Galen College of Nursing | Medical-Surgical Nursing II
NSG 233 Medical-Surgical Nursing II HESI Final
Examination 2026/2027 | Verified Questions
Galen College of Nursing | Medical-Surgical Nursing II | Professional Nursing Candidates
150 Verified Questions | 6 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | Medical-Surgical Nursing II
HESI Final Examination Actual Exam | Academic Year 2026/2027
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
,INTRODUCTION
This document contains 150 original verified questions that comprehensively cover the full NSG 233
Medical-Surgical Nursing II HESI Final Examination for the 2026/2027 academic year. The questions are
organized across six core domains: Cardiovascular & Hematologic Disorders; Respiratory &
Gastrointestinal Disorders; Renal, Endocrine & Immune Disorders; Neurologic, Musculoskeletal &
Integumentary Disorders; Oncology, Emergency & Perioperative Nursing; and Safe & Effective Care
Environment - Prioritization & Delegation. Content is original and designed to reinforce the official Galen
College of Nursing NSG 233 course objectives for actual exam readiness and medical-surgical nursing
proficiency, aligned to the 2026/2027 academic year.
ACTUAL QUESTIONS
Domain 1: Cardiovascular & Hematologic Disorders
Question 1. A client with acute decompensated heart failure develops acute pulmonary
edema. The priority nursing intervention is to:
A. Encourage ambulation
B. Place the client in high-Fowler’s position and administer ordered IV diuretic
C. Restrict all oral fluids indefinitely without assessment
D. Apply sequential compression devices only
Correct Answer: D
Rationale: High-Fowler’s positioning reduces venous return (preload) and improves ventilation; rapid
IV diuresis decreases fluid overload. These actions address the immediate threats to oxygenation and
cardiac workload.
Question 2. The nurse monitors the international normalized ratio (INR) for a client
receiving warfarin because:
A. Warfarin has a wide therapeutic window
B. Warfarin has a narrow therapeutic range that balances thromboembolic prevention against
bleeding risk
C. INR is used only for heparin therapy
D. No laboratory monitoring is required
Correct Answer: A
Rationale: Warfarin’s anticoagulant effect is monitored with INR; the therapeutic range is narrow,
requiring regular laboratory surveillance to avoid under- or over-anticoagulation.
Question 3. A client is scheduled for cardiac catheterization with contrast. Which
assessment finding is most important to report before the procedure?
A. Allergy to shellfish only
B. Decreased urine output or elevated creatinine indicating risk for contrast-induced nephropathy
C. Mild anxiety
D. History of seasonal allergies
Correct Answer: C
Rationale: Pre-existing renal impairment markedly increases the risk of contrast-induced acute kidney
injury; urine output and creatinine must be evaluated and optimized before contrast administration.
Question 4. The therapeutic effect of dobutamine in a client with heart failure is evidenced
by:
A. Decreased cardiac output
B. Increased cardiac output secondary to positive inotropic action
C. Increased systemic vascular resistance only
D. Decreased heart rate exclusively
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
,Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and thereby
augments cardiac output in clients with low-output heart failure.
Question 5. The classic symptom triad of severe aortic stenosis includes angina, syncope,
and:
A. Palpitations only
B. Dyspnea on exertion
C. Claudication
D. Hemoptysis
Correct Answer: C
Rationale: The classic triad of symptomatic severe aortic stenosis is angina, syncope (or near-syncope),
and heart-failure symptoms, most commonly dyspnea on exertion.
Question 6. A client with atrial fibrillation and a CHA2DS2-VASc score of 4 is most
appropriately managed with:
A. Aspirin alone
B. Oral anticoagulation unless contraindications exist
C. No antithrombotic therapy
D. Dual antiplatelet therapy indefinitely without assessment
Correct Answer: A
Rationale: A CHA2DS2-VASc score ≥2 in men (or ≥3 in women) warrants oral anticoagulation for
stroke prevention in non-valvular atrial fibrillation.
Question 7. Left-sided heart failure is most closely associated with which assessment
findings?
A. Jugular venous distention and peripheral edema only
B. Pulmonary crackles, orthopnea, and paroxysmal nocturnal dyspnea
C. Hepatomegaly alone
D. Ascites without pulmonary findings
Correct Answer: C
Rationale: Left-sided failure produces pulmonary congestion manifested by crackles, orthopnea, and
paroxysmal nocturnal dyspnea.
Question 8. A client receiving heparin infusion has an aPTT that is critically elevated. The
priority action is to:
A. Increase the infusion rate
B. Stop or hold the heparin infusion and notify the provider; prepare for possible protamine
administration
C. Administer an additional bolus
D. Ignore the laboratory value
Correct Answer: A
Rationale: A critically elevated aPTT indicates excessive anticoagulation and bleeding risk; the infusion
is held and the provider is notified while protamine is considered.
Question 9. Which laboratory value most strongly supports a diagnosis of heart failure in a
dyspneic client?
A. BNP <50 pg/mL
B. BNP >100 pg/mL
C. Normal troponin only
D. Low creatinine
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
, Rationale: Elevated BNP (>100 pg/mL) has high negative predictive value for excluding heart failure
and supports the diagnosis when elevated in the appropriate clinical context.
Question 10. A client with deep-vein thrombosis is started on heparin. The nurse
prioritizes monitoring for:
A. Only blood pressure changes
B. Signs of bleeding and heparin-induced thrombocytopenia
C. Only urine output
D. Only temperature elevation
Correct Answer: B
Rationale: Heparin therapy requires vigilant surveillance for bleeding and for the immune-mediated
complication of heparin-induced thrombocytopenia.
Question 11. The priority nursing action for a client experiencing acute chest pain
suggestive of myocardial ischemia is to:
A. Ambulate the client
B. Obtain a 12-lead ECG, assess vital signs, and administer ordered oxygen and nitroglycerin while
notifying the provider
C. Encourage deep breathing only
D. Administer a sedative first
Correct Answer: A
Rationale: Rapid ECG acquisition, vital-sign assessment, and initiation of ordered anti-ischemic
therapy while activating the response team are essential to limit myocardial injury.
Question 12. A client with chronic anemia is prescribed epoetin alfa. The nurse anticipates
improvement in which laboratory value?
A. White-blood-cell count
B. Hemoglobin and hematocrit
C. Platelet count only
D. Serum potassium only
Correct Answer: D
Rationale: Epoetin alfa stimulates erythropoiesis; the expected response is a rise in hemoglobin and
hematocrit over subsequent weeks.
Question 13. Which finding indicates that a client with heart failure is responding
favorably to prescribed therapy?
A. Weight gain of 3 kg in two days
B. Decreased dyspnea, stable weight, and improved activity tolerance
C. Increased peripheral edema
D. Rising BNP levels
Correct Answer: B
Rationale: Clinical improvement is evidenced by reduced congestion symptoms, euvolemia (stable
weight), and better functional capacity.
Question 14. A client with peripheral arterial disease reports intermittent claudication.
The nurse reinforces teaching to:
A. Elevate the legs above the heart at all times
B. Engage in a supervised walking program and avoid crossing the legs
C. Apply heat directly to ischemic areas
D. Restrict all activity permanently
Correct Answer: D
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
NSG 233 Medical-Surgical Nursing II HESI Final
Examination 2026/2027 | Verified Questions
Galen College of Nursing | Medical-Surgical Nursing II | Professional Nursing Candidates
150 Verified Questions | 6 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | Medical-Surgical Nursing II
HESI Final Examination Actual Exam | Academic Year 2026/2027
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
,INTRODUCTION
This document contains 150 original verified questions that comprehensively cover the full NSG 233
Medical-Surgical Nursing II HESI Final Examination for the 2026/2027 academic year. The questions are
organized across six core domains: Cardiovascular & Hematologic Disorders; Respiratory &
Gastrointestinal Disorders; Renal, Endocrine & Immune Disorders; Neurologic, Musculoskeletal &
Integumentary Disorders; Oncology, Emergency & Perioperative Nursing; and Safe & Effective Care
Environment - Prioritization & Delegation. Content is original and designed to reinforce the official Galen
College of Nursing NSG 233 course objectives for actual exam readiness and medical-surgical nursing
proficiency, aligned to the 2026/2027 academic year.
ACTUAL QUESTIONS
Domain 1: Cardiovascular & Hematologic Disorders
Question 1. A client with acute decompensated heart failure develops acute pulmonary
edema. The priority nursing intervention is to:
A. Encourage ambulation
B. Place the client in high-Fowler’s position and administer ordered IV diuretic
C. Restrict all oral fluids indefinitely without assessment
D. Apply sequential compression devices only
Correct Answer: D
Rationale: High-Fowler’s positioning reduces venous return (preload) and improves ventilation; rapid
IV diuresis decreases fluid overload. These actions address the immediate threats to oxygenation and
cardiac workload.
Question 2. The nurse monitors the international normalized ratio (INR) for a client
receiving warfarin because:
A. Warfarin has a wide therapeutic window
B. Warfarin has a narrow therapeutic range that balances thromboembolic prevention against
bleeding risk
C. INR is used only for heparin therapy
D. No laboratory monitoring is required
Correct Answer: A
Rationale: Warfarin’s anticoagulant effect is monitored with INR; the therapeutic range is narrow,
requiring regular laboratory surveillance to avoid under- or over-anticoagulation.
Question 3. A client is scheduled for cardiac catheterization with contrast. Which
assessment finding is most important to report before the procedure?
A. Allergy to shellfish only
B. Decreased urine output or elevated creatinine indicating risk for contrast-induced nephropathy
C. Mild anxiety
D. History of seasonal allergies
Correct Answer: C
Rationale: Pre-existing renal impairment markedly increases the risk of contrast-induced acute kidney
injury; urine output and creatinine must be evaluated and optimized before contrast administration.
Question 4. The therapeutic effect of dobutamine in a client with heart failure is evidenced
by:
A. Decreased cardiac output
B. Increased cardiac output secondary to positive inotropic action
C. Increased systemic vascular resistance only
D. Decreased heart rate exclusively
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
,Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and thereby
augments cardiac output in clients with low-output heart failure.
Question 5. The classic symptom triad of severe aortic stenosis includes angina, syncope,
and:
A. Palpitations only
B. Dyspnea on exertion
C. Claudication
D. Hemoptysis
Correct Answer: C
Rationale: The classic triad of symptomatic severe aortic stenosis is angina, syncope (or near-syncope),
and heart-failure symptoms, most commonly dyspnea on exertion.
Question 6. A client with atrial fibrillation and a CHA2DS2-VASc score of 4 is most
appropriately managed with:
A. Aspirin alone
B. Oral anticoagulation unless contraindications exist
C. No antithrombotic therapy
D. Dual antiplatelet therapy indefinitely without assessment
Correct Answer: A
Rationale: A CHA2DS2-VASc score ≥2 in men (or ≥3 in women) warrants oral anticoagulation for
stroke prevention in non-valvular atrial fibrillation.
Question 7. Left-sided heart failure is most closely associated with which assessment
findings?
A. Jugular venous distention and peripheral edema only
B. Pulmonary crackles, orthopnea, and paroxysmal nocturnal dyspnea
C. Hepatomegaly alone
D. Ascites without pulmonary findings
Correct Answer: C
Rationale: Left-sided failure produces pulmonary congestion manifested by crackles, orthopnea, and
paroxysmal nocturnal dyspnea.
Question 8. A client receiving heparin infusion has an aPTT that is critically elevated. The
priority action is to:
A. Increase the infusion rate
B. Stop or hold the heparin infusion and notify the provider; prepare for possible protamine
administration
C. Administer an additional bolus
D. Ignore the laboratory value
Correct Answer: A
Rationale: A critically elevated aPTT indicates excessive anticoagulation and bleeding risk; the infusion
is held and the provider is notified while protamine is considered.
Question 9. Which laboratory value most strongly supports a diagnosis of heart failure in a
dyspneic client?
A. BNP <50 pg/mL
B. BNP >100 pg/mL
C. Normal troponin only
D. Low creatinine
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
, Rationale: Elevated BNP (>100 pg/mL) has high negative predictive value for excluding heart failure
and supports the diagnosis when elevated in the appropriate clinical context.
Question 10. A client with deep-vein thrombosis is started on heparin. The nurse
prioritizes monitoring for:
A. Only blood pressure changes
B. Signs of bleeding and heparin-induced thrombocytopenia
C. Only urine output
D. Only temperature elevation
Correct Answer: B
Rationale: Heparin therapy requires vigilant surveillance for bleeding and for the immune-mediated
complication of heparin-induced thrombocytopenia.
Question 11. The priority nursing action for a client experiencing acute chest pain
suggestive of myocardial ischemia is to:
A. Ambulate the client
B. Obtain a 12-lead ECG, assess vital signs, and administer ordered oxygen and nitroglycerin while
notifying the provider
C. Encourage deep breathing only
D. Administer a sedative first
Correct Answer: A
Rationale: Rapid ECG acquisition, vital-sign assessment, and initiation of ordered anti-ischemic
therapy while activating the response team are essential to limit myocardial injury.
Question 12. A client with chronic anemia is prescribed epoetin alfa. The nurse anticipates
improvement in which laboratory value?
A. White-blood-cell count
B. Hemoglobin and hematocrit
C. Platelet count only
D. Serum potassium only
Correct Answer: D
Rationale: Epoetin alfa stimulates erythropoiesis; the expected response is a rise in hemoglobin and
hematocrit over subsequent weeks.
Question 13. Which finding indicates that a client with heart failure is responding
favorably to prescribed therapy?
A. Weight gain of 3 kg in two days
B. Decreased dyspnea, stable weight, and improved activity tolerance
C. Increased peripheral edema
D. Rising BNP levels
Correct Answer: B
Rationale: Clinical improvement is evidenced by reduced congestion symptoms, euvolemia (stable
weight), and better functional capacity.
Question 14. A client with peripheral arterial disease reports intermittent claudication.
The nurse reinforces teaching to:
A. Elevate the legs above the heart at all times
B. Engage in a supervised walking program and avoid crossing the legs
C. Apply heat directly to ischemic areas
D. Restrict all activity permanently
Correct Answer: D
NSG 233 Medical-Surgical Nursing II HESI Final Examination 2026/2027 | Verified Questions
