricular rhythms. Atropine (C) treats bradycardia. Digoxin (D) is not used for
acute VT.
Q8: A client with aortic stenosis reports syncope on exertion. Which assessment finding
indicates worsening obstruction?
A. Apical holosystolic murmur radiating to axilla
B. Decreased carotid upstroke amplitude
C. Bibasilar crackles
D. Jugular venous distension 4 cm above sternal angle
Correct Answer: B
Rationale: Diminished carotid pulse amplitude reflects reduced cardiac output across the stenotic
valve. Holosystolic murmur (A) suggests mitral regurgitation. Crackles (C) and JVD (D) indicate
left-sided or biventricular HF but are less specific for severity of obstruction.
Q9: The nurse is teaching a client with hypertension who has a new prescription for lisinopril.
Which statement indicates understanding?
A. “I will rise slowly from lying down.”
B. “I should take the pill with grapefruit juice.”
C. “I will stop the drug if I develop a dry cough.”
D. “I’ll use salt substitutes high in potassium.”
Correct Answer: A
Rationale: First-dose orthostatic hypotension is common; rising slowly prevents falls. Grapefruit
(B) does not affect ACE inhibitors. Dry cough (C) is common but patient must consult provider
before stopping. Salt substitutes (D) increase hyperkalemia risk with ACE inhibitor.
Q10: A client with pernicious anemia receives cyanocobalamin 1000 mcg IM. Which laboratory
result best demonstrates effective therapy after one week?
A. Reticulocyte count 2.8% (up from 0.4%)
B. Serum ferritin 450 ng/mL
C. Platelet count 90000/µL
D. Serum potassium 5.4 mEq/L
Correct Answer: A
Rationale: Reticulocyte surge (retic response) occurs 3–5 days after effective B12 replacement,
indicating new RBC production. Ferritin (B) reflects iron stores, unrelated. Platelet count (C)
may rise but is not the earliest indicator. Potassium (D) may drop (not rise) due to increased RBC
uptake—hypokalemia is monitored.
Q11: A patient with chronic HF is started on sacubitril/valsartan. Prior to the first dose, which
finding requires intervention?
A. Serum potassium 4.8 mEq/L
B. Systolic BP 98 mmHg
TEST BANK 2026/2027: COMPLETE WITH
VERIFIED ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 68-year-old with crushing substernal chest pain radiating to the left arm is admitted. Vital
signs: BP 88/50, HR 112, RR 26, SpO₂ 89%. Which action should the nurse take FIRST?
A. Obtain a stat 12-lead ECG.
B. Administer oxygen 4 L/min via nasal cannula.
C. Draw blood for cardiac enzymes & lactate.
D. Give sublingual nitroglycerin 0.4 mg.
Correct Answer: B
Rationale: The patient is hypoxemic (SpO₂ 89%) and hypotensive—oxygen is the immediate
priority to improve myocardial oxygenation. ECG (A) is next, but hypoxemia must be corrected
first. Labs (C) are important but not emergent before oxygen. Nitroglycerin (D) is
contraindicated with systolic BP <90 mmHg because it worsens hypotension and reduces
coronary perfusion.
Q2: Four days after coronary artery bypass graft (CABG), a client’s temperature spikes to 38.9
°C (102 °F) and chest-tube drainage is suddenly 20 mL/h less than the previous 4 h. What is the
nurse’s priority action?
A. Increase oral fluid intake.
B. Milk the chest tube toward the collection chamber.
C. Administer acetaminophen 650 mg PO.
D. Obtain stat chest x-ray.
Correct Answer: B
Rationale: Decreased output plus fever suggests chest-tube occlusion; milking prevents clot
obstruction and cardiac tamponade risk. Increasing fluids (A) does not address the occlusive
problem. Acetaminophen (C) treats symptom, not cause. Chest x-ray (D) is useful but only after
ensuring tube patency.
Q3: A client with HF is receiving digoxin 0.25 mg PO daily and furosemide 40 mg IV BID.
Which serum finding warrants immediate intervention?
A. Potassium 3.1 mEq/L
B. Creatinine 1.3 mg/dL
C. BNP 450 pg/mL
D. Sodium 138 mEq/L
Correct Answer: A
Rationale: Hypokalemia increases digoxin toxicity risk (ventricular ectopy). Normal K 3.5–5.0
mEq/L; 3.1 is dangerously low. Creatinine 1.3 (B) is mildly elevated but not emergent. BNP 450
,(C) confirms HF but is not an immediate safety issue. Sodium 138 (D) is normal.
Q4: A patient with DVT is started on enoxaparin 1 mg/kg subcutaneous q12h. Two hours after
the first dose, the patient reports sudden severe back pain and hypotension (BP 74/48). Which
action is most appropriate?
A. Apply warm compresses to the back.
B. Administer protamine sulfate per protocol.
C. Increase the rate of the maintenance IV fluids.
D. Hold the next enoxaparin dose and notify provider.
Correct Answer: B
Rationale: Sudden back pain plus shock suggests retroperitoneal hemorrhage; protamine reverses
enoxaparin’s anticoagulant effect. Warm compresses (A) are contraindicated with active
bleeding. IV fluids (C) support perfusion but do not stop bleeding. Holding the next dose (D) is
insufficient for life-threatening hemorrhage.
Q5: The nurse is caring for a client with microcytic anemia (Hb 8.2 g/dL). Which dietary
selection best supports the prescribed iron replacement?
A. Spinach salad with strawberries and iced tea
B. Oatmeal with milk and orange slices
C. Whole-grain toast with jelly and coffee
D. Cheese omelet with tomatoes and water
Correct Answer: B
Rationale: Non-heme iron in oatmeal is enhanced by vitamin C in oranges; milk calcium is
modest and does not significantly inhibit absorption. Spinach (A) contains oxalates that bind
iron, and tea polyphenols inhibit absorption. Coffee (C) and calcium-rich cheese (D) reduce iron
uptake.
Q6: A client in hypovolemic shock has a BP 72/50 and HR 130. Current order: infuse 1 L 0.9%
saline wide open. After 30 min, 600 mL has infused and BP is 80/54. What should the nurse do?
A. Slow the infusion to 125 mL/h to avoid fluid overload.
B. Continue rapid infusion and prepare to give packed RBCs.
C. Administer IV furosemide to prevent pulmonary edema.
D. Change fluid to D5W to supply free water.
Correct Answer: B
Rationale: Blood pressure remains low after partial response—ongoing hemorrhage or severe
fluid loss is likely; continue isotonic crystalloid and prepare blood products. Slowing (A) risks
irreversible shock. Diuretics (C) are contraindicated. D5W (D) is hypotonic and redistributes
intracellularly, worsening hypotension.
Q7: Post-MI client develops ventricular tachycardia at 160 bpm, BP 86/50, and is alert. Which
medication is the priority?
A. Adenosine 6 mg rapid IV push
B. Amiodarone 150 mg IV over 10 min
C. Atropine 0.5 mg IV
, D. Digoxin 0.25 mg IV
Correct Answer: B
Rationale: Amiodarone is first-line for stable monomorphic VT with hypotension. Adenosine (A)
is for supraventricular rhythms. Atropine (C) treats bradycardia. Digoxin (D) is not used for
acute VT.
Q8: A client with aortic stenosis reports syncope on exertion. Which assessment finding
indicates worsening obstruction?
A. Apical holosystolic murmur radiating to axilla
B. Decreased carotid upstroke amplitude
C. Bibasilar crackles
D. Jugular venous distension 4 cm above sternal angle
Correct Answer: B
Rationale: Diminished carotid pulse amplitude reflects reduced cardiac output across the stenotic
valve. Holosystolic murmur (A) suggests mitral regurgitation. Crackles (C) and JVD (D) indicate
left-sided or biventricular HF but are less specific for severity of obstruction.
Q9: The nurse is teaching a client with hypertension who has a new prescription for lisinopril.
Which statement indicates understanding?
A. “I will rise slowly from lying down.”
B. “I should take the pill with grapefruit juice.”
C. “I will stop the drug if I develop a dry cough.”
D. “I’ll use salt substitutes high in potassium.”
Correct Answer: A
Rationale: First-dose orthostatic hypotension is common; rising slowly prevents falls. Grapefruit
(B) does not affect ACE inhibitors. Dry cough (C) is common but patient must consult provider
before stopping. Salt substitutes (D) increase hyperkalemia risk with ACE inhibitor.
Q10: A client with pernicious anemia receives cyanocobalamin 1000 mcg IM. Which laboratory
result best demonstrates effective therapy after one week?
A. Reticulocyte count 2.8% (up from 0.4%)
B. Serum ferritin 450 ng/mL
C. Platelet count 90000/µL
D. Serum potassium 5.4 mEq/L
Correct Answer: A
Rationale: Reticulocyte surge (retic response) occurs 3–5 days after effective B12 replacement,
indicating new RBC production. Ferritin (B) reflects iron stores, unrelated. Platelet count (C)
may rise but is not the earliest indicator. Potassium (D) may drop (not rise) due to increased RBC
uptake—hypokalemia is monitored.
Q11: A patient with chronic HF is started on sacubitril/valsartan. Prior to the first dose, which
finding requires intervention?
A. Serum potassium 4.8 mEq/L
B. Systolic BP 98 mmHg
