Page 1 of 68
NSG 223 MED SURG HESI EXAM QUESTIONS LATEST EDITION 2026 -
2027 VERSION SOLVED QUESTIONS & ANSWERS
NSG 223 MED SURG HESI — 300 MULTIPLE-CHOICE QUESTIONS WITH RATIONALES
10-Point HESI Exam Coverage
Cardiovascular Disorders — Heart failure, MI, arrhythmias, hypertension, valvular
disease, peripheral vascular disease, anticoagulant therapy.
Respiratory Disorders — COPD, asthma, pneumonia, TB, PE, ARDS, chest tubes,
mechanical ventilation, ABG interpretation.
Neurological Disorders — Stroke, seizures, increased ICP, head injury, meningitis,
spinal cord injury, Parkinson's, Alzheimer's.
Renal & Urinary Disorders — AKI, CKD, dialysis, UTI, nephrolithiasis, BPH, electrolyte
imbalances.
Endocrine Disorders — Diabetes (DKA, HHS), thyroid disorders, adrenal disorders,
SIADH, DI, insulin and oral hypoglycemics.
Gastrointestinal & Hepatic Disorders — GI bleed, PUD, pancreatitis, cirrhosis,
hepatitis, bowel obstruction, ostomies, TPN.
Musculoskeletal & Integumentary — Fractures, joint replacement, osteoporosis,
burns, wound care, pressure injuries.
Shock, Sepsis & Emergency Care — Septic shock, hypovolemic shock, anaphylaxis,
cardiogenic shock, triage.
Perioperative Nursing — Preoperative, intraoperative, postoperative care, malignant
hyperthermia, PACU priorities.
Oncology & Immune Disorders — Chemotherapy, oncologic emergencies, HIV/AIDS,
immunosuppression, tumor lysis syndrome.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–35)
, Page 2 of 68
1. A client with acute decompensated heart failure has bilateral crackles, jugular
venous distention, and 3+ pitting edema. Which medication should the nurse
anticipate administering first?
A) Metoprolol
B) IV furosemide
C) Digoxin
D) Spironolactone
Answer: B
Rationale: IV loop diuretics such as furosemide are first-line for acute decompensated
heart failure with pulmonary congestion and fluid overload.
2. A client with a myocardial infarction has ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically
caused by occlusion of the right coronary artery.
3. A client with heart failure is prescribed digoxin. Which assessment finding
requires the nurse to hold the medication and notify the provider?
A) Heart rate of 88 bpm
B) Heart rate of 52 bpm
C) Blood pressure of 118/76 mmHg
D) Respiratory rate of 18
Answer: B
Rationale: Digoxin should be held for heart rate below 60 bpm in adults due to the risk
of worsening bradycardia and toxicity.
4. A client taking warfarin has an INR of 5.5. Which action should the nurse take
first?
A) Administer the next scheduled dose
B) Hold the warfarin and notify the provider
C) Encourage vitamin K-rich foods
D) Document the finding and reassess in 24 hours
Answer: B
Rationale: An INR of 5.5 is supratherapeutic and increases bleeding risk. Warfarin
should be held and the provider notified immediately.
5. A client with atrial fibrillation is prescribed apixaban. Which statement by the
client indicates a need for further teaching?
, Page 3 of 68
A) "I will take this medication at the same time every day."
B) "I will avoid contact sports while taking this medication."
C) "I will stop taking this medication if I see any bruising."
D) "I will report any unusual bleeding to my provider."
Answer: C
Rationale: Clients should never stop anticoagulants without provider instruction, even
if bruising occurs. Bruising should be reported, not a reason to discontinue.
6. A client with peripheral arterial disease reports pain in the calf that occurs with
walking and resolves with rest. Which term should the nurse use to document this
finding?
A) Paresthesia
B) Intermittent claudication
C) Rest pain
D) Phantom pain
Answer: B
Rationale: Intermittent claudication is muscle pain with exercise that resolves with
rest, characteristic of peripheral arterial disease.
7. A client is prescribed nitroglycerin sublingually for angina. Which instruction
should the nurse include?
A) "Swallow the tablet with water."
B) "Take one tablet every 5 minutes for up to 3 doses."
C) "Take all three tablets at once if pain is severe."
D) "Take the medication only after the pain becomes unbearable."
Answer: B
Rationale: Sublingual nitroglycerin is taken every 5 minutes for up to 3 doses. If pain
persists after 3 doses, emergency care should be sought.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse monitor for?
A) Dry cough
B) Bradycardia
C) Hyperkalemia
D) Hyperglycemia
Answer: A
Rationale: ACE inhibitors such as lisinopril commonly cause a persistent dry cough due
to bradykinin accumulation.
9. A client with heart failure is prescribed spironolactone. Which laboratory value
should the nurse monitor most closely?
A) Sodium
B) Potassium
, Page 4 of 68
C) Calcium
D) Magnesium
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia, especially when combined with ACE inhibitors or ARBs.
10. A client with a mechanical heart valve is prescribed warfarin. What is the target
INR range?
A) 1.0–1.5
B) 2.0–3.0
C) 3.0–4.0
D) 4.0–5.0
Answer: B
Rationale: The target INR for a mechanical heart valve is typically 2.0–3.0, though some
valve types require 2.5–3.5.
11. A client with heart failure is prescribed carvedilol. Which instruction should the
nurse include?
A) "Take the medication only when you feel short of breath."
B) "Do not stop the medication abruptly."
C) "Increase the dose if your heart rate is high."
D) "Take the medication with grapefruit juice."
Answer: B
Rationale: Abrupt discontinuation of beta-blockers can cause rebound tachycardia,
hypertension, and worsening angina.
12. A client with a deep vein thrombosis is prescribed heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A) INR
B) aPTT
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Unfractionated heparin therapy is monitored with aPTT, with a therapeutic
range of 1.5–2.5 times the control value.
13. A client with hypertension is prescribed hydrochlorothiazide. Which electrolyte
imbalance should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B
NSG 223 MED SURG HESI EXAM QUESTIONS LATEST EDITION 2026 -
2027 VERSION SOLVED QUESTIONS & ANSWERS
NSG 223 MED SURG HESI — 300 MULTIPLE-CHOICE QUESTIONS WITH RATIONALES
10-Point HESI Exam Coverage
Cardiovascular Disorders — Heart failure, MI, arrhythmias, hypertension, valvular
disease, peripheral vascular disease, anticoagulant therapy.
Respiratory Disorders — COPD, asthma, pneumonia, TB, PE, ARDS, chest tubes,
mechanical ventilation, ABG interpretation.
Neurological Disorders — Stroke, seizures, increased ICP, head injury, meningitis,
spinal cord injury, Parkinson's, Alzheimer's.
Renal & Urinary Disorders — AKI, CKD, dialysis, UTI, nephrolithiasis, BPH, electrolyte
imbalances.
Endocrine Disorders — Diabetes (DKA, HHS), thyroid disorders, adrenal disorders,
SIADH, DI, insulin and oral hypoglycemics.
Gastrointestinal & Hepatic Disorders — GI bleed, PUD, pancreatitis, cirrhosis,
hepatitis, bowel obstruction, ostomies, TPN.
Musculoskeletal & Integumentary — Fractures, joint replacement, osteoporosis,
burns, wound care, pressure injuries.
Shock, Sepsis & Emergency Care — Septic shock, hypovolemic shock, anaphylaxis,
cardiogenic shock, triage.
Perioperative Nursing — Preoperative, intraoperative, postoperative care, malignant
hyperthermia, PACU priorities.
Oncology & Immune Disorders — Chemotherapy, oncologic emergencies, HIV/AIDS,
immunosuppression, tumor lysis syndrome.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–35)
, Page 2 of 68
1. A client with acute decompensated heart failure has bilateral crackles, jugular
venous distention, and 3+ pitting edema. Which medication should the nurse
anticipate administering first?
A) Metoprolol
B) IV furosemide
C) Digoxin
D) Spironolactone
Answer: B
Rationale: IV loop diuretics such as furosemide are first-line for acute decompensated
heart failure with pulmonary congestion and fluid overload.
2. A client with a myocardial infarction has ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically
caused by occlusion of the right coronary artery.
3. A client with heart failure is prescribed digoxin. Which assessment finding
requires the nurse to hold the medication and notify the provider?
A) Heart rate of 88 bpm
B) Heart rate of 52 bpm
C) Blood pressure of 118/76 mmHg
D) Respiratory rate of 18
Answer: B
Rationale: Digoxin should be held for heart rate below 60 bpm in adults due to the risk
of worsening bradycardia and toxicity.
4. A client taking warfarin has an INR of 5.5. Which action should the nurse take
first?
A) Administer the next scheduled dose
B) Hold the warfarin and notify the provider
C) Encourage vitamin K-rich foods
D) Document the finding and reassess in 24 hours
Answer: B
Rationale: An INR of 5.5 is supratherapeutic and increases bleeding risk. Warfarin
should be held and the provider notified immediately.
5. A client with atrial fibrillation is prescribed apixaban. Which statement by the
client indicates a need for further teaching?
, Page 3 of 68
A) "I will take this medication at the same time every day."
B) "I will avoid contact sports while taking this medication."
C) "I will stop taking this medication if I see any bruising."
D) "I will report any unusual bleeding to my provider."
Answer: C
Rationale: Clients should never stop anticoagulants without provider instruction, even
if bruising occurs. Bruising should be reported, not a reason to discontinue.
6. A client with peripheral arterial disease reports pain in the calf that occurs with
walking and resolves with rest. Which term should the nurse use to document this
finding?
A) Paresthesia
B) Intermittent claudication
C) Rest pain
D) Phantom pain
Answer: B
Rationale: Intermittent claudication is muscle pain with exercise that resolves with
rest, characteristic of peripheral arterial disease.
7. A client is prescribed nitroglycerin sublingually for angina. Which instruction
should the nurse include?
A) "Swallow the tablet with water."
B) "Take one tablet every 5 minutes for up to 3 doses."
C) "Take all three tablets at once if pain is severe."
D) "Take the medication only after the pain becomes unbearable."
Answer: B
Rationale: Sublingual nitroglycerin is taken every 5 minutes for up to 3 doses. If pain
persists after 3 doses, emergency care should be sought.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse monitor for?
A) Dry cough
B) Bradycardia
C) Hyperkalemia
D) Hyperglycemia
Answer: A
Rationale: ACE inhibitors such as lisinopril commonly cause a persistent dry cough due
to bradykinin accumulation.
9. A client with heart failure is prescribed spironolactone. Which laboratory value
should the nurse monitor most closely?
A) Sodium
B) Potassium
, Page 4 of 68
C) Calcium
D) Magnesium
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia, especially when combined with ACE inhibitors or ARBs.
10. A client with a mechanical heart valve is prescribed warfarin. What is the target
INR range?
A) 1.0–1.5
B) 2.0–3.0
C) 3.0–4.0
D) 4.0–5.0
Answer: B
Rationale: The target INR for a mechanical heart valve is typically 2.0–3.0, though some
valve types require 2.5–3.5.
11. A client with heart failure is prescribed carvedilol. Which instruction should the
nurse include?
A) "Take the medication only when you feel short of breath."
B) "Do not stop the medication abruptly."
C) "Increase the dose if your heart rate is high."
D) "Take the medication with grapefruit juice."
Answer: B
Rationale: Abrupt discontinuation of beta-blockers can cause rebound tachycardia,
hypertension, and worsening angina.
12. A client with a deep vein thrombosis is prescribed heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A) INR
B) aPTT
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Unfractionated heparin therapy is monitored with aPTT, with a therapeutic
range of 1.5–2.5 times the control value.
13. A client with hypertension is prescribed hydrochlorothiazide. Which electrolyte
imbalance should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Answer: B
