Med Surg HESI Exam Questions with All Answers Verified
& Correct New Update Actual Exam 2026/2027 – Complete
Exam-Style Q&As | 100% Certified Verified – Pass
Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR DISORDERS (Questions 1–20)
Q1: A 68-year-old patient is admitted with chest pain described as "crushing pressure" radiating to the
left jaw and arm, accompanied by diaphoresis and nausea. Vital signs: BP 88/52, HR 118, RR 26, SpO2
89% on room air. The 12-lead ECG shows ST elevation in leads V1–V4. Which finding is most concerning
and requires immediate intervention?
A. The patient's report of nausea
B. The hypotension and anterior wall ST elevation indicating extensive left ventricular damage with risk
of cardiogenic shock [CORRECT]
C. The slightly elevated respiratory rate
D. The patient's age of 68 years
Correct Answer: B
Rationale: The best answer is B. Anterior wall STEMI with hypotension is a red flag for extensive left
ventricular damage and impending cardiogenic shock. The anterior wall is the largest territory, and
when it's affected with hemodynamic compromise, mortality skyrockets. This patient needs emergent
reperfusion, possible inotropes, and ICU-level care. Nausea is common with MI but not immediately life-
threatening. Tachypnea is concerning but secondary to the circulatory collapse. And age is a risk factor,
not an actionable finding.
Q2: A patient with heart failure is receiving IV furosemide 80 mg. Two hours later, the nurse notes the
patient has produced 50 mL of urine, has a respiratory rate of 34, and is using accessory muscles. The
patient is confused and restless. Which action should the nurse take first?
A. Increase the furosemide dose to promote more diuresis
,B. Call the rapid response team and prepare for possible intubation, as the patient is showing signs of
acute respiratory failure from worsening pulmonary edema [CORRECT]
C. Reassure the patient and encourage pursed-lip breathing
D. Administer a sedative to reduce the patient's restlessness
Correct Answer: B
Rationale: The best answer is B. Minimal urine output despite high-dose furosemide plus worsening
respiratory distress and altered mental status means this patient is in acute respiratory failure from
decompensated heart failure. The diuretics aren't working, and the patient is deteriorating fast. This is
rapid response territory—possible need for BiPAP or intubation, inotropes, and ICU transfer. More
diuretics won't help if the kidneys aren't responding. Reassurance is inadequate for respiratory failure.
And sedating a patient in respiratory distress is dangerous.
Q3: A patient with atrial fibrillation is prescribed amiodarone. The nurse should monitor for which
adverse effect that is unique to this medication?
A. Hypokalemia
B. Pulmonary fibrosis, thyroid dysfunction, and corneal deposits [CORRECT]
C. Hypoglycemia
D. Gastrointestinal bleeding
Correct Answer: B
Rationale: The best answer is B. Amiodarone is a highly effective antiarrhythmic with a notoriously toxic
side effect profile. Pulmonary fibrosis can be fatal, thyroid dysfunction (both hypo and hyper) is
common because of the iodine content, and corneal deposits are almost universal with long-term use.
Baseline and periodic chest X-rays, thyroid function tests, and liver function tests are essential.
Hypokalemia is more typical of diuretics. Hypoglycemia isn't an amiodarone issue. And GI bleeding isn't
a recognized adverse effect.
Q4: A patient in the ICU has a pulmonary artery catheter. The nurse notes the following readings: CVP 4
mmHg, PAP 28/14 mmHg, PAOP 8 mmHg, CO 4.5 L/min. The nurse interprets these findings as
consistent with:
A. Fluid overload and left heart failure
B. Hypovolemia with adequate cardiac output [CORRECT]
,C. Cardiogenic shock
D. Pulmonary hypertension
Correct Answer: B
Rationale: The best answer is B. A CVP of 4 is low (normal 2-6, but 4 is on the lower end), PAOP of 8 is
low-normal (normal 6-12), and cardiac output of 4.5 is acceptable. This pattern suggests the patient is a
bit dry but maintaining output—hypovolemia without shock. Fluid overload would show high CVP and
PAOP. Cardiogenic shock would show low CO and high PAOP. And pulmonary hypertension would show
elevated PAP with normal PAOP. These numbers tell you the patient could use some fluid but isn't in
crisis.
Q5: A patient with hypertension is prescribed carvedilol. The nurse should teach the patient to monitor
for which early sign of worsening heart failure?
A. Increased energy and ability to exercise
B. Sudden weight gain of 2-3 pounds in a day or 5 pounds in a week, increased shortness of breath, or
swelling in the legs [CORRECT]
C. Decreased appetite and weight loss
D. Improved sleep quality
Correct Answer: B
Rationale: The best answer is B. Beta-blockers like carvedilol are essential for heart failure, but they can
worsen symptoms initially or if the patient decompensates. Teaching patients to watch for rapid weight
gain (fluid retention), worsening dyspnea, or peripheral edema gives them early warning signs to call
before they end up in the ER. Increased energy and improved sleep are good things, not warning signs.
And decreased appetite with weight loss isn't typical of heart failure decompensation—fluid gain is.
Q6: A patient with a mechanical heart valve is prescribed warfarin. The patient's INR is 5.8, and they
have a small nosebleed that has stopped. Which action should the nurse take?
A. Administer vitamin K immediately and hold all future warfarin doses
B. Hold the next warfarin dose, monitor for bleeding, and notify the provider for further instructions
[CORRECT]
C. Continue the warfarin as scheduled since the nosebleed has stopped
D. Start the patient on aspirin in addition to warfarin
, Correct Answer: B
Rationale: The best answer is B. An INR of 5.8 is supratherapeutic, and while a small nosebleed that
stopped isn't a major bleed, it indicates the patient is at increased risk. Holding the next dose allows the
INR to drift down. Vitamin K is reserved for serious bleeding or very high INRs because it makes re-
anticoagulation difficult. Continuing the current dose risks a bigger bleed. And adding aspirin would
increase bleeding risk further. The provider needs to know and may adjust the maintenance dose.
Q7: A patient with acute coronary syndrome is receiving heparin. The nurse checks the aPTT and notes it
is 110 seconds (therapeutic range 60-80 seconds). Which action is most appropriate?
A. Continue the infusion and recheck in 4 hours
B. Hold the infusion for 1 hour, reduce the rate per protocol, and recheck the aPTT in 4-6 hours
[CORRECT]
C. Increase the infusion rate to achieve a higher therapeutic level
D. Discontinue the heparin and switch to aspirin only
Correct Answer: B
Rationale: The best answer is B. An aPTT of 110 is above the therapeutic range, indicating the patient is
at increased bleeding risk. The standard protocol is to hold the infusion briefly to let the level drop,
reduce the rate, and recheck. Continuing at the same rate risks bleeding. Increasing the rate would be
dangerous. And discontinuing heparin entirely without a replacement plan leaves the patient
unprotected from further clot formation. Follow the protocol, notify the provider, and monitor closely.
Q8: A patient with cardiogenic shock is receiving dobutamine. The nurse should monitor for which effect
that indicates the medication is working?
A. Decreased urine output and cool, clammy skin
B. Increased cardiac output, improved urine output, and warming of extremities [CORRECT]
C. Bradycardia and hypotension
D. Decreased level of consciousness
Correct Answer: B
Rationale: The best answer is B. Dobutamine is a positive inotrope—it strengthens cardiac contraction
and improves output. When it's working, you see better perfusion: increased urine output (kidneys are
getting blood), warmer extremities (peripheral perfusion is improving), and improved hemodynamics.
& Correct New Update Actual Exam 2026/2027 – Complete
Exam-Style Q&As | 100% Certified Verified – Pass
Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR DISORDERS (Questions 1–20)
Q1: A 68-year-old patient is admitted with chest pain described as "crushing pressure" radiating to the
left jaw and arm, accompanied by diaphoresis and nausea. Vital signs: BP 88/52, HR 118, RR 26, SpO2
89% on room air. The 12-lead ECG shows ST elevation in leads V1–V4. Which finding is most concerning
and requires immediate intervention?
A. The patient's report of nausea
B. The hypotension and anterior wall ST elevation indicating extensive left ventricular damage with risk
of cardiogenic shock [CORRECT]
C. The slightly elevated respiratory rate
D. The patient's age of 68 years
Correct Answer: B
Rationale: The best answer is B. Anterior wall STEMI with hypotension is a red flag for extensive left
ventricular damage and impending cardiogenic shock. The anterior wall is the largest territory, and
when it's affected with hemodynamic compromise, mortality skyrockets. This patient needs emergent
reperfusion, possible inotropes, and ICU-level care. Nausea is common with MI but not immediately life-
threatening. Tachypnea is concerning but secondary to the circulatory collapse. And age is a risk factor,
not an actionable finding.
Q2: A patient with heart failure is receiving IV furosemide 80 mg. Two hours later, the nurse notes the
patient has produced 50 mL of urine, has a respiratory rate of 34, and is using accessory muscles. The
patient is confused and restless. Which action should the nurse take first?
A. Increase the furosemide dose to promote more diuresis
,B. Call the rapid response team and prepare for possible intubation, as the patient is showing signs of
acute respiratory failure from worsening pulmonary edema [CORRECT]
C. Reassure the patient and encourage pursed-lip breathing
D. Administer a sedative to reduce the patient's restlessness
Correct Answer: B
Rationale: The best answer is B. Minimal urine output despite high-dose furosemide plus worsening
respiratory distress and altered mental status means this patient is in acute respiratory failure from
decompensated heart failure. The diuretics aren't working, and the patient is deteriorating fast. This is
rapid response territory—possible need for BiPAP or intubation, inotropes, and ICU transfer. More
diuretics won't help if the kidneys aren't responding. Reassurance is inadequate for respiratory failure.
And sedating a patient in respiratory distress is dangerous.
Q3: A patient with atrial fibrillation is prescribed amiodarone. The nurse should monitor for which
adverse effect that is unique to this medication?
A. Hypokalemia
B. Pulmonary fibrosis, thyroid dysfunction, and corneal deposits [CORRECT]
C. Hypoglycemia
D. Gastrointestinal bleeding
Correct Answer: B
Rationale: The best answer is B. Amiodarone is a highly effective antiarrhythmic with a notoriously toxic
side effect profile. Pulmonary fibrosis can be fatal, thyroid dysfunction (both hypo and hyper) is
common because of the iodine content, and corneal deposits are almost universal with long-term use.
Baseline and periodic chest X-rays, thyroid function tests, and liver function tests are essential.
Hypokalemia is more typical of diuretics. Hypoglycemia isn't an amiodarone issue. And GI bleeding isn't
a recognized adverse effect.
Q4: A patient in the ICU has a pulmonary artery catheter. The nurse notes the following readings: CVP 4
mmHg, PAP 28/14 mmHg, PAOP 8 mmHg, CO 4.5 L/min. The nurse interprets these findings as
consistent with:
A. Fluid overload and left heart failure
B. Hypovolemia with adequate cardiac output [CORRECT]
,C. Cardiogenic shock
D. Pulmonary hypertension
Correct Answer: B
Rationale: The best answer is B. A CVP of 4 is low (normal 2-6, but 4 is on the lower end), PAOP of 8 is
low-normal (normal 6-12), and cardiac output of 4.5 is acceptable. This pattern suggests the patient is a
bit dry but maintaining output—hypovolemia without shock. Fluid overload would show high CVP and
PAOP. Cardiogenic shock would show low CO and high PAOP. And pulmonary hypertension would show
elevated PAP with normal PAOP. These numbers tell you the patient could use some fluid but isn't in
crisis.
Q5: A patient with hypertension is prescribed carvedilol. The nurse should teach the patient to monitor
for which early sign of worsening heart failure?
A. Increased energy and ability to exercise
B. Sudden weight gain of 2-3 pounds in a day or 5 pounds in a week, increased shortness of breath, or
swelling in the legs [CORRECT]
C. Decreased appetite and weight loss
D. Improved sleep quality
Correct Answer: B
Rationale: The best answer is B. Beta-blockers like carvedilol are essential for heart failure, but they can
worsen symptoms initially or if the patient decompensates. Teaching patients to watch for rapid weight
gain (fluid retention), worsening dyspnea, or peripheral edema gives them early warning signs to call
before they end up in the ER. Increased energy and improved sleep are good things, not warning signs.
And decreased appetite with weight loss isn't typical of heart failure decompensation—fluid gain is.
Q6: A patient with a mechanical heart valve is prescribed warfarin. The patient's INR is 5.8, and they
have a small nosebleed that has stopped. Which action should the nurse take?
A. Administer vitamin K immediately and hold all future warfarin doses
B. Hold the next warfarin dose, monitor for bleeding, and notify the provider for further instructions
[CORRECT]
C. Continue the warfarin as scheduled since the nosebleed has stopped
D. Start the patient on aspirin in addition to warfarin
, Correct Answer: B
Rationale: The best answer is B. An INR of 5.8 is supratherapeutic, and while a small nosebleed that
stopped isn't a major bleed, it indicates the patient is at increased risk. Holding the next dose allows the
INR to drift down. Vitamin K is reserved for serious bleeding or very high INRs because it makes re-
anticoagulation difficult. Continuing the current dose risks a bigger bleed. And adding aspirin would
increase bleeding risk further. The provider needs to know and may adjust the maintenance dose.
Q7: A patient with acute coronary syndrome is receiving heparin. The nurse checks the aPTT and notes it
is 110 seconds (therapeutic range 60-80 seconds). Which action is most appropriate?
A. Continue the infusion and recheck in 4 hours
B. Hold the infusion for 1 hour, reduce the rate per protocol, and recheck the aPTT in 4-6 hours
[CORRECT]
C. Increase the infusion rate to achieve a higher therapeutic level
D. Discontinue the heparin and switch to aspirin only
Correct Answer: B
Rationale: The best answer is B. An aPTT of 110 is above the therapeutic range, indicating the patient is
at increased bleeding risk. The standard protocol is to hold the infusion briefly to let the level drop,
reduce the rate, and recheck. Continuing at the same rate risks bleeding. Increasing the rate would be
dangerous. And discontinuing heparin entirely without a replacement plan leaves the patient
unprotected from further clot formation. Follow the protocol, notify the provider, and monitor closely.
Q8: A patient with cardiogenic shock is receiving dobutamine. The nurse should monitor for which effect
that indicates the medication is working?
A. Decreased urine output and cool, clammy skin
B. Increased cardiac output, improved urine output, and warming of extremities [CORRECT]
C. Bradycardia and hypotension
D. Decreased level of consciousness
Correct Answer: B
Rationale: The best answer is B. Dobutamine is a positive inotrope—it strengthens cardiac contraction
and improves output. When it's working, you see better perfusion: increased urine output (kidneys are
getting blood), warmer extremities (peripheral perfusion is improving), and improved hemodynamics.
