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HESI MED-SURG PRACTICE QUESTIONS & KEY TERMS
2026/2027 | Comprehensive Terminology Integration |
Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Key Terms & Application (Q1-14)
Q1. A nurse is caring for a patient with heart failure. The physician orders an
echocardiogram to assess the percentage of blood ejected from the left ventricle
with each contraction. Which term describes this measurement?
A. Preload
B. Afterload
C. Ejection fraction [CORRECT]
D. Stroke volume
Rationale: Ejection fraction (EF) is the percentage of end-diastolic volume ejected
with each systole; normal is 55–70%. Preload is ventricular stretch at end-diastole,
afterload is resistance against which the ventricle pumps, and stroke volume is the
absolute volume ejected, not the percentage.
Correct Answer: C
Q2. A patient with acute decompensated heart failure has a blood pressure of 92/58
mmHg and a heart rate of 118 bpm. The nurse notes distended neck veins when the
head of the bed is elevated to 45 degrees. Which term describes this finding?
A. Pulsus paradoxus
B. Jugular venous distention (JVD) [CORRECT]
C. Hepatojugular reflux
D. Orthopnea
Rationale: JVD is the visible bulging of the internal jugular vein above the clavicle at
45 degrees, indicating elevated central venous pressure and right ventricular preload.
Pulsus paradoxus is an inspiratory drop in systolic BP; hepatojugular reflux is JVD
elicited by liver compression; orthopnea is dyspnea when supine.
,2
Correct Answer: B
Q3. A nurse performs the hepatojugular reflux maneuver on a patient with suspected
right heart failure. As the nurse applies firm pressure to the right upper quadrant, the
jugular veins become more distended and remain elevated for more than 10
seconds. What does this finding indicate?
A. Left ventricular hypertrophy
B. Incompetent tricuspid valve
C. Elevated right atrial pressure and right ventricular dysfunction [CORRECT]
D. Portal hypertension with esophageal varices
Rationale: A positive hepatojugular reflux (abdominojugular test) indicates that the
right ventricle cannot accommodate the increased venous return from hepatic
compression, confirming elevated right atrial pressure and right-sided heart failure. It
does not assess left ventricular function or portal hypertension.
Correct Answer: C
Q4. A patient with dilated cardiomyopathy has an S3 gallop heard at the apex during
diastole. The nurse understands that this sound is caused by which physiological
event?
A. Atrial contraction against a stiff, noncompliant ventricle
B. Rapid ventricular filling causing vibration of the ventricular walls [CORRECT]
C. Turbulent blood flow across a stenotic aortic valve
D. Closure of the pulmonic valve
Rationale: The S3 gallop (ventricular gallop) occurs during early diastole due to rapid
ventricular filling into a dilated, volume-overloaded ventricle. An S4 gallop (atrial
gallop) results from atrial contraction against a stiff ventricle. Turbulent flow
produces murmurs, not gallops.
Correct Answer: B
,3
Q5. A patient with hypertensive heart disease has an S4 gallop heard just before S1.
Which pathophysiological mechanism produces this sound?
A. Rapid early diastolic filling
B. Forceful atrial contraction against a stiff, noncompliant left ventricle [CORRECT]
C. Regurgitant flow through the mitral valve
D. Opening snap of a stenotic mitral valve
Rationale: The S4 gallop (atrial gallop) is produced by forceful atrial contraction
ejecting blood into a stiff, hypertrophied ventricle with decreased compliance. It is
common in hypertension, aortic stenosis, and ischemic heart disease. S3 is from rapid
filling; regurgitant flow causes murmurs.
Correct Answer: B
Q6. A patient with cardiac tamponade has a blood pressure of 98/76 mmHg. During
inspiration, the systolic pressure drops by 22 mmHg. Which term describes this
finding?
A. Pulsus alternans
B. Pulsus paradoxus [CORRECT]
C. Pulsus bisferiens
D. Pulsus tardus
Rationale: Pulsus paradoxus is an inspiratory drop in systolic blood pressure >10
mmHg, characteristic of cardiac tamponade, severe asthma, and COPD. It results
from impaired ventricular filling due to pericardial constriction. Pulsus alternans is
alternating strong/weak beats; pulsus bisferiens is a double-peaked pulse.
Correct Answer: B
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Q7. A nurse is reviewing hemodynamic parameters for a patient in cardiogenic shock.
The physician states that "afterload" is excessively high. Which factor most directly
increases afterload?
A. Increased venous return
B. Increased systemic vascular resistance [CORRECT]
C. Decreased blood volume
D. Increased ventricular compliance
Rationale: Afterload is the resistance the left ventricle must overcome to eject blood,
determined primarily by systemic vascular resistance (SVR) and aortic impedance.
Increased SVR raises afterload. Venous return and blood volume affect preload;
ventricular compliance affects diastolic filling.
Correct Answer: B
Q8. A patient with acute MI receives a PA catheter. The pulmonary capillary wedge
pressure (PCWP) is 24 mmHg (normal 6–12). Which parameter is elevated, and what
is its clinical significance?
A. Afterload; the heart is pumping against excessive resistance
B. Preload; the left ventricle is volume-overloaded [CORRECT]
C. Contractility; the heart muscle is hypercontractile
D. Ejection fraction; systolic function is preserved
Rationale: PCWP is an indirect measure of left atrial pressure and left ventricular end-
diastolic pressure (preload). An elevated PCWP of 24 mmHg indicates left ventricular
volume overload and elevated preload, consistent with left-sided heart failure.
Afterload is measured by SVR, not PCWP.
Correct Answer: B
HESI MED-SURG PRACTICE QUESTIONS & KEY TERMS
2026/2027 | Comprehensive Terminology Integration |
Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Key Terms & Application (Q1-14)
Q1. A nurse is caring for a patient with heart failure. The physician orders an
echocardiogram to assess the percentage of blood ejected from the left ventricle
with each contraction. Which term describes this measurement?
A. Preload
B. Afterload
C. Ejection fraction [CORRECT]
D. Stroke volume
Rationale: Ejection fraction (EF) is the percentage of end-diastolic volume ejected
with each systole; normal is 55–70%. Preload is ventricular stretch at end-diastole,
afterload is resistance against which the ventricle pumps, and stroke volume is the
absolute volume ejected, not the percentage.
Correct Answer: C
Q2. A patient with acute decompensated heart failure has a blood pressure of 92/58
mmHg and a heart rate of 118 bpm. The nurse notes distended neck veins when the
head of the bed is elevated to 45 degrees. Which term describes this finding?
A. Pulsus paradoxus
B. Jugular venous distention (JVD) [CORRECT]
C. Hepatojugular reflux
D. Orthopnea
Rationale: JVD is the visible bulging of the internal jugular vein above the clavicle at
45 degrees, indicating elevated central venous pressure and right ventricular preload.
Pulsus paradoxus is an inspiratory drop in systolic BP; hepatojugular reflux is JVD
elicited by liver compression; orthopnea is dyspnea when supine.
,2
Correct Answer: B
Q3. A nurse performs the hepatojugular reflux maneuver on a patient with suspected
right heart failure. As the nurse applies firm pressure to the right upper quadrant, the
jugular veins become more distended and remain elevated for more than 10
seconds. What does this finding indicate?
A. Left ventricular hypertrophy
B. Incompetent tricuspid valve
C. Elevated right atrial pressure and right ventricular dysfunction [CORRECT]
D. Portal hypertension with esophageal varices
Rationale: A positive hepatojugular reflux (abdominojugular test) indicates that the
right ventricle cannot accommodate the increased venous return from hepatic
compression, confirming elevated right atrial pressure and right-sided heart failure. It
does not assess left ventricular function or portal hypertension.
Correct Answer: C
Q4. A patient with dilated cardiomyopathy has an S3 gallop heard at the apex during
diastole. The nurse understands that this sound is caused by which physiological
event?
A. Atrial contraction against a stiff, noncompliant ventricle
B. Rapid ventricular filling causing vibration of the ventricular walls [CORRECT]
C. Turbulent blood flow across a stenotic aortic valve
D. Closure of the pulmonic valve
Rationale: The S3 gallop (ventricular gallop) occurs during early diastole due to rapid
ventricular filling into a dilated, volume-overloaded ventricle. An S4 gallop (atrial
gallop) results from atrial contraction against a stiff ventricle. Turbulent flow
produces murmurs, not gallops.
Correct Answer: B
,3
Q5. A patient with hypertensive heart disease has an S4 gallop heard just before S1.
Which pathophysiological mechanism produces this sound?
A. Rapid early diastolic filling
B. Forceful atrial contraction against a stiff, noncompliant left ventricle [CORRECT]
C. Regurgitant flow through the mitral valve
D. Opening snap of a stenotic mitral valve
Rationale: The S4 gallop (atrial gallop) is produced by forceful atrial contraction
ejecting blood into a stiff, hypertrophied ventricle with decreased compliance. It is
common in hypertension, aortic stenosis, and ischemic heart disease. S3 is from rapid
filling; regurgitant flow causes murmurs.
Correct Answer: B
Q6. A patient with cardiac tamponade has a blood pressure of 98/76 mmHg. During
inspiration, the systolic pressure drops by 22 mmHg. Which term describes this
finding?
A. Pulsus alternans
B. Pulsus paradoxus [CORRECT]
C. Pulsus bisferiens
D. Pulsus tardus
Rationale: Pulsus paradoxus is an inspiratory drop in systolic blood pressure >10
mmHg, characteristic of cardiac tamponade, severe asthma, and COPD. It results
from impaired ventricular filling due to pericardial constriction. Pulsus alternans is
alternating strong/weak beats; pulsus bisferiens is a double-peaked pulse.
Correct Answer: B
, 4
Q7. A nurse is reviewing hemodynamic parameters for a patient in cardiogenic shock.
The physician states that "afterload" is excessively high. Which factor most directly
increases afterload?
A. Increased venous return
B. Increased systemic vascular resistance [CORRECT]
C. Decreased blood volume
D. Increased ventricular compliance
Rationale: Afterload is the resistance the left ventricle must overcome to eject blood,
determined primarily by systemic vascular resistance (SVR) and aortic impedance.
Increased SVR raises afterload. Venous return and blood volume affect preload;
ventricular compliance affects diastolic filling.
Correct Answer: B
Q8. A patient with acute MI receives a PA catheter. The pulmonary capillary wedge
pressure (PCWP) is 24 mmHg (normal 6–12). Which parameter is elevated, and what
is its clinical significance?
A. Afterload; the heart is pumping against excessive resistance
B. Preload; the left ventricle is volume-overloaded [CORRECT]
C. Contractility; the heart muscle is hypercontractile
D. Ejection fraction; systolic function is preserved
Rationale: PCWP is an indirect measure of left atrial pressure and left ventricular end-
diastolic pressure (preload). An elevated PCWP of 24 mmHg indicates left ventricular
volume overload and elevated preload, consistent with left-sided heart failure.
Afterload is measured by SVR, not PCWP.
Correct Answer: B
