1
Med-Surg II HESI (Elsevier) 2026/2027
Test Bank Questions and Answers |
Perfect Guide | A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.9 mEq/L [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A potassium
level of 2.9 mEq/L represents severe hypokalemia that can precipitate life-threatening ventricular
dysrhythmias, muscle weakness, and respiratory paralysis. The nurse must notify the provider
immediately for potassium replacement. Sodium 135 mEq/L (A) is low-normal but not critical.
Creatinine 1.0 mg/dL (C) and hemoglobin 12.5 g/dL (D) are within acceptable ranges.
Q2: A patient with a history of atrial fibrillation is prescribed warfarin 5 mg daily. The nurse
notes today's INR is 4.2. What is the priority nursing action?
A. Administer the scheduled warfarin dose
B. Hold the warfarin and notify the provider [CORRECT]
C. Administer vitamin K 10 mg subcutaneously
D. Increase the warfarin dose to 7.5 mg
Correct Answer: B
Rationale: An INR of 4.2 exceeds the therapeutic range of 2.0-3.0 for atrial fibrillation,
indicating an increased bleeding risk. The nurse should hold the warfarin dose and notify the
,2
provider for further orders. Vitamin K (C) is reserved for INR >10 or active bleeding. Never
increase a supratherapeutic dose (D) or administer the scheduled dose (A).
Q3: Which patient should the nurse assess first?
A. Patient with stable angina requesting PRN nitroglycerin
B. Patient with STEMI who reports crushing chest pain unrelieved by morphine [CORRECT]
C. Patient with heart failure who has 2+ peripheral edema
D. Patient with hypertension whose BP is 158/92 mmHg
Correct Answer: B
Rationale: The patient with STEMI experiencing unrelieved crushing chest pain represents an
immediate threat to life, possibly indicating ongoing myocardial ischemia, extension of
infarction, or complications such as papillary muscle rupture or cardiogenic shock. This requires
immediate assessment and intervention. Stable angina (A), chronic edema (C), and moderately
elevated BP (D) are less urgent.
Q4: A nurse is monitoring a patient after cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
A. Patient reports mild discomfort at insertion site
B. Distal pulse absent on affected extremity [CORRECT]
C. Small hematoma 2 cm at insertion site
D. Patient ambulated 4 hours post-procedure per protocol
Correct Answer: B
Rationale: Absence of a distal pulse indicates arterial occlusion from thrombosis, dissection, or
hematoma expansion, threatening limb viability. This is a vascular emergency requiring
immediate notification of the interventional cardiologist and preparation for possible emergency
intervention. Mild discomfort (A) and small hematoma (C) are expected; ambulation at 4 hours
(D) follows standard protocols.
Q5: A patient with heart failure is prescribed lisinopril 10 mg daily. The nurse should monitor for
which potential adverse effect?
A. Hyperkalemia [CORRECT]
B. Hyperglycemia
C. Hypocalcemia
D. Hyponatremia
,3
Correct Answer: A
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by inhibiting aldosterone
secretion, which normally promotes potassium excretion. The nurse should monitor serum
potassium levels and assess for symptoms of hyperkalemia including muscle weakness,
paresthesias, and cardiac dysrhythmias. ACE inhibitors do not typically cause hyperglycemia
(B), hypocalcemia (C), or hyponatremia (D).
Q6: A patient with peripheral arterial disease (PAD) complains of severe leg pain at rest. Which
nursing intervention is most appropriate?
A. Apply warm compresses to the affected limb
B. Position legs in dependent position [CORRECT]
C. Elevate legs above heart level
D. Massage the affected extremity
Correct Answer: B
Rationale: Dependent positioning utilizes gravity to enhance arterial blood flow to ischemic
tissues, relieving rest pain in PAD. Elevating legs (C) worsens ischemia by reducing perfusion
pressure. Heat application (A) increases metabolic demand without improving supply. Massage
(D) can dislodge thrombi and is contraindicated.
Q7: A patient receiving heparin infusion has the following labs: aPTT 120 seconds, platelet count
80,000/mm³. What is the priority nursing action?
A. Continue heparin at current rate
B. Stop heparin immediately and notify provider [CORRECT]
C. Administer protamine sulfate 1 mg IV
D. Increase heparin infusion rate
Correct Answer: B
Rationale: This patient exhibits signs of heparin-induced thrombocytopenia (HIT) with
significant thrombocytopenia (platelets dropped >50% from baseline) and supratherapeutic
aPTT. Heparin must be stopped immediately to prevent thrombotic complications. Protamine (C)
reverses heparin but does not address HIT pathophysiology. Continuing (A) or increasing (D)
heparin is contraindicated.
Q8: Which ECG rhythm requires immediate defibrillation?
A. Sinus tachycardia at 150 bpm
, 4
B. Ventricular fibrillation [CORRECT]
C. Third-degree AV block
D. Atrial flutter with 4:1 conduction
Correct Answer: B
Rationale: Ventricular fibrillation is a pulseless, chaotic rhythm with no effective cardiac output,
representing cardiac arrest requiring immediate unsynchronized defibrillation. Sinus tachycardia
(A) and atrial flutter (D) are organized rhythms with pulses. Third-degree AV block (C) may
require pacing but not defibrillation.
Q9: A patient with dilated cardiomyopathy develops acute decompensated heart failure. Which
medication should the nurse prepare to administer first?
A. Furosemide 40 mg IV push [CORRECT]
B. Digoxin 0.25 mg PO
C. Carvedilol 6.25 mg PO
D. Lisinopril 5 mg PO
Correct Answer: A
Rationale: In acute decompensated heart failure, IV loop diuretics provide rapid symptom relief
by reducing preload through venodilation and diuresis. Beta-blockers (C) and ACE inhibitors (D)
are contraindicated in acute decompensation. Digoxin (B) has delayed onset and is not first-line
for acute management.
Q10: A nurse is caring for a patient post-MI who suddenly develops hypotension, clear lung
sounds, and distended jugular veins. Which complication should the nurse suspect?
A. Cardiogenic shock
B. Right ventricular infarction [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: Hypotension with clear lungs and JVD constitutes the classic triad of right ventricular
infarction. The right ventricle cannot pump blood forward, causing systemic venous congestion
without pulmonary edema. Cardiogenic shock (A) typically presents with pulmonary congestion.
Papillary muscle rupture (C) and VSD (D) cause new murmurs and pulmonary edema.
Med-Surg II HESI (Elsevier) 2026/2027
Test Bank Questions and Answers |
Perfect Guide | A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
A. Sodium 135 mEq/L
B. Potassium 2.9 mEq/L [CORRECT]
C. Creatinine 1.0 mg/dL
D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. A potassium
level of 2.9 mEq/L represents severe hypokalemia that can precipitate life-threatening ventricular
dysrhythmias, muscle weakness, and respiratory paralysis. The nurse must notify the provider
immediately for potassium replacement. Sodium 135 mEq/L (A) is low-normal but not critical.
Creatinine 1.0 mg/dL (C) and hemoglobin 12.5 g/dL (D) are within acceptable ranges.
Q2: A patient with a history of atrial fibrillation is prescribed warfarin 5 mg daily. The nurse
notes today's INR is 4.2. What is the priority nursing action?
A. Administer the scheduled warfarin dose
B. Hold the warfarin and notify the provider [CORRECT]
C. Administer vitamin K 10 mg subcutaneously
D. Increase the warfarin dose to 7.5 mg
Correct Answer: B
Rationale: An INR of 4.2 exceeds the therapeutic range of 2.0-3.0 for atrial fibrillation,
indicating an increased bleeding risk. The nurse should hold the warfarin dose and notify the
,2
provider for further orders. Vitamin K (C) is reserved for INR >10 or active bleeding. Never
increase a supratherapeutic dose (D) or administer the scheduled dose (A).
Q3: Which patient should the nurse assess first?
A. Patient with stable angina requesting PRN nitroglycerin
B. Patient with STEMI who reports crushing chest pain unrelieved by morphine [CORRECT]
C. Patient with heart failure who has 2+ peripheral edema
D. Patient with hypertension whose BP is 158/92 mmHg
Correct Answer: B
Rationale: The patient with STEMI experiencing unrelieved crushing chest pain represents an
immediate threat to life, possibly indicating ongoing myocardial ischemia, extension of
infarction, or complications such as papillary muscle rupture or cardiogenic shock. This requires
immediate assessment and intervention. Stable angina (A), chronic edema (C), and moderately
elevated BP (D) are less urgent.
Q4: A nurse is monitoring a patient after cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
A. Patient reports mild discomfort at insertion site
B. Distal pulse absent on affected extremity [CORRECT]
C. Small hematoma 2 cm at insertion site
D. Patient ambulated 4 hours post-procedure per protocol
Correct Answer: B
Rationale: Absence of a distal pulse indicates arterial occlusion from thrombosis, dissection, or
hematoma expansion, threatening limb viability. This is a vascular emergency requiring
immediate notification of the interventional cardiologist and preparation for possible emergency
intervention. Mild discomfort (A) and small hematoma (C) are expected; ambulation at 4 hours
(D) follows standard protocols.
Q5: A patient with heart failure is prescribed lisinopril 10 mg daily. The nurse should monitor for
which potential adverse effect?
A. Hyperkalemia [CORRECT]
B. Hyperglycemia
C. Hypocalcemia
D. Hyponatremia
,3
Correct Answer: A
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia by inhibiting aldosterone
secretion, which normally promotes potassium excretion. The nurse should monitor serum
potassium levels and assess for symptoms of hyperkalemia including muscle weakness,
paresthesias, and cardiac dysrhythmias. ACE inhibitors do not typically cause hyperglycemia
(B), hypocalcemia (C), or hyponatremia (D).
Q6: A patient with peripheral arterial disease (PAD) complains of severe leg pain at rest. Which
nursing intervention is most appropriate?
A. Apply warm compresses to the affected limb
B. Position legs in dependent position [CORRECT]
C. Elevate legs above heart level
D. Massage the affected extremity
Correct Answer: B
Rationale: Dependent positioning utilizes gravity to enhance arterial blood flow to ischemic
tissues, relieving rest pain in PAD. Elevating legs (C) worsens ischemia by reducing perfusion
pressure. Heat application (A) increases metabolic demand without improving supply. Massage
(D) can dislodge thrombi and is contraindicated.
Q7: A patient receiving heparin infusion has the following labs: aPTT 120 seconds, platelet count
80,000/mm³. What is the priority nursing action?
A. Continue heparin at current rate
B. Stop heparin immediately and notify provider [CORRECT]
C. Administer protamine sulfate 1 mg IV
D. Increase heparin infusion rate
Correct Answer: B
Rationale: This patient exhibits signs of heparin-induced thrombocytopenia (HIT) with
significant thrombocytopenia (platelets dropped >50% from baseline) and supratherapeutic
aPTT. Heparin must be stopped immediately to prevent thrombotic complications. Protamine (C)
reverses heparin but does not address HIT pathophysiology. Continuing (A) or increasing (D)
heparin is contraindicated.
Q8: Which ECG rhythm requires immediate defibrillation?
A. Sinus tachycardia at 150 bpm
, 4
B. Ventricular fibrillation [CORRECT]
C. Third-degree AV block
D. Atrial flutter with 4:1 conduction
Correct Answer: B
Rationale: Ventricular fibrillation is a pulseless, chaotic rhythm with no effective cardiac output,
representing cardiac arrest requiring immediate unsynchronized defibrillation. Sinus tachycardia
(A) and atrial flutter (D) are organized rhythms with pulses. Third-degree AV block (C) may
require pacing but not defibrillation.
Q9: A patient with dilated cardiomyopathy develops acute decompensated heart failure. Which
medication should the nurse prepare to administer first?
A. Furosemide 40 mg IV push [CORRECT]
B. Digoxin 0.25 mg PO
C. Carvedilol 6.25 mg PO
D. Lisinopril 5 mg PO
Correct Answer: A
Rationale: In acute decompensated heart failure, IV loop diuretics provide rapid symptom relief
by reducing preload through venodilation and diuresis. Beta-blockers (C) and ACE inhibitors (D)
are contraindicated in acute decompensation. Digoxin (B) has delayed onset and is not first-line
for acute management.
Q10: A nurse is caring for a patient post-MI who suddenly develops hypotension, clear lung
sounds, and distended jugular veins. Which complication should the nurse suspect?
A. Cardiogenic shock
B. Right ventricular infarction [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: Hypotension with clear lungs and JVD constitutes the classic triad of right ventricular
infarction. The right ventricle cannot pump blood forward, causing systemic venous congestion
without pulmonary edema. Cardiogenic shock (A) typically presents with pulmonary congestion.
Papillary muscle rupture (C) and VSD (D) cause new murmurs and pulmonary edema.
