MED-SURG II HESI TEST BANK 2026/2027 | Complete Final
Exam Guide | 2 Versions | 200 Q&A | HESI Blueprint Aligned |
Pass Guaranteed - A+ Graded
[VERSION 1: Med-Surg II HESI Final Exam – 100 Questions]
Question 1: A 68-year-old client is admitted with acute decompensated heart failure
(ADHF) with reduced ejection fraction (HFrEF, EF 25%). Vital signs: BP 88/52 mmHg, HR
118 bpm (irregularly irregular), RR 28, SpO₂ 89% on 2L NC. Assessment reveals bilateral
crackles to mid-lung fields, JVD 6 cm, 3+ peripheral edema, and cool, clammy
extremities. The client reports severe dyspnea and orthopnea. Current medications
include furosemide 80 mg IV, metoprolol 25 mg PO, and lisinopril 5 mg PO. Which action
should the nurse take first?
A. Administer the scheduled metoprolol to control heart rate
B. Increase the furosemide dose to promote diuresis
C. Prepare for possible dobutamine infusion initiation
D. Apply supplemental oxygen and prepare for BiPAP
Correct Answer: C
Rationale:
Option A: Administering metoprolol is contraindicated in this scenario. The client
presents with cardiogenic shock (hypotension 88/52, cool clammy skin, tachycardia,
ADHF) and an irregularly irregular rhythm suggesting atrial fibrillation with rapid
ventricular response. Beta-blockers in cardiogenic shock further depress myocardial
,contractility, worsen hypotension, and can precipitate asystole. Additionally, the client is
already hypotensive; negative inotropes are dangerous.
Option B: While diuresis is needed for volume overload, aggressive diuresis in
cardiogenic shock can worsen hypotension by reducing preload excessively. The
immediate problem is inadequate perfusion, not just congestion. Furosemide should be
given cautiously or deferred until hemodynamics stabilize with inotropic support.
Option C: [CORRECT] This client exhibits classic cardiogenic shock: systolic BP <90
mmHg, signs of tissue hypoperfusion (cool, clammy skin, altered mental status implied
by severity), and evidence of congestion (JVD, pulmonary edema). The "cold and wet"
profile requires inotropic support (dobutamine or milrinone) to improve contractility and
maintain perfusion while carefully managing congestion. Dobutamine is the first-line
inotrope for HFrEF with cardiogenic shock, providing β1 agonism to increase cardiac
output without excessive vasoconstriction. This is the priority life-saving intervention.
Option D: While oxygen is necessary (SpO₂ 89%), the client needs more than
supplemental O₂. However, BiPAP is relatively contraindicated in hypotension (risk of
further reducing preload and cardiac output) and should only be initiated after
hemodynamic stabilization or simultaneously with pressor/inotrope support. The
primary problem is pump failure, not respiratory failure alone.
Question 2 (SATA with 3 correct): A nurse is caring for a client 48 hours post-mitral
valve replacement who develops acute atrial fibrillation with rapid ventricular response
(RVR) at 150 bpm. The client is hemodynamically stable (BP 122/78, MAP 93). Which
interventions are appropriate? Select all that apply.
A. Administer IV amiodarone per protocol
B. Prepare for immediate synchronized cardioversion
,C. Assess for precipitating causes (electrolyte imbalances, pain, hypoxia)
D. Initiate therapeutic hypothermia protocol
E. Administer IV heparin for stroke prophylaxis
F. Apply vagal maneuvers as first-line treatment
Correct Answer: A, C, E
Rationale:
Option A: [CORRECT] Amiodarone is first-line pharmacologic rate/rhythm control for
postoperative atrial fibrillation. It is effective in hemodynamically stable clients, has
minimal negative inotropic effects (safe in recent cardiac surgery), and can be loaded IV
with transition to oral. It controls rate and may convert rhythm.
Option B: Synchronized cardioversion is reserved for hemodynamically unstable atrial
fibrillation (hypotension, ischemia, heart failure, altered mental status). This client is
stable (BP 122/78, adequate perfusion), so pharmacologic management is preferred to
avoid sedation risks and myocardial stunning post-cardiac surgery.
Option C: [CORRECT] Postoperative atrial fibrillation has identifiable triggers that must
be addressed: hypokalemia, hypomagnesemia, hypoxia, pain, volume overload, or
infection. Correcting these underlying causes is essential for successful rhythm
management and prevention of recurrence. This is fundamental nursing assessment.
Option D: Therapeutic hypothermia is indicated for cardiac arrest with return of
spontaneous circulation (neuroprotection), not for atrial fibrillation. It has no role in this
scenario and would be harmful (increased infection risk, coagulopathy, arrhythmias).
Option E: [CORRECT] Postoperative atrial fibrillation carries significant stroke risk
(similar to non-valvular AF). Anticoagulation with heparin (bridging to warfarin if
, mechanical valve, or direct oral anticoagulant if bioprosthetic) is essential. The
CHA₂DS₂-VASc score is likely elevated given age and recent surgery.
Option F: Vagal maneuvers (carotid massage, Valsalva) are ineffective for atrial
fibrillation RVR and potentially dangerous post-cardiac surgery (risk of dislodging
thrombus, hemodynamic compromise). They are used for SVT reentry tachycardias, not
AFib.
Question 3 (Ordered Response – Complex): A client with acute ST-elevation myocardial
infarction (STEMI) develops cardiogenic shock 6 hours post-percutaneous coronary
intervention (PCI) to the left anterior descending artery. Place the following nursing
interventions in priority order:
1. Initiate dobutamine infusion per protocol
2. Insert arterial line for continuous BP monitoring
3. Obtain 12-lead ECG
4. Assess level of consciousness and peripheral perfusion
5. Administer aspirin 325 mg
6. Prepare for possible intra-aortic balloon pump (IABP) or Impella
Correct Order: 4, 3, 2, 1, 6, 5 [CORRECT]
Rationale:
Step 1 (Assessment - #4): The nursing process always begins with assessment.
Determining baseline neurologic status (cerebral perfusion) and peripheral perfusion
(capillary refill, skin temperature, pulses) establishes severity of shock and provides
comparison for intervention effectiveness. This cannot be delegated and must precede
interventions.
Step 2 (ECG - #3): Immediate 12-lead ECG identifies ongoing ischemia, arrhythmias, or
mechanical complications (papillary muscle rupture, VSD) causing shock. This guides
whether emergency re-intervention is needed versus pure inotropic support.
Exam Guide | 2 Versions | 200 Q&A | HESI Blueprint Aligned |
Pass Guaranteed - A+ Graded
[VERSION 1: Med-Surg II HESI Final Exam – 100 Questions]
Question 1: A 68-year-old client is admitted with acute decompensated heart failure
(ADHF) with reduced ejection fraction (HFrEF, EF 25%). Vital signs: BP 88/52 mmHg, HR
118 bpm (irregularly irregular), RR 28, SpO₂ 89% on 2L NC. Assessment reveals bilateral
crackles to mid-lung fields, JVD 6 cm, 3+ peripheral edema, and cool, clammy
extremities. The client reports severe dyspnea and orthopnea. Current medications
include furosemide 80 mg IV, metoprolol 25 mg PO, and lisinopril 5 mg PO. Which action
should the nurse take first?
A. Administer the scheduled metoprolol to control heart rate
B. Increase the furosemide dose to promote diuresis
C. Prepare for possible dobutamine infusion initiation
D. Apply supplemental oxygen and prepare for BiPAP
Correct Answer: C
Rationale:
Option A: Administering metoprolol is contraindicated in this scenario. The client
presents with cardiogenic shock (hypotension 88/52, cool clammy skin, tachycardia,
ADHF) and an irregularly irregular rhythm suggesting atrial fibrillation with rapid
ventricular response. Beta-blockers in cardiogenic shock further depress myocardial
,contractility, worsen hypotension, and can precipitate asystole. Additionally, the client is
already hypotensive; negative inotropes are dangerous.
Option B: While diuresis is needed for volume overload, aggressive diuresis in
cardiogenic shock can worsen hypotension by reducing preload excessively. The
immediate problem is inadequate perfusion, not just congestion. Furosemide should be
given cautiously or deferred until hemodynamics stabilize with inotropic support.
Option C: [CORRECT] This client exhibits classic cardiogenic shock: systolic BP <90
mmHg, signs of tissue hypoperfusion (cool, clammy skin, altered mental status implied
by severity), and evidence of congestion (JVD, pulmonary edema). The "cold and wet"
profile requires inotropic support (dobutamine or milrinone) to improve contractility and
maintain perfusion while carefully managing congestion. Dobutamine is the first-line
inotrope for HFrEF with cardiogenic shock, providing β1 agonism to increase cardiac
output without excessive vasoconstriction. This is the priority life-saving intervention.
Option D: While oxygen is necessary (SpO₂ 89%), the client needs more than
supplemental O₂. However, BiPAP is relatively contraindicated in hypotension (risk of
further reducing preload and cardiac output) and should only be initiated after
hemodynamic stabilization or simultaneously with pressor/inotrope support. The
primary problem is pump failure, not respiratory failure alone.
Question 2 (SATA with 3 correct): A nurse is caring for a client 48 hours post-mitral
valve replacement who develops acute atrial fibrillation with rapid ventricular response
(RVR) at 150 bpm. The client is hemodynamically stable (BP 122/78, MAP 93). Which
interventions are appropriate? Select all that apply.
A. Administer IV amiodarone per protocol
B. Prepare for immediate synchronized cardioversion
,C. Assess for precipitating causes (electrolyte imbalances, pain, hypoxia)
D. Initiate therapeutic hypothermia protocol
E. Administer IV heparin for stroke prophylaxis
F. Apply vagal maneuvers as first-line treatment
Correct Answer: A, C, E
Rationale:
Option A: [CORRECT] Amiodarone is first-line pharmacologic rate/rhythm control for
postoperative atrial fibrillation. It is effective in hemodynamically stable clients, has
minimal negative inotropic effects (safe in recent cardiac surgery), and can be loaded IV
with transition to oral. It controls rate and may convert rhythm.
Option B: Synchronized cardioversion is reserved for hemodynamically unstable atrial
fibrillation (hypotension, ischemia, heart failure, altered mental status). This client is
stable (BP 122/78, adequate perfusion), so pharmacologic management is preferred to
avoid sedation risks and myocardial stunning post-cardiac surgery.
Option C: [CORRECT] Postoperative atrial fibrillation has identifiable triggers that must
be addressed: hypokalemia, hypomagnesemia, hypoxia, pain, volume overload, or
infection. Correcting these underlying causes is essential for successful rhythm
management and prevention of recurrence. This is fundamental nursing assessment.
Option D: Therapeutic hypothermia is indicated for cardiac arrest with return of
spontaneous circulation (neuroprotection), not for atrial fibrillation. It has no role in this
scenario and would be harmful (increased infection risk, coagulopathy, arrhythmias).
Option E: [CORRECT] Postoperative atrial fibrillation carries significant stroke risk
(similar to non-valvular AF). Anticoagulation with heparin (bridging to warfarin if
, mechanical valve, or direct oral anticoagulant if bioprosthetic) is essential. The
CHA₂DS₂-VASc score is likely elevated given age and recent surgery.
Option F: Vagal maneuvers (carotid massage, Valsalva) are ineffective for atrial
fibrillation RVR and potentially dangerous post-cardiac surgery (risk of dislodging
thrombus, hemodynamic compromise). They are used for SVT reentry tachycardias, not
AFib.
Question 3 (Ordered Response – Complex): A client with acute ST-elevation myocardial
infarction (STEMI) develops cardiogenic shock 6 hours post-percutaneous coronary
intervention (PCI) to the left anterior descending artery. Place the following nursing
interventions in priority order:
1. Initiate dobutamine infusion per protocol
2. Insert arterial line for continuous BP monitoring
3. Obtain 12-lead ECG
4. Assess level of consciousness and peripheral perfusion
5. Administer aspirin 325 mg
6. Prepare for possible intra-aortic balloon pump (IABP) or Impella
Correct Order: 4, 3, 2, 1, 6, 5 [CORRECT]
Rationale:
Step 1 (Assessment - #4): The nursing process always begins with assessment.
Determining baseline neurologic status (cerebral perfusion) and peripheral perfusion
(capillary refill, skin temperature, pulses) establishes severity of shock and provides
comparison for intervention effectiveness. This cannot be delegated and must precede
interventions.
Step 2 (ECG - #3): Immediate 12-lead ECG identifies ongoing ischemia, arrhythmias, or
mechanical complications (papillary muscle rupture, VSD) causing shock. This guides
whether emergency re-intervention is needed versus pure inotropic support.
