1
HESI MED-SURG RN CUSTOM EXAM (MED SURG II) -
ACTUAL EXAM 2026/2027 | EXPERT VERIFIED | 150
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
EXAM OVERVIEW
This comprehensive HESI Med-Surg RN Custom Exam is designed for Med Surg II students and is aligned
with Elsevier Evolve HESI testing standards and the NCSBN Clinical Judgment Measurement Model . It
covers core adult health nursing topics including cardiovascular, respiratory, neurological, endocrine,
gastrointestinal, renal, and emergency nursing care, with an emphasis on clinical judgment and prioritization .
QUESTION 1
A nurse is caring for a patient with unstable angina. Which of the following medications is used to prevent
platelet aggregation?
A) Nitroglycerin
B) Morphine
C) Aspirin
D) Metoprolol
Correct Answer: C
Rationale: Aspirin (162-325 mg chewable) is given immediately to prevent further platelet aggregation in
unstable angina . Nitroglycerin (A) relieves pain, morphine (B) reduces preload and pain, and metoprolol (D)
decreases myocardial oxygen demand .
QUESTION 2
A patient is receiving alteplase (tPA) for an acute ischemic stroke. Which of the following is the priority
assessment?
A) Blood pressure
B) Signs of bleeding
C) Neurological status
D) All of the above
Correct Answer: D
,2
Rationale: tPA increases bleeding risk, so the nurse must monitor for signs of intracranial hemorrhage
(change in LOC, severe headache), bleeding at IV sites, and other bleeding manifestations while also
monitoring blood pressure and neurological status . All assessments are priority.
QUESTION 3
A patient with a mechanical mitral valve is prescribed warfarin. Which of the following INR values is
therapeutic for this patient?
A) 1.5-2.0
B) 2.0-2.5
C) 2.5-3.5
D) 3.5-4.0
Correct Answer: C
Rationale: For mechanical mitral valves, the target INR is 2.5-3.5. For mechanical aortic valves, the target is
2.0-3.0. For atrial fibrillation without a mechanical valve, the target is 2.0-3.0 .
QUESTION 4
A patient is receiving heparin IV. Which of the following laboratory values should the nurse monitor to assess
therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) PT
Correct Answer: B
Rationale: Heparin therapy is monitored by aPTT (activated partial thromboplastin time). Therapeutic aPTT
is 1.5-2.5 times the normal value. INR (A) and PT (D) are used for warfarin monitoring. Platelet count (C) is
monitored for heparin-induced thrombocytopenia (HIT) .
QUESTION 5
A patient with hypertension is prescribed lisinopril. Which of the following adverse effects requires immediate
intervention?
A) Dry cough
B) Angioedema
,3
C) Dizziness
D) Headache
Correct Answer: B
Rationale: Angioedema (swelling of face, lips, tongue, or airway) is a life-threatening adverse effect of ACE
inhibitors requiring immediate intervention . Dry cough (A) is common but not life-threatening.
QUESTION 6
A nurse is caring for a patient with an abdominal aortic aneurysm (AAA). Which of the following findings
indicates rupture?
A) Back pain
B) Hypotension
C) Pulsatile abdominal mass
D) All of the above
Correct Answer: D
Rationale: AAA rupture presents with sudden, severe back or abdominal pain, hypotension, and a pulsatile
mass. This is a surgical emergency requiring immediate intervention .
QUESTION 7
A patient with peripheral arterial disease (PAD) reports leg pain when walking that is relieved by rest. This is
known as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathic pain
Correct Answer: B
Rationale: Intermittent claudication is ischemic muscle pain caused by inadequate blood flow during exercise
and relieved by rest . It is a classic symptom of peripheral arterial disease.
QUESTION 8
A patient is diagnosed with a pulmonary embolism (PE). Which of the following is the priority intervention?
, 4
A) Administer oxygen
B) Administer heparin
C) Prepare for thrombolytics
D) Obtain a chest x-ray
Correct Answer: A
Rationale: The priority is to correct hypoxemia with oxygen administration. Anticoagulation (B) and
thrombolytics (C) are important but follow airway and breathing priorities .
QUESTION 9
A patient with heart failure is prescribed carvedilol. Which of the following is a contraindication to this
medication?
A) Hypertension
B) Asthma
C) Diabetes
D) Hyperlipidemia
Correct Answer: B
Rationale: Carvedilol is a non-selective beta-blocker that can cause bronchospasm and is contraindicated in
patients with asthma or COPD . Cardioselective beta-blockers (metoprolol) may be used with caution.
QUESTION 10
A nurse is assessing a patient for orthostatic hypotension. Which of the following findings indicates a positive
finding?
A) BP drop of 10 mm Hg systolic upon standing
B) BP drop of 20 mm Hg systolic upon standing
C) Heart rate decrease of 10 bpm upon standing
D) BP increase of 10 mm Hg systolic upon standing
Correct Answer: B
Rationale: Orthostatic hypotension is defined as a drop of at least 20 mm Hg in systolic BP or at least 10 mm
Hg in diastolic BP within 3 minutes of standing .
HESI MED-SURG RN CUSTOM EXAM (MED SURG II) -
ACTUAL EXAM 2026/2027 | EXPERT VERIFIED | 150
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
EXAM OVERVIEW
This comprehensive HESI Med-Surg RN Custom Exam is designed for Med Surg II students and is aligned
with Elsevier Evolve HESI testing standards and the NCSBN Clinical Judgment Measurement Model . It
covers core adult health nursing topics including cardiovascular, respiratory, neurological, endocrine,
gastrointestinal, renal, and emergency nursing care, with an emphasis on clinical judgment and prioritization .
QUESTION 1
A nurse is caring for a patient with unstable angina. Which of the following medications is used to prevent
platelet aggregation?
A) Nitroglycerin
B) Morphine
C) Aspirin
D) Metoprolol
Correct Answer: C
Rationale: Aspirin (162-325 mg chewable) is given immediately to prevent further platelet aggregation in
unstable angina . Nitroglycerin (A) relieves pain, morphine (B) reduces preload and pain, and metoprolol (D)
decreases myocardial oxygen demand .
QUESTION 2
A patient is receiving alteplase (tPA) for an acute ischemic stroke. Which of the following is the priority
assessment?
A) Blood pressure
B) Signs of bleeding
C) Neurological status
D) All of the above
Correct Answer: D
,2
Rationale: tPA increases bleeding risk, so the nurse must monitor for signs of intracranial hemorrhage
(change in LOC, severe headache), bleeding at IV sites, and other bleeding manifestations while also
monitoring blood pressure and neurological status . All assessments are priority.
QUESTION 3
A patient with a mechanical mitral valve is prescribed warfarin. Which of the following INR values is
therapeutic for this patient?
A) 1.5-2.0
B) 2.0-2.5
C) 2.5-3.5
D) 3.5-4.0
Correct Answer: C
Rationale: For mechanical mitral valves, the target INR is 2.5-3.5. For mechanical aortic valves, the target is
2.0-3.0. For atrial fibrillation without a mechanical valve, the target is 2.0-3.0 .
QUESTION 4
A patient is receiving heparin IV. Which of the following laboratory values should the nurse monitor to assess
therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) PT
Correct Answer: B
Rationale: Heparin therapy is monitored by aPTT (activated partial thromboplastin time). Therapeutic aPTT
is 1.5-2.5 times the normal value. INR (A) and PT (D) are used for warfarin monitoring. Platelet count (C) is
monitored for heparin-induced thrombocytopenia (HIT) .
QUESTION 5
A patient with hypertension is prescribed lisinopril. Which of the following adverse effects requires immediate
intervention?
A) Dry cough
B) Angioedema
,3
C) Dizziness
D) Headache
Correct Answer: B
Rationale: Angioedema (swelling of face, lips, tongue, or airway) is a life-threatening adverse effect of ACE
inhibitors requiring immediate intervention . Dry cough (A) is common but not life-threatening.
QUESTION 6
A nurse is caring for a patient with an abdominal aortic aneurysm (AAA). Which of the following findings
indicates rupture?
A) Back pain
B) Hypotension
C) Pulsatile abdominal mass
D) All of the above
Correct Answer: D
Rationale: AAA rupture presents with sudden, severe back or abdominal pain, hypotension, and a pulsatile
mass. This is a surgical emergency requiring immediate intervention .
QUESTION 7
A patient with peripheral arterial disease (PAD) reports leg pain when walking that is relieved by rest. This is
known as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathic pain
Correct Answer: B
Rationale: Intermittent claudication is ischemic muscle pain caused by inadequate blood flow during exercise
and relieved by rest . It is a classic symptom of peripheral arterial disease.
QUESTION 8
A patient is diagnosed with a pulmonary embolism (PE). Which of the following is the priority intervention?
, 4
A) Administer oxygen
B) Administer heparin
C) Prepare for thrombolytics
D) Obtain a chest x-ray
Correct Answer: A
Rationale: The priority is to correct hypoxemia with oxygen administration. Anticoagulation (B) and
thrombolytics (C) are important but follow airway and breathing priorities .
QUESTION 9
A patient with heart failure is prescribed carvedilol. Which of the following is a contraindication to this
medication?
A) Hypertension
B) Asthma
C) Diabetes
D) Hyperlipidemia
Correct Answer: B
Rationale: Carvedilol is a non-selective beta-blocker that can cause bronchospasm and is contraindicated in
patients with asthma or COPD . Cardioselective beta-blockers (metoprolol) may be used with caution.
QUESTION 10
A nurse is assessing a patient for orthostatic hypotension. Which of the following findings indicates a positive
finding?
A) BP drop of 10 mm Hg systolic upon standing
B) BP drop of 20 mm Hg systolic upon standing
C) Heart rate decrease of 10 bpm upon standing
D) BP increase of 10 mm Hg systolic upon standing
Correct Answer: B
Rationale: Orthostatic hypotension is defined as a drop of at least 20 mm Hg in systolic BP or at least 10 mm
Hg in diastolic BP within 3 minutes of standing .
