,NSG 223 HESI Exam Medical-Surgical Nursing II Questions And
Answers 2026/2027 Herzing University
Q1. A client with atrial fibrillation has a ventricular rate of 146/min, blood
pressure of 78/44 mm Hg, and chest discomfort. Which intervention should
the nurse anticipate?
A) Oral warfarin
B) Synchronized cardioversion
C) Routine observation
D) Oral potassium replacement
Correct Answer: B) Synchronized cardioversion
Rationale: Atrial fibrillation with hemodynamic instability requires urgent
rhythm restoration, commonly with synchronized cardioversion.
Q2. Which ECG finding is characteristic of atrial fibrillation?
A) Regular rhythm with identical P waves
B) Irregularly irregular rhythm with no consistent P waves
C) Wide QRS complexes occurring regularly
D) Sawtooth waves with a regular ventricular rhythm
Correct Answer: B) Irregularly irregular rhythm with no consistent P waves
Rationale: Atrial fibrillation produces chaotic atrial electrical activity and an
irregularly irregular ventricular response.
Q3. Why is anticoagulation commonly prescribed for a client with atrial
fibrillation?
A) To reduce ventricular contractility
B) To prevent thromboembolic stroke
C) To increase cardiac output immediately
D) To correct the QT interval
Correct Answer: B) To prevent thromboembolic stroke
Rationale: Ineffective atrial contraction can promote blood stasis and
thrombus formation, increasing embolic stroke risk.
Q4. Which laboratory value is used to monitor warfarin therapy?
A) aPTT
B) INR
C) Troponin
D) BNP
Correct Answer: B) INR
Rationale: INR measures the anticoagulant effect of warfarin.
, Q5. A client taking warfarin has an INR of 5.8 and reports nosebleeds. Which
action is the priority?
A) Encourage increased activity
B) Notify the provider and assess for bleeding
C) Administer the next dose immediately
D) Encourage foods high in sodium
Correct Answer: B) Notify the provider and assess for bleeding
Rationale: A markedly elevated INR with active bleeding indicates excessive
anticoagulation and increased hemorrhage risk.
Q6. Which rhythm is described as a sawtooth atrial pattern?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular fibrillation
D) Sinus bradycardia
Correct Answer: A) Atrial flutter
Rationale: Atrial flutter commonly produces organized rapid atrial activity
that appears as sawtooth flutter waves.
Q7. A client with atrial flutter is stable. Which treatment may be used to
control the ventricular rate?
A) Diltiazem
B) Alteplase
C) Mannitol
D) Lactulose
Correct Answer: A) Diltiazem
Rationale: Diltiazem slows AV-node conduction and can reduce the
ventricular response in atrial flutter.
Q8. Which assessment finding indicates that a client with dysrhythmia is
becoming unstable?
A) Blood pressure 128/76 mm Hg
B) Mild fatigue
C) New hypotension with chest pain
D) Heart rate 82/min
Correct Answer: C) New hypotension with chest pain
Rationale: Hypotension and ischemic chest discomfort suggest impaired
cardiac output and hemodynamic instability.
Q9. Which type of angina is typically relieved by rest?
A) Stable angina
B) Variant angina
Answers 2026/2027 Herzing University
Q1. A client with atrial fibrillation has a ventricular rate of 146/min, blood
pressure of 78/44 mm Hg, and chest discomfort. Which intervention should
the nurse anticipate?
A) Oral warfarin
B) Synchronized cardioversion
C) Routine observation
D) Oral potassium replacement
Correct Answer: B) Synchronized cardioversion
Rationale: Atrial fibrillation with hemodynamic instability requires urgent
rhythm restoration, commonly with synchronized cardioversion.
Q2. Which ECG finding is characteristic of atrial fibrillation?
A) Regular rhythm with identical P waves
B) Irregularly irregular rhythm with no consistent P waves
C) Wide QRS complexes occurring regularly
D) Sawtooth waves with a regular ventricular rhythm
Correct Answer: B) Irregularly irregular rhythm with no consistent P waves
Rationale: Atrial fibrillation produces chaotic atrial electrical activity and an
irregularly irregular ventricular response.
Q3. Why is anticoagulation commonly prescribed for a client with atrial
fibrillation?
A) To reduce ventricular contractility
B) To prevent thromboembolic stroke
C) To increase cardiac output immediately
D) To correct the QT interval
Correct Answer: B) To prevent thromboembolic stroke
Rationale: Ineffective atrial contraction can promote blood stasis and
thrombus formation, increasing embolic stroke risk.
Q4. Which laboratory value is used to monitor warfarin therapy?
A) aPTT
B) INR
C) Troponin
D) BNP
Correct Answer: B) INR
Rationale: INR measures the anticoagulant effect of warfarin.
, Q5. A client taking warfarin has an INR of 5.8 and reports nosebleeds. Which
action is the priority?
A) Encourage increased activity
B) Notify the provider and assess for bleeding
C) Administer the next dose immediately
D) Encourage foods high in sodium
Correct Answer: B) Notify the provider and assess for bleeding
Rationale: A markedly elevated INR with active bleeding indicates excessive
anticoagulation and increased hemorrhage risk.
Q6. Which rhythm is described as a sawtooth atrial pattern?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular fibrillation
D) Sinus bradycardia
Correct Answer: A) Atrial flutter
Rationale: Atrial flutter commonly produces organized rapid atrial activity
that appears as sawtooth flutter waves.
Q7. A client with atrial flutter is stable. Which treatment may be used to
control the ventricular rate?
A) Diltiazem
B) Alteplase
C) Mannitol
D) Lactulose
Correct Answer: A) Diltiazem
Rationale: Diltiazem slows AV-node conduction and can reduce the
ventricular response in atrial flutter.
Q8. Which assessment finding indicates that a client with dysrhythmia is
becoming unstable?
A) Blood pressure 128/76 mm Hg
B) Mild fatigue
C) New hypotension with chest pain
D) Heart rate 82/min
Correct Answer: C) New hypotension with chest pain
Rationale: Hypotension and ischemic chest discomfort suggest impaired
cardiac output and hemodynamic instability.
Q9. Which type of angina is typically relieved by rest?
A) Stable angina
B) Variant angina
