HESI | Med-Surg II
OBJECTIVE ASSESSMENT - EXAM
Med-Surg RN
Custom Exam
HESI | Med Surg II Class
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Musculoskeletal & Integumentary Disorders
Gastrointestinal & Renal Conditions Perioperative & Emergency Nursing Care
Neurologic & Endocrine Dysfunction
COVER PAGE - 1
,SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | HESI Med-Surg RN Custom Exam 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of hypertension and hyperlipidemia presents to the emergency
department with crushing substernal chest pain radiating to the left arm that began 45 minutes ago. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Troponin levels are elevated. The
nurse anticipates which immediate intervention as the priority?
A. Administering thrombolytic therapy or preparing for percutaneous coronary intervention
B. Initiating beta-blocker therapy to reduce myocardial oxygen demand
C. Obtaining a chest radiograph to rule out aortic dissection
D. Administering prophylactic antibiotics to prevent infective endocarditis
Correct Answer: A
Rationale:
ST-elevation myocardial infarction (STEMI) requires immediate reperfusion through either thrombolytic
therapy or percutaneous coronary intervention to salvage myocardium and reduce mortality. Beta-blockers
are important but are not the first priority over reperfusion. A chest radiograph does not change the
immediate management of a clear STEMI. Prophylactic antibiotics are not indicated in acute MI.
Q2 Question 2 of 100
A 72-year-old female is admitted with acute decompensated heart failure. She has crackles bilaterally in
the lung bases, jugular venous distension, and 3+ pitting edema in both lower extremities. Her BNP level
is 1,800 pg/mL. The nurse understands that the primary pathophysiologic mechanism contributing to her
peripheral edema is which of the following?
A. Increased pulmonary vascular resistance causing right ventricular failure and subsequent peripheral edema
B. Decreased cardiac output leading to reduced renal perfusion and activation of the
renin-angiotensin-aldosterone system
C. Myocardial fibrosis leading to diastolic dysfunction and impaired ventricular filling
D. Atrial fibrillation with rapid ventricular response causing decreased diastolic filling time
Correct Answer: B
Rationale:
In heart failure, decreased cardiac output reduces renal perfusion, activating the
renin-angiotensin-aldosterone system, which causes sodium and water retention and thus peripheral
edema. Pulmonary vascular resistance increase is a secondary consequence, not the primary mechanism
for peripheral edema. Myocardial fibrosis and diastolic dysfunction explain impaired filling but not the fluid
retention mechanism. Atrial fibrillation may worsen heart failure but does not directly cause peripheral
edema.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 2 of 51
,Q3 Question 3 of 100
A 55-year-old male with a mechanical mitral valve replacement presents with an INR of 1.2 on his routine
lab draw. He reports missing several doses of warfarin over the past week. The nurse recognizes that
this INR level places the patient at greatest risk for which complication?
A. Hemorrhagic stroke due to erratic anticoagulation levels
B. Disseminated intravascular coagulation from coagulation factor consumption
C. Thromboembolic event such as a stroke or systemic embolism
D. Heparin-induced thrombocytopenia from cross-reactivity
Correct Answer: C
Rationale:
A subtherapeutic INR of 1.2 in a patient with a mechanical mitral valve significantly increases the risk of
thromboembolic events because mechanical valves are highly thrombogenic and require consistent
anticoagulation. Hemorrhagic stroke is a risk of supratherapeutic, not subtherapeutic, INR. DIC is
unrelated to warfarin nonadherence. Heparin-induced thrombocytopenia occurs with heparin exposure, not
warfarin.
Q4 Question 4 of 100
A 64-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis three
days after a total knee arthroplasty. Her oxygen saturation is 88% on room air and she is tachycardic.
The nurse suspects a pulmonary embolism and anticipates which diagnostic test as the gold standard?
A. D-dimer assay
B. Ventilation-perfusion lung scan
C. Lower extremity Doppler ultrasound
D. Pulmonary angiography with CT pulmonary angiogram
Correct Answer: D
Rationale:
CT pulmonary angiogram is the gold standard for diagnosing pulmonary embolism because it directly
visualizes thrombi in the pulmonary vasculature. D-dimer is a sensitive but nonspecific screening tool that
cannot confirm PE. V/Q scanning is used when CT is contraindicated. Lower extremity Doppler ultrasound
identifies DVT but does not confirm PE.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 3 of 51
, Q5 Question 5 of 100
A 47-year-old male with a 30-pack-year smoking history presents with chronic productive cough for three
months per year for the past two years, dyspnea on exertion, and wheezing. Spirometry shows an
FEV1/FVC ratio of 0.60 with minimal improvement after bronchodilator administration. The nurse
identifies these findings as most consistent with which diagnosis?
A. Chronic obstructive pulmonary disease
B. Bronchial asthma
C. Pulmonary fibrosis
D. Bronchiectasis
Correct Answer: A
Rationale:
The FEV1/FVC ratio below 0.70 with minimal bronchodilator reversibility is diagnostic of COPD, consistent
with the patient's significant smoking history and chronic productive cough. Asthma typically shows
significant reversibility with bronchodilators. Pulmonary fibrosis presents with restrictive pattern on
spirometry. Bronchiectasis is characterized by recurrent infections and copious sputum production with
different imaging findings.
Q6 Question 6 of 100
A 58-year-old male is admitted with a diagnosis of acute respiratory distress syndrome (ARDS) following
severe pneumonia. He is on mechanical ventilation with the following settings: assist-control mode, tidal
volume 6 mL/kg of predicted body weight, PEEP 12 cm H2O, and FiO2 60%. His PaO2 is 58 mmHg. The
nurse should anticipate which intervention to improve oxygenation?
A. Increasing tidal volume to 10 mL/kg to improve alveolar ventilation
B. Increasing PEEP to recruit collapsed alveoli and improve oxygenation
C. Decreasing FiO2 to prevent oxygen toxicity
D. Switching to pressure support ventilation to reduce work of breathing
Correct Answer: B
Rationale:
Increasing PEEP is the primary strategy to recruit collapsed alveoli and improve oxygenation in ARDS
while maintaining lung-protective ventilation with low tidal volumes. Increasing tidal volume to 10 mL/kg
would cause ventilator-induced lung injury. Decreasing FiO2 when the patient is already hypoxemic would
worsen oxygenation. Pressure support ventilation is not appropriate for severe ARDS requiring full
ventilatory support.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 4 of 51
OBJECTIVE ASSESSMENT - EXAM
Med-Surg RN
Custom Exam
HESI | Med Surg II Class
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Musculoskeletal & Integumentary Disorders
Gastrointestinal & Renal Conditions Perioperative & Emergency Nursing Care
Neurologic & Endocrine Dysfunction
COVER PAGE - 1
,SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | HESI Med-Surg RN Custom Exam 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of hypertension and hyperlipidemia presents to the emergency
department with crushing substernal chest pain radiating to the left arm that began 45 minutes ago. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Troponin levels are elevated. The
nurse anticipates which immediate intervention as the priority?
A. Administering thrombolytic therapy or preparing for percutaneous coronary intervention
B. Initiating beta-blocker therapy to reduce myocardial oxygen demand
C. Obtaining a chest radiograph to rule out aortic dissection
D. Administering prophylactic antibiotics to prevent infective endocarditis
Correct Answer: A
Rationale:
ST-elevation myocardial infarction (STEMI) requires immediate reperfusion through either thrombolytic
therapy or percutaneous coronary intervention to salvage myocardium and reduce mortality. Beta-blockers
are important but are not the first priority over reperfusion. A chest radiograph does not change the
immediate management of a clear STEMI. Prophylactic antibiotics are not indicated in acute MI.
Q2 Question 2 of 100
A 72-year-old female is admitted with acute decompensated heart failure. She has crackles bilaterally in
the lung bases, jugular venous distension, and 3+ pitting edema in both lower extremities. Her BNP level
is 1,800 pg/mL. The nurse understands that the primary pathophysiologic mechanism contributing to her
peripheral edema is which of the following?
A. Increased pulmonary vascular resistance causing right ventricular failure and subsequent peripheral edema
B. Decreased cardiac output leading to reduced renal perfusion and activation of the
renin-angiotensin-aldosterone system
C. Myocardial fibrosis leading to diastolic dysfunction and impaired ventricular filling
D. Atrial fibrillation with rapid ventricular response causing decreased diastolic filling time
Correct Answer: B
Rationale:
In heart failure, decreased cardiac output reduces renal perfusion, activating the
renin-angiotensin-aldosterone system, which causes sodium and water retention and thus peripheral
edema. Pulmonary vascular resistance increase is a secondary consequence, not the primary mechanism
for peripheral edema. Myocardial fibrosis and diastolic dysfunction explain impaired filling but not the fluid
retention mechanism. Atrial fibrillation may worsen heart failure but does not directly cause peripheral
edema.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 2 of 51
,Q3 Question 3 of 100
A 55-year-old male with a mechanical mitral valve replacement presents with an INR of 1.2 on his routine
lab draw. He reports missing several doses of warfarin over the past week. The nurse recognizes that
this INR level places the patient at greatest risk for which complication?
A. Hemorrhagic stroke due to erratic anticoagulation levels
B. Disseminated intravascular coagulation from coagulation factor consumption
C. Thromboembolic event such as a stroke or systemic embolism
D. Heparin-induced thrombocytopenia from cross-reactivity
Correct Answer: C
Rationale:
A subtherapeutic INR of 1.2 in a patient with a mechanical mitral valve significantly increases the risk of
thromboembolic events because mechanical valves are highly thrombogenic and require consistent
anticoagulation. Hemorrhagic stroke is a risk of supratherapeutic, not subtherapeutic, INR. DIC is
unrelated to warfarin nonadherence. Heparin-induced thrombocytopenia occurs with heparin exposure, not
warfarin.
Q4 Question 4 of 100
A 64-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis three
days after a total knee arthroplasty. Her oxygen saturation is 88% on room air and she is tachycardic.
The nurse suspects a pulmonary embolism and anticipates which diagnostic test as the gold standard?
A. D-dimer assay
B. Ventilation-perfusion lung scan
C. Lower extremity Doppler ultrasound
D. Pulmonary angiography with CT pulmonary angiogram
Correct Answer: D
Rationale:
CT pulmonary angiogram is the gold standard for diagnosing pulmonary embolism because it directly
visualizes thrombi in the pulmonary vasculature. D-dimer is a sensitive but nonspecific screening tool that
cannot confirm PE. V/Q scanning is used when CT is contraindicated. Lower extremity Doppler ultrasound
identifies DVT but does not confirm PE.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 3 of 51
, Q5 Question 5 of 100
A 47-year-old male with a 30-pack-year smoking history presents with chronic productive cough for three
months per year for the past two years, dyspnea on exertion, and wheezing. Spirometry shows an
FEV1/FVC ratio of 0.60 with minimal improvement after bronchodilator administration. The nurse
identifies these findings as most consistent with which diagnosis?
A. Chronic obstructive pulmonary disease
B. Bronchial asthma
C. Pulmonary fibrosis
D. Bronchiectasis
Correct Answer: A
Rationale:
The FEV1/FVC ratio below 0.70 with minimal bronchodilator reversibility is diagnostic of COPD, consistent
with the patient's significant smoking history and chronic productive cough. Asthma typically shows
significant reversibility with bronchodilators. Pulmonary fibrosis presents with restrictive pattern on
spirometry. Bronchiectasis is characterized by recurrent infections and copious sputum production with
different imaging findings.
Q6 Question 6 of 100
A 58-year-old male is admitted with a diagnosis of acute respiratory distress syndrome (ARDS) following
severe pneumonia. He is on mechanical ventilation with the following settings: assist-control mode, tidal
volume 6 mL/kg of predicted body weight, PEEP 12 cm H2O, and FiO2 60%. His PaO2 is 58 mmHg. The
nurse should anticipate which intervention to improve oxygenation?
A. Increasing tidal volume to 10 mL/kg to improve alveolar ventilation
B. Increasing PEEP to recruit collapsed alveoli and improve oxygenation
C. Decreasing FiO2 to prevent oxygen toxicity
D. Switching to pressure support ventilation to reduce work of breathing
Correct Answer: B
Rationale:
Increasing PEEP is the primary strategy to recruit collapsed alveoli and improve oxygenation in ARDS
while maintaining lung-protective ventilation with low tidal volumes. Increasing tidal volume to 10 mL/kg
would cause ventilator-induced lung injury. Decreasing FiO2 when the patient is already hypoxemic would
worsen oxygenation. Pressure support ventilation is not appropriate for severe ARDS requiring full
ventilatory support.
HESI Med-Surg RN Custom Exam -- 2026/2027 | Passing Score: 75% | Page 4 of 51
