1
Evolve HESI Medical-Surgical Exam Version 3
Actual Exam 2026/2027 | Complete Questions
with Verified Answers & Well-Elaborated
Rationales | Already Graded A+ (Brand New!!)
SECTION 1: CARDIOVASCULAR DISORDERS (20 Questions)
Case Study 1: Acute Myocardial Infarction Complications
Scenario: A 68-year-old male is 2 days post-anterior wall ST-elevation myocardial infarction
(STEMI). He suddenly becomes severely short of breath, has bilateral crackles halfway up the
lung fields, and O2 saturation drops to 88% on 2L nasal cannula. Heart rate is 110 bpm, blood
pressure 160/95 mmHg.
Q1: Based on these findings, what complication should the nurse suspect first?
A. Pulmonary embolism
B. Acute pulmonary edema secondary to heart failure
C. Pneumothorax
D. Acute pericarditis
Correct Answer: B. [CORRECT]
Rationale: Post-MI acute decompensated heart failure with pulmonary edema presents with
sudden onset dyspnea, bilateral crackles indicating fluid accumulation, and hypoxemia due to left
ventricular systolic dysfunction following anterior wall damage. The elevated blood pressure
reflects increased afterload and neurohormonal activation. Pulmonary embolism typically
presents with pleuritic chest pain and unilateral findings; pneumothorax would demonstrate
absent breath sounds and possible tracheal deviation; pericarditis presents with positional chest
pain relieved by sitting forward and a friction rub.
Q2: What is the priority nursing intervention for this patient?
A. Administer sublingual nitroglycerin
B. Apply non-rebreather mask at 15L/min and prepare for BiPAP
C. Administer IV morphine sulfate 4mg
D. Obtain stat 12-lead ECG
,2
Correct Answer: B. [CORRECT]
Rationale: Acute pulmonary edema with hypoxemia (SpO2 88%) requires immediate high-flow
oxygen therapy to correct hypoxia and reduce pulmonary vascular congestion. Non-rebreather
mask at 15L/min provides the highest FiO2 before intubation. BiPAP reduces preload and
afterload while improving oxygenation. While morphine and nitrates are important interventions,
oxygenation takes absolute priority in hypoxemic respiratory failure.
Q3: Which medication combination addresses both preload and afterload reduction in this
scenario?
A. Digoxin and furosemide
B. Nitroglycerin and enalapril
C. Dobutamine and dopamine
D. Metoprolol and aspirin
Correct Answer: B. [CORRECT]
Rationale: Nitroglycerin (venous and arterial dilator) reduces preload primarily and afterload
secondarily, while ACE inhibitors like enalapril reduce afterload through arterial vasodilation
and inhibit neurohormonal activation. This combination effectively decreases cardiac workload
and pulmonary congestion. Digoxin improves contractility but does not address acute
preload/afterload; inotropes like dobutamine are reserved for cardiogenic shock; metoprolol is
contraindicated in acute decompensated heart failure.
Q4: A patient with chronic heart failure is prescribed lisinopril 10mg daily, furosemide 40mg
BID, and spironolactone 25mg daily. Which laboratory value requires immediate notification of
the provider?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. BUN 22 mg/dL
D. Creatinine 1.4 mg/dL
Correct Answer: B. [CORRECT]
Rationale: Potassium 5.8 mEq/L represents severe hyperkalemia (>5.5 mEq/L) in a patient
receiving ACE inhibitor (lisinopril), loop diuretic (furosemide), and potassium-sparing diuretic
(spironolactone). This combination significantly increases hyperkalemia risk, which can cause
life-threatening cardiac dysrhythmias. While BUN and creatinine elevations warrant monitoring,
hyperkalemia requires immediate intervention including potential medication adjustment, ECG
monitoring, and administration of potassium-lowering agents.
,3
Q5: Which finding in a patient receiving IV heparin for STEMI requires immediate
discontinuation of the medication?
A. aPTT 80 seconds (control 30 seconds)
B. Platelet count decreased from 250,000 to 95,000/mm³
C. Hemoglobin decreased from 14.2 to 12.8 g/dL
D. INR 1.2
Correct Answer: B. [CORRECT]
Rationale: A platelet count decrease >50% from baseline or <100,000/mm³ indicates heparin-
induced thrombocytopenia (HIT), an immune-mediated prothrombotic condition requiring
immediate heparin discontinuation to prevent thrombosis. An aPTT of 80 seconds (2.5-2.7x
control) is therapeutic; mild hemoglobin drop may indicate minor bleeding but does not require
discontinuation; INR is not monitored for heparin therapy.
SATA Question 1: Anticoagulation Monitoring
Q6: Which laboratory values should be monitored for a patient receiving IV unfractionated
heparin? (Select all that apply)
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Hemoglobin and hematocrit
E. Prothrombin time (PT)
F. Anti-Xa activity
Correct Answers: A, C, D, F. [CORRECT]
Rationale: Unfractionated heparin requires monitoring of aPTT (therapeutic range typically 1.5-
2.5 times control or 60-80 seconds), platelet count (to detect HIT typically occurring days 5-10),
hemoglobin/hematocrit (to assess for occult bleeding), and anti-Xa activity (alternative
monitoring method, goal 0.3-0.7 IU/mL). INR and PT monitor warfarin therapy, not heparin.
Q7: A patient with new-onset atrial fibrillation has a heart rate of 152 bpm and blood pressure
88/52 mmHg. What is the priority intervention?
A. Administer IV diltiazem
B. Administer IV metoprolol
C. Prepare for synchronized cardioversion
D. Administer IV digoxin
, 4
Correct Answer: C. [CORRECT]
Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) and tachycardia-
induced hemodynamic compromise requires immediate synchronized cardioversion (100-200 J
biphasic) to restore sinus rhythm and cardiac output. Rate-control agents (diltiazem, metoprolol,
digoxin) are contraindicated in unstable patients as they further depress cardiac function and
blood pressure.
Q8: Which ECG finding indicates the need for immediate defibrillation?
A. Atrial fibrillation with rapid ventricular response at 140 bpm
B. Third-degree AV block with ventricular rate 35 bpm
C. Ventricular fibrillation
D. Sinus bradycardia at 48 bpm
Correct Answer: C. [CORRECT]
Rationale: Ventricular fibrillation is a pulseless, chaotic rhythm requiring immediate
unsynchronized defibrillation (120-200 J biphasic) as the definitive treatment. Delay increases
mortality exponentially. Atrial fibrillation with RVR requires rate control; third-degree block
requires pacing; sinus bradycardia requires atropine if symptomatic.
Q9: A patient post-cardiac catheterization via femoral approach develops a pulsatile mass at the
insertion site with a bruit. What complication has occurred?
A. Retroperitoneal bleed
B. Pseudoaneurysm
C. Arteriovenous fistula
D. Hematoma
Correct Answer: B. [CORRECT]
Rationale: A pulsatile mass with audible bruit following femoral catheterization indicates
pseudoaneurysm formation—an encapsulated hematoma communicating with the artery through
a neck. This requires ultrasound confirmation and potential thrombin injection or surgical repair.
Retroperitoneal bleed presents with back pain and hypotension; AV fistula creates continuous
machinery murmur; simple hematoma is non-pulsatile.
Q10: Which instruction is essential for a patient discharged on warfarin with a target INR 2.0-
3.0?
A. "Take aspirin 81mg daily for additional cardiac protection"
B. "Increase leafy green vegetables to improve nutrition"
Evolve HESI Medical-Surgical Exam Version 3
Actual Exam 2026/2027 | Complete Questions
with Verified Answers & Well-Elaborated
Rationales | Already Graded A+ (Brand New!!)
SECTION 1: CARDIOVASCULAR DISORDERS (20 Questions)
Case Study 1: Acute Myocardial Infarction Complications
Scenario: A 68-year-old male is 2 days post-anterior wall ST-elevation myocardial infarction
(STEMI). He suddenly becomes severely short of breath, has bilateral crackles halfway up the
lung fields, and O2 saturation drops to 88% on 2L nasal cannula. Heart rate is 110 bpm, blood
pressure 160/95 mmHg.
Q1: Based on these findings, what complication should the nurse suspect first?
A. Pulmonary embolism
B. Acute pulmonary edema secondary to heart failure
C. Pneumothorax
D. Acute pericarditis
Correct Answer: B. [CORRECT]
Rationale: Post-MI acute decompensated heart failure with pulmonary edema presents with
sudden onset dyspnea, bilateral crackles indicating fluid accumulation, and hypoxemia due to left
ventricular systolic dysfunction following anterior wall damage. The elevated blood pressure
reflects increased afterload and neurohormonal activation. Pulmonary embolism typically
presents with pleuritic chest pain and unilateral findings; pneumothorax would demonstrate
absent breath sounds and possible tracheal deviation; pericarditis presents with positional chest
pain relieved by sitting forward and a friction rub.
Q2: What is the priority nursing intervention for this patient?
A. Administer sublingual nitroglycerin
B. Apply non-rebreather mask at 15L/min and prepare for BiPAP
C. Administer IV morphine sulfate 4mg
D. Obtain stat 12-lead ECG
,2
Correct Answer: B. [CORRECT]
Rationale: Acute pulmonary edema with hypoxemia (SpO2 88%) requires immediate high-flow
oxygen therapy to correct hypoxia and reduce pulmonary vascular congestion. Non-rebreather
mask at 15L/min provides the highest FiO2 before intubation. BiPAP reduces preload and
afterload while improving oxygenation. While morphine and nitrates are important interventions,
oxygenation takes absolute priority in hypoxemic respiratory failure.
Q3: Which medication combination addresses both preload and afterload reduction in this
scenario?
A. Digoxin and furosemide
B. Nitroglycerin and enalapril
C. Dobutamine and dopamine
D. Metoprolol and aspirin
Correct Answer: B. [CORRECT]
Rationale: Nitroglycerin (venous and arterial dilator) reduces preload primarily and afterload
secondarily, while ACE inhibitors like enalapril reduce afterload through arterial vasodilation
and inhibit neurohormonal activation. This combination effectively decreases cardiac workload
and pulmonary congestion. Digoxin improves contractility but does not address acute
preload/afterload; inotropes like dobutamine are reserved for cardiogenic shock; metoprolol is
contraindicated in acute decompensated heart failure.
Q4: A patient with chronic heart failure is prescribed lisinopril 10mg daily, furosemide 40mg
BID, and spironolactone 25mg daily. Which laboratory value requires immediate notification of
the provider?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. BUN 22 mg/dL
D. Creatinine 1.4 mg/dL
Correct Answer: B. [CORRECT]
Rationale: Potassium 5.8 mEq/L represents severe hyperkalemia (>5.5 mEq/L) in a patient
receiving ACE inhibitor (lisinopril), loop diuretic (furosemide), and potassium-sparing diuretic
(spironolactone). This combination significantly increases hyperkalemia risk, which can cause
life-threatening cardiac dysrhythmias. While BUN and creatinine elevations warrant monitoring,
hyperkalemia requires immediate intervention including potential medication adjustment, ECG
monitoring, and administration of potassium-lowering agents.
,3
Q5: Which finding in a patient receiving IV heparin for STEMI requires immediate
discontinuation of the medication?
A. aPTT 80 seconds (control 30 seconds)
B. Platelet count decreased from 250,000 to 95,000/mm³
C. Hemoglobin decreased from 14.2 to 12.8 g/dL
D. INR 1.2
Correct Answer: B. [CORRECT]
Rationale: A platelet count decrease >50% from baseline or <100,000/mm³ indicates heparin-
induced thrombocytopenia (HIT), an immune-mediated prothrombotic condition requiring
immediate heparin discontinuation to prevent thrombosis. An aPTT of 80 seconds (2.5-2.7x
control) is therapeutic; mild hemoglobin drop may indicate minor bleeding but does not require
discontinuation; INR is not monitored for heparin therapy.
SATA Question 1: Anticoagulation Monitoring
Q6: Which laboratory values should be monitored for a patient receiving IV unfractionated
heparin? (Select all that apply)
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Hemoglobin and hematocrit
E. Prothrombin time (PT)
F. Anti-Xa activity
Correct Answers: A, C, D, F. [CORRECT]
Rationale: Unfractionated heparin requires monitoring of aPTT (therapeutic range typically 1.5-
2.5 times control or 60-80 seconds), platelet count (to detect HIT typically occurring days 5-10),
hemoglobin/hematocrit (to assess for occult bleeding), and anti-Xa activity (alternative
monitoring method, goal 0.3-0.7 IU/mL). INR and PT monitor warfarin therapy, not heparin.
Q7: A patient with new-onset atrial fibrillation has a heart rate of 152 bpm and blood pressure
88/52 mmHg. What is the priority intervention?
A. Administer IV diltiazem
B. Administer IV metoprolol
C. Prepare for synchronized cardioversion
D. Administer IV digoxin
, 4
Correct Answer: C. [CORRECT]
Rationale: Unstable atrial fibrillation with hypotension (SBP <90 mmHg) and tachycardia-
induced hemodynamic compromise requires immediate synchronized cardioversion (100-200 J
biphasic) to restore sinus rhythm and cardiac output. Rate-control agents (diltiazem, metoprolol,
digoxin) are contraindicated in unstable patients as they further depress cardiac function and
blood pressure.
Q8: Which ECG finding indicates the need for immediate defibrillation?
A. Atrial fibrillation with rapid ventricular response at 140 bpm
B. Third-degree AV block with ventricular rate 35 bpm
C. Ventricular fibrillation
D. Sinus bradycardia at 48 bpm
Correct Answer: C. [CORRECT]
Rationale: Ventricular fibrillation is a pulseless, chaotic rhythm requiring immediate
unsynchronized defibrillation (120-200 J biphasic) as the definitive treatment. Delay increases
mortality exponentially. Atrial fibrillation with RVR requires rate control; third-degree block
requires pacing; sinus bradycardia requires atropine if symptomatic.
Q9: A patient post-cardiac catheterization via femoral approach develops a pulsatile mass at the
insertion site with a bruit. What complication has occurred?
A. Retroperitoneal bleed
B. Pseudoaneurysm
C. Arteriovenous fistula
D. Hematoma
Correct Answer: B. [CORRECT]
Rationale: A pulsatile mass with audible bruit following femoral catheterization indicates
pseudoaneurysm formation—an encapsulated hematoma communicating with the artery through
a neck. This requires ultrasound confirmation and potential thrombin injection or surgical repair.
Retroperitoneal bleed presents with back pain and hypotension; AV fistula creates continuous
machinery murmur; simple hematoma is non-pulsatile.
Q10: Which instruction is essential for a patient discharged on warfarin with a target INR 2.0-
3.0?
A. "Take aspirin 81mg daily for additional cardiac protection"
B. "Increase leafy green vegetables to improve nutrition"
