Med-Surg II HESI Elsevier ACTUAL
EXAM 2026/2027 | Medical Surgical
Nursing II | Verified Q&A | Pass
Guaranteed - A+ Graded
Unit 1: Critical Care & Hemodynamics (18 questions)
Q1: A patient with septic shock has MAP 52 mm Hg despite two 30 mL/kg crystalloid boluses. Central
line placed. Which vasopressor is FIRST-line?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine [CORRECT]
Rationale: Surviving Sepsis Campaign: norepinephrine first-line for septic shock (alpha-1
vasoconstriction, less arrhythmogenic than dopamine). Dopamine (A) more arrhythmias. Epinephrine (B)
second-line. Vasopressin (C) add-on, not first.
Q2 (SATA): Patient with cardiogenic shock post-STEMI has IABP placed. Which indicate proper function?
A. Balloon inflates at onset of diastole (after dicrotic notch) [CORRECT]
B. Balloon deflates just before systole [CORRECT]
C. 1:2 augmentation ratio always
D. Augmented diastolic pressure > systolic pressure [CORRECT]
E. Flat arterial waveform during inflation
Rationale: Proper IABP: inflation at dicrotic notch (A), deflation before systole (B), augmented diastolic >
systolic (D). 1:2 ratio (C) is weaning mode. Flat waveform (E) indicates malfunction.
Q3: A patient has ABG: pH 7.32, PaCO2 55, HCO3 28. What is the disorder?
, A. Respiratory acidosis, metabolic compensation [CORRECT]
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: pH low (acidosis), PaCO2 high (respiratory cause), HCO3 high (compensation). Primary
respiratory acidosis with metabolic compensation.
Q4: A patient in pulseless VT is defibrillated. Rhythm shows asystole. What is next?
A. Defibrillate again immediately
B. Resume CPR, give epinephrine 1 mg IV/IO every 3-5 minutes, consider reversible causes (H's
and T's) [CORRECT]
C. Give atropine 1 mg
D. Administer amiodarone 300 mg
Rationale: Asystole/PEA: CPR + epinephrine, search reversible causes. No shock for asystole (A).
Atropine (C) removed from asystole algorithm. Amiodarone (D) for shockable rhythms.
Q5: A patient has CVP 4 mm Hg, PAOP 6 mm Hg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁵ after 2L fluid.
What type of shock?
A. Hypovolemic shock – low CVP/PAOP (preload), low CI, high SVR (compensation) [CORRECT]
B. Cardiogenic shock
C. Septic shock
D. Anaphylactic shock
Rationale: Low preload (CVP/PAOP), low CI, high SVR = hypovolemic shock. Cardiogenic (B): high PAOP,
low CI, high SVR. Septic/anaphylactic (C, D): low SVR.
Q6: A patient with ARDS is on mechanical ventilation. Which setting is lung-protective?
A. Tidal volume 12 mL/kg
B. Tidal volume 6 mL/kg predicted body weight, plateau pressure <30 cm H2O, appropriate PEEP
[CORRECT]
C. No PEEP to prevent barotrauma
D. High tidal volume to prevent atelectasis
,Rationale: ARDSnet: 6 mL/kg PBW, Pplat <30, PEEP for oxygenation. High volumes (A, D) cause lung
injury. PEEP essential (C incorrect).
Q7: A patient is being weaned from ventilator. Which parameter indicates readiness?
A. RSBI (Rapid Shallow Breathing Index) <105, NIF >-25 cm H2O, minute ventilation <10 L,
PaO2/FiO2 >200 [CORRECT]
B. RSBI >150
C. NIF -10 cm H2O
D. Minute ventilation 15 L
Rationale: Weaning parameters: RSBI <105 (good), NIF >-25 (adequate strength), VE <10 (acceptable
load), adequate oxygenation. High RSBI (B), poor NIF (C), high VE (D) predict failure.
Q8: A patient has anaphylactic shock. What is the FIRST medication?
A. Diphenhydramine 50 mg IV
B. Epinephrine 0.3-0.5 mg IM (1:1000) in anterolateral thigh, repeat every 5-15 min; airway,
oxygen, fluids [CORRECT]
C. Methylprednisolone 125 mg IV
D. Albuterol nebulizer
Rationale: Anaphylaxis: epinephrine is life-saving first-line. Antihistamines (A) and steroids (C) adjuncts.
Albuterol (D) for bronchospasm adjunct. IM epinephrine in thigh (rapid absorption).
Q9: A patient has neurogenic shock (T6 SCI). Hemodynamics show:
A. Hypertension, bradycardia
B. Hypotension, bradycardia, warm dry skin (loss of sympathetic tone, unopposed vagal tone)
[CORRECT]
C. Hypertension, tachycardia
D. Hypotension, tachycardia
Rationale: Neurogenic shock: hypotension (vasodilation), bradycardia (unopposed vagal), warm dry skin
(loss of sympathetic). Not hypertensive (A, C). Not tachycardic (D—different from hypovolemic).
Q10: A patient has DIC with bleeding and thrombosis. Platelets 45,000, fibrinogen 80, PT/PTT prolonged,
D-dimer elevated. What is the treatment?
A. Heparin infusion for all patients
, B. Treat underlying cause, transfuse (platelets, cryoprecipitate/fibrinogen, FFP, PRBCs), heparin
only if thrombosis predominant without bleeding [CORRECT]
C. Warfarin immediately
D. No treatment, observe only
Rationale: DIC: treat cause, blood products for bleeding. Heparin (A) only if thrombosis without
bleeding. Warfarin (C) contraindicated acutely. Treatment required (D incorrect).
Q11: A patient has metabolic acidosis with anion gap 18. What are possible causes (H's)?
A. Hypovolemia, hypoxia, hyper/hypokalemia only
B. H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper/Hypokalemia, Hypothermia; T's:
Toxins, Tamponade, Tension pneumothorax, Thrombosis (coronary/pulmonary), Trauma
[CORRECT]
C. Only hypoglycemia
D. Only hypercalcemia
Rationale: Anion gap metabolic acidosis: MUDPILES or H's/T's for cardiac arrest. Multiple causes (B). Not
single causes (C, D).
Q12: A patient has respiratory acidosis with acute-on-chronic COPD exacerbation. What is the
appropriate oxygen target?
A. SpO2 94-98%
B. SpO2 88-92% to avoid CO2 retention and respiratory depression (chronic hypercapnia
eliminates hypoxic drive) [CORRECT]
C. SpO2 >95% regardless
D. 100% FiO2 for all patients
Rationale: COPD with chronic hypercapnia: target 88-92%. Higher oxygen (A, C, D) can cause CO2
retention and respiratory failure.
Q13: A patient is on PEEP 10 cm H2O. What is the purpose?
A. Reduce mean airway pressure
B. Recruit alveoli, improve oxygenation, prevent alveolar collapse, reduce shunt [CORRECT]
C. Increase dead space
D. Reduce tidal volume
EXAM 2026/2027 | Medical Surgical
Nursing II | Verified Q&A | Pass
Guaranteed - A+ Graded
Unit 1: Critical Care & Hemodynamics (18 questions)
Q1: A patient with septic shock has MAP 52 mm Hg despite two 30 mL/kg crystalloid boluses. Central
line placed. Which vasopressor is FIRST-line?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine [CORRECT]
Rationale: Surviving Sepsis Campaign: norepinephrine first-line for septic shock (alpha-1
vasoconstriction, less arrhythmogenic than dopamine). Dopamine (A) more arrhythmias. Epinephrine (B)
second-line. Vasopressin (C) add-on, not first.
Q2 (SATA): Patient with cardiogenic shock post-STEMI has IABP placed. Which indicate proper function?
A. Balloon inflates at onset of diastole (after dicrotic notch) [CORRECT]
B. Balloon deflates just before systole [CORRECT]
C. 1:2 augmentation ratio always
D. Augmented diastolic pressure > systolic pressure [CORRECT]
E. Flat arterial waveform during inflation
Rationale: Proper IABP: inflation at dicrotic notch (A), deflation before systole (B), augmented diastolic >
systolic (D). 1:2 ratio (C) is weaning mode. Flat waveform (E) indicates malfunction.
Q3: A patient has ABG: pH 7.32, PaCO2 55, HCO3 28. What is the disorder?
, A. Respiratory acidosis, metabolic compensation [CORRECT]
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: pH low (acidosis), PaCO2 high (respiratory cause), HCO3 high (compensation). Primary
respiratory acidosis with metabolic compensation.
Q4: A patient in pulseless VT is defibrillated. Rhythm shows asystole. What is next?
A. Defibrillate again immediately
B. Resume CPR, give epinephrine 1 mg IV/IO every 3-5 minutes, consider reversible causes (H's
and T's) [CORRECT]
C. Give atropine 1 mg
D. Administer amiodarone 300 mg
Rationale: Asystole/PEA: CPR + epinephrine, search reversible causes. No shock for asystole (A).
Atropine (C) removed from asystole algorithm. Amiodarone (D) for shockable rhythms.
Q5: A patient has CVP 4 mm Hg, PAOP 6 mm Hg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁵ after 2L fluid.
What type of shock?
A. Hypovolemic shock – low CVP/PAOP (preload), low CI, high SVR (compensation) [CORRECT]
B. Cardiogenic shock
C. Septic shock
D. Anaphylactic shock
Rationale: Low preload (CVP/PAOP), low CI, high SVR = hypovolemic shock. Cardiogenic (B): high PAOP,
low CI, high SVR. Septic/anaphylactic (C, D): low SVR.
Q6: A patient with ARDS is on mechanical ventilation. Which setting is lung-protective?
A. Tidal volume 12 mL/kg
B. Tidal volume 6 mL/kg predicted body weight, plateau pressure <30 cm H2O, appropriate PEEP
[CORRECT]
C. No PEEP to prevent barotrauma
D. High tidal volume to prevent atelectasis
,Rationale: ARDSnet: 6 mL/kg PBW, Pplat <30, PEEP for oxygenation. High volumes (A, D) cause lung
injury. PEEP essential (C incorrect).
Q7: A patient is being weaned from ventilator. Which parameter indicates readiness?
A. RSBI (Rapid Shallow Breathing Index) <105, NIF >-25 cm H2O, minute ventilation <10 L,
PaO2/FiO2 >200 [CORRECT]
B. RSBI >150
C. NIF -10 cm H2O
D. Minute ventilation 15 L
Rationale: Weaning parameters: RSBI <105 (good), NIF >-25 (adequate strength), VE <10 (acceptable
load), adequate oxygenation. High RSBI (B), poor NIF (C), high VE (D) predict failure.
Q8: A patient has anaphylactic shock. What is the FIRST medication?
A. Diphenhydramine 50 mg IV
B. Epinephrine 0.3-0.5 mg IM (1:1000) in anterolateral thigh, repeat every 5-15 min; airway,
oxygen, fluids [CORRECT]
C. Methylprednisolone 125 mg IV
D. Albuterol nebulizer
Rationale: Anaphylaxis: epinephrine is life-saving first-line. Antihistamines (A) and steroids (C) adjuncts.
Albuterol (D) for bronchospasm adjunct. IM epinephrine in thigh (rapid absorption).
Q9: A patient has neurogenic shock (T6 SCI). Hemodynamics show:
A. Hypertension, bradycardia
B. Hypotension, bradycardia, warm dry skin (loss of sympathetic tone, unopposed vagal tone)
[CORRECT]
C. Hypertension, tachycardia
D. Hypotension, tachycardia
Rationale: Neurogenic shock: hypotension (vasodilation), bradycardia (unopposed vagal), warm dry skin
(loss of sympathetic). Not hypertensive (A, C). Not tachycardic (D—different from hypovolemic).
Q10: A patient has DIC with bleeding and thrombosis. Platelets 45,000, fibrinogen 80, PT/PTT prolonged,
D-dimer elevated. What is the treatment?
A. Heparin infusion for all patients
, B. Treat underlying cause, transfuse (platelets, cryoprecipitate/fibrinogen, FFP, PRBCs), heparin
only if thrombosis predominant without bleeding [CORRECT]
C. Warfarin immediately
D. No treatment, observe only
Rationale: DIC: treat cause, blood products for bleeding. Heparin (A) only if thrombosis without
bleeding. Warfarin (C) contraindicated acutely. Treatment required (D incorrect).
Q11: A patient has metabolic acidosis with anion gap 18. What are possible causes (H's)?
A. Hypovolemia, hypoxia, hyper/hypokalemia only
B. H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper/Hypokalemia, Hypothermia; T's:
Toxins, Tamponade, Tension pneumothorax, Thrombosis (coronary/pulmonary), Trauma
[CORRECT]
C. Only hypoglycemia
D. Only hypercalcemia
Rationale: Anion gap metabolic acidosis: MUDPILES or H's/T's for cardiac arrest. Multiple causes (B). Not
single causes (C, D).
Q12: A patient has respiratory acidosis with acute-on-chronic COPD exacerbation. What is the
appropriate oxygen target?
A. SpO2 94-98%
B. SpO2 88-92% to avoid CO2 retention and respiratory depression (chronic hypercapnia
eliminates hypoxic drive) [CORRECT]
C. SpO2 >95% regardless
D. 100% FiO2 for all patients
Rationale: COPD with chronic hypercapnia: target 88-92%. Higher oxygen (A, C, D) can cause CO2
retention and respiratory failure.
Q13: A patient is on PEEP 10 cm H2O. What is the purpose?
A. Reduce mean airway pressure
B. Recruit alveoli, improve oxygenation, prevent alveolar collapse, reduce shunt [CORRECT]
C. Increase dead space
D. Reduce tidal volume
