,MED-SURG HESI EXAM V1 (2026) | NGN-STYLE
QUESTIONS & CASE SCENARIOS
SECTION 1: CARDIOVASCULAR (Questions 1-15)
1. A client on telemetry has uncontrolled atrial fibrillation with a
rapid ventricular response. The nurse anticipates assisting with which
treatment?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate the client immediately
D. Administer atropine 0.4 mg IV push
Rationale: Synchronized cardioversion is the treatment of choice for
unstable atrial fibrillation with rapid ventricular response.
Lidocaine is for ventricular dysrhythmias, defibrillation is for V-
fib/pulseless V-tach, and atropine is for symptomatic bradycardia .
2. The nurse assesses a client with an arteriovenous (AV) shunt
scheduled for dialysis and notes absence of a thrill or bruit. What
action should the nurse take?
A. Advise the client the shunt is ready for dialysis
B. Elevate the shunt site above heart level
C. Notify the healthcare provider immediately
D. Flush the site with heparinized saline
Rationale: Absence of a thrill or bruit indicates possible shunt
obstruction, requiring immediate provider notification to restore
,function. Elevation will not resolve obstruction, and flushing an AV
shunt requires special needles .
3. A client with heart failure taking furosemide is at risk for which
electrolyte imbalance?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypophosphatemia
Rationale: Furosemide is a loop diuretic that causes potassium
wasting, placing the client at risk for hypokalemia .
4. A client with right-sided heart failure is likely to exhibit which
finding?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular venous distension (JVD)
D. Cough
Rationale: Right-sided heart failure causes systemic congestion,
including JVD, peripheral edema, and ascites. Pulmonary
symptoms (crackles, dyspnea, cough) are associated with left-sided
failure .
5. The nurse notes eight premature ventricular contractions (PVCs)
per minute in a client one day post-MI. Which intervention should the
nurse implement first?
, A. Obtain an IV pump for antiarrhythmic infusion
B. Increase the client's oxygen flow rate
C. Prepare for immediate countershock
D. Gather equipment for intubation
Rationale: Increasing oxygen provides more oxygen to the
myocardium, which may reduce PVCs. This is the least invasive
initial intervention .
6. A client with chronic angle-closure glaucoma has a new medication
order. Which prescription should the nurse question?
A. Antianginal with vasodilation effects
B. Anticholinergic with pupillary dilation side effects
C. Antihistamine with sedation side effects
D. Corticosteroid with hyperglycemia side effects
Rationale: Anticholinergic medications that dilate the pupil can
precipitate acute, severely increased intraocular pressure in angle-
closure glaucoma .
7. Which oxygen saturation range is the goal for a client with COPD?
A. 95%-100%
B. 88%-92%
C. 70%-80%
D. 100%
QUESTIONS & CASE SCENARIOS
SECTION 1: CARDIOVASCULAR (Questions 1-15)
1. A client on telemetry has uncontrolled atrial fibrillation with a
rapid ventricular response. The nurse anticipates assisting with which
treatment?
A. Administer lidocaine 75 mg IV push
B. Perform synchronized cardioversion
C. Defibrillate the client immediately
D. Administer atropine 0.4 mg IV push
Rationale: Synchronized cardioversion is the treatment of choice for
unstable atrial fibrillation with rapid ventricular response.
Lidocaine is for ventricular dysrhythmias, defibrillation is for V-
fib/pulseless V-tach, and atropine is for symptomatic bradycardia .
2. The nurse assesses a client with an arteriovenous (AV) shunt
scheduled for dialysis and notes absence of a thrill or bruit. What
action should the nurse take?
A. Advise the client the shunt is ready for dialysis
B. Elevate the shunt site above heart level
C. Notify the healthcare provider immediately
D. Flush the site with heparinized saline
Rationale: Absence of a thrill or bruit indicates possible shunt
obstruction, requiring immediate provider notification to restore
,function. Elevation will not resolve obstruction, and flushing an AV
shunt requires special needles .
3. A client with heart failure taking furosemide is at risk for which
electrolyte imbalance?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypophosphatemia
Rationale: Furosemide is a loop diuretic that causes potassium
wasting, placing the client at risk for hypokalemia .
4. A client with right-sided heart failure is likely to exhibit which
finding?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular venous distension (JVD)
D. Cough
Rationale: Right-sided heart failure causes systemic congestion,
including JVD, peripheral edema, and ascites. Pulmonary
symptoms (crackles, dyspnea, cough) are associated with left-sided
failure .
5. The nurse notes eight premature ventricular contractions (PVCs)
per minute in a client one day post-MI. Which intervention should the
nurse implement first?
, A. Obtain an IV pump for antiarrhythmic infusion
B. Increase the client's oxygen flow rate
C. Prepare for immediate countershock
D. Gather equipment for intubation
Rationale: Increasing oxygen provides more oxygen to the
myocardium, which may reduce PVCs. This is the least invasive
initial intervention .
6. A client with chronic angle-closure glaucoma has a new medication
order. Which prescription should the nurse question?
A. Antianginal with vasodilation effects
B. Anticholinergic with pupillary dilation side effects
C. Antihistamine with sedation side effects
D. Corticosteroid with hyperglycemia side effects
Rationale: Anticholinergic medications that dilate the pupil can
precipitate acute, severely increased intraocular pressure in angle-
closure glaucoma .
7. Which oxygen saturation range is the goal for a client with COPD?
A. 95%-100%
B. 88%-92%
C. 70%-80%
D. 100%
