HESI Med-Surg RN Custom Examination –
Medical-Surgical Nursing II 2026/2027: Actual
Questions with Verified Answers – Health Education
Systems, Inc. (HESI) / Elsevier – Complete Study
Guide – Graded A+
SECTION 1: CARDIOVASCULAR & HEMATOLOGY
(Questions 1-18 — 18-22% of exam)
Q1. A 58-year-old male (WT 78 kg) is admitted with anterior STEMI. Primary PCI is
planned within 45 minutes. Which IV antiplatelet loading dose is evidence-based
according to 2026 AHA guidelines?
A. Clopidogrel 600 mg
B. Ticagrelor 180 mg
C. Prasugrel 60 mg
D. Abciximab 0.25 mg/kg
Correct Answer: B. Ticagrelor 180 mg
Rationale: Ticagrelor 180 mg is Class I recommendation for primary PCI; it provides
faster, more consistent platelet inhibition than clopidogrel without requiring hepatic
,conversion. Prasugrel 60 mg is acceptable if PCI is certain and no history of CVA/TIA.
Clopidogrel has variable response due to genetic polymorphisms. Abciximab is a GP
IIb/IIIa inhibitor used adjunctively, not as primary antiplatelet loading.
HESI Strategy: Know current AHA guidelines—ticagrelor is preferred for STEMI unless
contraindicated.
Q2. (Select All That Apply) A patient with NYHA class III HFpEF (EF 55%) and new-onset
rapid atrial fibrillation is started on rivaroxaban 20 mg daily. Which parameters require
monitoring?
A. Serum creatinine
B. AST/ALT
C. INR q2days
D. CBC with platelets
E. Blood pressure
Correct Answers: A, B, D
Rationale: DOACs require:
● Renal function (A): Dose adjustment for CrCl <50 mL/min
● Hepatic function (B): Contraindicated with severe hepatic impairment
● CBC (D): Monitor for occult bleeding, anemia
INR (C) is NOT monitored with DOACs (unlike warfarin). Blood pressure (E) is important
for heart failure management but not specific to rivaroxaban safety monitoring.
HESI SATA Strategy: Treat each option independently. If unsure, leave it unselected—no
partial credit on actual HESI.
,Q3. (Priority/Ordered Response) Three patients return from cardiac catheterization on
the same elevator. Who should the nurse assess FIRST?
1. 42-year-old: Radial access, no closure device, took Metformin 2 grams this
morning
2. 67-year-old: Femoral access, 6-French, hemostasis with FemoStop™
3. 55-year-old: PCI to LAD, bivalirudin infusion running, sheath still in place
Correct Order: 3 → 2 → 1
Rationale:
● Patient 3 (Highest Priority): Active antithrombotic infusion + sheath-in-place =
highest bleed risk. Requires immediate assessment for hematoma, distal pulses,
and access site integrity.
● Patient 2 (Moderate Priority): Femoral access with mechanical compression
device requires monitoring for device effectiveness and vascular complications.
● Patient 1 (Lowest Priority): Radial access (lower bleed risk), no closure device
needed. Metformin held post-contrast (renal precaution) but not emergent.
HESI Priority Strategy: Use ABCs + unstable vs. stable. Active anticoagulation with
invasive device = instability.
Q4. A client on telemetry has uncontrolled atrial fibrillation with rapid ventricular
response. Based on this finding, the nurse anticipates assisting with which treatment?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate the client immediately
D. Administer atropine 0.4 mg IV push
Correct Answer: B. Perform synchronized cardioversion
, Rationale: Synchronized cardioversion (50-100 J biphasic) is treatment of choice for
symptomatic/uncontrolled Afib with RVR to restore normal sinus rhythm. Lidocaine (A)
is for ventricular dysrhythmias. Defibrillation (C) is for pulseless VT/VF
(unsynchronized). Atropine (D) is for symptomatic bradycardia.
Q5. A client with heart failure has gained 4 pounds in 3 days, has 2+ pitting edema, and
reports shortness of breath when lying flat. Which assessment finding requires
immediate action?
A. Heart rate 98 bpm
B. Respiratory rate 24 with crackles halfway up lung fields
C. Blood pressure 142/88 mmHg
D. Jugular vein distention at 45 degrees
Correct Answer: B. Respiratory rate 24 with crackles halfway up lung fields
Rationale: Crackles extending halfway up lung fields indicate significant pulmonary
edema requiring immediate intervention (diuretics, oxygen, positioning). While JVD and
edema are concerning CHF findings, respiratory compromise takes priority (ABC
principle). Tachycardia and hypertension are expected compensatory mechanisms.
Q6. A client receiving a blood transfusion develops low back pain, chills, and
hypotension 15 minutes after initiation. What is the priority action?
A. Slow the transfusion and notify the provider
B. Stop the transfusion and keep the IV line open with normal saline
C. Administer diphenhydramine and acetaminophen
Medical-Surgical Nursing II 2026/2027: Actual
Questions with Verified Answers – Health Education
Systems, Inc. (HESI) / Elsevier – Complete Study
Guide – Graded A+
SECTION 1: CARDIOVASCULAR & HEMATOLOGY
(Questions 1-18 — 18-22% of exam)
Q1. A 58-year-old male (WT 78 kg) is admitted with anterior STEMI. Primary PCI is
planned within 45 minutes. Which IV antiplatelet loading dose is evidence-based
according to 2026 AHA guidelines?
A. Clopidogrel 600 mg
B. Ticagrelor 180 mg
C. Prasugrel 60 mg
D. Abciximab 0.25 mg/kg
Correct Answer: B. Ticagrelor 180 mg
Rationale: Ticagrelor 180 mg is Class I recommendation for primary PCI; it provides
faster, more consistent platelet inhibition than clopidogrel without requiring hepatic
,conversion. Prasugrel 60 mg is acceptable if PCI is certain and no history of CVA/TIA.
Clopidogrel has variable response due to genetic polymorphisms. Abciximab is a GP
IIb/IIIa inhibitor used adjunctively, not as primary antiplatelet loading.
HESI Strategy: Know current AHA guidelines—ticagrelor is preferred for STEMI unless
contraindicated.
Q2. (Select All That Apply) A patient with NYHA class III HFpEF (EF 55%) and new-onset
rapid atrial fibrillation is started on rivaroxaban 20 mg daily. Which parameters require
monitoring?
A. Serum creatinine
B. AST/ALT
C. INR q2days
D. CBC with platelets
E. Blood pressure
Correct Answers: A, B, D
Rationale: DOACs require:
● Renal function (A): Dose adjustment for CrCl <50 mL/min
● Hepatic function (B): Contraindicated with severe hepatic impairment
● CBC (D): Monitor for occult bleeding, anemia
INR (C) is NOT monitored with DOACs (unlike warfarin). Blood pressure (E) is important
for heart failure management but not specific to rivaroxaban safety monitoring.
HESI SATA Strategy: Treat each option independently. If unsure, leave it unselected—no
partial credit on actual HESI.
,Q3. (Priority/Ordered Response) Three patients return from cardiac catheterization on
the same elevator. Who should the nurse assess FIRST?
1. 42-year-old: Radial access, no closure device, took Metformin 2 grams this
morning
2. 67-year-old: Femoral access, 6-French, hemostasis with FemoStop™
3. 55-year-old: PCI to LAD, bivalirudin infusion running, sheath still in place
Correct Order: 3 → 2 → 1
Rationale:
● Patient 3 (Highest Priority): Active antithrombotic infusion + sheath-in-place =
highest bleed risk. Requires immediate assessment for hematoma, distal pulses,
and access site integrity.
● Patient 2 (Moderate Priority): Femoral access with mechanical compression
device requires monitoring for device effectiveness and vascular complications.
● Patient 1 (Lowest Priority): Radial access (lower bleed risk), no closure device
needed. Metformin held post-contrast (renal precaution) but not emergent.
HESI Priority Strategy: Use ABCs + unstable vs. stable. Active anticoagulation with
invasive device = instability.
Q4. A client on telemetry has uncontrolled atrial fibrillation with rapid ventricular
response. Based on this finding, the nurse anticipates assisting with which treatment?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate the client immediately
D. Administer atropine 0.4 mg IV push
Correct Answer: B. Perform synchronized cardioversion
, Rationale: Synchronized cardioversion (50-100 J biphasic) is treatment of choice for
symptomatic/uncontrolled Afib with RVR to restore normal sinus rhythm. Lidocaine (A)
is for ventricular dysrhythmias. Defibrillation (C) is for pulseless VT/VF
(unsynchronized). Atropine (D) is for symptomatic bradycardia.
Q5. A client with heart failure has gained 4 pounds in 3 days, has 2+ pitting edema, and
reports shortness of breath when lying flat. Which assessment finding requires
immediate action?
A. Heart rate 98 bpm
B. Respiratory rate 24 with crackles halfway up lung fields
C. Blood pressure 142/88 mmHg
D. Jugular vein distention at 45 degrees
Correct Answer: B. Respiratory rate 24 with crackles halfway up lung fields
Rationale: Crackles extending halfway up lung fields indicate significant pulmonary
edema requiring immediate intervention (diuretics, oxygen, positioning). While JVD and
edema are concerning CHF findings, respiratory compromise takes priority (ABC
principle). Tachycardia and hypertension are expected compensatory mechanisms.
Q6. A client receiving a blood transfusion develops low back pain, chills, and
hypotension 15 minutes after initiation. What is the priority action?
A. Slow the transfusion and notify the provider
B. Stop the transfusion and keep the IV line open with normal saline
C. Administer diphenhydramine and acetaminophen
