HESI PN Medical-Surgical Nursing Exam
Comprehensive Assessment | NCLEX-PN Aligned
Latest 2026/2027 Update | 120 Multiple-Choice Questions | Practical Nursing
75% Scenario-Based | 20% Recall | 5% Calculation | Cognitive Levels: Recall 25% / Application 55% / Analysis 20%
12 Clinical Domains | Answer Key with Detailed Rationales
, SECTION 1: CARDIOVASCULAR NURSING (Q1-Q20)
Q1: A PN is caring for a client with heart failure who reports sudden onset of dyspnea and pink frothy sputum. The
client appears anxious and diaphoretic. Which action should the PN take FIRST?
A. Place the client in high Fowler's position [CORRECT]
B. Administer prescribed sublingual nitroglycerin
C. Obtain a 12-lead electrocardiogram
D. Auscultate the lung fields
Correct Answer: A
Rationale: Placing the client in high Fowler's position is the first priority action because it reduces venous return, decreases preload,
and maximizes lung expansion, immediately relieving acute pulmonary edema symptoms. While oxygen, medications, and assessment
are all important, positioning is the quickest nonpharmacological intervention that can rapidly improve the client's ability to breathe.
Q2: A client with atrial fibrillation is prescribed warfarin (Coumadin). The PN reviews the client's most recent
laboratory results: INR 1.4, PT 11 seconds. Which action by the PN is MOST appropriate?
A. Administer the next dose of warfarin as scheduled [CORRECT]
B. Hold the warfarin and notify the RN or provider
C. Double the next dose of warfarin to reach therapeutic range
D. Administer vitamin K as prescribed
Correct Answer: A
Rationale: An INR of 1.4 is below the therapeutic range of 2.0-3.0 for atrial fibrillation. However, the PN should continue to
administer the prescribed dose as ordered because the client has not yet reached therapeutic anticoagulation. Holding the dose
would further delay achieving the target INR. The PN should notify the provider of the subtherapeutic INR for potential dose
adjustment but should not independently hold or alter the medication.
Q3: A PN is providing discharge teaching to a client who received a permanent pacemaker. Which statement by the
client indicates the teaching has been effective?
A. I will avoid going through airport security detectors because they will damage my pacemaker
B. I will check my pulse daily and report any sudden changes to my provider [CORRECT]
C. I should keep my cell phone in the pocket directly over the pacemaker
D. I will avoid taking showers for the first 4 weeks after the procedure
Correct Answer: B
Rationale: Checking the pulse daily and reporting changes demonstrates effective teaching because the client understands the
importance of monitoring heart rate and rhythm. Modern pacemakers are designed to withstand airport security, cell phones are safe
when used normally, and showering is permitted once the incision heals. The client should avoid MRI machines, not routine security
detectors.
Q4: A client with peripheral arterial disease (PAD) complains of leg pain when walking that is relieved by rest. The
PN should document this finding using which medical term?
A. Intermittent claudication [CORRECT]
B. Deep vein thrombosis
C. Chronic venous insufficiency
D. Acute arterial occlusion
Correct Answer: A
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by pain in the muscles of the legs (typically calves)
that occurs during exercise and is relieved by rest. This occurs due to inadequate blood flow through narrowed arteries during
activity. Deep vein thrombosis and venous insufficiency produce different symptom patterns, and acute arterial occlusion presents
with sudden, severe pain at rest.
Q5: A PN is monitoring a client following a myocardial infarction (MI). Which laboratory value is MOST
important for the PN to monitor to assess for cardiac muscle damage?
, A. Troponin I [CORRECT]
B. Creatine kinase-MB (CK-MB)
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct Answer: A
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial muscle damage. It rises within 3-4 hours of
myocardial injury, peaks at 12-24 hours, and remains elevated for up to 10-14 days. While CK-MB is also used, troponin has largely
replaced it as the gold standard for MI diagnosis because of its higher cardiac specificity. BNP assesses heart failure, and CRP is a
nonspecific inflammatory marker.
Q6: A PN is caring for a client with left-sided heart failure. Which assessment finding should the PN EXPECT to
find?
A. Jugular vein distention
B. Crackles in the lung fields on auscultation [CORRECT]
C. Dependent peripheral edema
D. Hepatomegaly and ascites
Correct Answer: B
Rationale: Left-sided heart failure causes backup of blood into the pulmonary circulation, leading to pulmonary congestion
manifested as crackles (rales) on auscultation, dyspnea, orthopnea, and pink frothy sputum. Jugular vein distention, dependent
edema, and hepatomegaly are findings associated with right-sided heart failure due to systemic venous congestion.
Q7: A client with hypertension is prescribed lisinopril (Prinivil). The PN should instruct the client to report which
adverse effect?
A. Persistent dry cough [CORRECT]
B. Weight gain
C. Bradycardia
D. Hyperkalemia
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor, and a persistent dry cough is a well-known adverse effect that occurs in up to 20% of
patients due to bradykinin accumulation. While hyperkalemia can occur with ACE inhibitors, the cough is the most common and
distinctive side effect that patients should report. Weight gain and bradycardia are not typical adverse effects of ACE inhibitors.
Q8: A PN is assessing a client with infective endocarditis. Which finding is MOST characteristic of this condition?
A. Janeway lesions and Osler nodes [CORRECT]
B. Homan's sign
C. McBurney's point tenderness
D. Murphy's sign
Correct Answer: A
Rationale: Janeway lesions (painless, hemorrhagic macules on palms and soles) and Osler nodes (tender, raised nodules on fingers
and toes) are classic clinical manifestations of infective endocarditis caused by septic emboli. Homan's sign is associated with deep
vein thrombosis, McBurney's point with appendicitis, and Murphy's sign with cholecystitis.
Q9: A PN is reviewing the medication profile of a client prescribed digoxin (Lanoxin). Which finding should the PN
report to the provider IMMEDIATELY?
A. Potassium level of 3.0 mEq/L [CORRECT]
B. Heart rate of 72 bpm
C. Digoxin level of 0.8 ng/mL
D. Blood pressure of 118/76 mmHg
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L is critically low (normal 3.5-5.0) and places the client at high risk for digoxin toxicity
because hypokalemia potentiates the effects of digoxin on the myocardium. The PN must report this finding immediately. A heart rate
Comprehensive Assessment | NCLEX-PN Aligned
Latest 2026/2027 Update | 120 Multiple-Choice Questions | Practical Nursing
75% Scenario-Based | 20% Recall | 5% Calculation | Cognitive Levels: Recall 25% / Application 55% / Analysis 20%
12 Clinical Domains | Answer Key with Detailed Rationales
, SECTION 1: CARDIOVASCULAR NURSING (Q1-Q20)
Q1: A PN is caring for a client with heart failure who reports sudden onset of dyspnea and pink frothy sputum. The
client appears anxious and diaphoretic. Which action should the PN take FIRST?
A. Place the client in high Fowler's position [CORRECT]
B. Administer prescribed sublingual nitroglycerin
C. Obtain a 12-lead electrocardiogram
D. Auscultate the lung fields
Correct Answer: A
Rationale: Placing the client in high Fowler's position is the first priority action because it reduces venous return, decreases preload,
and maximizes lung expansion, immediately relieving acute pulmonary edema symptoms. While oxygen, medications, and assessment
are all important, positioning is the quickest nonpharmacological intervention that can rapidly improve the client's ability to breathe.
Q2: A client with atrial fibrillation is prescribed warfarin (Coumadin). The PN reviews the client's most recent
laboratory results: INR 1.4, PT 11 seconds. Which action by the PN is MOST appropriate?
A. Administer the next dose of warfarin as scheduled [CORRECT]
B. Hold the warfarin and notify the RN or provider
C. Double the next dose of warfarin to reach therapeutic range
D. Administer vitamin K as prescribed
Correct Answer: A
Rationale: An INR of 1.4 is below the therapeutic range of 2.0-3.0 for atrial fibrillation. However, the PN should continue to
administer the prescribed dose as ordered because the client has not yet reached therapeutic anticoagulation. Holding the dose
would further delay achieving the target INR. The PN should notify the provider of the subtherapeutic INR for potential dose
adjustment but should not independently hold or alter the medication.
Q3: A PN is providing discharge teaching to a client who received a permanent pacemaker. Which statement by the
client indicates the teaching has been effective?
A. I will avoid going through airport security detectors because they will damage my pacemaker
B. I will check my pulse daily and report any sudden changes to my provider [CORRECT]
C. I should keep my cell phone in the pocket directly over the pacemaker
D. I will avoid taking showers for the first 4 weeks after the procedure
Correct Answer: B
Rationale: Checking the pulse daily and reporting changes demonstrates effective teaching because the client understands the
importance of monitoring heart rate and rhythm. Modern pacemakers are designed to withstand airport security, cell phones are safe
when used normally, and showering is permitted once the incision heals. The client should avoid MRI machines, not routine security
detectors.
Q4: A client with peripheral arterial disease (PAD) complains of leg pain when walking that is relieved by rest. The
PN should document this finding using which medical term?
A. Intermittent claudication [CORRECT]
B. Deep vein thrombosis
C. Chronic venous insufficiency
D. Acute arterial occlusion
Correct Answer: A
Rationale: Intermittent claudication is the classic symptom of PAD, characterized by pain in the muscles of the legs (typically calves)
that occurs during exercise and is relieved by rest. This occurs due to inadequate blood flow through narrowed arteries during
activity. Deep vein thrombosis and venous insufficiency produce different symptom patterns, and acute arterial occlusion presents
with sudden, severe pain at rest.
Q5: A PN is monitoring a client following a myocardial infarction (MI). Which laboratory value is MOST
important for the PN to monitor to assess for cardiac muscle damage?
, A. Troponin I [CORRECT]
B. Creatine kinase-MB (CK-MB)
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct Answer: A
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial muscle damage. It rises within 3-4 hours of
myocardial injury, peaks at 12-24 hours, and remains elevated for up to 10-14 days. While CK-MB is also used, troponin has largely
replaced it as the gold standard for MI diagnosis because of its higher cardiac specificity. BNP assesses heart failure, and CRP is a
nonspecific inflammatory marker.
Q6: A PN is caring for a client with left-sided heart failure. Which assessment finding should the PN EXPECT to
find?
A. Jugular vein distention
B. Crackles in the lung fields on auscultation [CORRECT]
C. Dependent peripheral edema
D. Hepatomegaly and ascites
Correct Answer: B
Rationale: Left-sided heart failure causes backup of blood into the pulmonary circulation, leading to pulmonary congestion
manifested as crackles (rales) on auscultation, dyspnea, orthopnea, and pink frothy sputum. Jugular vein distention, dependent
edema, and hepatomegaly are findings associated with right-sided heart failure due to systemic venous congestion.
Q7: A client with hypertension is prescribed lisinopril (Prinivil). The PN should instruct the client to report which
adverse effect?
A. Persistent dry cough [CORRECT]
B. Weight gain
C. Bradycardia
D. Hyperkalemia
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor, and a persistent dry cough is a well-known adverse effect that occurs in up to 20% of
patients due to bradykinin accumulation. While hyperkalemia can occur with ACE inhibitors, the cough is the most common and
distinctive side effect that patients should report. Weight gain and bradycardia are not typical adverse effects of ACE inhibitors.
Q8: A PN is assessing a client with infective endocarditis. Which finding is MOST characteristic of this condition?
A. Janeway lesions and Osler nodes [CORRECT]
B. Homan's sign
C. McBurney's point tenderness
D. Murphy's sign
Correct Answer: A
Rationale: Janeway lesions (painless, hemorrhagic macules on palms and soles) and Osler nodes (tender, raised nodules on fingers
and toes) are classic clinical manifestations of infective endocarditis caused by septic emboli. Homan's sign is associated with deep
vein thrombosis, McBurney's point with appendicitis, and Murphy's sign with cholecystitis.
Q9: A PN is reviewing the medication profile of a client prescribed digoxin (Lanoxin). Which finding should the PN
report to the provider IMMEDIATELY?
A. Potassium level of 3.0 mEq/L [CORRECT]
B. Heart rate of 72 bpm
C. Digoxin level of 0.8 ng/mL
D. Blood pressure of 118/76 mmHg
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L is critically low (normal 3.5-5.0) and places the client at high risk for digoxin toxicity
because hypokalemia potentiates the effects of digoxin on the myocardium. The PN must report this finding immediately. A heart rate
