HESI MED SURG III FINAL EXAM 2026/2027 | Verified Edition
Questions and Answers | Advanced Medical-Surgical
Nursing | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1-30)
Q1: Which physiologic mechanism primarily contributes to the development of left-sided
heart failure?
A. Increased pulmonary vascular resistance
B. Impaired contractility and increased afterload
C. Backflow of blood into the right atrium
D. Decreased systemic venous return
Correct Answer: B
Rationale: Evidence-based pathophysiology indicates left-sided heart failure is primarily
caused by impaired contractility (systolic dysfunction) or increased afterload, reducing
forward cardiac output; options A and C describe right-sided heart failure mechanisms,
while option D does not cause left ventricular failure.
Q2: A client with suspected acute coronary syndrome reports substernal chest pain
radiating to the left jaw. Which laboratory biomarker is the most specific indicator of
myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. High-sensitivity troponin I
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct Answer: B
Rationale: Current AHA guidelines identify high-sensitivity troponin as the most specific
and sensitive biomarker for myocardial necrosis, rising within hours of injury; CK-MB is
less specific as it can be found in skeletal muscle, BNP indicates heart failure, and CRP
measures inflammation.
Q3: The nurse is auscultating a client's heart sounds and hears a loud S1 and a
rumbling mid-diastolic murmur at the cardiac apex. Which valvular disorder should the
nurse suspect?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral regurgitation
D. Aortic stenosis
Correct Answer: B
,Rationale: A loud S1 and a mid-diastolic rumbling murmur at the apex are classic
auscultation findings for mitral stenosis due to turbulent blood flow across the narrowed
valve; aortic regurgitation causes a diastolic decrescendo murmur, mitral regurgitation
causes a holosystolic murmur, and aortic stenosis causes a harsh systolic
crescendo-decrescendo murmur.
Q4: A client with a temporary transvenous pacemaker has the following nursing
interventions documented. Which action should the nurse delegate to an unlicensed
assistive personnel (UAP)?
A. Assessing the insertion site for signs of infection
B. Ensuring the client remains on bed rest with affected leg straight
C. Reminding the client to call for assistance before moving
D. Monitoring the pacemaker spikes on the cardiac monitor
Correct Answer: C
Rationale: Reminding the client to call for assistance is within the scope of a UAP,
whereas assessing the insertion site, monitoring pacemaker spikes, and enforcing strict
bed rest requiring clinical judgment must be performed by licensed nursing personnel.
Q5: What is the primary purpose of prescribed direct oral anticoagulants (DOACs) in a
client diagnosed with atrial fibrillation?
A. Convert the atrial rhythm to normal sinus rhythm
B. Prevent thromboembolic events originating from the left atrium
C. Decrease the ventricular response rate
D. Increase myocardial oxygen supply
Correct Answer: B
Rationale: DOACs such as apixaban are prescribed for atrial fibrillation to prevent
stroke by inhibiting thrombin or factor Xa, thereby preventing clot formation in the left
atrial appendage; they do not convert rhythm (antiarrhythmics do), control rate
(beta-blockers do), or increase oxygen supply (nitrates do).
Q6: A nurse is providing discharge teaching to a client taking an ACE inhibitor for heart
failure. Which instruction is most important to include?
A. "Expect a persistent dry cough while taking this medication."
B. "Monitor your blood pressure daily and report dizziness."
C. "Increase your dietary intake of potassium-rich foods."
D. "Take the medication only when you experience shortness of breath."
Correct Answer: B
Rationale: ACE inhibitors cause vasodilation and can induce hypotension, making daily
blood pressure monitoring essential for safety; although a dry cough is a side effect, it
warrants reporting rather than just expectation, potassium-rich foods are contraindicated
due to hyperkalemia risk, and ACE inhibitors must be taken daily, not PRN.
,Q7: A client with chronic heart failure is experiencing acute decompensation with severe
dyspnea and pink frothy sputum. Which intervention should the nurse implement first?
A. Administer intravenous furosemide
B. Apply high-flow oxygen via non-rebreather mask
C. Place the client in high-Fowler's position with legs dangling
D. Obtain a 12-lead electrocardiogram
Correct Answer: C
Rationale: The immediate priority for acute pulmonary edema is to reduce venous return
(preload) to the heart, which is rapidly achieved by placing the client in high-Fowler's
with legs dangling; oxygen and furosemide are critical subsequent steps, but positioning
optimizes hemodynamics immediately before other interventions take effect.
Q8: A client presents to the emergency department with a 4-hour history of severe chest
pain unrelieved by rest. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Circumflex
C. Right coronary artery (RCA)
D. Left main
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is typically supplied by the right coronary artery; the LAD
supplies the anterior wall, the circumflex supplies the lateral wall, and left main
occlusion causes widespread anterior and lateral changes.
Q9: A client receiving intravenous nitroglycerin for chest pain reports a sudden, severe
headache. Which action should the nurse take?
A. Discontinue the nitroglycerin infusion immediately
B. Administer prescribed PRN acetaminophen
C. Decrease the infusion rate by 50%
D. Assess the client's blood pressure
Correct Answer: D
Rationale: Nitroglycerin causes vasodilation, and a severe headache, while a common
side effect, warrants assessing blood pressure first to rule out dangerous hypotension
before treating the pain or adjusting the rate; discontinuing the infusion is premature
without a hemodynamic assessment.
Q10: A client with supraventricular tachycardia (SVT) is stable but symptomatic with a
heart rate of 180 bpm. Which intervention is most appropriate based on current ACLS
guidelines?
A. Immediate synchronized cardioversion
, B. Administration of adenosine IV push
C. Initiation of transcutaneous pacing
D. Administration of atropine IV push
Correct Answer: B
Rationale: For stable supraventricular tachycardia, the first-line pharmacologic
intervention is adenosine to slow conduction through the AV node and restore sinus
rhythm; synchronized cardioversion is reserved for unstable patients, pacing is for
bradycardia, and atropine is contraindicated in tachycardia.
Q11: A client who had a mechanical mitral valve replacement 3 days ago is preparing
for discharge. Which statement by the client indicates a need for further teaching?
A. "I will need to take a blood thinner for the rest of my life."
B. "I should use a soft-bristled toothbrush from now on."
C. "I will need to take antibiotics before going to the dentist."
D. "I can stop taking my heart medication once my incision heals."
Correct Answer: D
Rationale: Clients with mechanical valves require lifelong anticoagulation, bleeding
precautions, and infective endocarditis prophylaxis before dental procedures, but they
never discontinue cardiac medications post-surgery simply because the incision heals,
as this indicates a critical misunderstanding of chronic disease management.
Q12: The nurse is reviewing the laboratory results of a client taking spironolactone for
heart failure. Which result requires immediate notification of the healthcare provider?
A. Potassium 5.8 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 1.8 mg/dL
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic, and a potassium level of 5.8
mEq/L indicates hyperkalemia, placing the client at high risk for fatal dysrhythmias and
requiring immediate intervention; sodium, calcium, and magnesium levels are within
normal limits.
Q13: A client is 48 hours post-myocardial infarction and suddenly develops a new, loud
holosystolic murmur radiating to the left axilla. Which complication should the nurse
suspect?
A. Ventricular aneurysm
B. Papillary muscle rupture
C. Pericarditis
D. Dressler's syndrome
Correct Answer: B
Questions and Answers | Advanced Medical-Surgical
Nursing | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1-30)
Q1: Which physiologic mechanism primarily contributes to the development of left-sided
heart failure?
A. Increased pulmonary vascular resistance
B. Impaired contractility and increased afterload
C. Backflow of blood into the right atrium
D. Decreased systemic venous return
Correct Answer: B
Rationale: Evidence-based pathophysiology indicates left-sided heart failure is primarily
caused by impaired contractility (systolic dysfunction) or increased afterload, reducing
forward cardiac output; options A and C describe right-sided heart failure mechanisms,
while option D does not cause left ventricular failure.
Q2: A client with suspected acute coronary syndrome reports substernal chest pain
radiating to the left jaw. Which laboratory biomarker is the most specific indicator of
myocardial infarction?
A. Creatine kinase-MB (CK-MB)
B. High-sensitivity troponin I
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct Answer: B
Rationale: Current AHA guidelines identify high-sensitivity troponin as the most specific
and sensitive biomarker for myocardial necrosis, rising within hours of injury; CK-MB is
less specific as it can be found in skeletal muscle, BNP indicates heart failure, and CRP
measures inflammation.
Q3: The nurse is auscultating a client's heart sounds and hears a loud S1 and a
rumbling mid-diastolic murmur at the cardiac apex. Which valvular disorder should the
nurse suspect?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral regurgitation
D. Aortic stenosis
Correct Answer: B
,Rationale: A loud S1 and a mid-diastolic rumbling murmur at the apex are classic
auscultation findings for mitral stenosis due to turbulent blood flow across the narrowed
valve; aortic regurgitation causes a diastolic decrescendo murmur, mitral regurgitation
causes a holosystolic murmur, and aortic stenosis causes a harsh systolic
crescendo-decrescendo murmur.
Q4: A client with a temporary transvenous pacemaker has the following nursing
interventions documented. Which action should the nurse delegate to an unlicensed
assistive personnel (UAP)?
A. Assessing the insertion site for signs of infection
B. Ensuring the client remains on bed rest with affected leg straight
C. Reminding the client to call for assistance before moving
D. Monitoring the pacemaker spikes on the cardiac monitor
Correct Answer: C
Rationale: Reminding the client to call for assistance is within the scope of a UAP,
whereas assessing the insertion site, monitoring pacemaker spikes, and enforcing strict
bed rest requiring clinical judgment must be performed by licensed nursing personnel.
Q5: What is the primary purpose of prescribed direct oral anticoagulants (DOACs) in a
client diagnosed with atrial fibrillation?
A. Convert the atrial rhythm to normal sinus rhythm
B. Prevent thromboembolic events originating from the left atrium
C. Decrease the ventricular response rate
D. Increase myocardial oxygen supply
Correct Answer: B
Rationale: DOACs such as apixaban are prescribed for atrial fibrillation to prevent
stroke by inhibiting thrombin or factor Xa, thereby preventing clot formation in the left
atrial appendage; they do not convert rhythm (antiarrhythmics do), control rate
(beta-blockers do), or increase oxygen supply (nitrates do).
Q6: A nurse is providing discharge teaching to a client taking an ACE inhibitor for heart
failure. Which instruction is most important to include?
A. "Expect a persistent dry cough while taking this medication."
B. "Monitor your blood pressure daily and report dizziness."
C. "Increase your dietary intake of potassium-rich foods."
D. "Take the medication only when you experience shortness of breath."
Correct Answer: B
Rationale: ACE inhibitors cause vasodilation and can induce hypotension, making daily
blood pressure monitoring essential for safety; although a dry cough is a side effect, it
warrants reporting rather than just expectation, potassium-rich foods are contraindicated
due to hyperkalemia risk, and ACE inhibitors must be taken daily, not PRN.
,Q7: A client with chronic heart failure is experiencing acute decompensation with severe
dyspnea and pink frothy sputum. Which intervention should the nurse implement first?
A. Administer intravenous furosemide
B. Apply high-flow oxygen via non-rebreather mask
C. Place the client in high-Fowler's position with legs dangling
D. Obtain a 12-lead electrocardiogram
Correct Answer: C
Rationale: The immediate priority for acute pulmonary edema is to reduce venous return
(preload) to the heart, which is rapidly achieved by placing the client in high-Fowler's
with legs dangling; oxygen and furosemide are critical subsequent steps, but positioning
optimizes hemodynamics immediately before other interventions take effect.
Q8: A client presents to the emergency department with a 4-hour history of severe chest
pain unrelieved by rest. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Circumflex
C. Right coronary artery (RCA)
D. Left main
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is typically supplied by the right coronary artery; the LAD
supplies the anterior wall, the circumflex supplies the lateral wall, and left main
occlusion causes widespread anterior and lateral changes.
Q9: A client receiving intravenous nitroglycerin for chest pain reports a sudden, severe
headache. Which action should the nurse take?
A. Discontinue the nitroglycerin infusion immediately
B. Administer prescribed PRN acetaminophen
C. Decrease the infusion rate by 50%
D. Assess the client's blood pressure
Correct Answer: D
Rationale: Nitroglycerin causes vasodilation, and a severe headache, while a common
side effect, warrants assessing blood pressure first to rule out dangerous hypotension
before treating the pain or adjusting the rate; discontinuing the infusion is premature
without a hemodynamic assessment.
Q10: A client with supraventricular tachycardia (SVT) is stable but symptomatic with a
heart rate of 180 bpm. Which intervention is most appropriate based on current ACLS
guidelines?
A. Immediate synchronized cardioversion
, B. Administration of adenosine IV push
C. Initiation of transcutaneous pacing
D. Administration of atropine IV push
Correct Answer: B
Rationale: For stable supraventricular tachycardia, the first-line pharmacologic
intervention is adenosine to slow conduction through the AV node and restore sinus
rhythm; synchronized cardioversion is reserved for unstable patients, pacing is for
bradycardia, and atropine is contraindicated in tachycardia.
Q11: A client who had a mechanical mitral valve replacement 3 days ago is preparing
for discharge. Which statement by the client indicates a need for further teaching?
A. "I will need to take a blood thinner for the rest of my life."
B. "I should use a soft-bristled toothbrush from now on."
C. "I will need to take antibiotics before going to the dentist."
D. "I can stop taking my heart medication once my incision heals."
Correct Answer: D
Rationale: Clients with mechanical valves require lifelong anticoagulation, bleeding
precautions, and infective endocarditis prophylaxis before dental procedures, but they
never discontinue cardiac medications post-surgery simply because the incision heals,
as this indicates a critical misunderstanding of chronic disease management.
Q12: The nurse is reviewing the laboratory results of a client taking spironolactone for
heart failure. Which result requires immediate notification of the healthcare provider?
A. Potassium 5.8 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 1.8 mg/dL
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic, and a potassium level of 5.8
mEq/L indicates hyperkalemia, placing the client at high risk for fatal dysrhythmias and
requiring immediate intervention; sodium, calcium, and magnesium levels are within
normal limits.
Q13: A client is 48 hours post-myocardial infarction and suddenly develops a new, loud
holosystolic murmur radiating to the left axilla. Which complication should the nurse
suspect?
A. Ventricular aneurysm
B. Papillary muscle rupture
C. Pericarditis
D. Dressler's syndrome
Correct Answer: B
