Updated HESI RN Medical-Surgical Med-Surg
2026 with NGN Questions and Answers
Cardiovascular System
1. A client on telemetry has a pattern of uncontrolled atrial fibrillation
with a rapid ventricular response. Based on this finding, the nurse
anticipates assisting the physician with which treatment?
• A) Administering adenosine
• B) Performing synchronized cardioversion
• C) Starting an amiodarone drip
• D) Preparing for a pacemaker insertion
Answer: B) Performing synchronized cardioversion
Rationale: Uncontrolled atrial fibrillation with a rapid ventricular
response can cause hemodynamic instability. Synchronized
cardioversion is the treatment of choice to restore a normal sinus
rhythm in a client who is unstable .
2. A client with a history of myocardial infarction reports chest pain.
What should the nurse do first?
• A) Administer nitroglycerin sublingually
• B) Obtain a 12-lead ECG
• C) Auscultate heart sounds
• D) Check vital signs
,Answer: B) Obtain a 12-lead ECG
Rationale: A 12-lead ECG is the priority to identify ischemic changes
and guide immediate treatment. While pain management and vital
signs are important, the ECG provides critical diagnostic information for
a client with known coronary artery disease .
3. A client with a history of atrial fibrillation is receiving warfarin.
Which laboratory value should the nurse monitor?
• A) Platelet count
• B) INR
• C) aPTT
• D) Hemoglobin
Answer: B) INR
Rationale: Warfarin therapy is monitored using the International
Normalized Ratio (INR), with a therapeutic target typically between 2.0
and 3.0 for atrial fibrillation. Monitoring INR is essential to balance the
risk of thrombosis (if too low) and bleeding (if too high) .
4. A client who underwent cardiac stent placement 4 days ago arrives
to the emergency department reporting sudden onset of chest
pressure and shortness of breath. Which action should the nurse take
next?
• A) Listen for extra heart sounds, murmurs, and rhythm with the
bell of the stethoscope
• B) Evaluate upper and lower extremities for perfusion, pulse
volume, and pitting edema
• C) Obtain a 12-lead electrocardiogram (ECG) and begin continuous
cardiac monitoring
, • D) Prepare the client for immediate cardiac catheterization
Answer: C) Obtain a 12-lead electrocardiogram (ECG) and begin
continuous cardiac monitoring
Rationale: A client with sudden chest pressure and shortness of breath
after recent stenting is at high risk for acute stent thrombosis or
myocardial infarction (MI). Immediate acquisition of a 12-lead ECG is
critical to assess for ischemic changes and to prioritize timely
reperfusion therapy if needed. Continuous cardiac monitoring is
essential to detect life-threatening arrhythmias .
5. A client presents with chest pain radiating to the left arm, shortness
of breath, and diaphoresis. Which medication should the nurse
anticipate being prescribed?
• A) Fentanyl
• B) Hydromorphone
• C) Oxycodone
• D) Morphine
Answer: D) Morphine
Rationale: Morphine is the opioid of choice for chest pain in suspected
MI because it reduces preload and afterload, decreases myocardial
oxygen demand, and alleviates pain and anxiety .
6. A client with peripheral vascular disease (PVD) of the lower
extremities tells the nurse, "I've really tried to manage my condition
well." Which routine should the nurse evaluate as having been
appropriate for this client?
• A) Resting with the legs elevated above the level of the heart
• B) Walking slowly but steadily for 30 minutes twice a day
, • C) Minimizing activity
• D) Wearing antiembolism stockings at all times when out of bed
Answer: B) Walking slowly but steadily for 30 minutes twice a day
Rationale: Slow, steady walking is a recommended activity for clients
with peripheral vascular disease because it stimulates the development
of collateral circulation. The client with PVD should not remain inactive.
Elevating the legs above the heart or wearing antiembolism stockings is
a strategy for alleviating venous congestion and may worsen peripheral
arterial disease .
7. A client is scheduled to have an arteriogram. During the
arteriogram, the client reports having nausea, tingling, and dyspnea.
The nurse's immediate action should be to:
• A) Administer epinephrine
• B) Inform the physician
• C) Administer oxygen
• D) Inform the client that the procedure is almost over
Answer: B) Inform the physician
Rationale: Clients may have an immediate or delayed reaction to the
radiopaque dye. The physician should be notified immediately because
the symptoms suggest an allergic reaction, possibly anaphylaxis.
Treatment may involve administering oxygen and epinephrine .
8. The nurse is assessing a 75-year-old client for symptoms of
hyperglycemia. Which symptom of hyperglycemia is an older adult
most likely to exhibit?
• A) Polyuria
• B) Polydipsia
2026 with NGN Questions and Answers
Cardiovascular System
1. A client on telemetry has a pattern of uncontrolled atrial fibrillation
with a rapid ventricular response. Based on this finding, the nurse
anticipates assisting the physician with which treatment?
• A) Administering adenosine
• B) Performing synchronized cardioversion
• C) Starting an amiodarone drip
• D) Preparing for a pacemaker insertion
Answer: B) Performing synchronized cardioversion
Rationale: Uncontrolled atrial fibrillation with a rapid ventricular
response can cause hemodynamic instability. Synchronized
cardioversion is the treatment of choice to restore a normal sinus
rhythm in a client who is unstable .
2. A client with a history of myocardial infarction reports chest pain.
What should the nurse do first?
• A) Administer nitroglycerin sublingually
• B) Obtain a 12-lead ECG
• C) Auscultate heart sounds
• D) Check vital signs
,Answer: B) Obtain a 12-lead ECG
Rationale: A 12-lead ECG is the priority to identify ischemic changes
and guide immediate treatment. While pain management and vital
signs are important, the ECG provides critical diagnostic information for
a client with known coronary artery disease .
3. A client with a history of atrial fibrillation is receiving warfarin.
Which laboratory value should the nurse monitor?
• A) Platelet count
• B) INR
• C) aPTT
• D) Hemoglobin
Answer: B) INR
Rationale: Warfarin therapy is monitored using the International
Normalized Ratio (INR), with a therapeutic target typically between 2.0
and 3.0 for atrial fibrillation. Monitoring INR is essential to balance the
risk of thrombosis (if too low) and bleeding (if too high) .
4. A client who underwent cardiac stent placement 4 days ago arrives
to the emergency department reporting sudden onset of chest
pressure and shortness of breath. Which action should the nurse take
next?
• A) Listen for extra heart sounds, murmurs, and rhythm with the
bell of the stethoscope
• B) Evaluate upper and lower extremities for perfusion, pulse
volume, and pitting edema
• C) Obtain a 12-lead electrocardiogram (ECG) and begin continuous
cardiac monitoring
, • D) Prepare the client for immediate cardiac catheterization
Answer: C) Obtain a 12-lead electrocardiogram (ECG) and begin
continuous cardiac monitoring
Rationale: A client with sudden chest pressure and shortness of breath
after recent stenting is at high risk for acute stent thrombosis or
myocardial infarction (MI). Immediate acquisition of a 12-lead ECG is
critical to assess for ischemic changes and to prioritize timely
reperfusion therapy if needed. Continuous cardiac monitoring is
essential to detect life-threatening arrhythmias .
5. A client presents with chest pain radiating to the left arm, shortness
of breath, and diaphoresis. Which medication should the nurse
anticipate being prescribed?
• A) Fentanyl
• B) Hydromorphone
• C) Oxycodone
• D) Morphine
Answer: D) Morphine
Rationale: Morphine is the opioid of choice for chest pain in suspected
MI because it reduces preload and afterload, decreases myocardial
oxygen demand, and alleviates pain and anxiety .
6. A client with peripheral vascular disease (PVD) of the lower
extremities tells the nurse, "I've really tried to manage my condition
well." Which routine should the nurse evaluate as having been
appropriate for this client?
• A) Resting with the legs elevated above the level of the heart
• B) Walking slowly but steadily for 30 minutes twice a day
, • C) Minimizing activity
• D) Wearing antiembolism stockings at all times when out of bed
Answer: B) Walking slowly but steadily for 30 minutes twice a day
Rationale: Slow, steady walking is a recommended activity for clients
with peripheral vascular disease because it stimulates the development
of collateral circulation. The client with PVD should not remain inactive.
Elevating the legs above the heart or wearing antiembolism stockings is
a strategy for alleviating venous congestion and may worsen peripheral
arterial disease .
7. A client is scheduled to have an arteriogram. During the
arteriogram, the client reports having nausea, tingling, and dyspnea.
The nurse's immediate action should be to:
• A) Administer epinephrine
• B) Inform the physician
• C) Administer oxygen
• D) Inform the client that the procedure is almost over
Answer: B) Inform the physician
Rationale: Clients may have an immediate or delayed reaction to the
radiopaque dye. The physician should be notified immediately because
the symptoms suggest an allergic reaction, possibly anaphylaxis.
Treatment may involve administering oxygen and epinephrine .
8. The nurse is assessing a 75-year-old client for symptoms of
hyperglycemia. Which symptom of hyperglycemia is an older adult
most likely to exhibit?
• A) Polyuria
• B) Polydipsia
