HESI MED SURG III FINAL EXAM STUDY GUIDE 2026/2027 |
Verified Edition Questions and Answers | Advanced
Medical-Surgical Nursing Prep | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Disorders (Questions 1-45)
Q1: A patient with acute decompensated heart failure reports worsening dyspnea. Which finding
indicates that the prescribed guideline-directed medical therapy (GDMT) is effective?
A. Weight gain of 2 lbs overnight
B. Increased jugular venous distension
C. Daily weight decrease of 0.5 to 1 kg [CORRECT]
D. BNP level increased from 400 to 800 pg/mL
Correct Answer: C
Rationale: GDMT for HF aims to reduce fluid overload, evidenced by a safe daily weight loss of
0.5 to 1 kg. Weight gain and JVD indicate worsening fluid congestion. BNP levels should
decrease with effective treatment. STUDY TIP: "Weight dictates fluid fate" in HF management.
Q2: A nurse is assessing a patient with chronic heart failure who is taking sacubitril/valsartan.
Which instruction is most critical to include in the discharge teaching?
A. Avoid potassium-rich foods
B. Do not take within 36 hours of an ACE inhibitor [CORRECT]
C. Take the medication on an empty stomach
D. Expect a persistent dry cough
Correct Answer: B
Rationale: Sacubitril/valsartan is an ARNI; combining it with an ACE inhibitor can cause severe
angioedema due to bradykinin potentiation. A 36-hour washout period is required. It does not
cause a dry cough (ACE inhibitors do) and can be taken with food. STUDY TIP: "A-N-R-I needs
36 hours to clear the A-C-E."
Q3: A patient with coronary artery disease is scheduled for a percutaneous coronary
intervention (PCI). Which post-procedure assessment requires immediate notification of the
provider?
,A. Pedal pulse 2+ bilaterally
B. Presence of a palpable hematoma at the access site
C. New onset of ST-segment elevation on the cardiac monitor [CORRECT]
D. Report of mild discomfort at the groin access site
Correct Answer: C
Rationale: New ST-segment elevation indicates acute vessel closure, a life-threatening
complication of PCI requiring immediate intervention like repeat catheterization. A small
hematoma and mild site discomfort are common. STUDY TIP: "ST elevation post-PCI equals
emergency."
Q4: Which risk factor for coronary artery disease is classified as non-modifiable?
A. Hyperlipidemia
B. Type 2 diabetes mellitus
C. Family history of premature CAD [CORRECT]
D. Sedentary lifestyle
Correct Answer: C
Rationale: Family history of premature CAD (in a first-degree male relative <55 years or female
relative <65 years) cannot be changed. Hyperlipidemia, diabetes, and physical inactivity are
modifiable risk factors. STUDY TIP: "You can't change your genes, but you can change your
jeans (waistline)."
Q5: A nurse is evaluating the diagnostic results of a patient reporting chest pain. Which
laboratory biomarker is most specific for myocardial infarction?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. High-sensitivity troponin [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
Rationale: High-sensitivity troponin is the gold standard biomarker for myocardial infarction due
to its high cardiac specificity and rapid elevation. Myoglobin rises early but is not
cardiac-specific. STUDY TIP: "Troponin is the Tower of Power for cardiac specificity."
Q6: A patient on telemetry has a regular rhythm with a rate of 150 bpm, absent P waves, and
narrow QRS complexes. Which intervention is the priority?
A. Perform synchronized cardioversion
B. Administer adenosine IV push [CORRECT]
C. Initiate transcutaneous pacing
,D. Defibrillate at 200 Joules
Correct Answer: B
Rationale: This rhythm is supraventricular tachycardia (SVT). Unstable patients get
cardioversion, but if stable, the first-line treatment is adenosine to slow conduction through the
AV node and terminate the rhythm. Pacing is for bradycardia; defibrillation is for pulseless
VT/VF. STUDY TIP: "Adenosine is the 'pause button' for stable SVT."
Q7: A patient with atrial fibrillation is prescribed dabigatran. Which statement by the patient
indicates a need for further teaching?
A. "I will swallow the capsule whole."
B. "I can open the capsule and mix it with applesauce if needed." [CORRECT]
C. "I will keep the medication in the original bottle."
D. "I will notify my doctor if I have any severe bleeding."
Correct Answer: B
Rationale: Dabigatran capsules must be swallowed whole; opening them increases the risk of
fatal bleeding by enhancing systemic absorption. The drug is also highly moisture-sensitive and
must be kept in its original bottle. STUDY TIP: "Dabigatran demands a dry, intact capsule."
Q8: A patient with a permanent pacemaker is scheduled for an MRI. Which action is most
important for the nurse to take?
A. Confirm the pacemaker is MRI-conditional [CORRECT]
B. Turn off the pacemaker before the scan
C. Apply a magnet over the pacemaker site during the scan
D. Remove the pacemaker generator prior to the MRI suite
Correct Answer: A
Rationale: Only MRI-conditional pacemakers can safely undergo an MRI. Turning off a pacer is
dangerous if the patient is pacer-dependent. Magnets can alter pacing modes unpredictably in
modern devices. STUDY TIP: "Condition is the condition for MRI."
Q9: A nurse is caring for a patient who just had an implantable cardioverter-defibrillator (ICD)
placed. Which discharge instruction is essential?
A. Avoid lifting the left arm above the shoulder for 4 to 6 weeks [CORRECT]
B. Do not use a microwave oven in the home
C. Keep the incision site dry for 48 hours
D. Expect mild palpitations when the device fires
Correct Answer: A
, Rationale: To prevent lead displacement, patients should avoid lifting the arm ipsilateral to the
ICD above shoulder level for 4 to 6 weeks. Microwave ovens are safe. The site must be kept
clean and dry longer than 48 hours. STUDY TIP: "Arm down to keep the lead around."
Q10: A patient is undergoing catheter ablation for atrial fibrillation. What post-procedure
complication should the nurse monitor for specifically related to left-sided ablations?
A. Pulmonary vein stenosis
B. Left atrial esophageal fistula [CORRECT]
C. Right bundle branch block
D. Tricuspid regurgitation
Correct Answer: B
Rationale: Left atrial ablation carries a rare but fatal risk of atrioesophageal fistula due to the
proximity of the left atrium to the esophagus. Symptoms include sudden fever, dysphagia, and
neurological deficits. STUDY TIP: "Left Atrium lies next to the Esophagus (LE)."
Q11: A patient with severe aortic stenosis develops syncope. What does this symptom indicate
about the disease process?
A. The stenosis is mild and asymptomatic
B. Left ventricular hypertrophy has compensated
C. The stenosis is critical and carries a poor prognosis [CORRECT]
D. The patient has developed right-sided heart failure
Correct Answer: C
Rationale: The classic triad of aortic stenosis is syncope, angina, and dyspnea on exertion.
Syncope indicates critical, severe AS and is a harbinger of sudden cardiac death if the valve is
not replaced. STUDY TIP: "Syncope in AS = Surgical emergency."
Q12: An 82-year-old patient with severe symptomatic aortic stenosis is deemed high risk for
open-heart surgery. Which procedure will the nurse prepare the patient for?
A. Medical management with beta-blockers only
B. Balloon valvuloplasty
C. Transcatheter aortic valve replacement (TAVR) [CORRECT]
D. Mechanical valve replacement
Correct Answer: C
Rationale: TAVR is the standard of care for severe aortic stenosis in patients who are
intermediate or high risk for surgical aortic valve replacement (SAVR). Balloon valvuloplasty is
only a temporary bridge. STUDY TIP: "TAVR for the elderly, SAVR for the sturdy."
Verified Edition Questions and Answers | Advanced
Medical-Surgical Nursing Prep | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Disorders (Questions 1-45)
Q1: A patient with acute decompensated heart failure reports worsening dyspnea. Which finding
indicates that the prescribed guideline-directed medical therapy (GDMT) is effective?
A. Weight gain of 2 lbs overnight
B. Increased jugular venous distension
C. Daily weight decrease of 0.5 to 1 kg [CORRECT]
D. BNP level increased from 400 to 800 pg/mL
Correct Answer: C
Rationale: GDMT for HF aims to reduce fluid overload, evidenced by a safe daily weight loss of
0.5 to 1 kg. Weight gain and JVD indicate worsening fluid congestion. BNP levels should
decrease with effective treatment. STUDY TIP: "Weight dictates fluid fate" in HF management.
Q2: A nurse is assessing a patient with chronic heart failure who is taking sacubitril/valsartan.
Which instruction is most critical to include in the discharge teaching?
A. Avoid potassium-rich foods
B. Do not take within 36 hours of an ACE inhibitor [CORRECT]
C. Take the medication on an empty stomach
D. Expect a persistent dry cough
Correct Answer: B
Rationale: Sacubitril/valsartan is an ARNI; combining it with an ACE inhibitor can cause severe
angioedema due to bradykinin potentiation. A 36-hour washout period is required. It does not
cause a dry cough (ACE inhibitors do) and can be taken with food. STUDY TIP: "A-N-R-I needs
36 hours to clear the A-C-E."
Q3: A patient with coronary artery disease is scheduled for a percutaneous coronary
intervention (PCI). Which post-procedure assessment requires immediate notification of the
provider?
,A. Pedal pulse 2+ bilaterally
B. Presence of a palpable hematoma at the access site
C. New onset of ST-segment elevation on the cardiac monitor [CORRECT]
D. Report of mild discomfort at the groin access site
Correct Answer: C
Rationale: New ST-segment elevation indicates acute vessel closure, a life-threatening
complication of PCI requiring immediate intervention like repeat catheterization. A small
hematoma and mild site discomfort are common. STUDY TIP: "ST elevation post-PCI equals
emergency."
Q4: Which risk factor for coronary artery disease is classified as non-modifiable?
A. Hyperlipidemia
B. Type 2 diabetes mellitus
C. Family history of premature CAD [CORRECT]
D. Sedentary lifestyle
Correct Answer: C
Rationale: Family history of premature CAD (in a first-degree male relative <55 years or female
relative <65 years) cannot be changed. Hyperlipidemia, diabetes, and physical inactivity are
modifiable risk factors. STUDY TIP: "You can't change your genes, but you can change your
jeans (waistline)."
Q5: A nurse is evaluating the diagnostic results of a patient reporting chest pain. Which
laboratory biomarker is most specific for myocardial infarction?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. High-sensitivity troponin [CORRECT]
D. C-reactive protein (CRP)
Correct Answer: C
Rationale: High-sensitivity troponin is the gold standard biomarker for myocardial infarction due
to its high cardiac specificity and rapid elevation. Myoglobin rises early but is not
cardiac-specific. STUDY TIP: "Troponin is the Tower of Power for cardiac specificity."
Q6: A patient on telemetry has a regular rhythm with a rate of 150 bpm, absent P waves, and
narrow QRS complexes. Which intervention is the priority?
A. Perform synchronized cardioversion
B. Administer adenosine IV push [CORRECT]
C. Initiate transcutaneous pacing
,D. Defibrillate at 200 Joules
Correct Answer: B
Rationale: This rhythm is supraventricular tachycardia (SVT). Unstable patients get
cardioversion, but if stable, the first-line treatment is adenosine to slow conduction through the
AV node and terminate the rhythm. Pacing is for bradycardia; defibrillation is for pulseless
VT/VF. STUDY TIP: "Adenosine is the 'pause button' for stable SVT."
Q7: A patient with atrial fibrillation is prescribed dabigatran. Which statement by the patient
indicates a need for further teaching?
A. "I will swallow the capsule whole."
B. "I can open the capsule and mix it with applesauce if needed." [CORRECT]
C. "I will keep the medication in the original bottle."
D. "I will notify my doctor if I have any severe bleeding."
Correct Answer: B
Rationale: Dabigatran capsules must be swallowed whole; opening them increases the risk of
fatal bleeding by enhancing systemic absorption. The drug is also highly moisture-sensitive and
must be kept in its original bottle. STUDY TIP: "Dabigatran demands a dry, intact capsule."
Q8: A patient with a permanent pacemaker is scheduled for an MRI. Which action is most
important for the nurse to take?
A. Confirm the pacemaker is MRI-conditional [CORRECT]
B. Turn off the pacemaker before the scan
C. Apply a magnet over the pacemaker site during the scan
D. Remove the pacemaker generator prior to the MRI suite
Correct Answer: A
Rationale: Only MRI-conditional pacemakers can safely undergo an MRI. Turning off a pacer is
dangerous if the patient is pacer-dependent. Magnets can alter pacing modes unpredictably in
modern devices. STUDY TIP: "Condition is the condition for MRI."
Q9: A nurse is caring for a patient who just had an implantable cardioverter-defibrillator (ICD)
placed. Which discharge instruction is essential?
A. Avoid lifting the left arm above the shoulder for 4 to 6 weeks [CORRECT]
B. Do not use a microwave oven in the home
C. Keep the incision site dry for 48 hours
D. Expect mild palpitations when the device fires
Correct Answer: A
, Rationale: To prevent lead displacement, patients should avoid lifting the arm ipsilateral to the
ICD above shoulder level for 4 to 6 weeks. Microwave ovens are safe. The site must be kept
clean and dry longer than 48 hours. STUDY TIP: "Arm down to keep the lead around."
Q10: A patient is undergoing catheter ablation for atrial fibrillation. What post-procedure
complication should the nurse monitor for specifically related to left-sided ablations?
A. Pulmonary vein stenosis
B. Left atrial esophageal fistula [CORRECT]
C. Right bundle branch block
D. Tricuspid regurgitation
Correct Answer: B
Rationale: Left atrial ablation carries a rare but fatal risk of atrioesophageal fistula due to the
proximity of the left atrium to the esophagus. Symptoms include sudden fever, dysphagia, and
neurological deficits. STUDY TIP: "Left Atrium lies next to the Esophagus (LE)."
Q11: A patient with severe aortic stenosis develops syncope. What does this symptom indicate
about the disease process?
A. The stenosis is mild and asymptomatic
B. Left ventricular hypertrophy has compensated
C. The stenosis is critical and carries a poor prognosis [CORRECT]
D. The patient has developed right-sided heart failure
Correct Answer: C
Rationale: The classic triad of aortic stenosis is syncope, angina, and dyspnea on exertion.
Syncope indicates critical, severe AS and is a harbinger of sudden cardiac death if the valve is
not replaced. STUDY TIP: "Syncope in AS = Surgical emergency."
Q12: An 82-year-old patient with severe symptomatic aortic stenosis is deemed high risk for
open-heart surgery. Which procedure will the nurse prepare the patient for?
A. Medical management with beta-blockers only
B. Balloon valvuloplasty
C. Transcatheter aortic valve replacement (TAVR) [CORRECT]
D. Mechanical valve replacement
Correct Answer: C
Rationale: TAVR is the standard of care for severe aortic stenosis in patients who are
intermediate or high risk for surgical aortic valve replacement (SAVR). Balloon valvuloplasty is
only a temporary bridge. STUDY TIP: "TAVR for the elderly, SAVR for the sturdy."
