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 1-25)
Q1: A 58-year-old male presents to the ED with severe substernal chest pain radiating to the left
jaw, diaphoresis, and nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Time of arrival was 10 minutes ago. What is the priority intervention by the nurse?
A. Administer sublingual nitroglycerin and reassess pain in 5 minutes
B. Obtain a detailed cardiac history including familial risk factors
C. Prepare the patient for immediate transfer to the cardiac catheterization lab [CORRECT]
D. Draw cardiac biomarkers and wait for results to confirm myocardial infarction
Correct Answer: C
Rationale: The patient is experiencing an acute inferior STEMI. The priority time-sensitive
intervention is a door-to-balloon time of less than 90 minutes. Administering nitroglycerin (A) is a
delay trap and potentially contraindicated in inferior STEMIs due to right ventricular involvement
risk. Taking a detailed history (B) is a delay trap. Waiting for biomarkers (D) is a reassessment
trap; STEMI is a clinical and ECG diagnosis. HESI Point: Always look for "door-to-balloon" or
"door-to-needle" time constraints in ACS scenarios; the correct answer bypasses non-essential
steps to achieve reperfusion.
Q2: A patient with chronic heart failure is admitted with acute decompensated heart failure
(ADHF). Assessment reveals bilateral crackles, jugular venous distension (JVD), and 3+ pitting
edema. Which medication should the nurse anticipate administering first?
A. Carvedilol
B. Furosemide
C. Lisinopril
D. Digoxin
Correct Answer: B
Rationale: Furosemide, a loop diuretic, is the first-line intervention to reduce fluid overload in
ADHF by promoting diuresis and relieving pulmonary congestion. Carvedilol (A) and Lisinopril
(C) are chronic HF medications that are typically held or adjusted during acute decompensation
,due to hypotension risks. Digoxin (D) is not a first-line acute treatment. HESI Point: In ADHF
exacerbations, focus on symptom relief (fluid removal) first before optimizing chronic
neurohormonal blockers.
Q3: A 65-year-old post-operative CABG patient suddenly experiences sharp, stabbing chest
pain, dyspnea, and distended neck veins. Blood pressure drops to 80/50 mm Hg, and muffled
heart sounds are auscultated. What clinical condition should the nurse immediately recognize?
A. Tension pneumothorax
B. Cardiac tamponade
C. Acute pulmonary embolism
D. Ventricular free wall rupture
Correct Answer: B
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) is the classic presentation of
cardiac tamponade, a known post-cardiac surgery complication where fluid accumulates in the
pericardial space. Tension pneumothorax (A) presents with absent breath sounds and tracheal
deviation. PE (C) does not typically cause muffled heart sounds. Free wall rupture (D) causes
rapid pulseless electrical activity, not this specific triad. HESI Point: Recognizing classic "triads"
is a high-yield HESI strategy; Beck's triad directly points to tamponade requiring an emergency
pericardiocentesis.
Q4: A 52-year-old male with a history of uncontrolled hypertension presents with severe, tearing
chest pain radiating to the back. Blood pressure is 190/110 mm Hg in the right arm and 160/90
mm Hg in the left arm. What is the most critical initial medication intervention?
A. Administer intravenous nitroprusside to rapidly lower blood pressure
B. Administer intravenous labetalol to lower heart rate and blood pressure
C. Administer oral clonidine for gradual blood pressure reduction
D. Obtain a CT angiogram before administering any antihypertensives
Correct Answer: B
Rationale: The patient has an aortic dissection. The primary goal is to reduce shear force on the
aortic wall by decreasing heart rate (target < 60 bpm) and blood pressure (systolic < 120 mm
Hg). IV beta-blockers like labetalol are initiated first. Nitroprusside (A) is a delay trap; if given
before beta-blockers, it causes reflex tachycardia, increasing aortic wall stress. Clonidine (C) is
too slow. Waiting for a CT (D) is a deadly delay trap. HESI Point: In aortic dissection, always
choose a medication that controls heart rate first (beta-blocker) over pure vasodilators to
prevent fatal worsening of the dissection.
,Q5: A patient returns from a cardiac catheterization via the right femoral artery. Four hours
post-procedure, the nurse notes the right foot is cool, pale, and the pedal pulse is absent. What
is the priority nursing action?
A. Apply a warm blanket to the right leg to promote vasodilation
B. Compare the right pedal pulse to the left pedal pulse
C. Notify the healthcare provider immediately
D. Document the finding and reassess in 15 minutes
Correct Answer: C
Rationale: Absent pulse, pallor, and coolness indicate acute limb ischemia, a surgical
emergency requiring immediate intervention (e.g., femoral artery thrombectomy). Applying
warmth (A) is contraindicated as it increases tissue metabolic demand. Comparing pulses (B) is
a reassessment trap; the absence of a pulse is a critical finding that requires action.
Documenting and waiting (D) is a delay trap that risks limb loss. HESI Point: When assessing
for vascular complications post-catheterization, absent pulses require immediate provider
notification, not further nursing validation steps.
Q6: A patient with acute coronary syndrome is receiving a continuous heparin infusion. The
morning lab panel returns with a Platelet count of 85,000/mm³, down from 220,000/mm³ two
days ago. The patient complains of new onset severe thigh pain. What should the nurse do?
A. Administer prescribed PRN acetaminophen for the thigh pain
B. Stop the heparin infusion immediately and notify the provider
C. Request a repeat draw to verify the lab value
D. Assess the thigh for signs of deep vein thrombosis
Correct Answer: B
Rationale: A >50% drop in platelets coupled with new pain (possible thrombosis) is the hallmark
of Heparin-Induced Thrombocytopenia (HIT), a life-threatening adverse event. Heparin must be
stopped immediately to prevent further platelet activation and thrombosis. Acetaminophen (A) is
a delay trap. Repeating the lab (C) is a reassessment trap that delays life-saving treatment. DVT
assessment (D) is a delay trap. HESI Point: Recognize early warning signs of HIT; the correct
action is always to stop the heparin first, as continuing it can cause fatal clots.
Q7: A patient with heart failure is being discharged. Which statement by the patient indicates a
need for further teaching regarding self-management?
A. "I will weigh myself every morning before eating breakfast."
B. "I will drink no more than 8 glasses of water per day."
C. "If I gain 3 pounds in a day, I will take an extra furosemide."
D. "I will elevate my legs on pillows when I sit in my recliner."
, Correct Answer: C
Rationale: Patients should never independently adjust cardiac medications like diuretics without
provider instruction; a 2-3 lb weight gain in a day or a 5 lb gain in a week warrants a phone call
to the provider. Weighing in the morning (A), fluid restriction (B), and elevating legs (D) are
correct self-management strategies. HESI Point: Discharge teaching questions often feature the
"independent medication adjustment" distractor; the safe action is always to notify the provider
rather than self-treat.
Q8: A 70-year-old female presents with a sudden onset of severe dyspnea, diaphoresis, and
palpitations. Her ECG shows an irregularly irregular rhythm with no discernible P waves and a
ventricular rate of 155 bpm. Her blood pressure is 90/60 mm Hg. What is the priority
intervention?
A. Administer diltiazem IV to control the heart rate
B. Prepare for immediate synchronized cardioversion
C. Administer amiodarone IV to convert the rhythm
D. Apply oxygen via nasal cannula at 2 liters
Correct Answer: B
Rationale: The patient is in rapid atrial fibrillation with hemodynamic instability (hypotension).
The priority intervention for unstable tachycardia with a pulse is immediate synchronized
cardioversion. Diltiazem (A) and amiodarone (C) are delay traps and are contraindicated in
unstable patients as they can further drop blood pressure. Oxygen (D) is a reassessment trap
that does not address the lethal rhythm. HESI Point: The phrase "blood pressure 90/60" coupled
with a fast tachyarrhythmia is the ultimate HESI cue for "unstable"—always choose
cardioversion over medications.
Q9: A patient is diagnosed with a Stanford Type A aortic dissection. The nurse prepares the
patient for which intervention?
A. Medical management with strict blood pressure control only
B. Endovascular stent graft placement
C. Emergency surgical repair
D. Anticoagulation therapy with heparin
Correct Answer: C
Rationale: Stanford Type A dissections involve the ascending aorta and carry a high risk of
rupture into the pericardium (tamponade) or aortic valve disruption. They require immediate
emergency surgical repair. Medical management (A) and endovascular repair (B) are for Type B
Questions and Answers | Advanced Medical-Surgical
Nursing | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Questions 1-25)
Q1: A 58-year-old male presents to the ED with severe substernal chest pain radiating to the left
jaw, diaphoresis, and nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III,
and aVF. Time of arrival was 10 minutes ago. What is the priority intervention by the nurse?
A. Administer sublingual nitroglycerin and reassess pain in 5 minutes
B. Obtain a detailed cardiac history including familial risk factors
C. Prepare the patient for immediate transfer to the cardiac catheterization lab [CORRECT]
D. Draw cardiac biomarkers and wait for results to confirm myocardial infarction
Correct Answer: C
Rationale: The patient is experiencing an acute inferior STEMI. The priority time-sensitive
intervention is a door-to-balloon time of less than 90 minutes. Administering nitroglycerin (A) is a
delay trap and potentially contraindicated in inferior STEMIs due to right ventricular involvement
risk. Taking a detailed history (B) is a delay trap. Waiting for biomarkers (D) is a reassessment
trap; STEMI is a clinical and ECG diagnosis. HESI Point: Always look for "door-to-balloon" or
"door-to-needle" time constraints in ACS scenarios; the correct answer bypasses non-essential
steps to achieve reperfusion.
Q2: A patient with chronic heart failure is admitted with acute decompensated heart failure
(ADHF). Assessment reveals bilateral crackles, jugular venous distension (JVD), and 3+ pitting
edema. Which medication should the nurse anticipate administering first?
A. Carvedilol
B. Furosemide
C. Lisinopril
D. Digoxin
Correct Answer: B
Rationale: Furosemide, a loop diuretic, is the first-line intervention to reduce fluid overload in
ADHF by promoting diuresis and relieving pulmonary congestion. Carvedilol (A) and Lisinopril
(C) are chronic HF medications that are typically held or adjusted during acute decompensation
,due to hypotension risks. Digoxin (D) is not a first-line acute treatment. HESI Point: In ADHF
exacerbations, focus on symptom relief (fluid removal) first before optimizing chronic
neurohormonal blockers.
Q3: A 65-year-old post-operative CABG patient suddenly experiences sharp, stabbing chest
pain, dyspnea, and distended neck veins. Blood pressure drops to 80/50 mm Hg, and muffled
heart sounds are auscultated. What clinical condition should the nurse immediately recognize?
A. Tension pneumothorax
B. Cardiac tamponade
C. Acute pulmonary embolism
D. Ventricular free wall rupture
Correct Answer: B
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) is the classic presentation of
cardiac tamponade, a known post-cardiac surgery complication where fluid accumulates in the
pericardial space. Tension pneumothorax (A) presents with absent breath sounds and tracheal
deviation. PE (C) does not typically cause muffled heart sounds. Free wall rupture (D) causes
rapid pulseless electrical activity, not this specific triad. HESI Point: Recognizing classic "triads"
is a high-yield HESI strategy; Beck's triad directly points to tamponade requiring an emergency
pericardiocentesis.
Q4: A 52-year-old male with a history of uncontrolled hypertension presents with severe, tearing
chest pain radiating to the back. Blood pressure is 190/110 mm Hg in the right arm and 160/90
mm Hg in the left arm. What is the most critical initial medication intervention?
A. Administer intravenous nitroprusside to rapidly lower blood pressure
B. Administer intravenous labetalol to lower heart rate and blood pressure
C. Administer oral clonidine for gradual blood pressure reduction
D. Obtain a CT angiogram before administering any antihypertensives
Correct Answer: B
Rationale: The patient has an aortic dissection. The primary goal is to reduce shear force on the
aortic wall by decreasing heart rate (target < 60 bpm) and blood pressure (systolic < 120 mm
Hg). IV beta-blockers like labetalol are initiated first. Nitroprusside (A) is a delay trap; if given
before beta-blockers, it causes reflex tachycardia, increasing aortic wall stress. Clonidine (C) is
too slow. Waiting for a CT (D) is a deadly delay trap. HESI Point: In aortic dissection, always
choose a medication that controls heart rate first (beta-blocker) over pure vasodilators to
prevent fatal worsening of the dissection.
,Q5: A patient returns from a cardiac catheterization via the right femoral artery. Four hours
post-procedure, the nurse notes the right foot is cool, pale, and the pedal pulse is absent. What
is the priority nursing action?
A. Apply a warm blanket to the right leg to promote vasodilation
B. Compare the right pedal pulse to the left pedal pulse
C. Notify the healthcare provider immediately
D. Document the finding and reassess in 15 minutes
Correct Answer: C
Rationale: Absent pulse, pallor, and coolness indicate acute limb ischemia, a surgical
emergency requiring immediate intervention (e.g., femoral artery thrombectomy). Applying
warmth (A) is contraindicated as it increases tissue metabolic demand. Comparing pulses (B) is
a reassessment trap; the absence of a pulse is a critical finding that requires action.
Documenting and waiting (D) is a delay trap that risks limb loss. HESI Point: When assessing
for vascular complications post-catheterization, absent pulses require immediate provider
notification, not further nursing validation steps.
Q6: A patient with acute coronary syndrome is receiving a continuous heparin infusion. The
morning lab panel returns with a Platelet count of 85,000/mm³, down from 220,000/mm³ two
days ago. The patient complains of new onset severe thigh pain. What should the nurse do?
A. Administer prescribed PRN acetaminophen for the thigh pain
B. Stop the heparin infusion immediately and notify the provider
C. Request a repeat draw to verify the lab value
D. Assess the thigh for signs of deep vein thrombosis
Correct Answer: B
Rationale: A >50% drop in platelets coupled with new pain (possible thrombosis) is the hallmark
of Heparin-Induced Thrombocytopenia (HIT), a life-threatening adverse event. Heparin must be
stopped immediately to prevent further platelet activation and thrombosis. Acetaminophen (A) is
a delay trap. Repeating the lab (C) is a reassessment trap that delays life-saving treatment. DVT
assessment (D) is a delay trap. HESI Point: Recognize early warning signs of HIT; the correct
action is always to stop the heparin first, as continuing it can cause fatal clots.
Q7: A patient with heart failure is being discharged. Which statement by the patient indicates a
need for further teaching regarding self-management?
A. "I will weigh myself every morning before eating breakfast."
B. "I will drink no more than 8 glasses of water per day."
C. "If I gain 3 pounds in a day, I will take an extra furosemide."
D. "I will elevate my legs on pillows when I sit in my recliner."
, Correct Answer: C
Rationale: Patients should never independently adjust cardiac medications like diuretics without
provider instruction; a 2-3 lb weight gain in a day or a 5 lb gain in a week warrants a phone call
to the provider. Weighing in the morning (A), fluid restriction (B), and elevating legs (D) are
correct self-management strategies. HESI Point: Discharge teaching questions often feature the
"independent medication adjustment" distractor; the safe action is always to notify the provider
rather than self-treat.
Q8: A 70-year-old female presents with a sudden onset of severe dyspnea, diaphoresis, and
palpitations. Her ECG shows an irregularly irregular rhythm with no discernible P waves and a
ventricular rate of 155 bpm. Her blood pressure is 90/60 mm Hg. What is the priority
intervention?
A. Administer diltiazem IV to control the heart rate
B. Prepare for immediate synchronized cardioversion
C. Administer amiodarone IV to convert the rhythm
D. Apply oxygen via nasal cannula at 2 liters
Correct Answer: B
Rationale: The patient is in rapid atrial fibrillation with hemodynamic instability (hypotension).
The priority intervention for unstable tachycardia with a pulse is immediate synchronized
cardioversion. Diltiazem (A) and amiodarone (C) are delay traps and are contraindicated in
unstable patients as they can further drop blood pressure. Oxygen (D) is a reassessment trap
that does not address the lethal rhythm. HESI Point: The phrase "blood pressure 90/60" coupled
with a fast tachyarrhythmia is the ultimate HESI cue for "unstable"—always choose
cardioversion over medications.
Q9: A patient is diagnosed with a Stanford Type A aortic dissection. The nurse prepares the
patient for which intervention?
A. Medical management with strict blood pressure control only
B. Endovascular stent graft placement
C. Emergency surgical repair
D. Anticoagulation therapy with heparin
Correct Answer: C
Rationale: Stanford Type A dissections involve the ascending aorta and carry a high risk of
rupture into the pericardium (tamponade) or aortic valve disruption. They require immediate
emergency surgical repair. Medical management (A) and endovascular repair (B) are for Type B
