HESI RN MED SURG EXAM PACK– 2026
PRACTICE QUESTIONS WITH ANSWERS &
RATIONALES
Questions 1-20: Cardiovascular & Respiratory
1. A client with heart failure is prescribed furosemide
(Lasix) 40 mg IV push. Which assessment finding indicates
the medication is having the desired effect?
A. Increased jugular venous distention
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid
volume overload in heart failure. The desired effect is a
reduction in extracellular fluid, evidenced by decreased
peripheral edema, decreased jugular venous distention, and
,increased urine output. While blood pressure may decrease
slightly, it is not the primary indicator of effectiveness.
2. A nurse is caring for a client who is 2 days post-
operative following a coronary artery bypass graft (CABG).
Which assessment finding is most concerning and requires
immediate intervention?
A. Serous drainage on the sternal wound dressing
B. Client reports incisional pain of 5 on a 0-10 scale
C. New onset of muffled heart sounds and jugular vein
distention
D. Heart rate of 92 bpm and blood pressure of 138/88 mmHg
Correct Answer: C
Rationale: New onset of muffled heart sounds (muffled heart
tones) and jugular vein distention (JVD) are classic signs of
cardiac tamponade, a life-threatening complication where
blood or fluid accumulates in the pericardial sac, compressing
the heart. This requires immediate intervention, such as a
pericardiocentesis. The other findings are expected or less
urgent.
3. A client with chronic obstructive pulmonary disease
(COPD) has an arterial blood gas (ABG) result showing: pH
7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
,B. Partially compensated respiratory acidosis
C. Fully compensated respiratory alkalosis
D. Partially compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis) and PaCO2 is high
(respiratory acidosis). The HCO3- is elevated, indicating the
kidneys are attempting to compensate by retaining
bicarbonate. Because the pH is still not within normal range
(7.35-7.45), the compensation is partial (not full).
4. A nurse is preparing to administer a sublingual
nitroglycerin tablet to a client experiencing chest pain.
Which client statement should the nurse address before
administering the medication?
A. "I am having a little bit of a headache."
B. "My chest pain is about a 7 out of 10."
C. "I took my sildenafil (Viagra) about 4 hours ago."
D. "I feel a little dizzy when I stand up."
Correct Answer: C
Rationale: Nitroglycerin and sildenafil are both vasodilators.
Concurrent use can cause severe, life-threatening
hypotension. This is a critical contraindication. The headache
and dizziness are common side effects of nitroglycerin. The
chest pain is the reason for administration.
, 5. The nurse is assessing a client with suspected left-
sided heart failure. Which finding is a classic
manifestation?
A. Jugular vein distention
B. Peripheral edema
C. Crackles (rales) in the lung bases
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure leads to a backup of blood
into the pulmonary circulation, causing pulmonary congestion.
This manifests as crackles (or rales) on auscultation, dyspnea,
and cough. JVD, peripheral edema, and hepatomegaly are signs
of right-sided heart failure.
6. A client is prescribed enoxaparin (Lovenox) 40 mg
subcutaneously daily after hip replacement surgery. Which
action is essential for the nurse to take?
A. Administer the medication in the deltoid muscle.
B. Rub the injection site gently after administration.
C. Administer the medication at a 90-degree angle in the
abdomen.
D. Massage the site vigorously to promote absorption.
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin
(LMWH) that must be given subcutaneously. The preferred
PRACTICE QUESTIONS WITH ANSWERS &
RATIONALES
Questions 1-20: Cardiovascular & Respiratory
1. A client with heart failure is prescribed furosemide
(Lasix) 40 mg IV push. Which assessment finding indicates
the medication is having the desired effect?
A. Increased jugular venous distention
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid
volume overload in heart failure. The desired effect is a
reduction in extracellular fluid, evidenced by decreased
peripheral edema, decreased jugular venous distention, and
,increased urine output. While blood pressure may decrease
slightly, it is not the primary indicator of effectiveness.
2. A nurse is caring for a client who is 2 days post-
operative following a coronary artery bypass graft (CABG).
Which assessment finding is most concerning and requires
immediate intervention?
A. Serous drainage on the sternal wound dressing
B. Client reports incisional pain of 5 on a 0-10 scale
C. New onset of muffled heart sounds and jugular vein
distention
D. Heart rate of 92 bpm and blood pressure of 138/88 mmHg
Correct Answer: C
Rationale: New onset of muffled heart sounds (muffled heart
tones) and jugular vein distention (JVD) are classic signs of
cardiac tamponade, a life-threatening complication where
blood or fluid accumulates in the pericardial sac, compressing
the heart. This requires immediate intervention, such as a
pericardiocentesis. The other findings are expected or less
urgent.
3. A client with chronic obstructive pulmonary disease
(COPD) has an arterial blood gas (ABG) result showing: pH
7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
,B. Partially compensated respiratory acidosis
C. Fully compensated respiratory alkalosis
D. Partially compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis) and PaCO2 is high
(respiratory acidosis). The HCO3- is elevated, indicating the
kidneys are attempting to compensate by retaining
bicarbonate. Because the pH is still not within normal range
(7.35-7.45), the compensation is partial (not full).
4. A nurse is preparing to administer a sublingual
nitroglycerin tablet to a client experiencing chest pain.
Which client statement should the nurse address before
administering the medication?
A. "I am having a little bit of a headache."
B. "My chest pain is about a 7 out of 10."
C. "I took my sildenafil (Viagra) about 4 hours ago."
D. "I feel a little dizzy when I stand up."
Correct Answer: C
Rationale: Nitroglycerin and sildenafil are both vasodilators.
Concurrent use can cause severe, life-threatening
hypotension. This is a critical contraindication. The headache
and dizziness are common side effects of nitroglycerin. The
chest pain is the reason for administration.
, 5. The nurse is assessing a client with suspected left-
sided heart failure. Which finding is a classic
manifestation?
A. Jugular vein distention
B. Peripheral edema
C. Crackles (rales) in the lung bases
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure leads to a backup of blood
into the pulmonary circulation, causing pulmonary congestion.
This manifests as crackles (or rales) on auscultation, dyspnea,
and cough. JVD, peripheral edema, and hepatomegaly are signs
of right-sided heart failure.
6. A client is prescribed enoxaparin (Lovenox) 40 mg
subcutaneously daily after hip replacement surgery. Which
action is essential for the nurse to take?
A. Administer the medication in the deltoid muscle.
B. Rub the injection site gently after administration.
C. Administer the medication at a 90-degree angle in the
abdomen.
D. Massage the site vigorously to promote absorption.
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin
(LMWH) that must be given subcutaneously. The preferred
