HESI MED-SURG III FINAL EXAM 2026/2027 | High
Acuity & Critical Care Questions and Verified Answers
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (25 Questions)
Q1. A 68-year-old male with HFrEF (LVEF 30%) presents with
worsening dyspnea, 4+ pitting edema to thighs, and weight gain of 8
lbs in 5 days. Current medications include carvedilol 25mg BID,
sacubitril/valsartan 97/103mg BID, spironolactone 25mg daily, and
dapagliflozin 10mg daily. He reports taking his medications as
prescribed. Vital signs: BP 98/62 mmHg, HR 88 bpm, RR 24, SpO2
89% on 2L NC. The nurse hears bilateral crackles throughout all lung
fields. Which medication adjustment should the nurse anticipate
FIRST?
A. Increase carvedilol to 25mg TID for better rate control
B. Initiate furosemide 40mg IV push for acute decongestion
C. Hold dapagliflozin due to hypotension risk
D. Increase spironolactone to 50mg daily for additional diuresis
Correct Answer: B. Initiate furosemide 40mg IV push for acute
decongestion [CORRECT]
Rationale: This patient is presenting with acute decompensated
heart failure (ADHF) with volume overload, pulmonary edema, and
hypoxemia. Per 2026 ACC/AHA Heart Failure Guidelines, loop
,diuretics (IV furosemide) are first-line therapy for acute decongestion
in ADHF. Option A is incorrect—increasing beta-blockers during acute
decompensation can worsen heart failure and is contraindicated.
Option C is incorrect—SGLT2 inhibitors should be continued during
hospitalization unless contraindicated (eGFR <20, DKA). Option D is
incorrect—spironolactone provides only mild diuresis and is not
effective for acute volume overload.
Q2. A 55-year-old female presents to the ED with crushing substernal
chest pain radiating to her left arm for 45 minutes. 12-lead ECG
shows ST elevation in leads V1-V4 with reciprocal changes in II, III,
aVF. The cardiac catheterization lab is being activated. The nurse
receives an order for "MONA" therapy. Which medication should be
administered FIRST per current STEMI protocol?
A. Morphine 4mg IV push for pain
B. Oxygen 4L via NC to maintain SpO2 >94%
C. Aspirin 324mg chewed immediately
D. Nitroglycerin 0.4mg sublingual
Correct Answer: C. Aspirin 324mg chewed immediately [CORRECT]
Rationale: This patient has an anterior wall STEMI requiring
immediate reperfusion therapy. Per 2026 AHA Guidelines, aspirin
162-325mg (chewed for rapid absorption) is the FIRST medication to
administer for all suspected ACS/STEMI patients to inhibit platelet
aggregation via irreversible COX-1 inhibition. Option A is incorrect—
morphine is no longer routine and is associated with increased
mortality in STEMI. Option B is incorrect—oxygen should only be
,given if SpO2 <90% or signs of hypoxemia; hyperoxia causes
vasoconstriction and increased mortality. Option D is incorrect—
while nitroglycerin is appropriate, aspirin takes priority for its
antiplatelet effect.
Q3. A 72-year-old male with a history of atrial fibrillation presents
with confusion, nausea, and yellow-green halos in his vision. His
home medications include metoprolol 50mg BID and digoxin 0.25mg
daily. He was recently started on clarithromycin for pneumonia. Vital
signs: BP 110/68 mmHg, HR 52 bpm (irregularly irregular), RR 18.
Laboratory results: Potassium 3.2 mEq/L, Creatinine 1.8 mg/dL
(baseline 1.2), Digoxin level 3.2 ng/mL (therapeutic 0.5-2.0). Which
nursing intervention is the priority?
A. Administer IV potassium chloride to correct hypokalemia
B. Prepare for synchronized cardioversion
C. Hold digoxin and obtain order for digoxin immune fab (Digibind)
D. Administer atropine 0.5mg IV for symptomatic bradycardia
Correct Answer: C. Hold digoxin and obtain order for digoxin immune
fab (Digibind) [CORRECT]
Rationale: This patient has digoxin toxicity (level 3.2 ng/mL with
clinical manifestations: visual disturbances, bradycardia, nausea,
confusion) precipitated by renal impairment and macrolide antibiotic
interaction. Digoxin immune fab (Digibind) is the antidote for life-
threatening digoxin toxicity. Option A is incorrect—while
hypokalemia potentiates toxicity, potassium administration is
dangerous in this bradycardic patient and could worsen cardiac
, conduction abnormalities. Option B is incorrect—cardioversion is not
indicated for chronic atrial fibrillation with controlled rate. Option D
is incorrect—atropine may temporarily increase heart rate but does
not address the underlying toxicity.
Q4. A 64-year-old female with mitral regurgitation presents with
progressive dyspnea and fatigue. On auscultation, the nurse notes a
holosystolic murmur heard best at the cardiac apex radiating to the
axilla. Echocardiography shows severe mitral regurgitation with LVEF
60% and left atrial enlargement. Which pathophysiological
mechanism explains why this patient remains asymptomatic for
years before developing symptoms?
A. The left atrium is highly compliant and accommodates volume
overload without pressure increase
B. Regurgitant volume is limited by the mitral valve orifice size
regardless of left ventricular function
C. Afterload reduction occurs automatically due to backward flow
into the left atrium
D. The left ventricle hypertrophies to maintain cardiac output despite
regurgitation
Correct Answer: A. The left atrium is highly compliant and
accommodates volume overload without pressure increase
[CORRECT]
Rationale: In chronic mitral regurgitation, the left atrium
progressively dilates (compliance increases) to accommodate
regurgitant volume without significant pressure elevation, allowing
Acuity & Critical Care Questions and Verified Answers
| Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (25 Questions)
Q1. A 68-year-old male with HFrEF (LVEF 30%) presents with
worsening dyspnea, 4+ pitting edema to thighs, and weight gain of 8
lbs in 5 days. Current medications include carvedilol 25mg BID,
sacubitril/valsartan 97/103mg BID, spironolactone 25mg daily, and
dapagliflozin 10mg daily. He reports taking his medications as
prescribed. Vital signs: BP 98/62 mmHg, HR 88 bpm, RR 24, SpO2
89% on 2L NC. The nurse hears bilateral crackles throughout all lung
fields. Which medication adjustment should the nurse anticipate
FIRST?
A. Increase carvedilol to 25mg TID for better rate control
B. Initiate furosemide 40mg IV push for acute decongestion
C. Hold dapagliflozin due to hypotension risk
D. Increase spironolactone to 50mg daily for additional diuresis
Correct Answer: B. Initiate furosemide 40mg IV push for acute
decongestion [CORRECT]
Rationale: This patient is presenting with acute decompensated
heart failure (ADHF) with volume overload, pulmonary edema, and
hypoxemia. Per 2026 ACC/AHA Heart Failure Guidelines, loop
,diuretics (IV furosemide) are first-line therapy for acute decongestion
in ADHF. Option A is incorrect—increasing beta-blockers during acute
decompensation can worsen heart failure and is contraindicated.
Option C is incorrect—SGLT2 inhibitors should be continued during
hospitalization unless contraindicated (eGFR <20, DKA). Option D is
incorrect—spironolactone provides only mild diuresis and is not
effective for acute volume overload.
Q2. A 55-year-old female presents to the ED with crushing substernal
chest pain radiating to her left arm for 45 minutes. 12-lead ECG
shows ST elevation in leads V1-V4 with reciprocal changes in II, III,
aVF. The cardiac catheterization lab is being activated. The nurse
receives an order for "MONA" therapy. Which medication should be
administered FIRST per current STEMI protocol?
A. Morphine 4mg IV push for pain
B. Oxygen 4L via NC to maintain SpO2 >94%
C. Aspirin 324mg chewed immediately
D. Nitroglycerin 0.4mg sublingual
Correct Answer: C. Aspirin 324mg chewed immediately [CORRECT]
Rationale: This patient has an anterior wall STEMI requiring
immediate reperfusion therapy. Per 2026 AHA Guidelines, aspirin
162-325mg (chewed for rapid absorption) is the FIRST medication to
administer for all suspected ACS/STEMI patients to inhibit platelet
aggregation via irreversible COX-1 inhibition. Option A is incorrect—
morphine is no longer routine and is associated with increased
mortality in STEMI. Option B is incorrect—oxygen should only be
,given if SpO2 <90% or signs of hypoxemia; hyperoxia causes
vasoconstriction and increased mortality. Option D is incorrect—
while nitroglycerin is appropriate, aspirin takes priority for its
antiplatelet effect.
Q3. A 72-year-old male with a history of atrial fibrillation presents
with confusion, nausea, and yellow-green halos in his vision. His
home medications include metoprolol 50mg BID and digoxin 0.25mg
daily. He was recently started on clarithromycin for pneumonia. Vital
signs: BP 110/68 mmHg, HR 52 bpm (irregularly irregular), RR 18.
Laboratory results: Potassium 3.2 mEq/L, Creatinine 1.8 mg/dL
(baseline 1.2), Digoxin level 3.2 ng/mL (therapeutic 0.5-2.0). Which
nursing intervention is the priority?
A. Administer IV potassium chloride to correct hypokalemia
B. Prepare for synchronized cardioversion
C. Hold digoxin and obtain order for digoxin immune fab (Digibind)
D. Administer atropine 0.5mg IV for symptomatic bradycardia
Correct Answer: C. Hold digoxin and obtain order for digoxin immune
fab (Digibind) [CORRECT]
Rationale: This patient has digoxin toxicity (level 3.2 ng/mL with
clinical manifestations: visual disturbances, bradycardia, nausea,
confusion) precipitated by renal impairment and macrolide antibiotic
interaction. Digoxin immune fab (Digibind) is the antidote for life-
threatening digoxin toxicity. Option A is incorrect—while
hypokalemia potentiates toxicity, potassium administration is
dangerous in this bradycardic patient and could worsen cardiac
, conduction abnormalities. Option B is incorrect—cardioversion is not
indicated for chronic atrial fibrillation with controlled rate. Option D
is incorrect—atropine may temporarily increase heart rate but does
not address the underlying toxicity.
Q4. A 64-year-old female with mitral regurgitation presents with
progressive dyspnea and fatigue. On auscultation, the nurse notes a
holosystolic murmur heard best at the cardiac apex radiating to the
axilla. Echocardiography shows severe mitral regurgitation with LVEF
60% and left atrial enlargement. Which pathophysiological
mechanism explains why this patient remains asymptomatic for
years before developing symptoms?
A. The left atrium is highly compliant and accommodates volume
overload without pressure increase
B. Regurgitant volume is limited by the mitral valve orifice size
regardless of left ventricular function
C. Afterload reduction occurs automatically due to backward flow
into the left atrium
D. The left ventricle hypertrophies to maintain cardiac output despite
regurgitation
Correct Answer: A. The left atrium is highly compliant and
accommodates volume overload without pressure increase
[CORRECT]
Rationale: In chronic mitral regurgitation, the left atrium
progressively dilates (compliance increases) to accommodate
regurgitant volume without significant pressure elevation, allowing
