2026/2027 EVOLVE ELSEVIER
HESI MEDICAL-SURGICAL
NURSING EXAMINATION
Complete 200 Questions and Correct Detailed Answers
Verified Answers | Already Graded A+ | Brand New
Aligned with NCSBN Clinical Judgment Measurement Model (NGN)
Latest 2026/2027 Evolve Elsevier HESI Testing Standards
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Design: 75% Scenario-Based | 20% Direct Recall | 5% Critical Reasoning
1
,Section 1: Cardiovascular System and Peripheral Vascular Disorders (Questions 1-40)
Q1: A nurse is assessing a client with right-sided heart failure. Which of the following findings would the nurse
expect?
A. Dependent peripheral edema and jugular venous distention
B. Pulmonary crackles and S3 gallop on auscultation
C. Dry cough and orthopnea [CORRECT]
D. Chest pain relieved by nitroglycerin
Correct Answer: C
Rationale: Right-sided heart failure causes systemic venous congestion, leading to dependent peripheral edema, jugular venous
distention (JVD), hepatomegaly, and ascites. Pulmonary crackles and S3 gallop are classic findings of left-sided heart failure due to
pulmonary congestion. Orthopnea and paroxysmal nocturnal dyspnea are also associated with left-sided heart failure, not right-sided.
Chest pain relieved by nitroglycerin is more indicative of coronary artery disease or angina rather than heart failure.
Q2: A client with left-sided heart failure reports increasing shortness of breath when lying flat. Which intervention
should the nurse implement first?
A. Administer prescribed diuretic intravenously
B. Position the client in high Fowler's position [CORRECT]
C. Apply supplemental oxygen via nasal cannula
D. Obtain a portable chest X-ray
Correct Answer: B
Rationale: Positioning the client in high Fowler's position is the first priority intervention because it immediately reduces venous return
to the heart and decreases pulmonary congestion, providing rapid symptomatic relief from orthopnea. While diuretics and oxygen are
important interventions, positioning is a non-invasive, immediate action that the nurse can implement independently. A chest X-ray
provides diagnostic information but does not address the acute symptom of dyspnea. The nursing process prioritizes interventions that
provide the most immediate relief from life-threatening or distressing symptoms.
Q3: A nurse is caring for a client receiving a continuous heparin infusion. The aPTT result is 105 seconds. Which
action should the nurse take?
A. Increase the heparin infusion rate as ordered
B. Stop the heparin infusion and notify the healthcare provider [CORRECT]
C. Administer protamine sulfate as prescribed
D. Continue the current infusion and recheck aPTT in 4 hours
Correct Answer: B
Rationale: An aPTT of 105 seconds is significantly above the therapeutic range (typically 60-80 seconds, or 1.5-2.5 times the control
value) and indicates the client is at high risk for bleeding. The nurse should stop the heparin infusion immediately and notify the
healthcare provider. Increasing the rate would further increase bleeding risk. Protamine sulfate is the specific antidote for heparin,
but it should only be administered with a healthcare provider's order after assessment. Continuing the infusion at this supratherapeutic
level is unsafe. HESI testing emphasizes that critical lab values requiring immediate action take priority.
Q4: A client presents to the emergency department with chest pressure unrelieved by rest or sublingual nitroglycerin.
The nurse recognizes this finding as indicative of which condition?
A. Stable angina
2
, B. Acute coronary syndrome with early hypoperfusion [CORRECT]
C. Costochondritis
D. Pulmonary embolism
Correct Answer: B
Rationale: Chest pressure that is unrelieved by rest or nitroglycerin is a hallmark sign of acute coronary syndrome (ACS) and
indicates early myocardial hypoperfusion. Unlike stable angina, which is typically relieved by rest and nitroglycerin, ACS represents
an acute occlusion or critical narrowing of a coronary artery. Costochondritis typically presents with reproducible chest wall
tenderness. Pulmonary embolism presents with sudden dyspnea, pleuritic chest pain, and possibly hemoptysis, rather than pressure-like
chest pain. Early recognition of ACS is critical for timely intervention including reperfusion therapy.
Q5: The nurse is providing discharge teaching to a client who has had a myocardial infarction. The client asks about
resuming sexual activity. Which response by the nurse is most appropriate?
A. You should avoid sexual activity for at least 6 months after an MI.
B. Sexual activity requires about the same energy as climbing two flights of stairs.
C. You may resume sexual activity only after a stress test shows no further cardiac damage. [CORRECT]
D. Sexual activity is safe once you can walk one block without experiencing chest pain.
Correct Answer: C
Rationale: The American Heart Association guidelines indicate that sexual activity is comparable in energy expenditure to climbing
two flights of stairs, and patients who can perform this level of activity without symptoms can safely resume sexual intercourse. A
6-month abstinence is unnecessarily restrictive and not evidence-based. While a stress test provides useful information, it is not an
absolute prerequisite for resuming sexual activity. The one-block walking criterion is also used in practice, but the two-flight-of-stairs
comparison is the most recognized HESI standard for sexual activity counseling post-MI. The nurse should also counsel patients to
avoid sexual activity after heavy meals or alcohol consumption.
Q6: A nurse is reviewing laboratory results for a client suspected of having a myocardial infarction. Which statement
about cardiac biomarkers is correct?
A. CPK-MB remains elevated for 7-10 days after an MI
B. Troponin returns to normal within 72 hours
C. Troponin remains elevated for 7-10 days, allowing detection of delayed MI presentation [CORRECT]
D. CPK-MB is more specific than troponin for myocardial injury
Correct Answer: C
Rationale: Troponin I and T are highly specific cardiac biomarkers that remain elevated for 7-10 days after a myocardial
infarction, making them valuable for detecting delayed presentations of MI. CPK-MB, while also used, returns to normal within 72
hours (approximately 48-72 hours), making it less useful for detecting delayed MI presentations. Troponin is more specific to cardiac
muscle than CPK-MB, which can also be elevated from skeletal muscle injury. Understanding the temporal patterns of cardiac
biomarkers is essential for accurate MI diagnosis and for differentiating acute from evolving or recent cardiac events.
Q7: A client is receiving IV furosemide for heart failure. Which laboratory value should the nurse monitor as the
major concern with this medication?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypoglycemia
Correct Answer: B
3
, Rationale: Furosemide is a loop diuretic that causes increased excretion of sodium, chloride, potassium, and water. Hypokalemia is
the major concern because low potassium levels can cause cardiac dysrhythmias, muscle weakness, and on ECG, the appearance of U
waves. The nurse should monitor serum potassium levels closely and ensure potassium supplementation or potassium-sparing diuretics
are ordered as needed. Furosemide typically causes hyponatremia (not hypernatremia), does not significantly affect calcium levels,
and may cause hyperglycemia (not hypoglycemia) due to decreased insulin secretion. Monitoring daily weights, intake and output, and
serum electrolytes are essential nursing responsibilities when administering furosemide.
Q8: A client is admitted with hypovolemic shock following a motor vehicle accident. Which intervention should the
nurse implement first?
A. Administer a vasopressor medication
B. Initiate intravenous fluid resuscitation [CORRECT]
C. Obtain a type and crossmatch for blood products
D. Insert a urinary catheter to monitor urine output
Correct Answer: B
Rationale: In hypovolemic shock, the priority intervention is to restore intravascular volume through aggressive IV fluid resuscitation,
typically with isotonic crystalloid solutions such as 0.9% Normal Saline or Lactated Ringer's. Vasopressors are not first-line for
hypovolemic shock because they do not address the underlying volume deficit and may further compromise tissue perfusion. While
type and crossmatch and urinary catheter insertion are important, they are secondary to establishing adequate circulatory volume.
Fluid resuscitation addresses the primary problem of hypovolemia and supports perfusion to vital organs. The nurse should also
monitor vital signs frequently and assess for signs of adequate tissue perfusion during fluid resuscitation.
Q9: A client with cardiogenic shock is being treated with inotropic agents. The nurse understands that the primary
purpose of inotropic therapy in cardiogenic shock is to:
A. Reduce afterload and decrease cardiac workload
B. Increase myocardial contractility and improve cardiac output [CORRECT]
C. Prevent thrombus formation in the coronary arteries
D. Decrease heart rate and reduce myocardial oxygen demand
Correct Answer: B
Rationale: In cardiogenic shock, the heart's pumping ability is severely compromised, leading to inadequate tissue perfusion. Inotropic
agents such as dobutamine and milrinone increase myocardial contractility (positive inotropy), which directly improves stroke volume
and cardiac output. While afterload reduction (with agents like nitroprusside) is also part of cardiogenic shock management, the
primary purpose of inotropic agents is to strengthen cardiac contractions. Anticoagulants prevent thrombus formation but do not
address the pumping failure. Beta-blockers decrease heart rate and myocardial oxygen demand but are contraindicated in acute
cardiogenic shock because they would further depress cardiac output.
Q10: The nurse is caring for a client in septic shock. Which interventions should be included in the initial
management? Select the priority actions.
A. Administer broad-spectrum antibiotics within 1 hour and initiate fluid resuscitation [CORRECT]
B. Administer vasopressors first, then obtain blood cultures
C. Restrict IV fluids to prevent pulmonary edema
D. Wait for culture results before starting antibiotic therapy
Correct Answer: A
Rationale: The Surviving Sepsis Campaign guidelines emphasize that early administration of broad-spectrum antibiotics (within 1
hour of recognition) and aggressive fluid resuscitation are the cornerstones of septic shock management. Vasopressors such as
norepinephrine are initiated if the patient remains hypotensive despite adequate fluid resuscitation (typically after 30 mL/kg
crystalloid). Blood cultures should be obtained before antibiotics but should not delay antibiotic administration. Fluid restriction is
4
HESI MEDICAL-SURGICAL
NURSING EXAMINATION
Complete 200 Questions and Correct Detailed Answers
Verified Answers | Already Graded A+ | Brand New
Aligned with NCSBN Clinical Judgment Measurement Model (NGN)
Latest 2026/2027 Evolve Elsevier HESI Testing Standards
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Design: 75% Scenario-Based | 20% Direct Recall | 5% Critical Reasoning
1
,Section 1: Cardiovascular System and Peripheral Vascular Disorders (Questions 1-40)
Q1: A nurse is assessing a client with right-sided heart failure. Which of the following findings would the nurse
expect?
A. Dependent peripheral edema and jugular venous distention
B. Pulmonary crackles and S3 gallop on auscultation
C. Dry cough and orthopnea [CORRECT]
D. Chest pain relieved by nitroglycerin
Correct Answer: C
Rationale: Right-sided heart failure causes systemic venous congestion, leading to dependent peripheral edema, jugular venous
distention (JVD), hepatomegaly, and ascites. Pulmonary crackles and S3 gallop are classic findings of left-sided heart failure due to
pulmonary congestion. Orthopnea and paroxysmal nocturnal dyspnea are also associated with left-sided heart failure, not right-sided.
Chest pain relieved by nitroglycerin is more indicative of coronary artery disease or angina rather than heart failure.
Q2: A client with left-sided heart failure reports increasing shortness of breath when lying flat. Which intervention
should the nurse implement first?
A. Administer prescribed diuretic intravenously
B. Position the client in high Fowler's position [CORRECT]
C. Apply supplemental oxygen via nasal cannula
D. Obtain a portable chest X-ray
Correct Answer: B
Rationale: Positioning the client in high Fowler's position is the first priority intervention because it immediately reduces venous return
to the heart and decreases pulmonary congestion, providing rapid symptomatic relief from orthopnea. While diuretics and oxygen are
important interventions, positioning is a non-invasive, immediate action that the nurse can implement independently. A chest X-ray
provides diagnostic information but does not address the acute symptom of dyspnea. The nursing process prioritizes interventions that
provide the most immediate relief from life-threatening or distressing symptoms.
Q3: A nurse is caring for a client receiving a continuous heparin infusion. The aPTT result is 105 seconds. Which
action should the nurse take?
A. Increase the heparin infusion rate as ordered
B. Stop the heparin infusion and notify the healthcare provider [CORRECT]
C. Administer protamine sulfate as prescribed
D. Continue the current infusion and recheck aPTT in 4 hours
Correct Answer: B
Rationale: An aPTT of 105 seconds is significantly above the therapeutic range (typically 60-80 seconds, or 1.5-2.5 times the control
value) and indicates the client is at high risk for bleeding. The nurse should stop the heparin infusion immediately and notify the
healthcare provider. Increasing the rate would further increase bleeding risk. Protamine sulfate is the specific antidote for heparin,
but it should only be administered with a healthcare provider's order after assessment. Continuing the infusion at this supratherapeutic
level is unsafe. HESI testing emphasizes that critical lab values requiring immediate action take priority.
Q4: A client presents to the emergency department with chest pressure unrelieved by rest or sublingual nitroglycerin.
The nurse recognizes this finding as indicative of which condition?
A. Stable angina
2
, B. Acute coronary syndrome with early hypoperfusion [CORRECT]
C. Costochondritis
D. Pulmonary embolism
Correct Answer: B
Rationale: Chest pressure that is unrelieved by rest or nitroglycerin is a hallmark sign of acute coronary syndrome (ACS) and
indicates early myocardial hypoperfusion. Unlike stable angina, which is typically relieved by rest and nitroglycerin, ACS represents
an acute occlusion or critical narrowing of a coronary artery. Costochondritis typically presents with reproducible chest wall
tenderness. Pulmonary embolism presents with sudden dyspnea, pleuritic chest pain, and possibly hemoptysis, rather than pressure-like
chest pain. Early recognition of ACS is critical for timely intervention including reperfusion therapy.
Q5: The nurse is providing discharge teaching to a client who has had a myocardial infarction. The client asks about
resuming sexual activity. Which response by the nurse is most appropriate?
A. You should avoid sexual activity for at least 6 months after an MI.
B. Sexual activity requires about the same energy as climbing two flights of stairs.
C. You may resume sexual activity only after a stress test shows no further cardiac damage. [CORRECT]
D. Sexual activity is safe once you can walk one block without experiencing chest pain.
Correct Answer: C
Rationale: The American Heart Association guidelines indicate that sexual activity is comparable in energy expenditure to climbing
two flights of stairs, and patients who can perform this level of activity without symptoms can safely resume sexual intercourse. A
6-month abstinence is unnecessarily restrictive and not evidence-based. While a stress test provides useful information, it is not an
absolute prerequisite for resuming sexual activity. The one-block walking criterion is also used in practice, but the two-flight-of-stairs
comparison is the most recognized HESI standard for sexual activity counseling post-MI. The nurse should also counsel patients to
avoid sexual activity after heavy meals or alcohol consumption.
Q6: A nurse is reviewing laboratory results for a client suspected of having a myocardial infarction. Which statement
about cardiac biomarkers is correct?
A. CPK-MB remains elevated for 7-10 days after an MI
B. Troponin returns to normal within 72 hours
C. Troponin remains elevated for 7-10 days, allowing detection of delayed MI presentation [CORRECT]
D. CPK-MB is more specific than troponin for myocardial injury
Correct Answer: C
Rationale: Troponin I and T are highly specific cardiac biomarkers that remain elevated for 7-10 days after a myocardial
infarction, making them valuable for detecting delayed presentations of MI. CPK-MB, while also used, returns to normal within 72
hours (approximately 48-72 hours), making it less useful for detecting delayed MI presentations. Troponin is more specific to cardiac
muscle than CPK-MB, which can also be elevated from skeletal muscle injury. Understanding the temporal patterns of cardiac
biomarkers is essential for accurate MI diagnosis and for differentiating acute from evolving or recent cardiac events.
Q7: A client is receiving IV furosemide for heart failure. Which laboratory value should the nurse monitor as the
major concern with this medication?
A. Hypernatremia
B. Hypokalemia [CORRECT]
C. Hypercalcemia
D. Hypoglycemia
Correct Answer: B
3
, Rationale: Furosemide is a loop diuretic that causes increased excretion of sodium, chloride, potassium, and water. Hypokalemia is
the major concern because low potassium levels can cause cardiac dysrhythmias, muscle weakness, and on ECG, the appearance of U
waves. The nurse should monitor serum potassium levels closely and ensure potassium supplementation or potassium-sparing diuretics
are ordered as needed. Furosemide typically causes hyponatremia (not hypernatremia), does not significantly affect calcium levels,
and may cause hyperglycemia (not hypoglycemia) due to decreased insulin secretion. Monitoring daily weights, intake and output, and
serum electrolytes are essential nursing responsibilities when administering furosemide.
Q8: A client is admitted with hypovolemic shock following a motor vehicle accident. Which intervention should the
nurse implement first?
A. Administer a vasopressor medication
B. Initiate intravenous fluid resuscitation [CORRECT]
C. Obtain a type and crossmatch for blood products
D. Insert a urinary catheter to monitor urine output
Correct Answer: B
Rationale: In hypovolemic shock, the priority intervention is to restore intravascular volume through aggressive IV fluid resuscitation,
typically with isotonic crystalloid solutions such as 0.9% Normal Saline or Lactated Ringer's. Vasopressors are not first-line for
hypovolemic shock because they do not address the underlying volume deficit and may further compromise tissue perfusion. While
type and crossmatch and urinary catheter insertion are important, they are secondary to establishing adequate circulatory volume.
Fluid resuscitation addresses the primary problem of hypovolemia and supports perfusion to vital organs. The nurse should also
monitor vital signs frequently and assess for signs of adequate tissue perfusion during fluid resuscitation.
Q9: A client with cardiogenic shock is being treated with inotropic agents. The nurse understands that the primary
purpose of inotropic therapy in cardiogenic shock is to:
A. Reduce afterload and decrease cardiac workload
B. Increase myocardial contractility and improve cardiac output [CORRECT]
C. Prevent thrombus formation in the coronary arteries
D. Decrease heart rate and reduce myocardial oxygen demand
Correct Answer: B
Rationale: In cardiogenic shock, the heart's pumping ability is severely compromised, leading to inadequate tissue perfusion. Inotropic
agents such as dobutamine and milrinone increase myocardial contractility (positive inotropy), which directly improves stroke volume
and cardiac output. While afterload reduction (with agents like nitroprusside) is also part of cardiogenic shock management, the
primary purpose of inotropic agents is to strengthen cardiac contractions. Anticoagulants prevent thrombus formation but do not
address the pumping failure. Beta-blockers decrease heart rate and myocardial oxygen demand but are contraindicated in acute
cardiogenic shock because they would further depress cardiac output.
Q10: The nurse is caring for a client in septic shock. Which interventions should be included in the initial
management? Select the priority actions.
A. Administer broad-spectrum antibiotics within 1 hour and initiate fluid resuscitation [CORRECT]
B. Administer vasopressors first, then obtain blood cultures
C. Restrict IV fluids to prevent pulmonary edema
D. Wait for culture results before starting antibiotic therapy
Correct Answer: A
Rationale: The Surviving Sepsis Campaign guidelines emphasize that early administration of broad-spectrum antibiotics (within 1
hour of recognition) and aggressive fluid resuscitation are the cornerstones of septic shock management. Vasopressors such as
norepinephrine are initiated if the patient remains hypotensive despite adequate fluid resuscitation (typically after 30 mL/kg
crystalloid). Blood cultures should be obtained before antibiotics but should not delay antibiotic administration. Fluid restriction is
4
