NSG 233 HESI Final Exam 2026/2027 LATEST –
Galen College Med-Surg II | 200 Q&A +
Rationales
Section 1: Cardiovascular Disorders (Questions 1–25)
1. A nurse is assessing a client with heart failure who is receiving a continuous IV
infusion of dobutamine. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A) Decreased blood pressure
B) Increased heart rate
C) Increased cardiac output
D) Decreased urine output
Correct Answer: C
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases the force of myocardial
contraction (positive inotrope), leading to increased stroke volume and cardiac output. This
improves perfusion to vital organs. Decreased blood pressure, increased heart rate, and
decreased urine output are not desired therapeutic effects.
,2. The nurse is caring for a client diagnosed with a pulmonary embolism. Which
arterial blood gas (ABG) value would the nurse most expect to find?
A) pH 7.50, PaCO2 30, HCO3 24
B) pH 7.30, PaCO2 50, HCO3 26
C) pH 7.48, PaCO2 45, HCO3 32
D) pH 7.32, PaCO2 38, HCO3 19
Correct Answer: A
Rationale: A pulmonary embolism causes a ventilation-perfusion (V/Q) mismatch, leading to
respiratory alkalosis initially due to hyperventilation (blowing off CO2). ABG shows pH >
7.45, PaCO2 < 35. Respiratory acidosis (B) is seen in COPD exacerbation, metabolic
alkalosis (C) is not typical of acute PE, and metabolic acidosis (D) does not reflect the initial
compensatory response to PE.
3. A client with a history of heart failure presents with shortness of breath and an
irregularly irregular heart rate of 132 bpm. The nurse reviews the cardiac monitor.
Which medication should the nurse anticipate administering first?
A) Metoprolol
B) Digoxin
C) Amiodarone
D) Adenosine
Correct Answer: C
Rationale: The EKG shows rapid atrial fibrillation (irregularly irregular rhythm, no P waves).
In a hemodynamically unstable patient with acute heart failure exacerbation, amiodarone is
preferred for rate control and possible cardioversion. It has less negative inotropy than beta-
,blockers and faster onset than digoxin. Adenosine is contraindicated—it's for narrow-
complex supraventricular tachycardias with regular rhythm.
4. A nurse is caring for a patient 2 hours post-hip arthroplasty. The patient's blood
pressure is 98/52 mmHg, heart rate 118 bpm, respiratory rate 24/min, and oxygen
saturation 89% on room air. The patient reports sudden shortness of breath and
pleuritic chest pain. Which action should the nurse take first?
A) Notify the healthcare provider
B) Apply oxygen at 100% via non-rebreather mask
C) Elevate the head of the bed
D) Prepare for STAT chest x-ray
Correct Answer: B
Rationale: The presentation (sudden SOB, chest pain, tachypnea, hypoxemia, tachycardia,
hypotension in postoperative orthopedic patient) is classic for pulmonary embolism.
Following the ABC priority framework, airway and breathing take precedence. Immediate
high-flow oxygen improves oxygenation and reduces pulmonary vasoconstriction.
5. A patient with cirrhosis presents with abdominal distention, weight gain, and
difficulty breathing. The nurse should anticipate which intervention?
A) Administering a diuretic as prescribed
B) Restricting fluid intake
, C) Preparing for paracentesis
D) Placing the patient in Trendelenburg position
Correct Answer: C
Rationale: The patient is demonstrating signs of ascites (abdominal distention, weight gain,
difficulty breathing). Paracentesis is a therapeutic procedure used to remove excess fluid
from the abdominal cavity. While diuretics are part of management, paracentesis provides
immediate relief for respiratory compromise.
6. The nurse is reviewing laboratory results for a client receiving heparin therapy.
Which result requires immediate intervention?
A) aPTT of 45 seconds
B) aPTT of 60 seconds
C) aPTT of 90 seconds
D) aPTT of 120 seconds
Correct Answer: D
Rationale: Therapeutic aPTT for heparin therapy is typically 1.5-2.5 times the control value
(approximately 60-80 seconds). An aPTT of 120 seconds indicates excessive
anticoagulation and places the client at high risk for hemorrhage. The nurse should hold the
heparin and notify the provider immediately.
7. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should
the nurse monitor to evaluate therapeutic effectiveness?
Galen College Med-Surg II | 200 Q&A +
Rationales
Section 1: Cardiovascular Disorders (Questions 1–25)
1. A nurse is assessing a client with heart failure who is receiving a continuous IV
infusion of dobutamine. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A) Decreased blood pressure
B) Increased heart rate
C) Increased cardiac output
D) Decreased urine output
Correct Answer: C
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases the force of myocardial
contraction (positive inotrope), leading to increased stroke volume and cardiac output. This
improves perfusion to vital organs. Decreased blood pressure, increased heart rate, and
decreased urine output are not desired therapeutic effects.
,2. The nurse is caring for a client diagnosed with a pulmonary embolism. Which
arterial blood gas (ABG) value would the nurse most expect to find?
A) pH 7.50, PaCO2 30, HCO3 24
B) pH 7.30, PaCO2 50, HCO3 26
C) pH 7.48, PaCO2 45, HCO3 32
D) pH 7.32, PaCO2 38, HCO3 19
Correct Answer: A
Rationale: A pulmonary embolism causes a ventilation-perfusion (V/Q) mismatch, leading to
respiratory alkalosis initially due to hyperventilation (blowing off CO2). ABG shows pH >
7.45, PaCO2 < 35. Respiratory acidosis (B) is seen in COPD exacerbation, metabolic
alkalosis (C) is not typical of acute PE, and metabolic acidosis (D) does not reflect the initial
compensatory response to PE.
3. A client with a history of heart failure presents with shortness of breath and an
irregularly irregular heart rate of 132 bpm. The nurse reviews the cardiac monitor.
Which medication should the nurse anticipate administering first?
A) Metoprolol
B) Digoxin
C) Amiodarone
D) Adenosine
Correct Answer: C
Rationale: The EKG shows rapid atrial fibrillation (irregularly irregular rhythm, no P waves).
In a hemodynamically unstable patient with acute heart failure exacerbation, amiodarone is
preferred for rate control and possible cardioversion. It has less negative inotropy than beta-
,blockers and faster onset than digoxin. Adenosine is contraindicated—it's for narrow-
complex supraventricular tachycardias with regular rhythm.
4. A nurse is caring for a patient 2 hours post-hip arthroplasty. The patient's blood
pressure is 98/52 mmHg, heart rate 118 bpm, respiratory rate 24/min, and oxygen
saturation 89% on room air. The patient reports sudden shortness of breath and
pleuritic chest pain. Which action should the nurse take first?
A) Notify the healthcare provider
B) Apply oxygen at 100% via non-rebreather mask
C) Elevate the head of the bed
D) Prepare for STAT chest x-ray
Correct Answer: B
Rationale: The presentation (sudden SOB, chest pain, tachypnea, hypoxemia, tachycardia,
hypotension in postoperative orthopedic patient) is classic for pulmonary embolism.
Following the ABC priority framework, airway and breathing take precedence. Immediate
high-flow oxygen improves oxygenation and reduces pulmonary vasoconstriction.
5. A patient with cirrhosis presents with abdominal distention, weight gain, and
difficulty breathing. The nurse should anticipate which intervention?
A) Administering a diuretic as prescribed
B) Restricting fluid intake
, C) Preparing for paracentesis
D) Placing the patient in Trendelenburg position
Correct Answer: C
Rationale: The patient is demonstrating signs of ascites (abdominal distention, weight gain,
difficulty breathing). Paracentesis is a therapeutic procedure used to remove excess fluid
from the abdominal cavity. While diuretics are part of management, paracentesis provides
immediate relief for respiratory compromise.
6. The nurse is reviewing laboratory results for a client receiving heparin therapy.
Which result requires immediate intervention?
A) aPTT of 45 seconds
B) aPTT of 60 seconds
C) aPTT of 90 seconds
D) aPTT of 120 seconds
Correct Answer: D
Rationale: Therapeutic aPTT for heparin therapy is typically 1.5-2.5 times the control value
(approximately 60-80 seconds). An aPTT of 120 seconds indicates excessive
anticoagulation and places the client at high risk for hemorrhage. The nurse should hold the
heparin and notify the provider immediately.
7. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should
the nurse monitor to evaluate therapeutic effectiveness?
