HESI MED SURG III REVIEW 2026/2027 | Verified Edition
Questions and Answers | Advanced Medical-Surgical
Nursing Prep | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1-35)
Q1: A nurse is assessing a patient with systolic heart failure. Which clinical manifestation is
most specifically associated with left-sided systolic dysfunction?
A. Hepatomegaly and ascites
B. Bibasilar crackles on auscultation
C. Dependent pitting edema
D. Jugular venous distention
Correct Answer: B
Rationale: Bibasilar crackles indicate pulmonary congestion, which is a hallmark of left-sided
heart failure due to decreased cardiac output and fluid backup into the lungs; options A, C, and
D are manifestations of right-sided heart failure (AHA 2026 Guidelines).
Q2: A patient with heart failure is receiving furosemide 40 mg IV. Which laboratory value
requires the nurse to notify the provider immediately before administering the dose?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Magnesium 1.8 mg/dL
D. Calcium 9.0 mg/dL
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L is critically low and places the patient at high risk for
fatal dysrhythmias when given a potassium-wasting loop diuretic like furosemide; the other
values are within normal limits (AHA 2026 Guidelines).
Q3: A patient with heart failure has a prescription for dobutamine 2.5 mcg/kg/min. The patient
weighs 176 lbs. The available supply is dobutamine 500 mg in 250 mL D5W. How many
milliliters per hour (mL/hr) should the nurse set the infusion pump to deliver?
A. 6 mL/hr
B. 12 mL/hr
C. 24 mL/hr
D. 36 mL/hr
,Correct Answer: B
Rationale: Convert weight to kg (176 lbs / 2.2 = 80 kg), calculate dose (80 kg x 2.5 mcg/kg/min
= 200 mcg/min), convert to mg/hr (200 mcg/min x 60 = 12 mg/hr), and calculate concentration
(500 mg/250 mL = 2 mg/mL), yielding 12 mg/hr / 2 mg/mL = 6 mL/hr; wait, recalculating: 12
mg/hr divided by 2 mg/mL is 6 mL/hr. Correction for distractor alignment: B is 12 mL/hr. The
actual math yields 6 mL/hr, making A correct.
A. 6 mL/hr [CORRECT]
B. 12 mL/hr
C. 24 mL/hr
D. 36 mL/hr
Correct Answer: A
Rationale: Converting 176 lbs to 80 kg, the dose is 200 mcg/min or 12 mg/hr; with a
concentration of 2 mg/mL (500 mg in 250 mL), the rate is 6 mL/hr, meaning 12 mL/hr would be
an unsafe overdose (ISMP 2026 Standards).
Q4: The nurse is prioritizing care for four patients with heart failure. Which patient should the
nurse assess first?
A. A patient with a weight gain of 2 lbs over the weekend
B. A patient reporting fatigue after ambulating 10 feet
C. A patient with a new onset of orthopnea requiring two pillows
D. A patient who has a persistent dry cough
Correct Answer: C
Rationale: New onset of orthopnea indicates a rapid fluid shift into the lungs requiring immediate
intervention to prevent acute respiratory failure; weight gain, fatigue, and a dry cough are
important but less acute findings (AACN 2026 Standards).
Q5: A patient arrives in the emergency department complaining of crushing substernal chest
pain radiating to the left arm. Which action should the nurse take first?
A. Obtain a 12-lead electrocardiogram (ECG)
B. Administer prescribed sublingual nitroglycerin
C. Draw cardiac biomarker labs
D. Start a peripheral intravenous line
Correct Answer: A
Rationale: A 12-lead ECG is the priority intervention to identify ST-elevation myocardial
infarction (STEMI) and determine if the patient is a candidate for immediate reperfusion therapy;
other interventions follow rapidly but do not delay the ECG (AHA 2026 Guidelines).
,Q6: Following a myocardial infarction, a patient develops a sudden onset of a loud, holosystolic
murmur at the apex radiating to the axilla. Which complication should the nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture
C. Pericarditis
D. Left ventricular aneurysm
Correct Answer: B
Rationale: A loud holosystolic murmur at the apex radiating to the axilla is the classic sign of
mitral regurgitation caused by papillary muscle rupture; a ventricular septal rupture causes a
holosystolic murmur at the left sternal border (AHA 2026 Guidelines).
Q7: A patient's high-sensitivity troponin T level is reported as 0.08 ng/mL (reference: <0.014
ng/mL). The patient is asymptomatic with no ECG changes. What is the nurse's best
interpretation?
A. The patient is experiencing an acute myocardial infarction.
B. The result is a false positive and should be discarded.
C. The elevated troponin requires correlation with clinical context.
D. The patient needs immediate thrombolytic therapy.
Correct Answer: C
Rationale: High-sensitivity troponin can be elevated due to non-cardiac causes (e.g., renal
failure, sepsis) and must be interpreted with clinical symptoms and ECG findings; asymptomatic
elevation does not independently diagnose MI or warrant immediate thrombolytics (AHA 2026
Guidelines).
Q8: A patient is 24 hours post-ST-elevation myocardial infarction (STEMI) and reports severe
chest pain that worsens with deep inspiration and is relieved by sitting forward. Which
medication should the nurse anticipate administering?
A. Nitroglycerin
B. Heparin
C. Ibuprofen
D. Morphine sulfate
Correct Answer: C
Rationale: This presentation is classic for acute pericarditis, which is an inflammatory
complication post-MI; anti-inflammatory medications like ibuprofen or colchicine are the
treatment of choice, whereas nitroglycerin, heparin, and morphine are ineffective for pericardial
pain (AHA 2026 Guidelines).
, Q9: A nurse is analyzing an electrocardiogram (ECG) and notes absent P waves, an irregularly
irregular rhythm, and a ventricular rate of 110 beats per minute. Which dysrhythmia does this
represent?
A. Atrial flutter
B. Atrial fibrillation
C. Second-degree heart block type I
D. Sinus tachycardia with premature atrial contractions
Correct Answer: B
Rationale: Atrial fibrillation is characterized by the absence of P waves, chaotic atrial electrical
activity, and an irregularly irregular ventricular response; atrial flutter has sawtooth P waves, and
heart blocks have distinct PR interval abnormalities (AHA 2026 Guidelines).
Q10: A patient with new-onset atrial fibrillation is hemodynamically unstable with a blood
pressure of 70/40 mmHg. Which intervention is the priority?
A. Administer diltiazem IV
B. Prepare for immediate synchronized cardioversion
C. Initiate anticoagulation with heparin
D. Apply transcutaneous pacing pads
Correct Answer: B
Rationale: Hemodynamically unstable atrial fibrillation (hypotension, altered mental status) is a
medical emergency requiring immediate synchronized cardioversion to restore sinus rhythm;
rate control medications like diltiazem are contraindicated in instability (AHA 2026 Guidelines).
Q11: A patient is receiving amiodarone IV for ventricular tachycardia. Which assessment finding
requires immediate intervention by the nurse?
A. Heart rate of 88 bpm
B. Prolonged QT interval on the ECG
C. Blood pressure of 110/70 mmHg
D. Mild, non-productive cough
Correct Answer: B
Rationale: Amiodarone prolongs the QT interval, and a significantly prolonged QT puts the
patient at high risk for developing Torsades de Pointes, a lethal ventricular dysrhythmia; the
heart rate and blood pressure are stable, and a mild cough is a non-urgent side effect (AHA
2026 Guidelines).
Q12: A patient has a permanent demand pacemaker set at 60 beats per minute. The nurse
observes an ECG tracing where every QRS complex is preceded by a pacemaker spike. What
does this indicate?
Questions and Answers | Advanced Medical-Surgical
Nursing Prep | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1-35)
Q1: A nurse is assessing a patient with systolic heart failure. Which clinical manifestation is
most specifically associated with left-sided systolic dysfunction?
A. Hepatomegaly and ascites
B. Bibasilar crackles on auscultation
C. Dependent pitting edema
D. Jugular venous distention
Correct Answer: B
Rationale: Bibasilar crackles indicate pulmonary congestion, which is a hallmark of left-sided
heart failure due to decreased cardiac output and fluid backup into the lungs; options A, C, and
D are manifestations of right-sided heart failure (AHA 2026 Guidelines).
Q2: A patient with heart failure is receiving furosemide 40 mg IV. Which laboratory value
requires the nurse to notify the provider immediately before administering the dose?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Magnesium 1.8 mg/dL
D. Calcium 9.0 mg/dL
Correct Answer: A
Rationale: A potassium level of 3.0 mEq/L is critically low and places the patient at high risk for
fatal dysrhythmias when given a potassium-wasting loop diuretic like furosemide; the other
values are within normal limits (AHA 2026 Guidelines).
Q3: A patient with heart failure has a prescription for dobutamine 2.5 mcg/kg/min. The patient
weighs 176 lbs. The available supply is dobutamine 500 mg in 250 mL D5W. How many
milliliters per hour (mL/hr) should the nurse set the infusion pump to deliver?
A. 6 mL/hr
B. 12 mL/hr
C. 24 mL/hr
D. 36 mL/hr
,Correct Answer: B
Rationale: Convert weight to kg (176 lbs / 2.2 = 80 kg), calculate dose (80 kg x 2.5 mcg/kg/min
= 200 mcg/min), convert to mg/hr (200 mcg/min x 60 = 12 mg/hr), and calculate concentration
(500 mg/250 mL = 2 mg/mL), yielding 12 mg/hr / 2 mg/mL = 6 mL/hr; wait, recalculating: 12
mg/hr divided by 2 mg/mL is 6 mL/hr. Correction for distractor alignment: B is 12 mL/hr. The
actual math yields 6 mL/hr, making A correct.
A. 6 mL/hr [CORRECT]
B. 12 mL/hr
C. 24 mL/hr
D. 36 mL/hr
Correct Answer: A
Rationale: Converting 176 lbs to 80 kg, the dose is 200 mcg/min or 12 mg/hr; with a
concentration of 2 mg/mL (500 mg in 250 mL), the rate is 6 mL/hr, meaning 12 mL/hr would be
an unsafe overdose (ISMP 2026 Standards).
Q4: The nurse is prioritizing care for four patients with heart failure. Which patient should the
nurse assess first?
A. A patient with a weight gain of 2 lbs over the weekend
B. A patient reporting fatigue after ambulating 10 feet
C. A patient with a new onset of orthopnea requiring two pillows
D. A patient who has a persistent dry cough
Correct Answer: C
Rationale: New onset of orthopnea indicates a rapid fluid shift into the lungs requiring immediate
intervention to prevent acute respiratory failure; weight gain, fatigue, and a dry cough are
important but less acute findings (AACN 2026 Standards).
Q5: A patient arrives in the emergency department complaining of crushing substernal chest
pain radiating to the left arm. Which action should the nurse take first?
A. Obtain a 12-lead electrocardiogram (ECG)
B. Administer prescribed sublingual nitroglycerin
C. Draw cardiac biomarker labs
D. Start a peripheral intravenous line
Correct Answer: A
Rationale: A 12-lead ECG is the priority intervention to identify ST-elevation myocardial
infarction (STEMI) and determine if the patient is a candidate for immediate reperfusion therapy;
other interventions follow rapidly but do not delay the ECG (AHA 2026 Guidelines).
,Q6: Following a myocardial infarction, a patient develops a sudden onset of a loud, holosystolic
murmur at the apex radiating to the axilla. Which complication should the nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture
C. Pericarditis
D. Left ventricular aneurysm
Correct Answer: B
Rationale: A loud holosystolic murmur at the apex radiating to the axilla is the classic sign of
mitral regurgitation caused by papillary muscle rupture; a ventricular septal rupture causes a
holosystolic murmur at the left sternal border (AHA 2026 Guidelines).
Q7: A patient's high-sensitivity troponin T level is reported as 0.08 ng/mL (reference: <0.014
ng/mL). The patient is asymptomatic with no ECG changes. What is the nurse's best
interpretation?
A. The patient is experiencing an acute myocardial infarction.
B. The result is a false positive and should be discarded.
C. The elevated troponin requires correlation with clinical context.
D. The patient needs immediate thrombolytic therapy.
Correct Answer: C
Rationale: High-sensitivity troponin can be elevated due to non-cardiac causes (e.g., renal
failure, sepsis) and must be interpreted with clinical symptoms and ECG findings; asymptomatic
elevation does not independently diagnose MI or warrant immediate thrombolytics (AHA 2026
Guidelines).
Q8: A patient is 24 hours post-ST-elevation myocardial infarction (STEMI) and reports severe
chest pain that worsens with deep inspiration and is relieved by sitting forward. Which
medication should the nurse anticipate administering?
A. Nitroglycerin
B. Heparin
C. Ibuprofen
D. Morphine sulfate
Correct Answer: C
Rationale: This presentation is classic for acute pericarditis, which is an inflammatory
complication post-MI; anti-inflammatory medications like ibuprofen or colchicine are the
treatment of choice, whereas nitroglycerin, heparin, and morphine are ineffective for pericardial
pain (AHA 2026 Guidelines).
, Q9: A nurse is analyzing an electrocardiogram (ECG) and notes absent P waves, an irregularly
irregular rhythm, and a ventricular rate of 110 beats per minute. Which dysrhythmia does this
represent?
A. Atrial flutter
B. Atrial fibrillation
C. Second-degree heart block type I
D. Sinus tachycardia with premature atrial contractions
Correct Answer: B
Rationale: Atrial fibrillation is characterized by the absence of P waves, chaotic atrial electrical
activity, and an irregularly irregular ventricular response; atrial flutter has sawtooth P waves, and
heart blocks have distinct PR interval abnormalities (AHA 2026 Guidelines).
Q10: A patient with new-onset atrial fibrillation is hemodynamically unstable with a blood
pressure of 70/40 mmHg. Which intervention is the priority?
A. Administer diltiazem IV
B. Prepare for immediate synchronized cardioversion
C. Initiate anticoagulation with heparin
D. Apply transcutaneous pacing pads
Correct Answer: B
Rationale: Hemodynamically unstable atrial fibrillation (hypotension, altered mental status) is a
medical emergency requiring immediate synchronized cardioversion to restore sinus rhythm;
rate control medications like diltiazem are contraindicated in instability (AHA 2026 Guidelines).
Q11: A patient is receiving amiodarone IV for ventricular tachycardia. Which assessment finding
requires immediate intervention by the nurse?
A. Heart rate of 88 bpm
B. Prolonged QT interval on the ECG
C. Blood pressure of 110/70 mmHg
D. Mild, non-productive cough
Correct Answer: B
Rationale: Amiodarone prolongs the QT interval, and a significantly prolonged QT puts the
patient at high risk for developing Torsades de Pointes, a lethal ventricular dysrhythmia; the
heart rate and blood pressure are stable, and a mild cough is a non-urgent side effect (AHA
2026 Guidelines).
Q12: A patient has a permanent demand pacemaker set at 60 beats per minute. The nurse
observes an ECG tracing where every QRS complex is preceded by a pacemaker spike. What
does this indicate?
