HESI MED SURG FINAL EXAM ACTUAL 2026/2027 | Latest
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Section 1: Cardiovascular Disorders (Questions 1-16)
Question 1
A client with newly diagnosed heart failure is prescribed lisinopril, metoprolol, and
furosemide. The nurse reviews the morning laboratory results and notes a potassium
level of 3.1 mEq/L. Which action should the nurse take first?
A. Administer the scheduled furosemide and encourage potassium-rich foods
B. Hold the metoprolol and notify the provider of the hypokalemia
C. Hold the furosemide and notify the provider of the hypokalemia [CORRECT]
D. Administer all scheduled medications and recheck potassium in 4 hours
Rationale: Furosemide is a loop diuretic that causes potassium wasting; administering it
with a potassium of 3.1 mEq/L (below normal 3.5-5.0) could worsen hypokalemia and
precipitate life-threatening arrhythmias. The nurse must hold the furosemide and notify
the provider. Metoprolol does not significantly affect potassium; delaying notification is
unsafe.
Correct Answer: C
Question 2
A client receiving intravenous heparin has the following partial thromboplastin time
(PTT) results: 0900 PTT 28 seconds; 1200 PTT 32 seconds; 1500 PTT 82 seconds. The
therapeutic range is 60-80 seconds. Based on these results, which action should the
nurse take?
,A. Continue the current heparin infusion rate
B. Increase the heparin infusion rate by 2 units/kg/hr
C. Decrease the heparin infusion rate per protocol and notify the provider [CORRECT]
D. Stop the heparin infusion immediately and administer protamine sulfate
Rationale: The 1500 PTT of 82 seconds is supratherapeutic (>80 seconds), increasing
bleeding risk. The nurse should decrease the infusion per protocol and notify the
provider. Protamine sulfate is reserved for severe bleeding or heparin overdose, not mild
supratherapeutic values. Continuing or increasing the rate would further elevate
bleeding risk.
Correct Answer: C
Question 3
A client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the
INR and notes it is 4.2. The client denies bleeding. Which action should the nurse take?
A. Administer vitamin K 10 mg subcutaneously immediately
B. Hold the warfarin dose and notify the provider [CORRECT]
C. Administer the warfarin and recheck the INR in 1 week
D. Administer fresh frozen plasma prophylactically
Rationale: An INR of 4.2 is supratherapeutic (goal 2.0-3.0 for most indications),
increasing bleeding risk. The nurse should hold the dose and notify the provider for
dose adjustment. Vitamin K is reserved for INR >10 or active bleeding; FFP is for
life-threatening hemorrhage. Administering the dose would worsen the coagulopathy.
Correct Answer: B
Question 4
A client with chronic heart failure has a 3-pound weight gain in 24 hours, increased
dyspnea on exertion, and 1+ pitting edema in the lower extremities. Which assessment
finding requires the most immediate intervention?
,A. 1+ pitting edema in the lower extremities
B. 3-pound weight gain in 24 hours
C. Increased dyspnea on exertion
D. Jugular venous distension at 45 degrees [CORRECT]
Rationale: Jugular venous distension (JVD) at 45 degrees indicates elevated central
venous pressure and volume overload, reflecting right-sided heart failure
decompensation that requires immediate intervention to prevent pulmonary edema and
cardiogenic shock. While weight gain and edema are concerning, JVD is a more direct
indicator of hemodynamic compromise and fluid overload severity.
Correct Answer: D
Question 5
A client is 2 hours post-cardiac catheterization via the right femoral artery. The nurse
observes the client is restless, the right pedal pulse is absent, and the extremity is cool,
pale, and painful. Which complication should the nurse suspect?
A. Cardiac tamponade
B. Femoral artery thrombosis/embolism [CORRECT]
C. Hypovolemic shock from groin hematoma
D. Local anesthetic systemic toxicity
Rationale: Absence of pedal pulse, coolness, pallor, and pain in the affected extremity
post-catheterization indicates acute arterial occlusion from thrombosis or embolism at
the access site, requiring immediate vascular intervention. Cardiac tamponade presents
with hypotension, JVD, and muffled heart sounds; hypovolemic shock would show
systemic hypotension; LAST causes neurologic and cardiovascular symptoms.
Correct Answer: B
Question 6
, A client with heart failure is receiving dobutamine. Which parameter should the nurse
monitor most frequently to detect the earliest sign of medication toxicity?
A. Blood glucose every 4 hours
B. Heart rate and rhythm continuously [CORRECT]
C. Liver function tests daily
D. Serum potassium every 2 hours
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and
heart rate; excessive dosing can precipitate tachycardia, ventricular arrhythmias, and
myocardial ischemia. Continuous cardiac monitoring is essential. While electrolytes and
glucose matter, heart rate/rhythm changes are the earliest and most dangerous signs of
dobutamine toxicity.
Correct Answer: B
Question 7
A client with hypertension reports taking over-the-counter ibuprofen 400 mg three times
daily for arthritis pain. The nurse should explain that NSAIDs may interfere with which
antihypertensive medication class?
A. Angiotensin-converting enzyme inhibitors
B. Thiazide diuretics
C. All antihypertensive classes due to sodium/water retention and reduced
prostaglandin-mediated vasodilation [CORRECT]
D. Calcium channel blockers only
Rationale: NSAIDs reduce prostaglandin synthesis, which promotes vasodilation and
natriuresis, and cause sodium/water retention, thereby antagonizing the effectiveness
of all antihypertensive classes, particularly ACE inhibitors, ARBs, and diuretics. Clients
on antihypertensives should be counseled to avoid or limit NSAID use.
Correct Answer: C
Verified Answers Validation | Complete Q&A | Pass
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Section 1: Cardiovascular Disorders (Questions 1-16)
Question 1
A client with newly diagnosed heart failure is prescribed lisinopril, metoprolol, and
furosemide. The nurse reviews the morning laboratory results and notes a potassium
level of 3.1 mEq/L. Which action should the nurse take first?
A. Administer the scheduled furosemide and encourage potassium-rich foods
B. Hold the metoprolol and notify the provider of the hypokalemia
C. Hold the furosemide and notify the provider of the hypokalemia [CORRECT]
D. Administer all scheduled medications and recheck potassium in 4 hours
Rationale: Furosemide is a loop diuretic that causes potassium wasting; administering it
with a potassium of 3.1 mEq/L (below normal 3.5-5.0) could worsen hypokalemia and
precipitate life-threatening arrhythmias. The nurse must hold the furosemide and notify
the provider. Metoprolol does not significantly affect potassium; delaying notification is
unsafe.
Correct Answer: C
Question 2
A client receiving intravenous heparin has the following partial thromboplastin time
(PTT) results: 0900 PTT 28 seconds; 1200 PTT 32 seconds; 1500 PTT 82 seconds. The
therapeutic range is 60-80 seconds. Based on these results, which action should the
nurse take?
,A. Continue the current heparin infusion rate
B. Increase the heparin infusion rate by 2 units/kg/hr
C. Decrease the heparin infusion rate per protocol and notify the provider [CORRECT]
D. Stop the heparin infusion immediately and administer protamine sulfate
Rationale: The 1500 PTT of 82 seconds is supratherapeutic (>80 seconds), increasing
bleeding risk. The nurse should decrease the infusion per protocol and notify the
provider. Protamine sulfate is reserved for severe bleeding or heparin overdose, not mild
supratherapeutic values. Continuing or increasing the rate would further elevate
bleeding risk.
Correct Answer: C
Question 3
A client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the
INR and notes it is 4.2. The client denies bleeding. Which action should the nurse take?
A. Administer vitamin K 10 mg subcutaneously immediately
B. Hold the warfarin dose and notify the provider [CORRECT]
C. Administer the warfarin and recheck the INR in 1 week
D. Administer fresh frozen plasma prophylactically
Rationale: An INR of 4.2 is supratherapeutic (goal 2.0-3.0 for most indications),
increasing bleeding risk. The nurse should hold the dose and notify the provider for
dose adjustment. Vitamin K is reserved for INR >10 or active bleeding; FFP is for
life-threatening hemorrhage. Administering the dose would worsen the coagulopathy.
Correct Answer: B
Question 4
A client with chronic heart failure has a 3-pound weight gain in 24 hours, increased
dyspnea on exertion, and 1+ pitting edema in the lower extremities. Which assessment
finding requires the most immediate intervention?
,A. 1+ pitting edema in the lower extremities
B. 3-pound weight gain in 24 hours
C. Increased dyspnea on exertion
D. Jugular venous distension at 45 degrees [CORRECT]
Rationale: Jugular venous distension (JVD) at 45 degrees indicates elevated central
venous pressure and volume overload, reflecting right-sided heart failure
decompensation that requires immediate intervention to prevent pulmonary edema and
cardiogenic shock. While weight gain and edema are concerning, JVD is a more direct
indicator of hemodynamic compromise and fluid overload severity.
Correct Answer: D
Question 5
A client is 2 hours post-cardiac catheterization via the right femoral artery. The nurse
observes the client is restless, the right pedal pulse is absent, and the extremity is cool,
pale, and painful. Which complication should the nurse suspect?
A. Cardiac tamponade
B. Femoral artery thrombosis/embolism [CORRECT]
C. Hypovolemic shock from groin hematoma
D. Local anesthetic systemic toxicity
Rationale: Absence of pedal pulse, coolness, pallor, and pain in the affected extremity
post-catheterization indicates acute arterial occlusion from thrombosis or embolism at
the access site, requiring immediate vascular intervention. Cardiac tamponade presents
with hypotension, JVD, and muffled heart sounds; hypovolemic shock would show
systemic hypotension; LAST causes neurologic and cardiovascular symptoms.
Correct Answer: B
Question 6
, A client with heart failure is receiving dobutamine. Which parameter should the nurse
monitor most frequently to detect the earliest sign of medication toxicity?
A. Blood glucose every 4 hours
B. Heart rate and rhythm continuously [CORRECT]
C. Liver function tests daily
D. Serum potassium every 2 hours
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and
heart rate; excessive dosing can precipitate tachycardia, ventricular arrhythmias, and
myocardial ischemia. Continuous cardiac monitoring is essential. While electrolytes and
glucose matter, heart rate/rhythm changes are the earliest and most dangerous signs of
dobutamine toxicity.
Correct Answer: B
Question 7
A client with hypertension reports taking over-the-counter ibuprofen 400 mg three times
daily for arthritis pain. The nurse should explain that NSAIDs may interfere with which
antihypertensive medication class?
A. Angiotensin-converting enzyme inhibitors
B. Thiazide diuretics
C. All antihypertensive classes due to sodium/water retention and reduced
prostaglandin-mediated vasodilation [CORRECT]
D. Calcium channel blockers only
Rationale: NSAIDs reduce prostaglandin synthesis, which promotes vasodilation and
natriuresis, and cause sodium/water retention, thereby antagonizing the effectiveness
of all antihypertensive classes, particularly ACE inhibitors, ARBs, and diuretics. Clients
on antihypertensives should be counseled to avoid or limit NSAID use.
Correct Answer: C
