MED SURGE HESI REAL EXAM 1 & 2
200+ Questions Test Bank | Actual Exam
2026/2027
100% Verified | Detailed Rationales | Pass
Guaranteed | A+ Graded
SECTION 1: Cardiovascular Nursing (Questions 1-35)
Q1.
A 68-year-old client with heart failure is admitted with dyspnea and 3+ pitting edema. The nurse notes
JVD and crackles. Furosemide 40 mg IV is given. Which finding indicates effectiveness?
A. Weight decrease of 1.5 kg in 24 hours and improved lung sounds.
B. Blood pressure rise from 110/70 to 140/90 mm Hg.
C. Urine output of 30 mL/hour for 4 hours.
D. Serum potassium rising from 3.8 to 4.9 mEq/L.
Correct ANSWER: A
Rationale:
Option A (Correct): Effective diuresis reduces fluid overload as evidenced by weight loss (1 kg = 1 L fluid)
and improved lung sounds (resolution of pulmonary congestion). This indicates successful reduction of
preload.
,Option B (Incorrect): Rising BP suggests fluid volume excess or vasoconstriction, not effective diuresis.
The goal is to reduce volume overload, not increase blood pressure.
Option C (Incorrect): Urine output of 30 mL/hour is the minimum acceptable output but does not
indicate effective diuresis in a patient with significant fluid overload. Expected output should be higher.
Option D (Incorrect): Rising potassium could indicate hyperkalemia from excessive diuresis or renal
impairment, not effectiveness of therapy.
Q2.
A client with atrial fibrillation on warfarin has an INR of 4.8 and mild gum bleeding. Which action should
the nurse take first?
A. Hold the next warfarin dose and notify the provider.
B. Administer the scheduled dose and recheck INR in 24 hours.
C. Encourage soft-bristled toothbrush only.
D. Prepare to give vitamin K IM immediately.
Correct ANSWER: A
Rationale:
Option A (Correct): INR 4.8 is significantly above therapeutic range (2.0-3.0 for AFib). Holding the dose
and notifying the provider is the priority to prevent further bleeding risk while awaiting further orders.
Option B (Incorrect): Administering the scheduled dose would further increase INR and bleeding risk.
This is unsafe.
Option C (Incorrect): While soft-bristled toothbrush is appropriate teaching, it does not address the
critical lab value that requires immediate intervention.
,Option D (Incorrect): Vitamin K is indicated for significant bleeding (e.g., GI bleed, intracranial
hemorrhage), not mild gum bleeding. Giving it unnecessarily could reverse anticoagulation and increase
stroke risk.
Q3.
A post-MI client has a self-terminating 8-second run of VT. The client is asymptomatic with BP 118/72.
What is the priority action?
A. Document the event and continue close monitoring.
B. Prepare for immediate synchronized cardioversion.
C. Administer lidocaine bolus as standing order.
D. Call a code and begin compressions.
Correct ANSWER: A
Rationale:
Option A (Correct): Self-terminating, asymptomatic short VT (less than 30 seconds) in a stable patient is
managed with close monitoring, electrolyte evaluation, and ischemia assessment. No immediate
intervention is needed.
Option B (Incorrect): Synchronized cardioversion is indicated for unstable VT with symptoms (chest pain,
hypotension, altered mental status). This patient is asymptomatic and stable.
Option C (Incorrect): Lidocaine is no longer first-line for stable VT; amiodarone is preferred.
Administering without provider order is inappropriate.
Option D (Incorrect): Code blue is for pulseless VT or VF. This patient has a pulse and is stable.
Q4.
, A client with chronic stable angina has chest pain while walking that is unrelieved after 3 minutes of rest.
Nitroglycerin 0.4 mg SL is prescribed. What instruction is correct?
A. Take one tablet; if pain persists after 5 minutes call EMS and take a second tablet.
B. Take three tablets at once for maximum effect.
C. Swallow the tablet with water.
D. Wait another 10 minutes before any nitroglycerin.
Correct ANSWER: A
Rationale:
Option A (Correct): Standard protocol: take one SL tablet, wait 5 minutes. If pain persists, call 911/EMS
and take a second tablet. A third may be taken 5 minutes later if prescribed.
Option B (Incorrect): Taking multiple tablets at once increases risk of severe hypotension and does not
follow the prescribed dosing schedule.
Option C (Incorrect): Sublingual nitroglycerin must be dissolved under the tongue for rapid absorption.
Swallowing inactivates the drug through first-pass metabolism.
Option D (Incorrect): Delaying treatment increases risk of myocardial ischemia progressing to infarction.
Q5.
A client with heart failure is receiving digoxin and furosemide. Which assessment finding indicates
digoxin toxicity?
A. Heart rate of 62 bpm and PR interval of 0.20 seconds.
B. Nausea, vomiting, and yellow-green halos around lights.
C. Serum potassium of 4.0 mEq/L.
200+ Questions Test Bank | Actual Exam
2026/2027
100% Verified | Detailed Rationales | Pass
Guaranteed | A+ Graded
SECTION 1: Cardiovascular Nursing (Questions 1-35)
Q1.
A 68-year-old client with heart failure is admitted with dyspnea and 3+ pitting edema. The nurse notes
JVD and crackles. Furosemide 40 mg IV is given. Which finding indicates effectiveness?
A. Weight decrease of 1.5 kg in 24 hours and improved lung sounds.
B. Blood pressure rise from 110/70 to 140/90 mm Hg.
C. Urine output of 30 mL/hour for 4 hours.
D. Serum potassium rising from 3.8 to 4.9 mEq/L.
Correct ANSWER: A
Rationale:
Option A (Correct): Effective diuresis reduces fluid overload as evidenced by weight loss (1 kg = 1 L fluid)
and improved lung sounds (resolution of pulmonary congestion). This indicates successful reduction of
preload.
,Option B (Incorrect): Rising BP suggests fluid volume excess or vasoconstriction, not effective diuresis.
The goal is to reduce volume overload, not increase blood pressure.
Option C (Incorrect): Urine output of 30 mL/hour is the minimum acceptable output but does not
indicate effective diuresis in a patient with significant fluid overload. Expected output should be higher.
Option D (Incorrect): Rising potassium could indicate hyperkalemia from excessive diuresis or renal
impairment, not effectiveness of therapy.
Q2.
A client with atrial fibrillation on warfarin has an INR of 4.8 and mild gum bleeding. Which action should
the nurse take first?
A. Hold the next warfarin dose and notify the provider.
B. Administer the scheduled dose and recheck INR in 24 hours.
C. Encourage soft-bristled toothbrush only.
D. Prepare to give vitamin K IM immediately.
Correct ANSWER: A
Rationale:
Option A (Correct): INR 4.8 is significantly above therapeutic range (2.0-3.0 for AFib). Holding the dose
and notifying the provider is the priority to prevent further bleeding risk while awaiting further orders.
Option B (Incorrect): Administering the scheduled dose would further increase INR and bleeding risk.
This is unsafe.
Option C (Incorrect): While soft-bristled toothbrush is appropriate teaching, it does not address the
critical lab value that requires immediate intervention.
,Option D (Incorrect): Vitamin K is indicated for significant bleeding (e.g., GI bleed, intracranial
hemorrhage), not mild gum bleeding. Giving it unnecessarily could reverse anticoagulation and increase
stroke risk.
Q3.
A post-MI client has a self-terminating 8-second run of VT. The client is asymptomatic with BP 118/72.
What is the priority action?
A. Document the event and continue close monitoring.
B. Prepare for immediate synchronized cardioversion.
C. Administer lidocaine bolus as standing order.
D. Call a code and begin compressions.
Correct ANSWER: A
Rationale:
Option A (Correct): Self-terminating, asymptomatic short VT (less than 30 seconds) in a stable patient is
managed with close monitoring, electrolyte evaluation, and ischemia assessment. No immediate
intervention is needed.
Option B (Incorrect): Synchronized cardioversion is indicated for unstable VT with symptoms (chest pain,
hypotension, altered mental status). This patient is asymptomatic and stable.
Option C (Incorrect): Lidocaine is no longer first-line for stable VT; amiodarone is preferred.
Administering without provider order is inappropriate.
Option D (Incorrect): Code blue is for pulseless VT or VF. This patient has a pulse and is stable.
Q4.
, A client with chronic stable angina has chest pain while walking that is unrelieved after 3 minutes of rest.
Nitroglycerin 0.4 mg SL is prescribed. What instruction is correct?
A. Take one tablet; if pain persists after 5 minutes call EMS and take a second tablet.
B. Take three tablets at once for maximum effect.
C. Swallow the tablet with water.
D. Wait another 10 minutes before any nitroglycerin.
Correct ANSWER: A
Rationale:
Option A (Correct): Standard protocol: take one SL tablet, wait 5 minutes. If pain persists, call 911/EMS
and take a second tablet. A third may be taken 5 minutes later if prescribed.
Option B (Incorrect): Taking multiple tablets at once increases risk of severe hypotension and does not
follow the prescribed dosing schedule.
Option C (Incorrect): Sublingual nitroglycerin must be dissolved under the tongue for rapid absorption.
Swallowing inactivates the drug through first-pass metabolism.
Option D (Incorrect): Delaying treatment increases risk of myocardial ischemia progressing to infarction.
Q5.
A client with heart failure is receiving digoxin and furosemide. Which assessment finding indicates
digoxin toxicity?
A. Heart rate of 62 bpm and PR interval of 0.20 seconds.
B. Nausea, vomiting, and yellow-green halos around lights.
C. Serum potassium of 4.0 mEq/L.
