2026 HESI Medical Surgical Nursing Practice
Questions Answer Explanations Adult Health
Disorders Assessment Nursing Interventions
Prioritization Clinical Review
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A nurse is assessing a patient with heart failure. Which finding indicates
worsening of the patient's condition?
A) Weight loss of 1 kg
B) Urine output of 50 mL/hr
C) Crackles in bilateral lung bases
D) Heart rate of 88 bpm
Answer: C) Crackles in bilateral lung bases
Rationale: Crackles indicate pulmonary congestion from fluid accumulation, a
sign of worsening left-sided heart failure. Weight loss, adequate urine output, and
normal heart rate indicate stability or improvement.
2. A patient with atrial fibrillation has a heart rate of 148 bpm. Which
complication is the priority concern?
A) Anxiety
B) Thromboembolism
C) Palpitations
D) Fatigue
Answer: B) Thromboembolism
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of
clot formation and embolization, especially to the brain (stroke).
3. A patient with acute myocardial infarction reports crushing chest pain.
Which action should the nurse take first?
A) Administer morphine
B) Obtain a 12-lead ECG
C) Administer oxygen
D) Start an IV line
Answer: B) Obtain a 12-lead ECG
,Rationale: The priority is to obtain a 12-lead ECG within 10 minutes of arrival to
diagnose STEMI and determine the need for reperfusion therapy.
4. A patient with peripheral arterial disease has a non-healing ulcer on the
great toe. Which finding is expected?
A) Pitting edema
B) Warm, red skin
C) Absent pedal pulses
D) Copious drainage
Answer: C) Absent pedal pulses
Rationale: PAD causes decreased arterial blood flow, leading to absent or
diminished pulses, cool skin, and pale color.
5. A patient with infective endocarditis has a new murmur. Which mechanism
explains this finding?
A) Pericardial inflammation
B) Valvular vegetation and destruction
C) Myocardial ischemia
D) Aortic aneurysm
Answer: B) Valvular vegetation and destruction
Rationale: Infective endocarditis involves infection of the endocardium, most
commonly valves, leading to vegetations that damage valve leaflets.
6. A patient with hypertension has a blood pressure of 190/120 mm Hg and
reports a severe headache. Which action should the nurse take first?
A) Administer antihypertensive as ordered
B) Assess for neurological deficits
C) Recheck blood pressure in 15 minutes
D) Encourage relaxation
Answer: B) Assess for neurological deficits
Rationale: Severe hypertension with headache may indicate hypertensive crisis
with neurological involvement. Assessment for deficits guides immediate
intervention.
7. A patient with heart failure has a BNP of 1,500 pg/mL. Which mechanism
explains this finding?
A) Increased renal excretion
B) Ventricular stretch from volume overload
C) Decreased myocardial contractility
D) Pulmonary vasoconstriction
Answer: B) Ventricular stretch from volume overload
,Rationale: BNP is released by ventricular myocytes in response to stretch from
volume overload.
8. A patient with a mechanical heart valve is prescribed warfarin. Which
laboratory test should the nurse monitor?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
Answer: B) PT/INR
Rationale: Warfarin therapy is monitored with PT/INR. Mechanical valves require
lifelong anticoagulation with a target INR.
9. A patient with pericarditis reports chest pain that worsens with inspiration.
Which position relieves this pain?
A) Supine
B) Leaning forward
C) Left lateral recumbent
D) Trendelenburg
Answer: B) Leaning forward
Rationale: Pericarditis pain is pleuritic and relieved by leaning forward, which
reduces friction between inflamed pericardial layers.
10. A patient with an abdominal aortic aneurysm reports sudden severe back
pain. Which action should the nurse take first?
A) Administer pain medication
B) Assess vital signs and notify the provider
C) Place in supine position
D) Obtain a urine specimen
Answer: B) Assess vital signs and notify the provider
Rationale: Sudden severe back pain may indicate rupture, a life-threatening
emergency. Immediate assessment and notification are critical.
11. A patient with deep vein thrombosis is at risk for which life-threatening
complication?
A) Pulmonary embolism
B) Myocardial infarction
C) Stroke
D) Aortic dissection
Answer: A) Pulmonary embolism
, Rationale: DVT can dislodge and travel to the pulmonary circulation, causing a
pulmonary embolism.
12. A patient with left-sided heart failure has orthopnea. Which mechanism
explains this finding?
A) Systemic venous congestion
B) Pulmonary congestion when supine
C) Decreased cardiac output
D) Peripheral edema
Answer: B) Pulmonary congestion when supine
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation. When supine, increased venous return worsens pulmonary congestion.
13. A patient with cardiogenic shock has a blood pressure of 80/50 mm Hg.
Which finding is expected?
A) Warm, dry skin
B) Decreased urine output
C) Bradycardia
D) Increased cardiac output
Answer: B) Decreased urine output
Rationale: Cardiogenic shock causes decreased cardiac output and hypotension,
leading to poor renal perfusion and decreased urine output.
14. A patient with a venous stasis ulcer has edema and brown discoloration.
Which mechanism explains this finding?
A) Arterial insufficiency
B) Venous hypertension and hemosiderin deposition
C) Infection
D) Neuropathy
Answer: B) Venous hypertension and hemosiderin deposition
Rationale: Venous insufficiency causes venous hypertension, leading to edema
and leakage of red blood cells. Hemosiderin deposition causes brown
discoloration.
15. A patient with a history of rheumatic fever is at risk for which valvular
disorder?
A) Aortic stenosis
B) Mitral stenosis
C) Tricuspid regurgitation
D) Pulmonary stenosis
Answer: B) Mitral stenosis
Questions Answer Explanations Adult Health
Disorders Assessment Nursing Interventions
Prioritization Clinical Review
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A nurse is assessing a patient with heart failure. Which finding indicates
worsening of the patient's condition?
A) Weight loss of 1 kg
B) Urine output of 50 mL/hr
C) Crackles in bilateral lung bases
D) Heart rate of 88 bpm
Answer: C) Crackles in bilateral lung bases
Rationale: Crackles indicate pulmonary congestion from fluid accumulation, a
sign of worsening left-sided heart failure. Weight loss, adequate urine output, and
normal heart rate indicate stability or improvement.
2. A patient with atrial fibrillation has a heart rate of 148 bpm. Which
complication is the priority concern?
A) Anxiety
B) Thromboembolism
C) Palpitations
D) Fatigue
Answer: B) Thromboembolism
Rationale: Atrial fibrillation causes blood stasis in the atria, increasing the risk of
clot formation and embolization, especially to the brain (stroke).
3. A patient with acute myocardial infarction reports crushing chest pain.
Which action should the nurse take first?
A) Administer morphine
B) Obtain a 12-lead ECG
C) Administer oxygen
D) Start an IV line
Answer: B) Obtain a 12-lead ECG
,Rationale: The priority is to obtain a 12-lead ECG within 10 minutes of arrival to
diagnose STEMI and determine the need for reperfusion therapy.
4. A patient with peripheral arterial disease has a non-healing ulcer on the
great toe. Which finding is expected?
A) Pitting edema
B) Warm, red skin
C) Absent pedal pulses
D) Copious drainage
Answer: C) Absent pedal pulses
Rationale: PAD causes decreased arterial blood flow, leading to absent or
diminished pulses, cool skin, and pale color.
5. A patient with infective endocarditis has a new murmur. Which mechanism
explains this finding?
A) Pericardial inflammation
B) Valvular vegetation and destruction
C) Myocardial ischemia
D) Aortic aneurysm
Answer: B) Valvular vegetation and destruction
Rationale: Infective endocarditis involves infection of the endocardium, most
commonly valves, leading to vegetations that damage valve leaflets.
6. A patient with hypertension has a blood pressure of 190/120 mm Hg and
reports a severe headache. Which action should the nurse take first?
A) Administer antihypertensive as ordered
B) Assess for neurological deficits
C) Recheck blood pressure in 15 minutes
D) Encourage relaxation
Answer: B) Assess for neurological deficits
Rationale: Severe hypertension with headache may indicate hypertensive crisis
with neurological involvement. Assessment for deficits guides immediate
intervention.
7. A patient with heart failure has a BNP of 1,500 pg/mL. Which mechanism
explains this finding?
A) Increased renal excretion
B) Ventricular stretch from volume overload
C) Decreased myocardial contractility
D) Pulmonary vasoconstriction
Answer: B) Ventricular stretch from volume overload
,Rationale: BNP is released by ventricular myocytes in response to stretch from
volume overload.
8. A patient with a mechanical heart valve is prescribed warfarin. Which
laboratory test should the nurse monitor?
A) aPTT
B) PT/INR
C) Bleeding time
D) Platelet count
Answer: B) PT/INR
Rationale: Warfarin therapy is monitored with PT/INR. Mechanical valves require
lifelong anticoagulation with a target INR.
9. A patient with pericarditis reports chest pain that worsens with inspiration.
Which position relieves this pain?
A) Supine
B) Leaning forward
C) Left lateral recumbent
D) Trendelenburg
Answer: B) Leaning forward
Rationale: Pericarditis pain is pleuritic and relieved by leaning forward, which
reduces friction between inflamed pericardial layers.
10. A patient with an abdominal aortic aneurysm reports sudden severe back
pain. Which action should the nurse take first?
A) Administer pain medication
B) Assess vital signs and notify the provider
C) Place in supine position
D) Obtain a urine specimen
Answer: B) Assess vital signs and notify the provider
Rationale: Sudden severe back pain may indicate rupture, a life-threatening
emergency. Immediate assessment and notification are critical.
11. A patient with deep vein thrombosis is at risk for which life-threatening
complication?
A) Pulmonary embolism
B) Myocardial infarction
C) Stroke
D) Aortic dissection
Answer: A) Pulmonary embolism
, Rationale: DVT can dislodge and travel to the pulmonary circulation, causing a
pulmonary embolism.
12. A patient with left-sided heart failure has orthopnea. Which mechanism
explains this finding?
A) Systemic venous congestion
B) Pulmonary congestion when supine
C) Decreased cardiac output
D) Peripheral edema
Answer: B) Pulmonary congestion when supine
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation. When supine, increased venous return worsens pulmonary congestion.
13. A patient with cardiogenic shock has a blood pressure of 80/50 mm Hg.
Which finding is expected?
A) Warm, dry skin
B) Decreased urine output
C) Bradycardia
D) Increased cardiac output
Answer: B) Decreased urine output
Rationale: Cardiogenic shock causes decreased cardiac output and hypotension,
leading to poor renal perfusion and decreased urine output.
14. A patient with a venous stasis ulcer has edema and brown discoloration.
Which mechanism explains this finding?
A) Arterial insufficiency
B) Venous hypertension and hemosiderin deposition
C) Infection
D) Neuropathy
Answer: B) Venous hypertension and hemosiderin deposition
Rationale: Venous insufficiency causes venous hypertension, leading to edema
and leakage of red blood cells. Hemosiderin deposition causes brown
discoloration.
15. A patient with a history of rheumatic fever is at risk for which valvular
disorder?
A) Aortic stenosis
B) Mitral stenosis
C) Tricuspid regurgitation
D) Pulmonary stenosis
Answer: B) Mitral stenosis
