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NSG 222 HESI-Style – Complete Practice Test (2026) Questions and Answers
with detailed Rationales | Updates | 100% Correct
Domain 1: Cardiovascular Emergencies (MI, Heart Failure, Shock, Arrhythmias)
1. A 62-year-old male with a history of hypertension and diabetes presents to
the ED with acute onset of severe, crushing substernal chest pain radiating to his
left arm. He is diaphoretic and nauseous. He took 2 aspirins at home. His blood
pressure is 150/90 mmHg, heart rate is 115 bpm. ECG shows ST-segment
elevation in leads V1-V4. The nearest cardiac catheterization lab is 2.5 hours
away by ambulance. What is the most appropriate immediate management?
A) Administer sublingual nitroglycerin, start a heparin drip, and prepare for
thrombolytic therapy (fibrinolysis) while arranging transfer.
B) Wait for transfer to the catheterization lab without any other interventions.
C) Administer oral beta-blockers and schedule an outpatient stress test.
D) Administer a calcium channel blocker and monitor.
Answer: A
Rationale: The patient is having an acute STEMI. The goal is reperfusion within 90
minutes of first medical contact. Since PCI is not available within 90 minutes, the
next best option is fibrinolysis (thrombolytic therapy) if the patient has no
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contraindications. Nitroglycerin and heparin are also immediate standard
therapies.
2. A 72-year-old female with a history of heart failure with reduced ejection
fraction (HFrEF) presents with progressive dyspnea, orthopnea, and 3+ pitting
edema in the lower extremities. She has crackles in the lung bases. She is
currently on lisinopril, carvedilol, and furosemide. Her blood pressure is 90/60
mmHg and heart rate is 105 bpm. What is the most appropriate next step in
management?
A) Discontinue carvedilol and temporarily increase the furosemide dose.
B) Increase the lisinopril dose.
C) Administer an IV inotropic agent (e.g., dobutamine) and initiate non-invasive
positive pressure ventilation (NIPPV).
D) Administer oral digoxin immediately.
Answer: C
Rationale: The patient is in acute decompensated heart failure with cardiogenic
shock (hypotension, tachycardia, and signs of fluid overload). Inotropic support
(dobutamine) and NIPPV (BiPAP) are indicated for stabilization. Beta-blockers
should be held until the patient is hemodynamically stable.
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3. The nurse is caring for a patient who is receiving IV heparin for a DVT. The
patient's aPTT is 120 seconds. What is the priority nursing action?
A) Continue the heparin infusion as prescribed.
B) Stop the heparin infusion and notify the provider immediately (the aPTT is
dangerously elevated, indicating a high risk of bleeding).
C) Increase the heparin infusion rate.
D) Administer protamine sulfate immediately without notifying the provider.
Answer: B
Rationale: The therapeutic aPTT for heparin is typically 1.5-2.5 times the control
(usually 60-80 seconds). An aPTT of 120 seconds is dangerously elevated. The
nurse must stop the infusion and notify the provider.
4. A 60-year-old male with a history of atrial fibrillation presents with a 1-day
history of sudden onset of severe, tearing chest pain radiating to his back. His
blood pressure is 210/110 mmHg. What is the most likely diagnosis, and what is
the immediate action?
A) Aortic dissection; immediately reduce blood pressure with IV labetalol and
order a CT angiogram.
B) Acute MI; proceed to cardiac catheterization.
NSG 222 HESI-Style – Complete Practice Test (2026) Questions and Answers
with detailed Rationales | Updates | 100% Correct
Domain 1: Cardiovascular Emergencies (MI, Heart Failure, Shock, Arrhythmias)
1. A 62-year-old male with a history of hypertension and diabetes presents to
the ED with acute onset of severe, crushing substernal chest pain radiating to his
left arm. He is diaphoretic and nauseous. He took 2 aspirins at home. His blood
pressure is 150/90 mmHg, heart rate is 115 bpm. ECG shows ST-segment
elevation in leads V1-V4. The nearest cardiac catheterization lab is 2.5 hours
away by ambulance. What is the most appropriate immediate management?
A) Administer sublingual nitroglycerin, start a heparin drip, and prepare for
thrombolytic therapy (fibrinolysis) while arranging transfer.
B) Wait for transfer to the catheterization lab without any other interventions.
C) Administer oral beta-blockers and schedule an outpatient stress test.
D) Administer a calcium channel blocker and monitor.
Answer: A
Rationale: The patient is having an acute STEMI. The goal is reperfusion within 90
minutes of first medical contact. Since PCI is not available within 90 minutes, the
next best option is fibrinolysis (thrombolytic therapy) if the patient has no
, Page |2
contraindications. Nitroglycerin and heparin are also immediate standard
therapies.
2. A 72-year-old female with a history of heart failure with reduced ejection
fraction (HFrEF) presents with progressive dyspnea, orthopnea, and 3+ pitting
edema in the lower extremities. She has crackles in the lung bases. She is
currently on lisinopril, carvedilol, and furosemide. Her blood pressure is 90/60
mmHg and heart rate is 105 bpm. What is the most appropriate next step in
management?
A) Discontinue carvedilol and temporarily increase the furosemide dose.
B) Increase the lisinopril dose.
C) Administer an IV inotropic agent (e.g., dobutamine) and initiate non-invasive
positive pressure ventilation (NIPPV).
D) Administer oral digoxin immediately.
Answer: C
Rationale: The patient is in acute decompensated heart failure with cardiogenic
shock (hypotension, tachycardia, and signs of fluid overload). Inotropic support
(dobutamine) and NIPPV (BiPAP) are indicated for stabilization. Beta-blockers
should be held until the patient is hemodynamically stable.
, Page |3
3. The nurse is caring for a patient who is receiving IV heparin for a DVT. The
patient's aPTT is 120 seconds. What is the priority nursing action?
A) Continue the heparin infusion as prescribed.
B) Stop the heparin infusion and notify the provider immediately (the aPTT is
dangerously elevated, indicating a high risk of bleeding).
C) Increase the heparin infusion rate.
D) Administer protamine sulfate immediately without notifying the provider.
Answer: B
Rationale: The therapeutic aPTT for heparin is typically 1.5-2.5 times the control
(usually 60-80 seconds). An aPTT of 120 seconds is dangerously elevated. The
nurse must stop the infusion and notify the provider.
4. A 60-year-old male with a history of atrial fibrillation presents with a 1-day
history of sudden onset of severe, tearing chest pain radiating to his back. His
blood pressure is 210/110 mmHg. What is the most likely diagnosis, and what is
the immediate action?
A) Aortic dissection; immediately reduce blood pressure with IV labetalol and
order a CT angiogram.
B) Acute MI; proceed to cardiac catheterization.
