MED SURG HESI 2 EXAM 2022 QUESTIONS AND ANSWERS
CORE DOMAINS
Cardiovascular Disorders
Respiratory Disorders
Endocrine and Metabolic Disorders
Renal and Urinary Disorders
Gastrointestinal and Hepatobiliary Disorders
Neurological and Musculoskeletal Disorders
Perioperative Care and Surgical Complications
Oncologic and Hematologic Emergencies
INTRODUCTION
This original practice examination is designed for nursing students
preparing for the Med Surg HESI 2 exam. Questions cover the core content
domains tested, including cardiovascular, respiratory, endocrine, renal,
gastrointestinal, neurologic, perioperative, and oncologic emergencies.
Each question includes a detailed rationale grounded in current clinical
guidelines. These are original questions created for study purposes and are
not derived from any proprietary examination. Emphasis is placed on
clinical judgment, prioritization, and safe nursing practice.
SECTION ONE: CARDIOVASCULAR DISORDERS
1. 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
A. Administer oxygen therapy
RATIONALE: 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 .
2. 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
B. Papillary muscle rupture
RATIONALE: Papillary muscle rupture is a life-threatening mechanical
complication of acute MI that typically occurs 2-7 days post-infarction. 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 .
3. 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
B. Notify the provider for catheterization
RATIONALE: Recurrent chest pain and ST elevation post-MI suggest
reinfarction, requiring urgent percutaneous coronary intervention (PCI).
Aspirin and morphine are adjuncts, and oxygen is supportive but not the
priority .
, 4. A patient with increased intracranial pressure (ICP) receives
mannitol. Which assessment finding indicates a therapeutic
response?
A. Increased urine output
B. Decreased serum osmolality
C. Improved level of consciousness
D. Increased blood pressure
A. Increased urine output
RATIONALE: Mannitol is an osmotic diuretic that reduces ICP by
drawing fluid from brain tissue into the vasculature for renal excretion.
Increased urine output indicates the medication is working .
5. A patient with chronic heart failure is prescribed spironolactone.
Which adverse effect should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
A. Hyperkalemia
RATIONALE: Spironolactone is a potassium-sparing diuretic that can
cause hyperkalemia, especially when combined with ACE inhibitors or
ARBs. Serum potassium should be monitored closely.
6. A patient is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
B. aPTT
RATIONALE: Heparin therapy is monitored using the activated partial
CORE DOMAINS
Cardiovascular Disorders
Respiratory Disorders
Endocrine and Metabolic Disorders
Renal and Urinary Disorders
Gastrointestinal and Hepatobiliary Disorders
Neurological and Musculoskeletal Disorders
Perioperative Care and Surgical Complications
Oncologic and Hematologic Emergencies
INTRODUCTION
This original practice examination is designed for nursing students
preparing for the Med Surg HESI 2 exam. Questions cover the core content
domains tested, including cardiovascular, respiratory, endocrine, renal,
gastrointestinal, neurologic, perioperative, and oncologic emergencies.
Each question includes a detailed rationale grounded in current clinical
guidelines. These are original questions created for study purposes and are
not derived from any proprietary examination. Emphasis is placed on
clinical judgment, prioritization, and safe nursing practice.
SECTION ONE: CARDIOVASCULAR DISORDERS
1. 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
A. Administer oxygen therapy
RATIONALE: 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 .
2. 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
B. Papillary muscle rupture
RATIONALE: Papillary muscle rupture is a life-threatening mechanical
complication of acute MI that typically occurs 2-7 days post-infarction. 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 .
3. 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
B. Notify the provider for catheterization
RATIONALE: Recurrent chest pain and ST elevation post-MI suggest
reinfarction, requiring urgent percutaneous coronary intervention (PCI).
Aspirin and morphine are adjuncts, and oxygen is supportive but not the
priority .
, 4. A patient with increased intracranial pressure (ICP) receives
mannitol. Which assessment finding indicates a therapeutic
response?
A. Increased urine output
B. Decreased serum osmolality
C. Improved level of consciousness
D. Increased blood pressure
A. Increased urine output
RATIONALE: Mannitol is an osmotic diuretic that reduces ICP by
drawing fluid from brain tissue into the vasculature for renal excretion.
Increased urine output indicates the medication is working .
5. A patient with chronic heart failure is prescribed spironolactone.
Which adverse effect should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
A. Hyperkalemia
RATIONALE: Spironolactone is a potassium-sparing diuretic that can
cause hyperkalemia, especially when combined with ACE inhibitors or
ARBs. Serum potassium should be monitored closely.
6. A patient is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic
effectiveness?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
B. aPTT
RATIONALE: Heparin therapy is monitored using the activated partial
