Evolve HESI Med-Surg II Exam 2026/2027 –Verified
Questions & Answers with Detailed Rationales |
Medical-Surgical Nursing II Study Guide
Prepare for the Evolve HESI Medical-Surgical Nursing II Exam with exam-style multiple-
choice questions covering cardiovascular, respiratory, renal, endocrine, gastrointestinal,
neurological, musculoskeletal, hematological, fluid/electrolyte, and perioperative nursing
care. Each question includes a verified updated answer and a detailed rationale to support
clinical reasoning, retention, and first-attempt passing success. This organized digital study
guide is ideal for Stuvia and Docsity buyers seeking a concise, sale-ready HESI Med-Surg II
exam resource with zero question repetition.
Section 1: Cardiovascular Disorders (Questions 1–60)
1. A patient is admitted with acute anterior ST-elevation myocardial infarction
(STEMI). The nurse notes new onset of a loud holosystolic murmur at the apex with
radiation to the axilla. The patient becomes acutely dyspneic and hypotensive. Which
complication should the nurse suspect?
A. Ventricular septal defect (VSD)
B. Papillary muscle rupture
C. Dressler syndrome
D. Right ventricular infarction
Answer: B. Papillary muscle rupture
**Explanation: Papillary muscle rupture is a life-threatening mechanical complication of
acute MI that typically occurs 2-7 days post-infarction, most commonly with inferior MIs
affecting the posteromedial papillary muscle. The acute onset of a loud holosystolic murmur
,at the apex with radiation to the axilla, combined with acute pulmonary edema and
hypotension, is pathognomonic for papillary muscle rupture causing acute mitral
regurgitation. Ventricular septal defect would produce a harsh holosystolic murmur at the
left sternal border, Dressler syndrome presents days to weeks later with pericarditis and
fever, and right ventricular infarction would show JVD, clear lungs, and hypotension without
a new murmur. **
2. A nurse is caring for a client with acute myocardial infarction who is receiving
thrombolytic therapy. Which assessment finding requires immediate intervention?
A. Chest pain rated 3 on a scale of 0-10
B. Blood pressure of 142/88 mmHg
C. Bleeding from the IV site
D. Heart rate of 92 bpm
Answer: C. Bleeding from the IV site
**Explanation: Thrombolytic therapy increases the risk of bleeding. Bleeding from the IV site
or any other site requires immediate intervention, including stopping the infusion and
notifying the provider. Chest pain, elevated BP, and tachycardia are expected in MI and do
not require immediate intervention compared to active bleeding. **
3. A client with chronic heart failure is prescribed sacubitril/valsartan (Entresto).
Which finding would the nurse report to the healthcare provider before administering
this medication?
A. Serum potassium of 4.8 mEq/L
B. Blood pressure of 102/68 mmHg
C. Serum creatinine of 1.8 mg/dL
D. Weight gain of 1 pound in 24 hours
Answer: B. Blood pressure of 102/68 mmHg
**Explanation: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin
inhibitor (ARNI) that can cause significant hypotension. A blood pressure of 102/68 mmHg is
relatively low and should be reported before administration. The medication is
contraindicated in clients with hypotension (systolic < 100 mmHg). Serum potassium is
within normal limits. Creatinine of 1.8 may indicate renal impairment but is not the priority.
Weight gain of 1 pound is not significant. **
,4. A client is admitted with a diagnosis of acute myocardial infarction (MI). Which
assessment finding warrants immediate notification of the healthcare provider?
A. Blood pressure of 118/76 mmHg and heart rate of 88 beats/minute
B. New onset of fine crackles bilaterally in the lung bases and an S3 heart sound
C. Mild, dull chest discomfort controlled with sublingual nitroglycerin
D. Serum troponin T level elevated at 4.5 ng/mL
Answer: B. New onset of fine crackles bilaterally in the lung bases and an S3 heart
sound
**Explanation: The development of bilateral basal crackles and an S3 heart sound indicates
acute left ventricular failure leading to pulmonary congestion, which is a life-threatening
complication of myocardial infarction requiring immediate intervention. While elevated
troponin confirms myocardial injury and chest discomfort requires ongoing monitoring,
acute heart failure symptoms demand rapid intervention to prevent pulmonary edema and
cardiogenic shock. **
5. A client with atrial fibrillation shows an irregular rhythm on an ECG strip. Which
treatment should the nurse anticipate?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate immediately
D. Administer atropine 0.4 mg IV push
Answer: B. Perform synchronized cardioversion
**Explanation: Synchronized cardioversion is the treatment of choice for uncontrolled atrial
fibrillation to restore sinus rhythm. Lidocaine is for ventricular dysrhythmias, defibrillation
is for ventricular fibrillation, and atropine is for bradycardia. **
6. A patient with heart failure presents with dyspnea and bilateral crackles. What is
the priority nursing intervention?
A. Administer oxygen therapy
B. Place the patient in a supine position
C. Encourage fluid intake
D. Administer a beta-blocker
, Answer: A. Administer oxygen therapy
**Explanation: Dyspnea and crackles indicate pulmonary edema in heart failure, requiring
immediate oxygen therapy to improve oxygenation. Supine positioning worsens dyspnea,
fluid intake exacerbates fluid overload, and beta-blockers are not acute interventions. **
7. A nurse is assessing a client with a diagnosis of early left ventricular heart failure.
Specific to this type of heart failure, the nurse expects the client to state:
A. "My ankles are swollen."
B. "I am tired at the end of the day."
C. "When I eat a large meal, I feel bloated."
D. "I have trouble breathing when I walk rapidly."
Answer: D. "I have trouble breathing when I walk rapidly."
**Explanation: Early left ventricular failure typically presents with exertional dyspnea due to
pulmonary congestion. Right-sided heart failure would present with dependent edema,
fatigue, and abdominal bloating. **
8. The nurse is assessing a client for signs of right ventricular failure. What should
the nurse expect if this occurs?
A. Slowed pulse rate
B. Pleural friction rub
C. Neck vein distention
D. Increasing hypotension
Answer: C. Neck vein distention
**Explanation: Right ventricular failure leads to systemic venous congestion, manifested by
jugular venous distention, peripheral edema, and hepatomegaly. **
9. A patient post-myocardial infarction develops chest pain and ST elevation. What is
the priority action?
A. Administer aspirin
B. Notify the provider for catheterization
C. Increase oxygen flow
D. Administer morphine
Questions & Answers with Detailed Rationales |
Medical-Surgical Nursing II Study Guide
Prepare for the Evolve HESI Medical-Surgical Nursing II Exam with exam-style multiple-
choice questions covering cardiovascular, respiratory, renal, endocrine, gastrointestinal,
neurological, musculoskeletal, hematological, fluid/electrolyte, and perioperative nursing
care. Each question includes a verified updated answer and a detailed rationale to support
clinical reasoning, retention, and first-attempt passing success. This organized digital study
guide is ideal for Stuvia and Docsity buyers seeking a concise, sale-ready HESI Med-Surg II
exam resource with zero question repetition.
Section 1: Cardiovascular Disorders (Questions 1–60)
1. A patient is admitted with acute anterior ST-elevation myocardial infarction
(STEMI). The nurse notes new onset of a loud holosystolic murmur at the apex with
radiation to the axilla. The patient becomes acutely dyspneic and hypotensive. Which
complication should the nurse suspect?
A. Ventricular septal defect (VSD)
B. Papillary muscle rupture
C. Dressler syndrome
D. Right ventricular infarction
Answer: B. Papillary muscle rupture
**Explanation: Papillary muscle rupture is a life-threatening mechanical complication of
acute MI that typically occurs 2-7 days post-infarction, most commonly with inferior MIs
affecting the posteromedial papillary muscle. The acute onset of a loud holosystolic murmur
,at the apex with radiation to the axilla, combined with acute pulmonary edema and
hypotension, is pathognomonic for papillary muscle rupture causing acute mitral
regurgitation. Ventricular septal defect would produce a harsh holosystolic murmur at the
left sternal border, Dressler syndrome presents days to weeks later with pericarditis and
fever, and right ventricular infarction would show JVD, clear lungs, and hypotension without
a new murmur. **
2. A nurse is caring for a client with acute myocardial infarction who is receiving
thrombolytic therapy. Which assessment finding requires immediate intervention?
A. Chest pain rated 3 on a scale of 0-10
B. Blood pressure of 142/88 mmHg
C. Bleeding from the IV site
D. Heart rate of 92 bpm
Answer: C. Bleeding from the IV site
**Explanation: Thrombolytic therapy increases the risk of bleeding. Bleeding from the IV site
or any other site requires immediate intervention, including stopping the infusion and
notifying the provider. Chest pain, elevated BP, and tachycardia are expected in MI and do
not require immediate intervention compared to active bleeding. **
3. A client with chronic heart failure is prescribed sacubitril/valsartan (Entresto).
Which finding would the nurse report to the healthcare provider before administering
this medication?
A. Serum potassium of 4.8 mEq/L
B. Blood pressure of 102/68 mmHg
C. Serum creatinine of 1.8 mg/dL
D. Weight gain of 1 pound in 24 hours
Answer: B. Blood pressure of 102/68 mmHg
**Explanation: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin
inhibitor (ARNI) that can cause significant hypotension. A blood pressure of 102/68 mmHg is
relatively low and should be reported before administration. The medication is
contraindicated in clients with hypotension (systolic < 100 mmHg). Serum potassium is
within normal limits. Creatinine of 1.8 may indicate renal impairment but is not the priority.
Weight gain of 1 pound is not significant. **
,4. A client is admitted with a diagnosis of acute myocardial infarction (MI). Which
assessment finding warrants immediate notification of the healthcare provider?
A. Blood pressure of 118/76 mmHg and heart rate of 88 beats/minute
B. New onset of fine crackles bilaterally in the lung bases and an S3 heart sound
C. Mild, dull chest discomfort controlled with sublingual nitroglycerin
D. Serum troponin T level elevated at 4.5 ng/mL
Answer: B. New onset of fine crackles bilaterally in the lung bases and an S3 heart
sound
**Explanation: The development of bilateral basal crackles and an S3 heart sound indicates
acute left ventricular failure leading to pulmonary congestion, which is a life-threatening
complication of myocardial infarction requiring immediate intervention. While elevated
troponin confirms myocardial injury and chest discomfort requires ongoing monitoring,
acute heart failure symptoms demand rapid intervention to prevent pulmonary edema and
cardiogenic shock. **
5. A client with atrial fibrillation shows an irregular rhythm on an ECG strip. Which
treatment should the nurse anticipate?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate immediately
D. Administer atropine 0.4 mg IV push
Answer: B. Perform synchronized cardioversion
**Explanation: Synchronized cardioversion is the treatment of choice for uncontrolled atrial
fibrillation to restore sinus rhythm. Lidocaine is for ventricular dysrhythmias, defibrillation
is for ventricular fibrillation, and atropine is for bradycardia. **
6. A patient with heart failure presents with dyspnea and bilateral crackles. What is
the priority nursing intervention?
A. Administer oxygen therapy
B. Place the patient in a supine position
C. Encourage fluid intake
D. Administer a beta-blocker
, Answer: A. Administer oxygen therapy
**Explanation: Dyspnea and crackles indicate pulmonary edema in heart failure, requiring
immediate oxygen therapy to improve oxygenation. Supine positioning worsens dyspnea,
fluid intake exacerbates fluid overload, and beta-blockers are not acute interventions. **
7. A nurse is assessing a client with a diagnosis of early left ventricular heart failure.
Specific to this type of heart failure, the nurse expects the client to state:
A. "My ankles are swollen."
B. "I am tired at the end of the day."
C. "When I eat a large meal, I feel bloated."
D. "I have trouble breathing when I walk rapidly."
Answer: D. "I have trouble breathing when I walk rapidly."
**Explanation: Early left ventricular failure typically presents with exertional dyspnea due to
pulmonary congestion. Right-sided heart failure would present with dependent edema,
fatigue, and abdominal bloating. **
8. The nurse is assessing a client for signs of right ventricular failure. What should
the nurse expect if this occurs?
A. Slowed pulse rate
B. Pleural friction rub
C. Neck vein distention
D. Increasing hypotension
Answer: C. Neck vein distention
**Explanation: Right ventricular failure leads to systemic venous congestion, manifested by
jugular venous distention, peripheral edema, and hepatomegaly. **
9. A patient post-myocardial infarction develops chest pain and ST elevation. What is
the priority action?
A. Administer aspirin
B. Notify the provider for catheterization
C. Increase oxygen flow
D. Administer morphine
