MED SURG II HESI NEWEST 2026/ 2027
TEST BANK| ELSEVIER HESI MED SURG II
EXAM
Cardiovascular Disorders
1. A patient with heart failure has crackles in both lungs, jugular venous
distention, and 3+ pitting edema in the lower extremities. Which priority
medication does the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B) Furosemide
Rationale: The patient shows signs of fluid overload (crackles, JVD, edema). Loop
diuretics like furosemide are first-line to rapidly reduce preload. Digoxin improves
contractility but not immediate fluid removal. Metoprolol is a beta-blocker for
chronic management. Spironolactone is a potassium-sparing diuretic, less potent
for acute overload .
2. A patient with Chronic Kidney Disease (CKD) is prescribed Spironolactone.
Which lab value is the priority for the nurse to monitor?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) Glucose 110 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B) Potassium 5.8 mEq/L
,Rationale: Spironolactone is a potassium-sparing diuretic. In CKD, the kidneys
cannot excrete potassium effectively, placing the patient at high risk for life-
threatening hyperkalemia .
3. A patient post-myocardial infarction develops crackles halfway up the lung
fields, S3 gallop, and oxygen desaturation to 89%. What complication does the
nurse suspect?
A) Cardiogenic shock
B) Acute pericarditis
C) Left-sided heart failure
D) Pulmonary embolism
Answer: C) Left-sided heart failure
Rationale: S3 gallop, crackles (pulmonary congestion), and hypoxemia indicate left
ventricular failure post-MI. Cardiogenic shock would include hypotension and cool
extremities. Pericarditis causes chest pain worse with lying flat. PE typically
presents with sudden dyspnea, pleuritic pain .
4. A patient is prescribed Apixaban (Eliquis) for Atrial Fibrillation. Which
symptom should the nurse instruct the patient to report immediately?
A) Dry mouth
B) Increased appetite
C) Frequent nosebleeds (epistaxis)
D) Occasional mild headaches
Answer: C) Frequent nosebleeds (epistaxis)
Rationale: Apixaban is an anticoagulant. Epistaxis, hematuria, or bruising are signs
of excessive bleeding that require immediate intervention .
,5. A patient with an acute MI has a heart rate of 120 bpm and blood pressure of
85/50 mm Hg. Which of the following is the priority action?
A) Administer morphine
B) Administer nitroglycerin
C) Administer dobutamine
D) Notify the provider immediately
Answer: D) Notify the provider immediately
Rationale: This patient is in cardiogenic shock. Immediate notification of the
provider is essential. Inotropes (dobutamine) and vasopressors may be ordered.
Nitroglycerin is contraindicated in hypotension .
6. A nurse is caring for a patient with unstable angina. Which medication is used
to prevent platelet aggregation?
A) Nitroglycerin
B) Morphine
C) Aspirin
D) Metoprolol
Answer: C) Aspirin
Rationale: Aspirin (162-325 mg chewable) is given immediately to prevent further
platelet aggregation. Nitroglycerin relieves pain, morphine reduces preload and
pain, and metoprolol decreases myocardial oxygen demand .
7. A patient with heart failure is prescribed carvedilol. Which condition is a
contraindication to this medication?
A) Hypertension
B) Asthma
C) Diabetes
D) Hyperlipidemia
, Answer: B) Asthma
Rationale: Carvedilol is a non-selective beta-blocker that can cause bronchospasm
and is contraindicated in patients with asthma or COPD. Cardioselective beta-
blockers (metoprolol) may be used with caution .
8. A patient receiving heparin IV has an aPTT of 70 seconds (control 30). What is
the nurse's interpretation?
A) Subtherapeutic
B) Therapeutic
C) Supratherapeutic
D) Normal
Answer: B) Therapeutic
Rationale: Heparin therapy is monitored by aPTT; therapeutic goal is 1.5-2.5 times
control (45-75 sec). INR monitors warfarin. Platelet count is monitored for
heparin-induced thrombocytopenia .
9. A patient with a mechanical mitral valve is prescribed warfarin. Which INR
value is therapeutic?
A) 1.5-2.0
B) 2.0-2.5
C) 2.5-3.5
D) 3.5-4.0
Answer: C) 2.5-3.5
Rationale: For mechanical mitral valves, target INR is 2.5-3.5. For mechanical
aortic valves, target is 2.0-3.0. For atrial fibrillation without mechanical valve,
target is 2.0-3.0 .
TEST BANK| ELSEVIER HESI MED SURG II
EXAM
Cardiovascular Disorders
1. A patient with heart failure has crackles in both lungs, jugular venous
distention, and 3+ pitting edema in the lower extremities. Which priority
medication does the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B) Furosemide
Rationale: The patient shows signs of fluid overload (crackles, JVD, edema). Loop
diuretics like furosemide are first-line to rapidly reduce preload. Digoxin improves
contractility but not immediate fluid removal. Metoprolol is a beta-blocker for
chronic management. Spironolactone is a potassium-sparing diuretic, less potent
for acute overload .
2. A patient with Chronic Kidney Disease (CKD) is prescribed Spironolactone.
Which lab value is the priority for the nurse to monitor?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) Glucose 110 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B) Potassium 5.8 mEq/L
,Rationale: Spironolactone is a potassium-sparing diuretic. In CKD, the kidneys
cannot excrete potassium effectively, placing the patient at high risk for life-
threatening hyperkalemia .
3. A patient post-myocardial infarction develops crackles halfway up the lung
fields, S3 gallop, and oxygen desaturation to 89%. What complication does the
nurse suspect?
A) Cardiogenic shock
B) Acute pericarditis
C) Left-sided heart failure
D) Pulmonary embolism
Answer: C) Left-sided heart failure
Rationale: S3 gallop, crackles (pulmonary congestion), and hypoxemia indicate left
ventricular failure post-MI. Cardiogenic shock would include hypotension and cool
extremities. Pericarditis causes chest pain worse with lying flat. PE typically
presents with sudden dyspnea, pleuritic pain .
4. A patient is prescribed Apixaban (Eliquis) for Atrial Fibrillation. Which
symptom should the nurse instruct the patient to report immediately?
A) Dry mouth
B) Increased appetite
C) Frequent nosebleeds (epistaxis)
D) Occasional mild headaches
Answer: C) Frequent nosebleeds (epistaxis)
Rationale: Apixaban is an anticoagulant. Epistaxis, hematuria, or bruising are signs
of excessive bleeding that require immediate intervention .
,5. A patient with an acute MI has a heart rate of 120 bpm and blood pressure of
85/50 mm Hg. Which of the following is the priority action?
A) Administer morphine
B) Administer nitroglycerin
C) Administer dobutamine
D) Notify the provider immediately
Answer: D) Notify the provider immediately
Rationale: This patient is in cardiogenic shock. Immediate notification of the
provider is essential. Inotropes (dobutamine) and vasopressors may be ordered.
Nitroglycerin is contraindicated in hypotension .
6. A nurse is caring for a patient with unstable angina. Which medication is used
to prevent platelet aggregation?
A) Nitroglycerin
B) Morphine
C) Aspirin
D) Metoprolol
Answer: C) Aspirin
Rationale: Aspirin (162-325 mg chewable) is given immediately to prevent further
platelet aggregation. Nitroglycerin relieves pain, morphine reduces preload and
pain, and metoprolol decreases myocardial oxygen demand .
7. A patient with heart failure is prescribed carvedilol. Which condition is a
contraindication to this medication?
A) Hypertension
B) Asthma
C) Diabetes
D) Hyperlipidemia
, Answer: B) Asthma
Rationale: Carvedilol is a non-selective beta-blocker that can cause bronchospasm
and is contraindicated in patients with asthma or COPD. Cardioselective beta-
blockers (metoprolol) may be used with caution .
8. A patient receiving heparin IV has an aPTT of 70 seconds (control 30). What is
the nurse's interpretation?
A) Subtherapeutic
B) Therapeutic
C) Supratherapeutic
D) Normal
Answer: B) Therapeutic
Rationale: Heparin therapy is monitored by aPTT; therapeutic goal is 1.5-2.5 times
control (45-75 sec). INR monitors warfarin. Platelet count is monitored for
heparin-induced thrombocytopenia .
9. A patient with a mechanical mitral valve is prescribed warfarin. Which INR
value is therapeutic?
A) 1.5-2.0
B) 2.0-2.5
C) 2.5-3.5
D) 3.5-4.0
Answer: C) 2.5-3.5
Rationale: For mechanical mitral valves, target INR is 2.5-3.5. For mechanical
aortic valves, target is 2.0-3.0. For atrial fibrillation without mechanical valve,
target is 2.0-3.0 .
