180 Multiple-Choice Questions with Detailed Rationales
HESI Medical-Surgical Nursing —
Comprehensive Advanced Practice
Examination
EXAM TITLE: HESI Medical-Surgical Nursing Mastery — A Comprehensive Examination
Covering: Cardiovascular, Respiratory, Gastrointestinal, Endocrine, Neurological,
Musculoskeletal, Renal, Reproductive, Integumentary, and Immunological Disorders with
Evidence-Based Nursing Interventions for Adult Patient Care
SECTION 1: CARDIOVASCULAR SYSTEM — Questions 1–25
Question 1
A 68-year-old male with a history of hypertension and diabetes presents with
progressive dyspnea on exertion, orthopnea, and peripheral edema. Echocardiography
reveals an ejection fraction of 32% with global hypokinesis. Which medication class has
been shown to provide the greatest mortality benefit in this patient population?
Loop diuretics
B. Calcium channel blockers
C. ACE inhibitors
D. Digoxin
E. Beta-blockers alone
Correct Answer: C
Rationale: ACE inhibitors (and ARBs) are the cornerstone of heart failure with reduced
ejection fraction (HFrEF) therapy and have demonstrated significant mortality reduction.
While beta-blockers also reduce mortality, ACE inhibitors provide the greatest mortality
,benefit in HFrEF. Loop diuretics relieve symptoms but do not improve survival. Digoxin
reduces hospitalizations but not mortality.
Question 2
A 55-year-old male presents with substernal chest pressure that occurs predictably with
exertion and is relieved within 5 minutes of rest. His ECG is normal at rest. Which is the
most appropriate initial diagnostic test?
Coronary angiography
B. Exercise stress test
C. CT coronary angiography
D. Resting echocardiogram
E. Holter monitor
Correct Answer: B
Rationale: The patient's symptoms are classic for stable angina. With a normal resting
ECG, an exercise stress test is the most appropriate initial diagnostic test to evaluate for
inducible ischemia. Coronary angiography is invasive and reserved for patients with high-
risk features or positive stress tests. CT coronary angiography may be appropriate but is
not the initial test of choice.
Question 3
A 72-year-old female presents with syncope and a systolic ejection murmur heard best
at the right upper sternal border that radiates to the carotids. Which finding would most
likely be present on physical examination?
Bounding carotid upstrokes
B. Delayed and diminished carotid upstrokes
C. Mid-systolic click
D. Fixed split S2
E. Opening snap
Correct Answer: B
, Rationale: The clinical presentation is classic for aortic stenosis. Delayed and diminished
carotid upstrokes (parvus et tardus) are characteristic findings. Syncope is a classic
symptom of severe aortic stenosis.
Question 4
A 45-year-old male with no significant past medical history presents with acute onset of
severe, tearing chest pain that radiates to his back. Blood pressure is 190/110 mmHg in
the right arm and 130/80 mmHg in the left arm. Which is the most appropriate initial
imaging study?
Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Transesophageal echocardiogram
E. MRI of the chest
Correct Answer: C
Rationale: CT angiography of the chest is the gold standard and most appropriate initial
test for suspected aortic dissection. It has high sensitivity and specificity and can be
obtained rapidly. The differential blood pressures between arms and tearing chest pain
are classic findings. While transesophageal echocardiography is also sensitive, CT
angiography is more readily available in most emergency settings.
Question 5
A 60-year-old female with a history of hypertension and hyperlipidemia presents with
palpitations. Her ECG shows an irregularly irregular rhythm with no discernible P waves.
Which is the most appropriate initial management strategy for rate control?
Amiodarone
B. Digoxin
C. Beta-blocker
D. Direct current cardioversion
E. Aspirin
HESI Medical-Surgical Nursing —
Comprehensive Advanced Practice
Examination
EXAM TITLE: HESI Medical-Surgical Nursing Mastery — A Comprehensive Examination
Covering: Cardiovascular, Respiratory, Gastrointestinal, Endocrine, Neurological,
Musculoskeletal, Renal, Reproductive, Integumentary, and Immunological Disorders with
Evidence-Based Nursing Interventions for Adult Patient Care
SECTION 1: CARDIOVASCULAR SYSTEM — Questions 1–25
Question 1
A 68-year-old male with a history of hypertension and diabetes presents with
progressive dyspnea on exertion, orthopnea, and peripheral edema. Echocardiography
reveals an ejection fraction of 32% with global hypokinesis. Which medication class has
been shown to provide the greatest mortality benefit in this patient population?
Loop diuretics
B. Calcium channel blockers
C. ACE inhibitors
D. Digoxin
E. Beta-blockers alone
Correct Answer: C
Rationale: ACE inhibitors (and ARBs) are the cornerstone of heart failure with reduced
ejection fraction (HFrEF) therapy and have demonstrated significant mortality reduction.
While beta-blockers also reduce mortality, ACE inhibitors provide the greatest mortality
,benefit in HFrEF. Loop diuretics relieve symptoms but do not improve survival. Digoxin
reduces hospitalizations but not mortality.
Question 2
A 55-year-old male presents with substernal chest pressure that occurs predictably with
exertion and is relieved within 5 minutes of rest. His ECG is normal at rest. Which is the
most appropriate initial diagnostic test?
Coronary angiography
B. Exercise stress test
C. CT coronary angiography
D. Resting echocardiogram
E. Holter monitor
Correct Answer: B
Rationale: The patient's symptoms are classic for stable angina. With a normal resting
ECG, an exercise stress test is the most appropriate initial diagnostic test to evaluate for
inducible ischemia. Coronary angiography is invasive and reserved for patients with high-
risk features or positive stress tests. CT coronary angiography may be appropriate but is
not the initial test of choice.
Question 3
A 72-year-old female presents with syncope and a systolic ejection murmur heard best
at the right upper sternal border that radiates to the carotids. Which finding would most
likely be present on physical examination?
Bounding carotid upstrokes
B. Delayed and diminished carotid upstrokes
C. Mid-systolic click
D. Fixed split S2
E. Opening snap
Correct Answer: B
, Rationale: The clinical presentation is classic for aortic stenosis. Delayed and diminished
carotid upstrokes (parvus et tardus) are characteristic findings. Syncope is a classic
symptom of severe aortic stenosis.
Question 4
A 45-year-old male with no significant past medical history presents with acute onset of
severe, tearing chest pain that radiates to his back. Blood pressure is 190/110 mmHg in
the right arm and 130/80 mmHg in the left arm. Which is the most appropriate initial
imaging study?
Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Transesophageal echocardiogram
E. MRI of the chest
Correct Answer: C
Rationale: CT angiography of the chest is the gold standard and most appropriate initial
test for suspected aortic dissection. It has high sensitivity and specificity and can be
obtained rapidly. The differential blood pressures between arms and tearing chest pain
are classic findings. While transesophageal echocardiography is also sensitive, CT
angiography is more readily available in most emergency settings.
Question 5
A 60-year-old female with a history of hypertension and hyperlipidemia presents with
palpitations. Her ECG shows an irregularly irregular rhythm with no discernible P waves.
Which is the most appropriate initial management strategy for rate control?
Amiodarone
B. Digoxin
C. Beta-blocker
D. Direct current cardioversion
E. Aspirin
