HESI MEDICAL-SURGICAL NURSING TEST BANK
2026/2027: COMPLETE WITH VERIFIED
ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 62-year-old male is admitted with crushing substernal chest pain radiating to the
left arm. Vital signs: BP 90/60 mmHg, HR 110 bpm, RR 24/min, SpO₂ 89% on room air.
The nurse obtains an ECG showing ST-segment elevation in leads II, III, and aVF. What
should the nurse do FIRST?
A. Administer morphine 4 mg IV
B. Apply high-flow oxygen via non-rebreather mask
C. Obtain a chest X-ray
D. Give sublingual nitroglycerin 0.4 mg
Correct Answer: B
Rationale: ST-elevation in inferior leads and SpO₂ 89% indicate acute inferior MI with
hypoxemia. Oxygen is the immediate priority per ACLS protocol to improve myocardial
oxygenation. Morphine is second-line for pain/anxiety after oxygen. Nitroglycerin is
contraindicated with systolic BP < 90 mmHg due to risk of worsening hypotension.
Chest X-ray is useful but not emergently diagnostic for MI.
Q2: A patient with chronic heart failure (EF 30%) reports increased fatigue and 3-lb
weight gain overnight. JVD is present at 45°, and there are bibasilar crackles. Which
assessment finding requires IMMEDIATE intervention?
A. Serum potassium 3.2 mEq/L
B. BNP 900 pg/mL
C. Oxygen saturation 86% on 2 L nasal cannula
D. Pedal edema 2+ bilaterally
,Correct Answer: C
Rationale: Hypoxemia (SpO₂ 86%) reflects acute pulmonary edema and is the most
immediate threat. High-flow oxygen or non-invasive ventilation is urgent. Hypokalemia
(A) increases arrhythmia risk but is not immediately life-threatening. BNP 900 pg/mL (B)
confirms decompensation but is not an action trigger. Edema (D) is expected and
managed with diuretics after oxygenation is optimized.
Q3: A patient with a newly implanted mechanical aortic valve is prescribed warfarin. The
INR is 1.8 (target 2.5–3.5). The nurse anticipates which prescription?
A. Hold next dose and restart at lower dose
B. Increase warfarin dose tonight
C. Administer vitamin K 5 mg IV
D. Switch to subcutaneous heparin
Correct Answer: B
Rationale: INR below target for mechanical aortic valve increases thrombo-embolic risk;
increasing warfarin dose is appropriate. Vitamin K (C) is used for supratherapeutic INR.
Holding dose (A) would further lower INR. Heparin (D) is bridge therapy but unnecessary
if INR can be raised quickly.
Q4: A 48-year-old female post–total hip replacement suddenly reports pleuritic chest
pain and dyspnea. Vital signs: HR 108, RR 26, BP 100/60, SpO₂ 90%. Which order should
the nurse implement FIRST?
A. Stat chest CT angiography
B. Start IV heparin bolus 80 units/kg
C. Obtain D-dimer level
D. Administer oxygen 100% NRB
Correct Answer: D
, Rationale: Hypoxemia and clinical picture suggest pulmonary embolism; oxygen is the
immediate priority while confirming diagnosis. CT angiography (A) is diagnostic gold
standard but requires stable oxygenation. Empiric heparin (B) is reasonable after
oxygen. D-dimer (C) is sensitive but not specific and delays definitive imaging.
Q5: A patient with anemia (Hb 7.8 g/dL) receives 1 unit PRBCs. Thirty minutes into the
transfusion, the patient reports chills and flank pain. Temperature is 38.9°C. The nurse’s
FIRST action is:
A. Stop the transfusion immediately
B. Give acetaminophen 650 mg PO
C. Culture the blood bag and tubing
D. Slow the infusion rate
Correct Answer: A
Rationale: Signs indicate acute hemolytic transfusion reaction; stopping the infusion
prevents further red-cell destruction and antigen exposure. Acetaminophen (B) treats
fever but does not address the cause. Cultures (C) are done later. Slowing rate (D)
continues antigen exposure and worsens reaction.
Q6: A patient in cardiogenic shock has a pulmonary artery catheter showing PAOP 24
mmHg, CI 1.8 L/min/m², SVR 1800 dynes·s/cm⁵. Which vasoactive medication is MOST
appropriate?
A. Dobutamine
B. Norepinephrine
C. Nitroprusside
D. Phenylephrine
Correct Answer: A
Rationale: Low CI, high PAOP, and elevated SVR indicate pump failure with
vasoconstriction; dobutamine provides inotropic support and mild afterload reduction.
Norepinephrine (B) and phenylephrine (D) increase afterload, worsening workload.
2026/2027: COMPLETE WITH VERIFIED
ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 62-year-old male is admitted with crushing substernal chest pain radiating to the
left arm. Vital signs: BP 90/60 mmHg, HR 110 bpm, RR 24/min, SpO₂ 89% on room air.
The nurse obtains an ECG showing ST-segment elevation in leads II, III, and aVF. What
should the nurse do FIRST?
A. Administer morphine 4 mg IV
B. Apply high-flow oxygen via non-rebreather mask
C. Obtain a chest X-ray
D. Give sublingual nitroglycerin 0.4 mg
Correct Answer: B
Rationale: ST-elevation in inferior leads and SpO₂ 89% indicate acute inferior MI with
hypoxemia. Oxygen is the immediate priority per ACLS protocol to improve myocardial
oxygenation. Morphine is second-line for pain/anxiety after oxygen. Nitroglycerin is
contraindicated with systolic BP < 90 mmHg due to risk of worsening hypotension.
Chest X-ray is useful but not emergently diagnostic for MI.
Q2: A patient with chronic heart failure (EF 30%) reports increased fatigue and 3-lb
weight gain overnight. JVD is present at 45°, and there are bibasilar crackles. Which
assessment finding requires IMMEDIATE intervention?
A. Serum potassium 3.2 mEq/L
B. BNP 900 pg/mL
C. Oxygen saturation 86% on 2 L nasal cannula
D. Pedal edema 2+ bilaterally
,Correct Answer: C
Rationale: Hypoxemia (SpO₂ 86%) reflects acute pulmonary edema and is the most
immediate threat. High-flow oxygen or non-invasive ventilation is urgent. Hypokalemia
(A) increases arrhythmia risk but is not immediately life-threatening. BNP 900 pg/mL (B)
confirms decompensation but is not an action trigger. Edema (D) is expected and
managed with diuretics after oxygenation is optimized.
Q3: A patient with a newly implanted mechanical aortic valve is prescribed warfarin. The
INR is 1.8 (target 2.5–3.5). The nurse anticipates which prescription?
A. Hold next dose and restart at lower dose
B. Increase warfarin dose tonight
C. Administer vitamin K 5 mg IV
D. Switch to subcutaneous heparin
Correct Answer: B
Rationale: INR below target for mechanical aortic valve increases thrombo-embolic risk;
increasing warfarin dose is appropriate. Vitamin K (C) is used for supratherapeutic INR.
Holding dose (A) would further lower INR. Heparin (D) is bridge therapy but unnecessary
if INR can be raised quickly.
Q4: A 48-year-old female post–total hip replacement suddenly reports pleuritic chest
pain and dyspnea. Vital signs: HR 108, RR 26, BP 100/60, SpO₂ 90%. Which order should
the nurse implement FIRST?
A. Stat chest CT angiography
B. Start IV heparin bolus 80 units/kg
C. Obtain D-dimer level
D. Administer oxygen 100% NRB
Correct Answer: D
, Rationale: Hypoxemia and clinical picture suggest pulmonary embolism; oxygen is the
immediate priority while confirming diagnosis. CT angiography (A) is diagnostic gold
standard but requires stable oxygenation. Empiric heparin (B) is reasonable after
oxygen. D-dimer (C) is sensitive but not specific and delays definitive imaging.
Q5: A patient with anemia (Hb 7.8 g/dL) receives 1 unit PRBCs. Thirty minutes into the
transfusion, the patient reports chills and flank pain. Temperature is 38.9°C. The nurse’s
FIRST action is:
A. Stop the transfusion immediately
B. Give acetaminophen 650 mg PO
C. Culture the blood bag and tubing
D. Slow the infusion rate
Correct Answer: A
Rationale: Signs indicate acute hemolytic transfusion reaction; stopping the infusion
prevents further red-cell destruction and antigen exposure. Acetaminophen (B) treats
fever but does not address the cause. Cultures (C) are done later. Slowing rate (D)
continues antigen exposure and worsens reaction.
Q6: A patient in cardiogenic shock has a pulmonary artery catheter showing PAOP 24
mmHg, CI 1.8 L/min/m², SVR 1800 dynes·s/cm⁵. Which vasoactive medication is MOST
appropriate?
A. Dobutamine
B. Norepinephrine
C. Nitroprusside
D. Phenylephrine
Correct Answer: A
Rationale: Low CI, high PAOP, and elevated SVR indicate pump failure with
vasoconstriction; dobutamine provides inotropic support and mild afterload reduction.
Norepinephrine (B) and phenylephrine (D) increase afterload, worsening workload.
