HESI MED SURG EXIT EXAM V2 2026 | 150 NGN-Style Questions |
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SECTION 1: STANDARD FORMAT ITEMS (Questions 1-97)
Question 1:
A 72-year-old male is admitted with acute decompensated heart failure (ADHF) with
reduced ejection fraction. He has a pulmonary artery catheter in place. Hemodynamic
data shows: CI 1.8 L/min/m² (normal 2.5-4), PCWP 28 mmHg (normal 6-12), SVR 1800
dynes/sec/cm⁻⁵ (normal 800-1200), mixed venous oxygen saturation (SvO₂) 52%
(normal 60-80%). The client is dyspneic, hypotensive (BP 78/52), and has cool, clammy
skin. Which intervention should the nurse prioritize?
A. Administer furosemide 40 mg IV push to reduce preload
B. Begin dobutamine infusion at 5 mcg/kg/min to increase contractility
C. Initiate nitroprusside infusion to afterload reduction
D. Administer 500 mL normal saline bolus to increase preload
Correct Answer: B
Rationale:
,Option A: Furosemide reduces preload, which is already elevated (PCWP 28), but this
client has cardiogenic shock with low cardiac index and hypotension. Further reducing
preload without addressing contractility would worsen hypotension and perfusion. This
is contraindicated in this presentation.
Option B: [CORRECT] This client has cardiogenic shock (CI <2.2, hypotension, cool
clammy skin, low SvO₂) with elevated preload (PCWP 28) and elevated afterload (SVR
1800). Dobutamine is an inotrope that increases contractility and cardiac output while
causing mild vasodilation. It addresses the primary problem of pump failure. The
clinical judgment layer is Analyze Cues—recognizing that low CI with high filling
pressures indicates pump failure requiring inotropic support, not volume or afterload
reduction alone.
Option C: Nitroprusside reduces afterload, which is elevated, but in a hypotensive client
(BP 78/52), pure vasodilation would cause cardiovascular collapse. This is absolutely
contraindicated without inotropic support.
Option D: Volume loading is contraindicated because PCWP is already elevated (28
mmHg), indicating fluid overload and poor left ventricular compliance. Additional fluid
would worsen pulmonary edema without improving output.
Question 2 (SATA with 5 correct):
A nurse is caring for a client 48 hours post-open repair of abdominal aortic aneurysm.
Which findings indicate potential graft infection or early complication requiring
immediate intervention? Select all that apply.
A. Temperature 101.8°F (38.8°C) with chills
,B. White blood cell count 14,500/mm³
C. New onset of back pain radiating to flank
D. Decreased urine output from 50 mL/hr to 15 mL/hr over 4 hours
E. Slight erythema at incision edges
F. Bounding pedal pulses bilaterally
G. Report of nausea with abdominal distension
Correct Answer: A, B, C, D, G
Rationale:
Option A: [CORRECT] Fever with chills post-vascular surgery suggests graft infection or
systemic inflammatory response. This requires immediate blood cultures and
broad-spectrum antibiotics. Temperature >101°F in first 48 hours post-major vascular
surgery is abnormal and concerning.
Option B: [CORRECT] Leukocytosis >12,000 in postoperative day 2, especially with left
shift, indicates infection or significant inflammatory response. This requires
investigation for graft infection, anastomotic leak, or other source.
Option C: [CORRECT] New back/flank pain post-AAA repair suggests retroperitoneal
hematoma, graft leak, or spinal cord ischemia. This is a surgical emergency requiring
immediate CT angiography.
Option D: [CORRECT] Oliguria indicates either hypovolemia, graft thrombosis with renal
ischemia, or contrast-induced nephropathy. Given the timing, this suggests either
hypoperfusion from bleeding or renal artery compromise.
, Option E: Incorrect. Minimal erythema at incision edges in first 48 hours is normal
inflammatory response. Significant erythema with purulence, warmth, or dehiscence
would be concerning.
Option F: Incorrect. Bounding pulses indicate good distal perfusion and graft patency.
This is a positive finding, not a complication.
Option G: [CORRECT] Nausea with abdominal distension suggests ileus, mesenteric
ischemia, or anastomotic leak. In the context of AAA repair, this requires immediate
evaluation for bowel ischemia from graft compromise.
Question 3 (Ordered Response – Complex Emergency with Branching Logic):
A client with massive pulmonary embolism (PE) presents with syncope, hypotension
(BP 68/42), tachycardia (HR 134), and severe hypoxemia (SpO₂ 78% on 100%
non-rebreather). The team is preparing for systemic thrombolysis. Place the following
interventions in priority order.
1. Obtain CT pulmonary angiography to confirm diagnosis
2. Administer alteplase 100 mg IV over 2 hours
3. Establish large-bore IV access and draw baseline labs
4. Administer heparin 80 units/kg IV bolus
5. Prepare for potential intubation and mechanical ventilation
6. Apply vasopressors (norepinephrine) to maintain MAP >65
7. Position client in left lateral decubitus with head down
Correct Order: 3, 6, 5, 2, 4, 7, 1
Rationale:
Real Q&A with Verified Answers | Complete Exam Simulation | Pass
Guaranteed - A+ Graded
SECTION 1: STANDARD FORMAT ITEMS (Questions 1-97)
Question 1:
A 72-year-old male is admitted with acute decompensated heart failure (ADHF) with
reduced ejection fraction. He has a pulmonary artery catheter in place. Hemodynamic
data shows: CI 1.8 L/min/m² (normal 2.5-4), PCWP 28 mmHg (normal 6-12), SVR 1800
dynes/sec/cm⁻⁵ (normal 800-1200), mixed venous oxygen saturation (SvO₂) 52%
(normal 60-80%). The client is dyspneic, hypotensive (BP 78/52), and has cool, clammy
skin. Which intervention should the nurse prioritize?
A. Administer furosemide 40 mg IV push to reduce preload
B. Begin dobutamine infusion at 5 mcg/kg/min to increase contractility
C. Initiate nitroprusside infusion to afterload reduction
D. Administer 500 mL normal saline bolus to increase preload
Correct Answer: B
Rationale:
,Option A: Furosemide reduces preload, which is already elevated (PCWP 28), but this
client has cardiogenic shock with low cardiac index and hypotension. Further reducing
preload without addressing contractility would worsen hypotension and perfusion. This
is contraindicated in this presentation.
Option B: [CORRECT] This client has cardiogenic shock (CI <2.2, hypotension, cool
clammy skin, low SvO₂) with elevated preload (PCWP 28) and elevated afterload (SVR
1800). Dobutamine is an inotrope that increases contractility and cardiac output while
causing mild vasodilation. It addresses the primary problem of pump failure. The
clinical judgment layer is Analyze Cues—recognizing that low CI with high filling
pressures indicates pump failure requiring inotropic support, not volume or afterload
reduction alone.
Option C: Nitroprusside reduces afterload, which is elevated, but in a hypotensive client
(BP 78/52), pure vasodilation would cause cardiovascular collapse. This is absolutely
contraindicated without inotropic support.
Option D: Volume loading is contraindicated because PCWP is already elevated (28
mmHg), indicating fluid overload and poor left ventricular compliance. Additional fluid
would worsen pulmonary edema without improving output.
Question 2 (SATA with 5 correct):
A nurse is caring for a client 48 hours post-open repair of abdominal aortic aneurysm.
Which findings indicate potential graft infection or early complication requiring
immediate intervention? Select all that apply.
A. Temperature 101.8°F (38.8°C) with chills
,B. White blood cell count 14,500/mm³
C. New onset of back pain radiating to flank
D. Decreased urine output from 50 mL/hr to 15 mL/hr over 4 hours
E. Slight erythema at incision edges
F. Bounding pedal pulses bilaterally
G. Report of nausea with abdominal distension
Correct Answer: A, B, C, D, G
Rationale:
Option A: [CORRECT] Fever with chills post-vascular surgery suggests graft infection or
systemic inflammatory response. This requires immediate blood cultures and
broad-spectrum antibiotics. Temperature >101°F in first 48 hours post-major vascular
surgery is abnormal and concerning.
Option B: [CORRECT] Leukocytosis >12,000 in postoperative day 2, especially with left
shift, indicates infection or significant inflammatory response. This requires
investigation for graft infection, anastomotic leak, or other source.
Option C: [CORRECT] New back/flank pain post-AAA repair suggests retroperitoneal
hematoma, graft leak, or spinal cord ischemia. This is a surgical emergency requiring
immediate CT angiography.
Option D: [CORRECT] Oliguria indicates either hypovolemia, graft thrombosis with renal
ischemia, or contrast-induced nephropathy. Given the timing, this suggests either
hypoperfusion from bleeding or renal artery compromise.
, Option E: Incorrect. Minimal erythema at incision edges in first 48 hours is normal
inflammatory response. Significant erythema with purulence, warmth, or dehiscence
would be concerning.
Option F: Incorrect. Bounding pulses indicate good distal perfusion and graft patency.
This is a positive finding, not a complication.
Option G: [CORRECT] Nausea with abdominal distension suggests ileus, mesenteric
ischemia, or anastomotic leak. In the context of AAA repair, this requires immediate
evaluation for bowel ischemia from graft compromise.
Question 3 (Ordered Response – Complex Emergency with Branching Logic):
A client with massive pulmonary embolism (PE) presents with syncope, hypotension
(BP 68/42), tachycardia (HR 134), and severe hypoxemia (SpO₂ 78% on 100%
non-rebreather). The team is preparing for systemic thrombolysis. Place the following
interventions in priority order.
1. Obtain CT pulmonary angiography to confirm diagnosis
2. Administer alteplase 100 mg IV over 2 hours
3. Establish large-bore IV access and draw baseline labs
4. Administer heparin 80 units/kg IV bolus
5. Prepare for potential intubation and mechanical ventilation
6. Apply vasopressors (norepinephrine) to maintain MAP >65
7. Position client in left lateral decubitus with head down
Correct Order: 3, 6, 5, 2, 4, 7, 1
Rationale:
