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HESI Med Surg Exit Exam V1 2026/2027 Actual
Exam | Real Questions with Verified Answers |
NGN Format | Pass Guaranteed - A+ Graded
UNFOLDING CASE STUDY: Myocardial Infarction
Scenario Part 1 (Recognizing Cues)
A 62-year-old male patient is brought to the emergency department with substernal chest pain
radiating to the left arm. He reports the pain started 45 minutes ago while walking. He is
diaphoretic, nauseated, and short of breath. Vital signs: BP 150/90 mmHg, HR 110 bpm, RR
22/min, O2 sat 92% on room air.
Q1: Which of the following cues are MOST significant for this patient? (Select all that apply)
A. [ ] Age 62 years
B. [X] Substernal chest pain radiating to left arm [CORRECT]
C. [X] Diaphoresis [CORRECT]
D. [X] Nausea [CORRECT]
E. [X] Shortness of breath [CORRECT]
Correct Answer: B, C, D, E
Rationale: Chest pain radiating to the arm, diaphoresis, nausea, and shortness of breath are
classic signs of acute myocardial infarction. Age (A) is a risk factor but not an acute cue.
Scenario Part 2 (Analyzing Cues)
ECG shows ST-segment elevation in leads V1-V4. Troponin I is elevated at 5.2 ng/mL (normal
<0.04). The patient is diagnosed with ST-elevation myocardial infarction (STEMI).
Q2: Based on the ECG findings, which area of the heart is MOST likely affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall [CORRECT]
D. Posterior wall
Correct Answer: C
Rationale: ST elevation in leads V1-V4 indicates anterior wall myocardial infarction (left
anterior descending artery distribution).
,2
Scenario Part 3 (Prioritizing Hypotheses)
The patient is being prepared for percutaneous coronary intervention (PCI). The patient asks,
"What is the best treatment for my heart attack?"
Q3: Which of the following is the priority hypothesis for this patient?
A. Anxiety related to diagnosis
B. Impaired gas exchange related to pulmonary congestion
C. Decreased cardiac output related to myocardial damage
D. Risk for dysrhythmias related to myocardial ischemia [CORRECT]
Correct Answer: D
Rationale: While all options are valid, the most immediate life-threatening risk in STEMI is
dysrhythmias. The patient requires continuous cardiac monitoring and immediate reperfusion.
Scenario Part 4 (Generating Solutions)
The patient is taken to the cardiac catheterization lab. A stent is placed in the left anterior
descending artery. The patient is transferred to the cardiac intensive care unit.
Q4: Which of the following interventions are appropriate for this patient in the immediate post-
PCI period? (Select all that apply)
A. [X] Maintain bed rest with the affected leg straight for 4-6 hours [CORRECT]
B. [X] Assess the access site for bleeding or hematoma [CORRECT]
C. [ ] Encourage active range of motion of the affected leg
D. [X] Monitor vital signs and cardiac rhythm [CORRECT]
E. [X] Administer aspirin as ordered [CORRECT]
Correct Answer: A, B, D, E
Rationale: Post-PCI care includes bed rest with leg straight, site assessment, monitoring, and
antiplatelet therapy. Active range of motion (C) should be avoided until the sheath is removed
and the site is stable.
Scenario Part 5 (Taking Action)
Two hours after the procedure, the patient's blood pressure drops to 90/50 mmHg. The access site
shows a small hematoma. The patient reports feeling lightheaded.
Q5: Which of the following actions should the nurse take FIRST?
A. Administer IV fluids as ordered
B. Apply manual pressure to the access site [CORRECT]
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C. Notify the provider
D. Elevate the head of bed
Correct Answer: B
Rationale: Hypotension with hematoma may indicate bleeding at the access site. The first action
is to apply pressure to the site to control bleeding. Options A and C should follow after
immediate pressure is applied. Option D may worsen hypotension.
Scenario Part 6 (Evaluating Outcomes)
After applying pressure, the hematoma stabilizes, and the patient's blood pressure returns to
118/72 mmHg. The patient reports no further chest pain.
Q6: Which of the following outcomes indicates that the patient's condition is improving?
A. Heart rate 110 bpm
B. Blood pressure 118/72 mmHg [CORRECT]
C. Hematoma increasing in size
D. Patient reports chest pain of 2/10
Correct Answer: B
Rationale: Blood pressure returning to normal indicates hemodynamic stability. Option A (HR
110) is still elevated. Option C (increasing hematoma) is worsening. Option D (ongoing chest
pain) is concerning.
STAND-ALONE QUESTIONS
Cardiovascular Disorders
Q7: A patient with heart failure has an ejection fraction of 35%. This indicates:
A. Diastolic heart failure
B. Systolic heart failure [CORRECT]
C. Normal cardiac function
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Ejection fraction <40% indicates systolic heart failure (HFrEF). Diastolic heart
failure has preserved ejection fraction (>50%). Option C is 55-70%. Option D may have normal
or increased EF.
Q8: A patient with a history of atrial fibrillation is prescribed warfarin. Which of the following
lab values should the nurse monitor MOST closely?
HESI Med Surg Exit Exam V1 2026/2027 Actual
Exam | Real Questions with Verified Answers |
NGN Format | Pass Guaranteed - A+ Graded
UNFOLDING CASE STUDY: Myocardial Infarction
Scenario Part 1 (Recognizing Cues)
A 62-year-old male patient is brought to the emergency department with substernal chest pain
radiating to the left arm. He reports the pain started 45 minutes ago while walking. He is
diaphoretic, nauseated, and short of breath. Vital signs: BP 150/90 mmHg, HR 110 bpm, RR
22/min, O2 sat 92% on room air.
Q1: Which of the following cues are MOST significant for this patient? (Select all that apply)
A. [ ] Age 62 years
B. [X] Substernal chest pain radiating to left arm [CORRECT]
C. [X] Diaphoresis [CORRECT]
D. [X] Nausea [CORRECT]
E. [X] Shortness of breath [CORRECT]
Correct Answer: B, C, D, E
Rationale: Chest pain radiating to the arm, diaphoresis, nausea, and shortness of breath are
classic signs of acute myocardial infarction. Age (A) is a risk factor but not an acute cue.
Scenario Part 2 (Analyzing Cues)
ECG shows ST-segment elevation in leads V1-V4. Troponin I is elevated at 5.2 ng/mL (normal
<0.04). The patient is diagnosed with ST-elevation myocardial infarction (STEMI).
Q2: Based on the ECG findings, which area of the heart is MOST likely affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall [CORRECT]
D. Posterior wall
Correct Answer: C
Rationale: ST elevation in leads V1-V4 indicates anterior wall myocardial infarction (left
anterior descending artery distribution).
,2
Scenario Part 3 (Prioritizing Hypotheses)
The patient is being prepared for percutaneous coronary intervention (PCI). The patient asks,
"What is the best treatment for my heart attack?"
Q3: Which of the following is the priority hypothesis for this patient?
A. Anxiety related to diagnosis
B. Impaired gas exchange related to pulmonary congestion
C. Decreased cardiac output related to myocardial damage
D. Risk for dysrhythmias related to myocardial ischemia [CORRECT]
Correct Answer: D
Rationale: While all options are valid, the most immediate life-threatening risk in STEMI is
dysrhythmias. The patient requires continuous cardiac monitoring and immediate reperfusion.
Scenario Part 4 (Generating Solutions)
The patient is taken to the cardiac catheterization lab. A stent is placed in the left anterior
descending artery. The patient is transferred to the cardiac intensive care unit.
Q4: Which of the following interventions are appropriate for this patient in the immediate post-
PCI period? (Select all that apply)
A. [X] Maintain bed rest with the affected leg straight for 4-6 hours [CORRECT]
B. [X] Assess the access site for bleeding or hematoma [CORRECT]
C. [ ] Encourage active range of motion of the affected leg
D. [X] Monitor vital signs and cardiac rhythm [CORRECT]
E. [X] Administer aspirin as ordered [CORRECT]
Correct Answer: A, B, D, E
Rationale: Post-PCI care includes bed rest with leg straight, site assessment, monitoring, and
antiplatelet therapy. Active range of motion (C) should be avoided until the sheath is removed
and the site is stable.
Scenario Part 5 (Taking Action)
Two hours after the procedure, the patient's blood pressure drops to 90/50 mmHg. The access site
shows a small hematoma. The patient reports feeling lightheaded.
Q5: Which of the following actions should the nurse take FIRST?
A. Administer IV fluids as ordered
B. Apply manual pressure to the access site [CORRECT]
, 3
C. Notify the provider
D. Elevate the head of bed
Correct Answer: B
Rationale: Hypotension with hematoma may indicate bleeding at the access site. The first action
is to apply pressure to the site to control bleeding. Options A and C should follow after
immediate pressure is applied. Option D may worsen hypotension.
Scenario Part 6 (Evaluating Outcomes)
After applying pressure, the hematoma stabilizes, and the patient's blood pressure returns to
118/72 mmHg. The patient reports no further chest pain.
Q6: Which of the following outcomes indicates that the patient's condition is improving?
A. Heart rate 110 bpm
B. Blood pressure 118/72 mmHg [CORRECT]
C. Hematoma increasing in size
D. Patient reports chest pain of 2/10
Correct Answer: B
Rationale: Blood pressure returning to normal indicates hemodynamic stability. Option A (HR
110) is still elevated. Option C (increasing hematoma) is worsening. Option D (ongoing chest
pain) is concerning.
STAND-ALONE QUESTIONS
Cardiovascular Disorders
Q7: A patient with heart failure has an ejection fraction of 35%. This indicates:
A. Diastolic heart failure
B. Systolic heart failure [CORRECT]
C. Normal cardiac function
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Ejection fraction <40% indicates systolic heart failure (HFrEF). Diastolic heart
failure has preserved ejection fraction (>50%). Option C is 55-70%. Option D may have normal
or increased EF.
Q8: A patient with a history of atrial fibrillation is prescribed warfarin. Which of the following
lab values should the nurse monitor MOST closely?
