HESI MED SURG II EXAM 2026/2027 | 130 Exam Questions
and Correct Answers | 100% Correct Graded A+ | Med-Surg II
Latest | Pass Guaranteed
Domain 1: Cardiovascular - Advanced Heart Failure, Dysrhythmias, Valvular Disease,
Vascular Emergencies, Shock (20 Questions)
Q1: A client with Stage D heart failure is receiving dobutamine 5 mcg/kg/min via
continuous IV infusion. The nurse notes the client's heart rate has increased from 88
bpm to 122 bpm over the past hour. Which intervention is the priority?
A. Decrease the dobutamine infusion rate by 50%
B. Obtain a 12-lead ECG immediately
C. Assess for chest pain and auscultate heart sounds
D. Notify the provider to discontinue the dobutamine
Correct Answer: C
Rationale: Dobutamine is a beta-1 agonist that increases contractility and heart rate. A
heart rate increase to 122 bpm indicates significant tachycardia, which increases
myocardial oxygen demand and can precipitate ischemia in a failing heart. The priority
nursing intervention is to assess for signs of myocardial ischemia (chest pain) and
evaluate heart sounds for new murmurs or gallops that might indicate worsening
function. Option A is a provider order and outside nursing scope without contacting the
provider first. Option B is important but assessment comes first in the nursing process.
Option D is premature—tachycardia is an expected effect of dobutamine, and
discontinuation may worsen heart failure; the provider needs assessment data to titrate
,appropriately. Dobutamine can cause ventricular ectopy and increase infarct size if
ischemia is present, making clinical assessment critical before any rate change.
Q2: A client with acute decompensated heart failure is receiving nesiritide. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure decrease from 142/88 mmHg to 118/76 mmHg
B. Serum creatinine increase from 1.2 mg/dL to 1.5 mg/dL
C. Urine output increase from 30 mL/hr to 65 mL/hr
D. Dyspnea improvement from severe to mild with oxygen saturation 94%
Correct Answer: B
Rationale: Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation and natriuresis. However, it is associated with worsening renal function
and increased mortality risk in some studies. A creatinine increase of 0.3 mg/dL (25%
increase) indicates acute kidney injury and requires immediate intervention—potentially
discontinuing the drug and notifying the provider. Option A represents an expected
therapeutic effect (afterload reduction). Option C is a desired outcome (improved
perfusion and diuresis). Option D is the intended therapeutic effect. The nurse must
monitor renal function closely during nesiritide therapy as it can cause azotemia,
particularly in clients with baseline renal impairment or hypotension.
Q3: A client with an LVAD is admitted with suspected pump thrombosis. Which
assessment finding is most consistent with this complication?
A. Increased LVAD flow with decreased power consumption
,B. Decreased LVAD flow with increased power consumption
C. Normal LVAD flow with audible alarm for battery depletion
D. Increased LVAD flow with hemoglobin of 8.2 g/dL
Correct Answer: B
Rationale: LVAD pump thrombosis occurs when a clot forms in the pump, obstructing
flow. This causes the pump to work harder (increased power consumption) to maintain
output, but flow decreases due to the obstruction. Option A is physiologically
opposite—thrombosis increases resistance. Option C describes a power issue, not
thrombosis. Option D describes anemia with high flow, not thrombosis. Additional signs
of pump thrombosis include hemolysis (elevated LDH, plasma free hemoglobin,
decreased haptoglobin), new neurological deficits (embolic events), and heart failure
symptoms. This is a medical emergency requiring immediate anticoagulation
assessment, possible thrombolysis, or device exchange.
Q4: A client with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which anticoagulation
regimen is most appropriate for long-term stroke prevention?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Apixaban 5 mg twice daily
D. Clopidogrel 75 mg daily
Correct Answer: C
, Rationale: A CHA₂DS₂-VASc score of 4 indicates high stroke risk (approximately 4%
annual stroke risk), requiring oral anticoagulation, not antiplatelet therapy. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for non-valvular AF
due to lower bleeding risk, fewer drug interactions, and no monitoring requirements.
Option A (aspirin) is insufficient for this risk level. Option B (warfarin) is acceptable but
not preferred unless mechanical valve or moderate-severe mitral stenosis present.
Option D (clopidogrel) is inappropriate as monotherapy. Apixaban 5 mg BID is standard
dosing; reduce to 2.5 mg BID if two of the following: age ≥80, weight ≤60 kg, or
creatinine ≥1.5 mg/dL.
Q5: A client with new-onset atrial fibrillation (rate 142 bpm, BP 98/64 mmHg) is
hemodynamically unstable. Which intervention is the priority?
A. Administer metoprolol 5 mg IV push
B. Perform synchronized cardioversion at 100-200 joules
C. Administer amiodarone 150 mg IV over 10 minutes
D. Initiate heparin infusion for anticoagulation
Correct Answer: B
Rationale: Hemodynamic instability in AF (hypotension, acute heart failure, ongoing
ischemia, or altered mental status) requires immediate synchronized cardioversion to
restore sinus rhythm and hemodynamic stability. Delaying cardioversion for
medications risks clinical deterioration. Option A (beta-blocker) is contraindicated with
hypotension. Option C (amiodarone) is for stable patients or after cardioversion for
rhythm maintenance. Option D (anticoagulation) is important but does not address the
immediate hemodynamic compromise. Synchronized cardioversion (synchronized to
and Correct Answers | 100% Correct Graded A+ | Med-Surg II
Latest | Pass Guaranteed
Domain 1: Cardiovascular - Advanced Heart Failure, Dysrhythmias, Valvular Disease,
Vascular Emergencies, Shock (20 Questions)
Q1: A client with Stage D heart failure is receiving dobutamine 5 mcg/kg/min via
continuous IV infusion. The nurse notes the client's heart rate has increased from 88
bpm to 122 bpm over the past hour. Which intervention is the priority?
A. Decrease the dobutamine infusion rate by 50%
B. Obtain a 12-lead ECG immediately
C. Assess for chest pain and auscultate heart sounds
D. Notify the provider to discontinue the dobutamine
Correct Answer: C
Rationale: Dobutamine is a beta-1 agonist that increases contractility and heart rate. A
heart rate increase to 122 bpm indicates significant tachycardia, which increases
myocardial oxygen demand and can precipitate ischemia in a failing heart. The priority
nursing intervention is to assess for signs of myocardial ischemia (chest pain) and
evaluate heart sounds for new murmurs or gallops that might indicate worsening
function. Option A is a provider order and outside nursing scope without contacting the
provider first. Option B is important but assessment comes first in the nursing process.
Option D is premature—tachycardia is an expected effect of dobutamine, and
discontinuation may worsen heart failure; the provider needs assessment data to titrate
,appropriately. Dobutamine can cause ventricular ectopy and increase infarct size if
ischemia is present, making clinical assessment critical before any rate change.
Q2: A client with acute decompensated heart failure is receiving nesiritide. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure decrease from 142/88 mmHg to 118/76 mmHg
B. Serum creatinine increase from 1.2 mg/dL to 1.5 mg/dL
C. Urine output increase from 30 mL/hr to 65 mL/hr
D. Dyspnea improvement from severe to mild with oxygen saturation 94%
Correct Answer: B
Rationale: Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation and natriuresis. However, it is associated with worsening renal function
and increased mortality risk in some studies. A creatinine increase of 0.3 mg/dL (25%
increase) indicates acute kidney injury and requires immediate intervention—potentially
discontinuing the drug and notifying the provider. Option A represents an expected
therapeutic effect (afterload reduction). Option C is a desired outcome (improved
perfusion and diuresis). Option D is the intended therapeutic effect. The nurse must
monitor renal function closely during nesiritide therapy as it can cause azotemia,
particularly in clients with baseline renal impairment or hypotension.
Q3: A client with an LVAD is admitted with suspected pump thrombosis. Which
assessment finding is most consistent with this complication?
A. Increased LVAD flow with decreased power consumption
,B. Decreased LVAD flow with increased power consumption
C. Normal LVAD flow with audible alarm for battery depletion
D. Increased LVAD flow with hemoglobin of 8.2 g/dL
Correct Answer: B
Rationale: LVAD pump thrombosis occurs when a clot forms in the pump, obstructing
flow. This causes the pump to work harder (increased power consumption) to maintain
output, but flow decreases due to the obstruction. Option A is physiologically
opposite—thrombosis increases resistance. Option C describes a power issue, not
thrombosis. Option D describes anemia with high flow, not thrombosis. Additional signs
of pump thrombosis include hemolysis (elevated LDH, plasma free hemoglobin,
decreased haptoglobin), new neurological deficits (embolic events), and heart failure
symptoms. This is a medical emergency requiring immediate anticoagulation
assessment, possible thrombolysis, or device exchange.
Q4: A client with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which anticoagulation
regimen is most appropriate for long-term stroke prevention?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Apixaban 5 mg twice daily
D. Clopidogrel 75 mg daily
Correct Answer: C
, Rationale: A CHA₂DS₂-VASc score of 4 indicates high stroke risk (approximately 4%
annual stroke risk), requiring oral anticoagulation, not antiplatelet therapy. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for non-valvular AF
due to lower bleeding risk, fewer drug interactions, and no monitoring requirements.
Option A (aspirin) is insufficient for this risk level. Option B (warfarin) is acceptable but
not preferred unless mechanical valve or moderate-severe mitral stenosis present.
Option D (clopidogrel) is inappropriate as monotherapy. Apixaban 5 mg BID is standard
dosing; reduce to 2.5 mg BID if two of the following: age ≥80, weight ≤60 kg, or
creatinine ≥1.5 mg/dL.
Q5: A client with new-onset atrial fibrillation (rate 142 bpm, BP 98/64 mmHg) is
hemodynamically unstable. Which intervention is the priority?
A. Administer metoprolol 5 mg IV push
B. Perform synchronized cardioversion at 100-200 joules
C. Administer amiodarone 150 mg IV over 10 minutes
D. Initiate heparin infusion for anticoagulation
Correct Answer: B
Rationale: Hemodynamic instability in AF (hypotension, acute heart failure, ongoing
ischemia, or altered mental status) requires immediate synchronized cardioversion to
restore sinus rhythm and hemodynamic stability. Delaying cardioversion for
medications risks clinical deterioration. Option A (beta-blocker) is contraindicated with
hypotension. Option C (amiodarone) is for stable patients or after cardioversion for
rhythm maintenance. Option D (anticoagulation) is important but does not address the
immediate hemodynamic compromise. Synchronized cardioversion (synchronized to
