HESI MED-SURG RETAKE REVIEW 2026/2027 | Questions &
Answers | Verified Answers Edition | Retake Success Guide |
Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD REMEDIATION TOPICS
Targeting concepts with highest retake failure rates based on HESI performance analytics
Q1: A patient with acute decompensated heart failure (ADHF) has BP 82/54 mmHg, HR
118 bpm, RR 26/min, SpO2 88% on 2L NC, and crackles bilaterally to the apices. The
provider orders milrinone 0.375 mcg/kg/min IV infusion. The patient weighs 85 kg. How
many mcg/min should the nurse administer? (Round to nearest whole number)
A. 24 mcg/min
B. 28 mcg/min
C. 32 mcg/min [CORRECT]
D. 38 mcg/min
Correct Answer: C
Rationale: Calculation: 0.375 mcg/kg/min × 85 kg = 31.875 mcg/min → 32 mcg/min
(rounded).
Clinical Context: This patient has cardiogenic shock with low output (hypotension,
tachycardia, hypoxemia). Milrinone is a phosphodiesterase-3 inhibitor with inodilator
properties (positive inotropy + vasodilation). Critical consideration: While milrinone
improves contractility, it can worsen hypotension through vasodilation. In this scenario,
the patient may require vasopressor support (norepinephrine) to maintain perfusion
pressure while milrinone improves cardiac function.
,Why A is incorrect: 24 mcg/min would result from using 0.25 mcg/kg/min (low dose) or
calculation error (0.375 × 64 kg).
Why B is incorrect: 28 mcg/min suggests rounding error or weight miscalculation (0.375
× 74.6 kg).
Why D is incorrect: 38 mcg/min suggests using 0.45 mcg/kg/min (maximum dose) or
calculation error (0.375 × 101 kg).
Test-Taking Strategy: Weight-based calculations: always verify units (mcg vs. mg),
confirm weight in kg (not lbs), and double-check decimal placement. Milrinone dosing
range is 0.125-0.75 mcg/kg/min; 0.375 is standard maintenance.
Q2: A patient with ST-elevation MI (STEMI) received tenecteplase (TNK-tPA) 30 minutes
ago. The nurse notes bleeding from the arterial sheath insertion site, oozing from all IV
sites, and a 4 cm hematoma at the femoral access site. Vital signs: BP 94/62 mmHg,
HR 112 bpm. Which intervention is priority?
A. Apply pressure to the femoral site and notify the provider
B. Stop the tenecteplase infusion immediately [CORRECT]
C. Administer protamine sulfate 25 mg IV
D. Draw aPTT and PT/INR stat
Correct Answer: B
Rationale: Tenecteplase is a fibrinolytic with half-life 20-24 minutes. The patient
demonstrates fibrinolytic bleeding syndrome—the priority is stopping the medication to
halt further plasminogen activation. Unlike heparin (reversible with protamine) or
warfarin (vitamin K), fibrinolytics have no specific antidote. Management: stop drug,
local pressure, fluid resuscitation, blood products if needed, antifibrinolytics (tranexamic
acid) for severe bleeding.
,Why A is incorrect: Local pressure is necessary but secondary to stopping the systemic
cause.
Why C is incorrect: Protamine reverses heparin, not fibrinolytics. Inappropriate and
potentially harmful if heparin not given.
Why D is incorrect: Labs confirm diagnosis but do not treat active bleeding; stopping the
drug is immediate priority.
Memory Trick: "FIBrinolytics cause FIBrin breakdown"—bleeding is systemic, not local.
Stop the source first.
Q3: Select all that apply regarding cardiac tamponade recognition and management:
(Select all that apply)
A. Pulsus paradoxus >10 mmHg systolic drop with inspiration [CORRECT]
B. Electrical alternans on ECG (alternating QRS amplitude) [CORRECT]
C. Elevated JVP with clear lung fields on auscultation [CORRECT]
D. Narrow pulse pressure and hypotension [CORRECT]
E. Immediate pericardiocentesis for all cases regardless of hemodynamics
Correct Answers: A, B, C, D
Rationale: Beck's Triad (classic but present in only 10-40%): hypotension, elevated JVP,
muffled heart sounds. Additional findings:
● Pulsus paradoxus: Exaggerated (>10 mmHg) inspiratory drop in systolic BP due
to impaired ventricular filling
● Electrical alternans: Alternating QRS height from swinging heart in fluid
● Equalization of pressures: RA = RV = PA diastolic = PCWP (diagnostic on
catheterization)
● Clear lungs: Unlike heart failure, pulmonary edema is absent because right heart
cannot transmit pressure to pulmonary circulation
, Why E is incorrect: Pericardiocentesis is indicated for hemodynamic compromise
(tamponade with hypotension). Asymptomatic or hemodynamically stable effusions
may be observed or treated medically.
Clinical Judgment: The combination of elevated JVP + clear lungs + hypotension is
pathognomonic for tamponade (or constrictive pericarditis). In heart failure, JVP and
lung findings correlate.
Q4: A patient with infective endocarditis (IE) has a vegetation on the mitral valve. The
nurse notes sudden left-sided weakness, aphasia, and right gaze preference. Which
complication has occurred?
A. Septic embolus to left middle cerebral artery [CORRECT]
B. Hemorrhagic conversion of ischemic stroke
C. Brain abscess from direct extension
D. Mycotic aneurysm rupture
Correct Answer: A
Rationale: Left-sided weakness + aphasia + right gaze preference indicates left MCA
territory stroke (left gaze center controls right gaze, so right gaze preference suggests
left hemisphere lesion). In IE, septic emboli from vegetations travel to brain (20-40% of
IE cases), causing ischemic stroke. Emboli typically cause sudden focal deficits without
headache (unlike hemorrhage).
Why B is incorrect: Hemorrhagic conversion would show headache, decreased
consciousness, vomiting; this presentation is classic embolic stroke.
Why C is incorrect: Brain abscess presents with subacute fever, headache, focal deficits
over days-weeks, not sudden onset.
Answers | Verified Answers Edition | Retake Success Guide |
Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD REMEDIATION TOPICS
Targeting concepts with highest retake failure rates based on HESI performance analytics
Q1: A patient with acute decompensated heart failure (ADHF) has BP 82/54 mmHg, HR
118 bpm, RR 26/min, SpO2 88% on 2L NC, and crackles bilaterally to the apices. The
provider orders milrinone 0.375 mcg/kg/min IV infusion. The patient weighs 85 kg. How
many mcg/min should the nurse administer? (Round to nearest whole number)
A. 24 mcg/min
B. 28 mcg/min
C. 32 mcg/min [CORRECT]
D. 38 mcg/min
Correct Answer: C
Rationale: Calculation: 0.375 mcg/kg/min × 85 kg = 31.875 mcg/min → 32 mcg/min
(rounded).
Clinical Context: This patient has cardiogenic shock with low output (hypotension,
tachycardia, hypoxemia). Milrinone is a phosphodiesterase-3 inhibitor with inodilator
properties (positive inotropy + vasodilation). Critical consideration: While milrinone
improves contractility, it can worsen hypotension through vasodilation. In this scenario,
the patient may require vasopressor support (norepinephrine) to maintain perfusion
pressure while milrinone improves cardiac function.
,Why A is incorrect: 24 mcg/min would result from using 0.25 mcg/kg/min (low dose) or
calculation error (0.375 × 64 kg).
Why B is incorrect: 28 mcg/min suggests rounding error or weight miscalculation (0.375
× 74.6 kg).
Why D is incorrect: 38 mcg/min suggests using 0.45 mcg/kg/min (maximum dose) or
calculation error (0.375 × 101 kg).
Test-Taking Strategy: Weight-based calculations: always verify units (mcg vs. mg),
confirm weight in kg (not lbs), and double-check decimal placement. Milrinone dosing
range is 0.125-0.75 mcg/kg/min; 0.375 is standard maintenance.
Q2: A patient with ST-elevation MI (STEMI) received tenecteplase (TNK-tPA) 30 minutes
ago. The nurse notes bleeding from the arterial sheath insertion site, oozing from all IV
sites, and a 4 cm hematoma at the femoral access site. Vital signs: BP 94/62 mmHg,
HR 112 bpm. Which intervention is priority?
A. Apply pressure to the femoral site and notify the provider
B. Stop the tenecteplase infusion immediately [CORRECT]
C. Administer protamine sulfate 25 mg IV
D. Draw aPTT and PT/INR stat
Correct Answer: B
Rationale: Tenecteplase is a fibrinolytic with half-life 20-24 minutes. The patient
demonstrates fibrinolytic bleeding syndrome—the priority is stopping the medication to
halt further plasminogen activation. Unlike heparin (reversible with protamine) or
warfarin (vitamin K), fibrinolytics have no specific antidote. Management: stop drug,
local pressure, fluid resuscitation, blood products if needed, antifibrinolytics (tranexamic
acid) for severe bleeding.
,Why A is incorrect: Local pressure is necessary but secondary to stopping the systemic
cause.
Why C is incorrect: Protamine reverses heparin, not fibrinolytics. Inappropriate and
potentially harmful if heparin not given.
Why D is incorrect: Labs confirm diagnosis but do not treat active bleeding; stopping the
drug is immediate priority.
Memory Trick: "FIBrinolytics cause FIBrin breakdown"—bleeding is systemic, not local.
Stop the source first.
Q3: Select all that apply regarding cardiac tamponade recognition and management:
(Select all that apply)
A. Pulsus paradoxus >10 mmHg systolic drop with inspiration [CORRECT]
B. Electrical alternans on ECG (alternating QRS amplitude) [CORRECT]
C. Elevated JVP with clear lung fields on auscultation [CORRECT]
D. Narrow pulse pressure and hypotension [CORRECT]
E. Immediate pericardiocentesis for all cases regardless of hemodynamics
Correct Answers: A, B, C, D
Rationale: Beck's Triad (classic but present in only 10-40%): hypotension, elevated JVP,
muffled heart sounds. Additional findings:
● Pulsus paradoxus: Exaggerated (>10 mmHg) inspiratory drop in systolic BP due
to impaired ventricular filling
● Electrical alternans: Alternating QRS height from swinging heart in fluid
● Equalization of pressures: RA = RV = PA diastolic = PCWP (diagnostic on
catheterization)
● Clear lungs: Unlike heart failure, pulmonary edema is absent because right heart
cannot transmit pressure to pulmonary circulation
, Why E is incorrect: Pericardiocentesis is indicated for hemodynamic compromise
(tamponade with hypotension). Asymptomatic or hemodynamically stable effusions
may be observed or treated medically.
Clinical Judgment: The combination of elevated JVP + clear lungs + hypotension is
pathognomonic for tamponade (or constrictive pericarditis). In heart failure, JVP and
lung findings correlate.
Q4: A patient with infective endocarditis (IE) has a vegetation on the mitral valve. The
nurse notes sudden left-sided weakness, aphasia, and right gaze preference. Which
complication has occurred?
A. Septic embolus to left middle cerebral artery [CORRECT]
B. Hemorrhagic conversion of ischemic stroke
C. Brain abscess from direct extension
D. Mycotic aneurysm rupture
Correct Answer: A
Rationale: Left-sided weakness + aphasia + right gaze preference indicates left MCA
territory stroke (left gaze center controls right gaze, so right gaze preference suggests
left hemisphere lesion). In IE, septic emboli from vegetations travel to brain (20-40% of
IE cases), causing ischemic stroke. Emboli typically cause sudden focal deficits without
headache (unlike hemorrhage).
Why B is incorrect: Hemorrhagic conversion would show headache, decreased
consciousness, vomiting; this presentation is classic embolic stroke.
Why C is incorrect: Brain abscess presents with subacute fever, headache, focal deficits
over days-weeks, not sudden onset.
