, NSG 233 Medical-Surgical Nursing II HESI Final Exam 2026/2027 | 150
Verified Questions & Answers | Galen College of Nursing Prep | 6 Core
Domains | Instant Download .
SECTION 1: CARDIOVASCULAR (Questions 1-25)
Question 1:
A patient with heart failure has gained 5 lb (2.3 kg) in one week. The nurse should recognize this as a
sign of:
A) Dehydration
B) Improved nutritional status
C) Fluid overload and worsening heart failure
D) Medication side effect
Correct Answer: C) Fluid overload and worsening heart failure
Rationale: Rapid weight gain (≥2-3 lb in 24 hours or ≥5 lb in one week) indicates fluid overload and
worsening heart failure. This is due to fluid retention, not increased body mass. Notify the provider and
assess for other exacerbation signs (dyspnea, edema, crackles).
Question 2:
A patient prescribed furosemide (Lasix) should have which laboratory value monitored most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia can lead to
cardiac arrhythmias, especially in patients on digoxin. Monitor potassium levels closely and replace as
needed.
Question 3:
A patient with atrial fibrillation is prescribed metoprolol. The nurse recognizes this medication is used
for:
A) Rhythm control
B) Rate control
,C) Anticoagulation
D) Blood pressure elevation
Correct Answer: B) Rate control
Rationale: Beta-blockers (metoprolol) and calcium channel blockers (diltiazem) are first-line for rate
control in atrial fibrillation. Amiodarone is used for rhythm control. Anticoagulation prevents stroke.
Question 4:
A patient on digoxin presents with nausea, vomiting, and yellow-green halos around lights. The nurse
should:
A) Administer the next dose of digoxin
B) Hold digoxin and notify the provider
C) Increase the digoxin dose
D) Encourage fluid intake
Correct Answer: B) Hold digoxin and notify the provider
Rationale: These are signs of digoxin toxicity. Risk factors include hypokalemia, renal impairment, and
drug interactions. Hold the medication and notify the provider immediately. Digoxin level should be
checked.
Question 5:
A patient with an inferior wall MI has ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C) Right coronary artery
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI, typically caused by occlusion
of the right coronary artery (RCA) . Anterior STEMIs (V1-V4) are associated with LAD occlusion.
Question 6:
A patient is prescribed lisinopril. Which adverse effect should the nurse educate the patient about?
A) Hyperkalemia
B) Persistent dry cough
C) Tachycardia
D) Weight gain
, Correct Answer: B) Persistent dry cough
Rationale: Lisinopril is an ACE inhibitor. A persistent dry cough is a common side effect due to
bradykinin accumulation. If bothersome, switch to an ARB (e.g., losartan), which does not cause cough.
Question 7:
A patient with a carotid bruit and 75% stenosis is asymptomatic. What is the most appropriate
management?
A) Aspirin and statin therapy
B) Immediate carotid endarterectomy
C) Carotid stenting
D) Anticoagulation with warfarin
Correct Answer: A) Aspirin and statin therapy
Rationale: Asymptomatic carotid stenosis <80% is managed medically with antiplatelet therapy
(aspirin) and statins. Carotid endarterectomy is reserved for symptomatic patients or >80% stenosis.
Question 8:
A patient with heart failure has crackles in the lung bases, peripheral edema, and jugular venous
distention. These findings are consistent with:
A) Left-sided heart failure only
B) Right-sided heart failure only
C) Biventricular heart failure
D) Pericarditis
Correct Answer: C) Biventricular heart failure
Rationale: Crackles indicate left-sided heart failure (pulmonary congestion). Peripheral edema and JVD
indicate right-sided heart failure (systemic congestion). Both together suggest biventricular failure.
Question 9:
A patient prescribed warfarin should be monitored with which laboratory test?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: B) INR
Rationale: Warfarin is monitored using the International Normalized Ratio (INR) . Therapeutic INR for
atrial fibrillation is typically 2.0-3.0. aPTT is monitored for heparin therapy.
Verified Questions & Answers | Galen College of Nursing Prep | 6 Core
Domains | Instant Download .
SECTION 1: CARDIOVASCULAR (Questions 1-25)
Question 1:
A patient with heart failure has gained 5 lb (2.3 kg) in one week. The nurse should recognize this as a
sign of:
A) Dehydration
B) Improved nutritional status
C) Fluid overload and worsening heart failure
D) Medication side effect
Correct Answer: C) Fluid overload and worsening heart failure
Rationale: Rapid weight gain (≥2-3 lb in 24 hours or ≥5 lb in one week) indicates fluid overload and
worsening heart failure. This is due to fluid retention, not increased body mass. Notify the provider and
assess for other exacerbation signs (dyspnea, edema, crackles).
Question 2:
A patient prescribed furosemide (Lasix) should have which laboratory value monitored most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia can lead to
cardiac arrhythmias, especially in patients on digoxin. Monitor potassium levels closely and replace as
needed.
Question 3:
A patient with atrial fibrillation is prescribed metoprolol. The nurse recognizes this medication is used
for:
A) Rhythm control
B) Rate control
,C) Anticoagulation
D) Blood pressure elevation
Correct Answer: B) Rate control
Rationale: Beta-blockers (metoprolol) and calcium channel blockers (diltiazem) are first-line for rate
control in atrial fibrillation. Amiodarone is used for rhythm control. Anticoagulation prevents stroke.
Question 4:
A patient on digoxin presents with nausea, vomiting, and yellow-green halos around lights. The nurse
should:
A) Administer the next dose of digoxin
B) Hold digoxin and notify the provider
C) Increase the digoxin dose
D) Encourage fluid intake
Correct Answer: B) Hold digoxin and notify the provider
Rationale: These are signs of digoxin toxicity. Risk factors include hypokalemia, renal impairment, and
drug interactions. Hold the medication and notify the provider immediately. Digoxin level should be
checked.
Question 5:
A patient with an inferior wall MI has ST elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Correct Answer: C) Right coronary artery
Rationale: ST elevation in leads II, III, and aVF indicates an inferior STEMI, typically caused by occlusion
of the right coronary artery (RCA) . Anterior STEMIs (V1-V4) are associated with LAD occlusion.
Question 6:
A patient is prescribed lisinopril. Which adverse effect should the nurse educate the patient about?
A) Hyperkalemia
B) Persistent dry cough
C) Tachycardia
D) Weight gain
, Correct Answer: B) Persistent dry cough
Rationale: Lisinopril is an ACE inhibitor. A persistent dry cough is a common side effect due to
bradykinin accumulation. If bothersome, switch to an ARB (e.g., losartan), which does not cause cough.
Question 7:
A patient with a carotid bruit and 75% stenosis is asymptomatic. What is the most appropriate
management?
A) Aspirin and statin therapy
B) Immediate carotid endarterectomy
C) Carotid stenting
D) Anticoagulation with warfarin
Correct Answer: A) Aspirin and statin therapy
Rationale: Asymptomatic carotid stenosis <80% is managed medically with antiplatelet therapy
(aspirin) and statins. Carotid endarterectomy is reserved for symptomatic patients or >80% stenosis.
Question 8:
A patient with heart failure has crackles in the lung bases, peripheral edema, and jugular venous
distention. These findings are consistent with:
A) Left-sided heart failure only
B) Right-sided heart failure only
C) Biventricular heart failure
D) Pericarditis
Correct Answer: C) Biventricular heart failure
Rationale: Crackles indicate left-sided heart failure (pulmonary congestion). Peripheral edema and JVD
indicate right-sided heart failure (systemic congestion). Both together suggest biventricular failure.
Question 9:
A patient prescribed warfarin should be monitored with which laboratory test?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Correct Answer: B) INR
Rationale: Warfarin is monitored using the International Normalized Ratio (INR) . Therapeutic INR for
atrial fibrillation is typically 2.0-3.0. aPTT is monitored for heparin therapy.
