MED SURG HESI REAL EXAM 1 & 2 2026/2027 | Medical
Surgical HESI Test Bank | Complete Q&A | Verified Answers |
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MED SURGE HESI EXAM - VERSION 1
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SECTION: CARDIOVASCULAR (Questions 1-15)
Q1: A 68-year-old male is admitted with acute coronary syndrome. His vital signs are:
BP 88/52 mmHg, HR 110 bpm, RR 24/min, SpO2 91% on room air. He reports crushing
chest pain rated 9/10. Which action should the nurse take FIRST?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG within 10 minutes
C. Start supplemental oxygen at 2 L/min via nasal cannula
D. Establish IV access and prepare for morphine administration
Correct Answer: B
Rationale: The FIRST priority in suspected acute coronary syndrome (ACS) is obtaining
a 12-lead ECG within 10 minutes of arrival or symptom onset. This is a core quality
measure because the ECG determines whether the patient has ST-elevation myocardial
infarction (STEMI) requiring immediate reperfusion therapy.
, ● Option A: While nitroglycerin is appropriate for ACS, it is contraindicated with
hypotension (SBP <90 mmHg) and should not precede the diagnostic ECG.
● Option C: Oxygen is no longer routinely recommended for all ACS patients; it
should only be administered if SpO2 <90%, respiratory distress, or high-risk
features are present. While this patient's SpO2 is 91%, the ECG takes precedence
for treatment pathway determination.
● Option D: IV access and pain management are important but do not supersede
the diagnostic priority of the ECG, which guides all subsequent interventions
including whether the patient needs emergency catheterization.
Pathophysiology note: Time is myocardium—rapid ECG identification of STEMI allows
door-to-balloon time <90 minutes or door-to-needle time <30 minutes.
Q2: A patient with heart failure is prescribed furosemide 40 mg IV daily. Which
laboratory values require immediate notification of the healthcare provider? (Select all
that apply)
A. Sodium 138 mEq/L
B. Potassium 2.8 mEq/L
C. Creatinine 1.9 mg/dL (baseline 1.1 mg/dL)
D. BUN 28 mg/dL
E. Magnesium 1.2 mg/dL
Correct Answer: B, C, E
Rationale: Loop diuretics like furosemide cause significant electrolyte wasting and
potential renal dysfunction.
● B. Potassium 2.8 mEq/L [CORRECT]: Severe hypokalemia (<3.0 mEq/L) increases
risk of life-threatening cardiac dysrhythmias. Furosemide causes kaliuresis; this
requires immediate potassium replacement and provider notification.
, ● C. Creatinine 1.9 mg/dL [CORRECT]: Acute kidney injury (rise from 1.1 to 1.9
indicates >50% increase) may indicate over-diuresis, hypovolemia, or
nephrotoxicity. Requires immediate evaluation of volume status and potential
diuretic adjustment.
● E. Magnesium 1.2 mg/dL [CORRECT]: Severe hypomagnesemia (<1.4 mg/dL).
Magnesium deficiency exacerbates potassium wasting and predisposes to
ventricular arrhythmias (Torsades de Pointes). Must be corrected before or with
potassium repletion.
Incorrect options:
● A: Sodium 138 mEq/L is within normal range (136-145 mEq/L).
● D: BUN 28 mg/dL is elevated but expected with diuretic therapy and reduced
renal perfusion; while monitoring is needed, this alone does not require
immediate notification unless accompanied by symptoms or rising creatinine.
Q3: A nurse is caring for a patient 24 hours post-percutaneous coronary intervention
(PCI) with femoral access. The patient complains of sudden severe back pain and has
developed hypotension. Which complication should the nurse suspect?
A. Contrast-induced nephropathy
B. Retroperitoneal hemorrhage
C. Acute stent thrombosis
D. Vasovagal response
Correct Answer: B
Rationale: Retroperitoneal hemorrhage is a rare but life-threatening complication of
femoral artery catheterization, occurring in 0.15-6% of cases. The classic triad includes:
hypotension, back/flank pain, and dropping hemoglobin without obvious external
bleeding.
, ● Option A: Contrast-induced nephropathy presents with rising creatinine 24-48
hours post-procedure, not acute back pain and hypotension.
● Option C: Acute stent thrombosis presents with recurrent chest pain,
ST-elevation, and hemodynamic collapse, not isolated back pain.
● Option D: Vasovagal response causes hypotension and bradycardia, typically
during sheath removal or with pain, but does not cause severe back pain or
continued bleeding.
Clinical reasoning: The femoral artery courses posteriorly against the pelvic bone;
puncture above the inguinal ligament allows bleeding into the retroperitoneal space,
which can accommodate 4+ liters of blood without external signs. Immediate actions:
Activate rapid response, prepare for fluid resuscitation/blood products, manual
compression, and possible surgical intervention.
Q4: A patient with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse notes the
INR is 4.2. Which action is most appropriate?
A. Hold the next dose and notify the provider
B. Administer vitamin K 10 mg subcutaneously
C. Continue the current dose and recheck in one week
D. Administer the dose and increase to 7.5 mg daily
Correct Answer: A
Rationale: An INR of 4.2 represents supratherapeutic anticoagulation (goal INR 2.0-3.0
for most indications). The nurse should hold the next dose and notify the provider
immediately.
Management rationale:
Surgical HESI Test Bank | Complete Q&A | Verified Answers |
Pass Guaranteed - A+ Graded
=====================================
MED SURGE HESI EXAM - VERSION 1
=====================================
SECTION: CARDIOVASCULAR (Questions 1-15)
Q1: A 68-year-old male is admitted with acute coronary syndrome. His vital signs are:
BP 88/52 mmHg, HR 110 bpm, RR 24/min, SpO2 91% on room air. He reports crushing
chest pain rated 9/10. Which action should the nurse take FIRST?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a 12-lead ECG within 10 minutes
C. Start supplemental oxygen at 2 L/min via nasal cannula
D. Establish IV access and prepare for morphine administration
Correct Answer: B
Rationale: The FIRST priority in suspected acute coronary syndrome (ACS) is obtaining
a 12-lead ECG within 10 minutes of arrival or symptom onset. This is a core quality
measure because the ECG determines whether the patient has ST-elevation myocardial
infarction (STEMI) requiring immediate reperfusion therapy.
, ● Option A: While nitroglycerin is appropriate for ACS, it is contraindicated with
hypotension (SBP <90 mmHg) and should not precede the diagnostic ECG.
● Option C: Oxygen is no longer routinely recommended for all ACS patients; it
should only be administered if SpO2 <90%, respiratory distress, or high-risk
features are present. While this patient's SpO2 is 91%, the ECG takes precedence
for treatment pathway determination.
● Option D: IV access and pain management are important but do not supersede
the diagnostic priority of the ECG, which guides all subsequent interventions
including whether the patient needs emergency catheterization.
Pathophysiology note: Time is myocardium—rapid ECG identification of STEMI allows
door-to-balloon time <90 minutes or door-to-needle time <30 minutes.
Q2: A patient with heart failure is prescribed furosemide 40 mg IV daily. Which
laboratory values require immediate notification of the healthcare provider? (Select all
that apply)
A. Sodium 138 mEq/L
B. Potassium 2.8 mEq/L
C. Creatinine 1.9 mg/dL (baseline 1.1 mg/dL)
D. BUN 28 mg/dL
E. Magnesium 1.2 mg/dL
Correct Answer: B, C, E
Rationale: Loop diuretics like furosemide cause significant electrolyte wasting and
potential renal dysfunction.
● B. Potassium 2.8 mEq/L [CORRECT]: Severe hypokalemia (<3.0 mEq/L) increases
risk of life-threatening cardiac dysrhythmias. Furosemide causes kaliuresis; this
requires immediate potassium replacement and provider notification.
, ● C. Creatinine 1.9 mg/dL [CORRECT]: Acute kidney injury (rise from 1.1 to 1.9
indicates >50% increase) may indicate over-diuresis, hypovolemia, or
nephrotoxicity. Requires immediate evaluation of volume status and potential
diuretic adjustment.
● E. Magnesium 1.2 mg/dL [CORRECT]: Severe hypomagnesemia (<1.4 mg/dL).
Magnesium deficiency exacerbates potassium wasting and predisposes to
ventricular arrhythmias (Torsades de Pointes). Must be corrected before or with
potassium repletion.
Incorrect options:
● A: Sodium 138 mEq/L is within normal range (136-145 mEq/L).
● D: BUN 28 mg/dL is elevated but expected with diuretic therapy and reduced
renal perfusion; while monitoring is needed, this alone does not require
immediate notification unless accompanied by symptoms or rising creatinine.
Q3: A nurse is caring for a patient 24 hours post-percutaneous coronary intervention
(PCI) with femoral access. The patient complains of sudden severe back pain and has
developed hypotension. Which complication should the nurse suspect?
A. Contrast-induced nephropathy
B. Retroperitoneal hemorrhage
C. Acute stent thrombosis
D. Vasovagal response
Correct Answer: B
Rationale: Retroperitoneal hemorrhage is a rare but life-threatening complication of
femoral artery catheterization, occurring in 0.15-6% of cases. The classic triad includes:
hypotension, back/flank pain, and dropping hemoglobin without obvious external
bleeding.
, ● Option A: Contrast-induced nephropathy presents with rising creatinine 24-48
hours post-procedure, not acute back pain and hypotension.
● Option C: Acute stent thrombosis presents with recurrent chest pain,
ST-elevation, and hemodynamic collapse, not isolated back pain.
● Option D: Vasovagal response causes hypotension and bradycardia, typically
during sheath removal or with pain, but does not cause severe back pain or
continued bleeding.
Clinical reasoning: The femoral artery courses posteriorly against the pelvic bone;
puncture above the inguinal ligament allows bleeding into the retroperitoneal space,
which can accommodate 4+ liters of blood without external signs. Immediate actions:
Activate rapid response, prepare for fluid resuscitation/blood products, manual
compression, and possible surgical intervention.
Q4: A patient with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse notes the
INR is 4.2. Which action is most appropriate?
A. Hold the next dose and notify the provider
B. Administer vitamin K 10 mg subcutaneously
C. Continue the current dose and recheck in one week
D. Administer the dose and increase to 7.5 mg daily
Correct Answer: A
Rationale: An INR of 4.2 represents supratherapeutic anticoagulation (goal INR 2.0-3.0
for most indications). The nurse should hold the next dose and notify the provider
immediately.
Management rationale:
