HESI MEDICAL-SURGICAL NURSING TEST BANK
2026/2027: COMPLETE WITH VERIFIED
ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 67-year-old male with a history of HTN and hyperlipidemia is admitted with
crushing chest pain that began 45 minutes ago. Vital signs: BP 88/50, HR 108 (regular),
RR 24, SpO₂ 92 % on 2 L NC. 12-lead ECG shows 3 mm ST-segment elevation in leads II,
III, aVF. The nurse’s FIRST priority is to:
A. Obtain a chest X-ray to rule out aortic dissection
B. Administer 324 mg chewable aspirin per protocol
C. Draw serial troponins every 6 h
D. Start IV metoprolol 5 mg to reduce heart rate
Correct Answer: B
Rationale: Immediate aspirin inhibits platelet aggregation and reduces mortality in
STEMI; hypotension and inferior ST elevation suggest right-ventricular involvement,
making metoprolol (D) risky. Chest X-ray (A) delays reperfusion, and troponins (C) are
diagnostic but not the immediate life-saving action.
Q2: A 58-year-old female with heart failure (EF 30 %) is receiving dobutamine 5
mcg/kg/min. Over 2 h her HR rises from 92 to 128 bpm and she reports palpitations.
Which action is MOST appropriate?
A. Increase the infusion to improve contractility
B. Decrease the infusion rate and notify the provider
,C. Check BP and if stable continue current rate
D. Switch dopamine immediately
Correct Answer: B
Rationale: Dobutamine can cause tachycardia and arrhythmias; reducing the rate (B)
prevents further sympathetic overstimulation. Increasing (A) would worsen the rhythm,
while switching dopamine (D) is not indicated without provider orders.
Q3: A post-MI client on heparin infusion has an aPTT of 95 s (control 30 s). The nurse’s
FIRST action is to:
A. Stop the infusion and call the provider
B. Reduce the rate per protocol and recheck in 6 h
C. Continue the current rate; this is therapeutic
D. Administer protamine sulfate stat
Correct Answer: A
Rationale: aPTT > 3 × control indicates bleeding risk; stopping (A) prevents hemorrhage.
Protamine (D) is used for life-threatening bleeding, not first-line for lab elevation.
Q4: A 72-year-old female with new-onset atrial fibrillation is started on warfarin. Which
lab value BEST guides initial dosing?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
,Correct Answer: A
Rationale: PT/INR directly measures warfarin’s anticoagulant effect; aPTT (B) monitors
heparin, platelets (C) assess thrombocytopenia, and D-dimer (D) indicates clot
breakdown, not dosing.
Q5: A 55-year-old male with severe aortic stenosis develops hypotension (BP 78/44)
and crackles. Which finding on physical exam is MOST consistent with acute LV failure?
A. Murmur intensity decreases
B. New S3 gallop
C. Bounding carotid pulses
D. Narrow pulse pressure
Correct Answer: B
Rationale: S3 reflects rapid ventricular filling in volume overload; bounding pulses (C)
and wide pulse pressure occur in high-output states, not acute LV failure.
Q6: A 63-year-old male with COPD develops sudden dyspnea and pleuritic chest pain.
ABG on room air: pH 7.48, PaCO₂ 30 mmHg, PaO₂ 58 mmHg, HCO₃ 22 mEq/L. Which
ABG interpretation is CORRECT?
A. Acute respiratory acidosis
B. Acute respiratory alkalosis with hypoxemia
C. Metabolic alkalosis
D. Compensated metabolic acidosis
Correct Answer: B
, Rationale: Low PaCO₂ and normal HCO₃ indicate acute hyperventilation (respiratory
alkalosis), while PaO₂ < 60 mmHg confirms hypoxemia, consistent with possible
pulmonary embolism.
Q7: A 70-year-old female with COPD is receiving BiPAP. Which parameter change BEST
improves CO₂ elimination?
A. Increase IPAP by 2 cmH₂O
B. Decrease EPAP by 2 cmH₂O
C. Increase FiO₂ to 0.5
D. Decrease rate to 8/min
Correct Answer: A
Rationale: Increasing IPAP augments tidal volume, enhancing alveolar ventilation and
CO₂ washout; EPAP (B) affects oxygenation, and decreasing rate (D) would worsen
hypercapnia.
Q8: A 28-year-old female with T1DM presents with Kussmaul respirations, BG 480
mg/dL, pH 7.12, HCO₃ 8 mEq/L. Which electrolyte abnormality is MOST life-threatening
initially?
A. Hypernatremia
B. Hypokalemia (after insulin starts)
C. Hyperphosphatemia
D. Hyperchloremia
Correct Answer: B
2026/2027: COMPLETE WITH VERIFIED
ANSWERS & RATIONALES
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 67-year-old male with a history of HTN and hyperlipidemia is admitted with
crushing chest pain that began 45 minutes ago. Vital signs: BP 88/50, HR 108 (regular),
RR 24, SpO₂ 92 % on 2 L NC. 12-lead ECG shows 3 mm ST-segment elevation in leads II,
III, aVF. The nurse’s FIRST priority is to:
A. Obtain a chest X-ray to rule out aortic dissection
B. Administer 324 mg chewable aspirin per protocol
C. Draw serial troponins every 6 h
D. Start IV metoprolol 5 mg to reduce heart rate
Correct Answer: B
Rationale: Immediate aspirin inhibits platelet aggregation and reduces mortality in
STEMI; hypotension and inferior ST elevation suggest right-ventricular involvement,
making metoprolol (D) risky. Chest X-ray (A) delays reperfusion, and troponins (C) are
diagnostic but not the immediate life-saving action.
Q2: A 58-year-old female with heart failure (EF 30 %) is receiving dobutamine 5
mcg/kg/min. Over 2 h her HR rises from 92 to 128 bpm and she reports palpitations.
Which action is MOST appropriate?
A. Increase the infusion to improve contractility
B. Decrease the infusion rate and notify the provider
,C. Check BP and if stable continue current rate
D. Switch dopamine immediately
Correct Answer: B
Rationale: Dobutamine can cause tachycardia and arrhythmias; reducing the rate (B)
prevents further sympathetic overstimulation. Increasing (A) would worsen the rhythm,
while switching dopamine (D) is not indicated without provider orders.
Q3: A post-MI client on heparin infusion has an aPTT of 95 s (control 30 s). The nurse’s
FIRST action is to:
A. Stop the infusion and call the provider
B. Reduce the rate per protocol and recheck in 6 h
C. Continue the current rate; this is therapeutic
D. Administer protamine sulfate stat
Correct Answer: A
Rationale: aPTT > 3 × control indicates bleeding risk; stopping (A) prevents hemorrhage.
Protamine (D) is used for life-threatening bleeding, not first-line for lab elevation.
Q4: A 72-year-old female with new-onset atrial fibrillation is started on warfarin. Which
lab value BEST guides initial dosing?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
,Correct Answer: A
Rationale: PT/INR directly measures warfarin’s anticoagulant effect; aPTT (B) monitors
heparin, platelets (C) assess thrombocytopenia, and D-dimer (D) indicates clot
breakdown, not dosing.
Q5: A 55-year-old male with severe aortic stenosis develops hypotension (BP 78/44)
and crackles. Which finding on physical exam is MOST consistent with acute LV failure?
A. Murmur intensity decreases
B. New S3 gallop
C. Bounding carotid pulses
D. Narrow pulse pressure
Correct Answer: B
Rationale: S3 reflects rapid ventricular filling in volume overload; bounding pulses (C)
and wide pulse pressure occur in high-output states, not acute LV failure.
Q6: A 63-year-old male with COPD develops sudden dyspnea and pleuritic chest pain.
ABG on room air: pH 7.48, PaCO₂ 30 mmHg, PaO₂ 58 mmHg, HCO₃ 22 mEq/L. Which
ABG interpretation is CORRECT?
A. Acute respiratory acidosis
B. Acute respiratory alkalosis with hypoxemia
C. Metabolic alkalosis
D. Compensated metabolic acidosis
Correct Answer: B
, Rationale: Low PaCO₂ and normal HCO₃ indicate acute hyperventilation (respiratory
alkalosis), while PaO₂ < 60 mmHg confirms hypoxemia, consistent with possible
pulmonary embolism.
Q7: A 70-year-old female with COPD is receiving BiPAP. Which parameter change BEST
improves CO₂ elimination?
A. Increase IPAP by 2 cmH₂O
B. Decrease EPAP by 2 cmH₂O
C. Increase FiO₂ to 0.5
D. Decrease rate to 8/min
Correct Answer: A
Rationale: Increasing IPAP augments tidal volume, enhancing alveolar ventilation and
CO₂ washout; EPAP (B) affects oxygenation, and decreasing rate (D) would worsen
hypercapnia.
Q8: A 28-year-old female with T1DM presents with Kussmaul respirations, BG 480
mg/dL, pH 7.12, HCO₃ 8 mEq/L. Which electrolyte abnormality is MOST life-threatening
initially?
A. Hypernatremia
B. Hypokalemia (after insulin starts)
C. Hyperphosphatemia
D. Hyperchloremia
Correct Answer: B
