MED SURG HESI VERSION A+ GRAD Actual Exam 2026/2027
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematology | Q1 – Q10
Section 2 | Respiratory & Acid-Base | Q11 – Q20
Section 3 | Gastrointestinal & Nutrition | Q21 – Q30
Section 4 | Renal, Endocrine & Metabolic | Q31 – Q40
Section 5 | Neurological, Musculoskeletal & Integumentary | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CARDIOVASCULAR & HEMATOLOGY Q1 – Q10
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Question 1 of 50
A 68-year-old male with a history of atrial fibrillation presents to the ED with sudden
onset of left-sided weakness and slurred speech. His vital signs are BP 158/92, HR 104
(irregular), RR 18, SpO2 96% on room air. He last took his apixaban 12 hours ago. The
CT scan shows no hemorrhage. The provider orders alteplase. What is the nurse's
priority action before initiating the infusion?
A. Verify the exact time of the last dose of apixaban and confirm it was within the
acceptable window. ✓ CORRECT
B. Draw a comprehensive metabolic panel to assess baseline renal function.
C. Insert a Foley catheter to monitor urine output during the infusion.
D. Administer a 250 mL bolus of normal saline to support blood pressure.
Correct Answer: A
Rationale: Alteplase is contraindicated in patients on direct oral anticoagulants if the
last dose was within 48 hours, so verifying the timing of apixaban is essential before
,starting the infusion. Drawing a metabolic panel is important but not the priority when a
time-sensitive thrombolytic is ordered. The nurse must also confirm the patient meets
all inclusion criteria for stroke protocol.
Question 2 of 50
A 54-year-old woman is admitted with acute decompensated heart failure. She has 2+
pitting edema in both lower extremities, an S3 gallop, and reports waking up breathless
three times last night. Her current medications include furosemide 40 mg daily at home.
The provider orders furosemide 80 mg IV push now. What assessment finding would
the nurse expect first as a positive response to this intervention?
A. A decrease in blood pressure from 158/96 to 134/78 mmHg
B. An increase in urine output to greater than 0.5 mL/kg/hr within the first hour ✓
CORRECT
C. Resolution of the S3 gallop on cardiac auscultation
D. Complete clearing of the bilateral crackles on lung examination
Correct Answer: B
Rationale: Furosemide is a loop diuretic that works within minutes when given
intravenously, so the earliest indicator of effectiveness is increased urine output
reflecting reduced preload. Blood pressure may drop but is not the primary therapeutic
target, and cardiac and pulmonary findings take longer to resolve with diuresis.
Question 3 of 50
A 72-year-old man with a history of hypertension and hyperlipidemia is recovering on
the telemetry unit after an uncomplicated inferior wall MI three days ago. During the
nurse's assessment, he reports a new squeezing chest pain that radiates to his jaw. The
monitor shows ST elevation in leads II, III, and aVF. His BP is 88/54 mmHg and HR is 52
bpm. What is the nurse's immediate priority?
,A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes for up to three doses.
B. Prepare the patient for immediate synchronized cardioversion.
C. Position the patient supine and initiate a normal saline bolus per protocol. ✓
CORRECT
D. Administer morphine sulfate 2 mg IV push for pain relief.
Correct Answer: C
Rationale: An inferior wall MI often involves the right ventricle, which is preload
dependent; the patient is hypotensive and bradycardic, so positioning supine and giving
a fluid bolus supports cardiac output. Nitroglycerin is contraindicated in right ventricular
infarction because it reduces preload and can worsen hypotension. Morphine may be
needed later but hemodynamic stabilization comes first.
Question 4 of 50
A 45-year-old woman with sickle cell disease arrives in the emergency department
complaining of severe left hip pain rated 10/10. She says this feels like her typical
vaso-occlusive crisis. Her temperature is 38.2°C, HR 118, BP 142/88, RR 24. She is alert
and oriented. What is the nurse's priority intervention?
A. Apply supplemental oxygen at 4 L/min via nasal cannula to improve tissue
oxygenation.
B. Begin a normal saline infusion at 250 mL/hr to reduce blood viscosity.
C. Administer the PRN hydromorphone 1 mg IV and reassess pain in 30 minutes.
D. Initiate aggressive hydration and administer the ordered opioid analgesic promptly. ✓
CORRECT
Correct Answer: D
Rationale: The priority in a vaso-occlusive crisis is aggressive hydration to reduce
sickling and prompt pain management, as severe pain increases metabolic demand and
worsens the crisis. Supplemental oxygen is not indicated unless the patient is
hypoxemic, and delaying analgesia while waiting for fluids alone is inappropriate.
, Question 5 of 50
A 61-year-old male is post-op day 2 after coronary artery bypass grafting. He has a
mediastinal chest tube draining 75 mL/hr of bright red blood. His BP is 94/62, HR 128,
and he is restless. The surgeon is en route. What is the nurse's first action?
A. Prepare to administer the ordered blood products and continue close hemodynamic
monitoring. ✓ CORRECT
B. Clamp the chest tube to prevent further blood loss and tamponade.
C. Increase the negative suction on the chest tube to -40 cm H2O.
D. Remove the chest tube dressing to assess for subcutaneous emphysema.
Correct Answer: A
Rationale: Post-cardiac surgery bleeding exceeding 100 mL/hr with hemodynamic
instability indicates hemorrhage; the nurse should prepare blood products and monitor
closely while awaiting the surgeon. Clamping the chest tube can cause tamponade and
is never appropriate, and increasing suction is not the priority over hemodynamic
support.
Question 6 of 50
A 78-year-old woman with a permanent pacemaker is admitted for syncope workup. Her
pacemaker was implanted 6 years ago. During the admission assessment, she tells the
nurse she has been feeling more fatigued and occasionally dizzy over the past month.
Her ECG shows capture spikes but no consistent ventricular response. What is the most
likely cause of her symptoms?
A. Lead dislodgement from excessive arm movement after implantation.
B. Pacemaker battery depletion requiring elective generator replacement. ✓ CORRECT
C. Electromagnetic interference from her household microwave oven.
D. Inappropriate sensing of diaphragmatic muscle contractions.
Correct Answer: B
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified Pass Guaranteed – A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematology | Q1 – Q10
Section 2 | Respiratory & Acid-Base | Q11 – Q20
Section 3 | Gastrointestinal & Nutrition | Q21 – Q30
Section 4 | Renal, Endocrine & Metabolic | Q31 – Q40
Section 5 | Neurological, Musculoskeletal & Integumentary | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male with a history of atrial fibrillation presents to the ED with sudden
onset of left-sided weakness and slurred speech. His vital signs are BP 158/92, HR 104
(irregular), RR 18, SpO2 96% on room air. He last took his apixaban 12 hours ago. The
CT scan shows no hemorrhage. The provider orders alteplase. What is the nurse's
priority action before initiating the infusion?
A. Verify the exact time of the last dose of apixaban and confirm it was within the
acceptable window. ✓ CORRECT
B. Draw a comprehensive metabolic panel to assess baseline renal function.
C. Insert a Foley catheter to monitor urine output during the infusion.
D. Administer a 250 mL bolus of normal saline to support blood pressure.
Correct Answer: A
Rationale: Alteplase is contraindicated in patients on direct oral anticoagulants if the
last dose was within 48 hours, so verifying the timing of apixaban is essential before
,starting the infusion. Drawing a metabolic panel is important but not the priority when a
time-sensitive thrombolytic is ordered. The nurse must also confirm the patient meets
all inclusion criteria for stroke protocol.
Question 2 of 50
A 54-year-old woman is admitted with acute decompensated heart failure. She has 2+
pitting edema in both lower extremities, an S3 gallop, and reports waking up breathless
three times last night. Her current medications include furosemide 40 mg daily at home.
The provider orders furosemide 80 mg IV push now. What assessment finding would
the nurse expect first as a positive response to this intervention?
A. A decrease in blood pressure from 158/96 to 134/78 mmHg
B. An increase in urine output to greater than 0.5 mL/kg/hr within the first hour ✓
CORRECT
C. Resolution of the S3 gallop on cardiac auscultation
D. Complete clearing of the bilateral crackles on lung examination
Correct Answer: B
Rationale: Furosemide is a loop diuretic that works within minutes when given
intravenously, so the earliest indicator of effectiveness is increased urine output
reflecting reduced preload. Blood pressure may drop but is not the primary therapeutic
target, and cardiac and pulmonary findings take longer to resolve with diuresis.
Question 3 of 50
A 72-year-old man with a history of hypertension and hyperlipidemia is recovering on
the telemetry unit after an uncomplicated inferior wall MI three days ago. During the
nurse's assessment, he reports a new squeezing chest pain that radiates to his jaw. The
monitor shows ST elevation in leads II, III, and aVF. His BP is 88/54 mmHg and HR is 52
bpm. What is the nurse's immediate priority?
,A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes for up to three doses.
B. Prepare the patient for immediate synchronized cardioversion.
C. Position the patient supine and initiate a normal saline bolus per protocol. ✓
CORRECT
D. Administer morphine sulfate 2 mg IV push for pain relief.
Correct Answer: C
Rationale: An inferior wall MI often involves the right ventricle, which is preload
dependent; the patient is hypotensive and bradycardic, so positioning supine and giving
a fluid bolus supports cardiac output. Nitroglycerin is contraindicated in right ventricular
infarction because it reduces preload and can worsen hypotension. Morphine may be
needed later but hemodynamic stabilization comes first.
Question 4 of 50
A 45-year-old woman with sickle cell disease arrives in the emergency department
complaining of severe left hip pain rated 10/10. She says this feels like her typical
vaso-occlusive crisis. Her temperature is 38.2°C, HR 118, BP 142/88, RR 24. She is alert
and oriented. What is the nurse's priority intervention?
A. Apply supplemental oxygen at 4 L/min via nasal cannula to improve tissue
oxygenation.
B. Begin a normal saline infusion at 250 mL/hr to reduce blood viscosity.
C. Administer the PRN hydromorphone 1 mg IV and reassess pain in 30 minutes.
D. Initiate aggressive hydration and administer the ordered opioid analgesic promptly. ✓
CORRECT
Correct Answer: D
Rationale: The priority in a vaso-occlusive crisis is aggressive hydration to reduce
sickling and prompt pain management, as severe pain increases metabolic demand and
worsens the crisis. Supplemental oxygen is not indicated unless the patient is
hypoxemic, and delaying analgesia while waiting for fluids alone is inappropriate.
, Question 5 of 50
A 61-year-old male is post-op day 2 after coronary artery bypass grafting. He has a
mediastinal chest tube draining 75 mL/hr of bright red blood. His BP is 94/62, HR 128,
and he is restless. The surgeon is en route. What is the nurse's first action?
A. Prepare to administer the ordered blood products and continue close hemodynamic
monitoring. ✓ CORRECT
B. Clamp the chest tube to prevent further blood loss and tamponade.
C. Increase the negative suction on the chest tube to -40 cm H2O.
D. Remove the chest tube dressing to assess for subcutaneous emphysema.
Correct Answer: A
Rationale: Post-cardiac surgery bleeding exceeding 100 mL/hr with hemodynamic
instability indicates hemorrhage; the nurse should prepare blood products and monitor
closely while awaiting the surgeon. Clamping the chest tube can cause tamponade and
is never appropriate, and increasing suction is not the priority over hemodynamic
support.
Question 6 of 50
A 78-year-old woman with a permanent pacemaker is admitted for syncope workup. Her
pacemaker was implanted 6 years ago. During the admission assessment, she tells the
nurse she has been feeling more fatigued and occasionally dizzy over the past month.
Her ECG shows capture spikes but no consistent ventricular response. What is the most
likely cause of her symptoms?
A. Lead dislodgement from excessive arm movement after implantation.
B. Pacemaker battery depletion requiring elective generator replacement. ✓ CORRECT
C. Electromagnetic interference from her household microwave oven.
D. Inappropriate sensing of diaphragmatic muscle contractions.
Correct Answer: B
