NSG 233 Medical-Surgical Nursing II HESI Actual Exam
2026/2027 Academic Year – 100+ Questions with
ANSWERs & Rationales
SECTION A: CARDIOVASCULAR DISORDERS (Questions 1-20)
1. A nurse is caring for a client with acute decompensated heart failure who has received IV furosemide
(Lasix). Which assessment finding indicates the medication is having the desired therapeutic effect?
A. Increased blood pressure from 110/70 to 140/90 mmHg
B. Urine output of 150 mL over the past 4 hours
C. Weight decrease of 2 kg (4.4 lb) in 24 hours
D. Heart rate increase from 80 to 100 bpm
ANSWER: C. Weight decrease of 2 kg (4.4 lb) in 24 hours
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart failure. The
desired effect is diuresis, evidenced by weight loss (1 kg = approximately 1 L of fluid). A weight loss of 2
kg in 24 hours indicates effective fluid removal. Urine output of 150 mL over 4 hours is only 37.5 mL/hr,
which is inadequate and suggests possible renal impairment. Blood pressure should decrease, not
increase, with fluid removal, and tachycardia can indicate compensatory mechanisms or medication side
effects .
2. The nurse is caring for a client with hypertension who is prescribed labetalol. Which finding would
indicate the need to hold the medication and notify the healthcare provider?
,A. Blood pressure 145/90 mmHg
B. Heart rate 52 bpm
C. Respiratory rate 18 breaths/min
D. Serum glucose 110 mg/dL
ANSWER: B. Heart rate 52 bpm
Rationale: Labetalol is a beta-blocker that decreases heart rate and blood pressure. The medication
should be held if the heart rate is below 60 bpm in adults, and the healthcare provider should be
notified. A heart rate of 52 bpm indicates bradycardia, which can lead to decreased cardiac output and
hypotension. The blood pressure of 145/90 is elevated and would indicate the medication is needed,
while the other vital signs and glucose are within normal limits .
3. A client is admitted with hypertensive emergency. The nurse understands that the priority goal for
blood pressure reduction is:
A. Reduce BP to normal within 30 minutes
B. Reduce mean arterial pressure by 20-25% in the first hour
C. Reduce systolic BP to 120 mmHg immediately
D. Maintain BP at current level until diagnostics are complete
ANSWER: B. Reduce mean arterial pressure by 20-25% in the first hour
,Rationale: In hypertensive emergency, blood pressure should be reduced in a controlled manner. The
recommended approach is to reduce mean arterial pressure (MAP) by 20-25% within the first hour, then
gradually to 160/100-110 over the next 6 hours. Rapid reduction can cause cerebral ischemia and end-
organ hypoperfusion. The goal is to balance organ protection with avoiding complications from overly
rapid reduction .
4. A client with acute myocardial infarction develops cardiogenic shock. Which assessment finding is
most concerning and requires immediate intervention?
A. Heart rate 110 bpm
B. Cool, clammy extremities
C. Urine output of 20 mL/hr
D. Systolic blood pressure 80 mmHg with altered mental status
ANSWER: D. Systolic blood pressure 80 mmHg with altered mental status
Rationale: Cardiogenic shock is characterized by hypotension, tachycardia, cool clammy extremities, and
oliguria. The most concerning finding is a systolic BP of 80 mmHg with altered mental status, which
indicates cerebral hypoperfusion and impending organ failure. This requires immediate intervention
with vasopressors, inotropes, and possibly mechanical circulatory support. While all findings are
concerning, altered mental status indicates significant cerebral hypoperfusion requiring urgent action .
5. The nurse is assessing a client for complications following an ST-elevation myocardial infarction
(STEMI). Which clinical manifestation suggests the development of pericarditis (Dressler's syndrome)?
A. Sudden onset of severe dyspnea and pink frothy sputum
B. Pleuritic chest pain, fever, and pericardial friction rub
, C. Hypotension, jugular venous distention, and muffled heart sounds
D. New holosystolic murmur at the apex
ANSWER: B. Pleuritic chest pain, fever, and pericardial friction rub
Rationale: Dressler's syndrome is a post-MI or post-cardiac injury pericarditis that can develop weeks to
months after the initial event. Classic manifestations include fever, pleuritic chest pain that worsens
with inspiration and lying flat, and a pericardial friction rub. Option A describes acute pulmonary edema;
Option C describes cardiac tamponade; Option D suggests papillary muscle rupture causing mitral
regurgitation .
6. A client with heart failure is prescribed carvedilol. Which statement by the client indicates
understanding of this medication?
A. "I should take this medication when my blood pressure is high."
B. "I will monitor my weight daily and report any sudden gain."
C. "This medication will make my heart beat faster."
D. "I can stop taking this if I feel dizzy."
ANSWER: B. "I will monitor my weight daily and report any sudden gain."
Rationale: Carvedilol is a beta-blocker used in heart failure that decreases heart rate and myocardial
oxygen demand. Clients should monitor daily weights to detect fluid retention (indicated by weight gain
of 2-3 lbs in 1-2 days) and report changes. Beta-blockers should not be stopped abruptly (can cause
rebound tachycardia/hypertension), do not make the heart beat faster (they slow it), and should be
taken consistently regardless of blood pressure .
2026/2027 Academic Year – 100+ Questions with
ANSWERs & Rationales
SECTION A: CARDIOVASCULAR DISORDERS (Questions 1-20)
1. A nurse is caring for a client with acute decompensated heart failure who has received IV furosemide
(Lasix). Which assessment finding indicates the medication is having the desired therapeutic effect?
A. Increased blood pressure from 110/70 to 140/90 mmHg
B. Urine output of 150 mL over the past 4 hours
C. Weight decrease of 2 kg (4.4 lb) in 24 hours
D. Heart rate increase from 80 to 100 bpm
ANSWER: C. Weight decrease of 2 kg (4.4 lb) in 24 hours
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart failure. The
desired effect is diuresis, evidenced by weight loss (1 kg = approximately 1 L of fluid). A weight loss of 2
kg in 24 hours indicates effective fluid removal. Urine output of 150 mL over 4 hours is only 37.5 mL/hr,
which is inadequate and suggests possible renal impairment. Blood pressure should decrease, not
increase, with fluid removal, and tachycardia can indicate compensatory mechanisms or medication side
effects .
2. The nurse is caring for a client with hypertension who is prescribed labetalol. Which finding would
indicate the need to hold the medication and notify the healthcare provider?
,A. Blood pressure 145/90 mmHg
B. Heart rate 52 bpm
C. Respiratory rate 18 breaths/min
D. Serum glucose 110 mg/dL
ANSWER: B. Heart rate 52 bpm
Rationale: Labetalol is a beta-blocker that decreases heart rate and blood pressure. The medication
should be held if the heart rate is below 60 bpm in adults, and the healthcare provider should be
notified. A heart rate of 52 bpm indicates bradycardia, which can lead to decreased cardiac output and
hypotension. The blood pressure of 145/90 is elevated and would indicate the medication is needed,
while the other vital signs and glucose are within normal limits .
3. A client is admitted with hypertensive emergency. The nurse understands that the priority goal for
blood pressure reduction is:
A. Reduce BP to normal within 30 minutes
B. Reduce mean arterial pressure by 20-25% in the first hour
C. Reduce systolic BP to 120 mmHg immediately
D. Maintain BP at current level until diagnostics are complete
ANSWER: B. Reduce mean arterial pressure by 20-25% in the first hour
,Rationale: In hypertensive emergency, blood pressure should be reduced in a controlled manner. The
recommended approach is to reduce mean arterial pressure (MAP) by 20-25% within the first hour, then
gradually to 160/100-110 over the next 6 hours. Rapid reduction can cause cerebral ischemia and end-
organ hypoperfusion. The goal is to balance organ protection with avoiding complications from overly
rapid reduction .
4. A client with acute myocardial infarction develops cardiogenic shock. Which assessment finding is
most concerning and requires immediate intervention?
A. Heart rate 110 bpm
B. Cool, clammy extremities
C. Urine output of 20 mL/hr
D. Systolic blood pressure 80 mmHg with altered mental status
ANSWER: D. Systolic blood pressure 80 mmHg with altered mental status
Rationale: Cardiogenic shock is characterized by hypotension, tachycardia, cool clammy extremities, and
oliguria. The most concerning finding is a systolic BP of 80 mmHg with altered mental status, which
indicates cerebral hypoperfusion and impending organ failure. This requires immediate intervention
with vasopressors, inotropes, and possibly mechanical circulatory support. While all findings are
concerning, altered mental status indicates significant cerebral hypoperfusion requiring urgent action .
5. The nurse is assessing a client for complications following an ST-elevation myocardial infarction
(STEMI). Which clinical manifestation suggests the development of pericarditis (Dressler's syndrome)?
A. Sudden onset of severe dyspnea and pink frothy sputum
B. Pleuritic chest pain, fever, and pericardial friction rub
, C. Hypotension, jugular venous distention, and muffled heart sounds
D. New holosystolic murmur at the apex
ANSWER: B. Pleuritic chest pain, fever, and pericardial friction rub
Rationale: Dressler's syndrome is a post-MI or post-cardiac injury pericarditis that can develop weeks to
months after the initial event. Classic manifestations include fever, pleuritic chest pain that worsens
with inspiration and lying flat, and a pericardial friction rub. Option A describes acute pulmonary edema;
Option C describes cardiac tamponade; Option D suggests papillary muscle rupture causing mitral
regurgitation .
6. A client with heart failure is prescribed carvedilol. Which statement by the client indicates
understanding of this medication?
A. "I should take this medication when my blood pressure is high."
B. "I will monitor my weight daily and report any sudden gain."
C. "This medication will make my heart beat faster."
D. "I can stop taking this if I feel dizzy."
ANSWER: B. "I will monitor my weight daily and report any sudden gain."
Rationale: Carvedilol is a beta-blocker used in heart failure that decreases heart rate and myocardial
oxygen demand. Clients should monitor daily weights to detect fluid retention (indicated by weight gain
of 2-3 lbs in 1-2 days) and report changes. Beta-blockers should not be stopped abruptly (can cause
rebound tachycardia/hypertension), do not make the heart beat faster (they slow it), and should be
taken consistently regardless of blood pressure .
