HESI MED-SURG III FINAL EXAM 2026/2027 | Proctored
Mastery Assessment | Verified Q&A for Advanced Care | Pass
Guaranteed - A+ Graded
Section 1: Advanced Cardiovascular & Hemodynamic Mastery (Q1-20)
Q1. A client in cardiogenic shock has a pulmonary artery catheter inserted. The
waveform shows a systolic pressure of 28 mmHg, diastolic pressure of 12 mmHg, and
mean pressure of 18 mmHg with characteristic tall v waves. The balloon is inflated and
the waveform changes to a mean pressure of 22 mmHg with a, c, and v waves. These
measurements represent:
A. Pulmonary artery diastolic pressure and pulmonary artery occlusion pressure
B. Central venous pressure and right ventricular pressure
C. Pulmonary artery systolic pressure and left ventricular end-diastolic pressure
D. Systemic arterial pressure and pulmonary capillary wedge pressure
A. Pulmonary artery diastolic pressure and pulmonary artery occlusion pressure
[CORRECT]
Rationale: The tall v waves and systolic/diastolic values describe the pulmonary artery
pressure waveform; when the balloon is inflated, it occludes flow and measures
pulmonary artery occlusion pressure (PAOP), which reflects left atrial pressure and
approximates LVEDP. Central venous pressure (B) is measured in the right atrium, and
systemic arterial pressure (D) is measured in the aorta.
Correct Answer: A
Q2. A client with septic shock has a cardiac output of 8.5 L/min and a systemic vascular
resistance of 400 dynes·sec/cm⁵. A client with cardiogenic shock has a cardiac output
,of 4.2 L/min and an SVR of 1,800 dynes·sec/cm⁵. These hemodynamic profiles
demonstrate that:
A. Both shock states produce identical hemodynamic patterns
B. Septic shock is characterized by high cardiac output and low afterload, while
cardiogenic shock is characterized by low cardiac output and high afterload
C. Septic shock always presents with low cardiac output and high SVR
D. Cardiogenic shock is best treated with pure vasoconstrictors to further increase SVR
B. Septic shock is characterized by high cardiac output and low afterload, while
cardiogenic shock is characterized by low cardiac output and high afterload [CORRECT]
Rationale: Septic shock (distributive) typically presents with high or normal cardiac
output and profoundly decreased SVR due to vasodilation; cardiogenic shock presents
with low cardiac output and elevated SVR from compensatory vasoconstriction.
Increasing SVR further in cardiogenic shock (D) worsens myocardial workload and
oxygen demand.
Correct Answer: B
Q3. A mechanically ventilated client is receiving a fluid challenge. The pulse pressure
variation (PPV) is 18% before the challenge and decreases to 6% after 500 mL of
crystalloid. The nurse understands that:
A. The client is fluid responsive and stroke volume increased with the challenge
B. The client is fluid unresponsive and further fluids will cause pulmonary edema
C. PPV is not valid in mechanically ventilated patients
D. The client requires vasopressors rather than fluids
A. The client is fluid responsive and stroke volume increased with the challenge
[CORRECT]
,Rationale: PPV >13% in mechanically ventilated patients predicts fluid responsiveness; a
decrease in PPV after fluid administration indicates that stroke volume increased with
preload augmentation, confirming responsiveness. PPV is specifically validated in
ventilated patients with regular rhythms and no spontaneous breathing.
Correct Answer: A
Q4. A client with an acute myocardial infarction develops hypotension, cool clammy
skin, and oliguria. The pulmonary artery catheter reveals a cardiac index of 1.8
L/min/m², PAOP of 24 mmHg, and SVR of 2,100 dynes·sec/cm⁵. The most appropriate
initial pharmacologic intervention is:
A. Norepinephrine infusion to increase afterload
B. Dobutamine infusion to increase contractility and cardiac output
C. Phenylephrine infusion to increase preload
D. Nitroprusside infusion to reduce afterload aggressively
B. Dobutamine infusion to increase contractility and cardiac output [CORRECT]
Rationale: This profile (low CI, high PAOP, high SVR) indicates cardiogenic shock with
pulmonary congestion; dobutamine (beta-1 inotrope) increases contractility and cardiac
output without further increasing afterload. Norepinephrine (A) and phenylephrine (C)
increase afterload and worsen myocardial oxygen demand, while nitroprusside (D) may
cause catastrophic hypotension without inotropic support.
Correct Answer: B
Q5. A client with a pulmonary artery catheter suddenly develops hemoptysis,
hypoxemia, and a new arrhythmia. The nurse suspects:
A. Catheter migration into the right ventricle
, B. Pulmonary artery rupture from balloon overinflation or distal migration
C. Normal catheter wedging in a small branch
D. Systemic air embolism from the introducer
B. Pulmonary artery rupture from balloon overinflation or distal migration [CORRECT]
Rationale: Pulmonary artery rupture is a catastrophic complication of PA
catheterization, presenting with hemoptysis, hypoxemia, and cardiovascular collapse; it
results from balloon overinflation in a distal, small-caliber vessel or from catheter
migration. Immediate deflation of the balloon, positioning with the affected side down,
and emergent intervention are required.
Correct Answer: B
Q6. The critical care team is managing a client in shock. The goal for mean arterial
pressure (MAP) in most shock states is:
A. ≥55 mmHg
B. ≥65 mmHg
C. ≥85 mmHg
D. ≥100 mmHg
B. ≥65 mmHg [CORRECT]
Rationale: A MAP ≥65 mmHg is the generally accepted target for adequate tissue
perfusion in septic and other shock states; this pressure ensures sufficient organ
perfusion without excessive afterload. Lower targets (A) risk hypoperfusion, while
higher targets (C, D) increase vasopressor requirements and myocardial workload
without proven benefit.
Correct Answer: B
Mastery Assessment | Verified Q&A for Advanced Care | Pass
Guaranteed - A+ Graded
Section 1: Advanced Cardiovascular & Hemodynamic Mastery (Q1-20)
Q1. A client in cardiogenic shock has a pulmonary artery catheter inserted. The
waveform shows a systolic pressure of 28 mmHg, diastolic pressure of 12 mmHg, and
mean pressure of 18 mmHg with characteristic tall v waves. The balloon is inflated and
the waveform changes to a mean pressure of 22 mmHg with a, c, and v waves. These
measurements represent:
A. Pulmonary artery diastolic pressure and pulmonary artery occlusion pressure
B. Central venous pressure and right ventricular pressure
C. Pulmonary artery systolic pressure and left ventricular end-diastolic pressure
D. Systemic arterial pressure and pulmonary capillary wedge pressure
A. Pulmonary artery diastolic pressure and pulmonary artery occlusion pressure
[CORRECT]
Rationale: The tall v waves and systolic/diastolic values describe the pulmonary artery
pressure waveform; when the balloon is inflated, it occludes flow and measures
pulmonary artery occlusion pressure (PAOP), which reflects left atrial pressure and
approximates LVEDP. Central venous pressure (B) is measured in the right atrium, and
systemic arterial pressure (D) is measured in the aorta.
Correct Answer: A
Q2. A client with septic shock has a cardiac output of 8.5 L/min and a systemic vascular
resistance of 400 dynes·sec/cm⁵. A client with cardiogenic shock has a cardiac output
,of 4.2 L/min and an SVR of 1,800 dynes·sec/cm⁵. These hemodynamic profiles
demonstrate that:
A. Both shock states produce identical hemodynamic patterns
B. Septic shock is characterized by high cardiac output and low afterload, while
cardiogenic shock is characterized by low cardiac output and high afterload
C. Septic shock always presents with low cardiac output and high SVR
D. Cardiogenic shock is best treated with pure vasoconstrictors to further increase SVR
B. Septic shock is characterized by high cardiac output and low afterload, while
cardiogenic shock is characterized by low cardiac output and high afterload [CORRECT]
Rationale: Septic shock (distributive) typically presents with high or normal cardiac
output and profoundly decreased SVR due to vasodilation; cardiogenic shock presents
with low cardiac output and elevated SVR from compensatory vasoconstriction.
Increasing SVR further in cardiogenic shock (D) worsens myocardial workload and
oxygen demand.
Correct Answer: B
Q3. A mechanically ventilated client is receiving a fluid challenge. The pulse pressure
variation (PPV) is 18% before the challenge and decreases to 6% after 500 mL of
crystalloid. The nurse understands that:
A. The client is fluid responsive and stroke volume increased with the challenge
B. The client is fluid unresponsive and further fluids will cause pulmonary edema
C. PPV is not valid in mechanically ventilated patients
D. The client requires vasopressors rather than fluids
A. The client is fluid responsive and stroke volume increased with the challenge
[CORRECT]
,Rationale: PPV >13% in mechanically ventilated patients predicts fluid responsiveness; a
decrease in PPV after fluid administration indicates that stroke volume increased with
preload augmentation, confirming responsiveness. PPV is specifically validated in
ventilated patients with regular rhythms and no spontaneous breathing.
Correct Answer: A
Q4. A client with an acute myocardial infarction develops hypotension, cool clammy
skin, and oliguria. The pulmonary artery catheter reveals a cardiac index of 1.8
L/min/m², PAOP of 24 mmHg, and SVR of 2,100 dynes·sec/cm⁵. The most appropriate
initial pharmacologic intervention is:
A. Norepinephrine infusion to increase afterload
B. Dobutamine infusion to increase contractility and cardiac output
C. Phenylephrine infusion to increase preload
D. Nitroprusside infusion to reduce afterload aggressively
B. Dobutamine infusion to increase contractility and cardiac output [CORRECT]
Rationale: This profile (low CI, high PAOP, high SVR) indicates cardiogenic shock with
pulmonary congestion; dobutamine (beta-1 inotrope) increases contractility and cardiac
output without further increasing afterload. Norepinephrine (A) and phenylephrine (C)
increase afterload and worsen myocardial oxygen demand, while nitroprusside (D) may
cause catastrophic hypotension without inotropic support.
Correct Answer: B
Q5. A client with a pulmonary artery catheter suddenly develops hemoptysis,
hypoxemia, and a new arrhythmia. The nurse suspects:
A. Catheter migration into the right ventricle
, B. Pulmonary artery rupture from balloon overinflation or distal migration
C. Normal catheter wedging in a small branch
D. Systemic air embolism from the introducer
B. Pulmonary artery rupture from balloon overinflation or distal migration [CORRECT]
Rationale: Pulmonary artery rupture is a catastrophic complication of PA
catheterization, presenting with hemoptysis, hypoxemia, and cardiovascular collapse; it
results from balloon overinflation in a distal, small-caliber vessel or from catheter
migration. Immediate deflation of the balloon, positioning with the affected side down,
and emergent intervention are required.
Correct Answer: B
Q6. The critical care team is managing a client in shock. The goal for mean arterial
pressure (MAP) in most shock states is:
A. ≥55 mmHg
B. ≥65 mmHg
C. ≥85 mmHg
D. ≥100 mmHg
B. ≥65 mmHg [CORRECT]
Rationale: A MAP ≥65 mmHg is the generally accepted target for adequate tissue
perfusion in septic and other shock states; this pressure ensures sufficient organ
perfusion without excessive afterload. Lower targets (A) risk hypoperfusion, while
higher targets (C, D) increase vasopressor requirements and myocardial workload
without proven benefit.
Correct Answer: B
