HESI MED-SURG II TEST BANK 2026/2027 | Verified
Questions & Answers | Complete Q&A for Advanced
Med-Surg | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Q1-20)
Q1. A patient admitted with acute decompensated heart failure has crackles in bilateral
lung bases, 3+ pitting edema, and a weight gain of 4.5 kg over 3 days. The provider
orders furosemide 80 mg IV push. Which assessment finding indicates the medication
is achieving the desired therapeutic effect?
A. Decreased blood pressure from 158/92 to 110/68 mmHg
B. Increased urine output of 200 mL/hour for 2 hours
C. Decreased heart rate from 110 to 72 beats/minute
D. Increased serum sodium from 128 to 142 mEq/L
B. Increased urine output of 200 mL/hour for 2 hours [CORRECT]
Rationale: Furosemide is a loop diuretic that promotes diuresis to reduce fluid overload
in heart failure; increased urine output is the direct indicator of therapeutic effect. While
blood pressure may decrease (A) and heart rate may improve (C), these are secondary
effects, and sodium changes (D) are not the primary goal of acute diuretic therapy.
"Correct Answer: B"
Q2. A patient weighs 80 kg and is prescribed a heparin bolus of 80 units/kg followed by
an infusion of 18 units/kg/hour. The pharmacy supplies heparin 25,000 units in 250 mL
D5W. What is the correct bolus dose in units, and what pump rate in mL/hour should the
nurse set?
A. Bolus 6,400 units; infusion rate 14.4 mL/hour
,B. Bolus 6,400 units; infusion rate 28.8 mL/hour
C. Bolus 8,000 units; infusion rate 18.0 mL/hour
D. Bolus 8,000 units; infusion rate 36.0 mL/hour
A. Bolus 6,400 units; infusion rate 14.4 mL/hour [CORRECT]
Rationale: The bolus is 80 units/kg × 80 kg = 6,400 units; the hourly infusion dose is 18
units/kg/hour × 80 kg = 1,440 units/hour, and with a concentration of 100 units/mL
(25,000/250), the pump rate is 14.4 mL/hour. Options B, C, and D miscalculate either the
concentration, the weight-based dose, or the unit conversion.
"Correct Answer: A"
Q3. A patient with a STEMI is being prepared for emergent percutaneous coronary
intervention. Which medication should the nurse question if the patient reports a severe
allergy to shellfish?
A. Aspirin
B. Metoprolol
C. Iodinated contrast dye
D. Atorvastatin
C. Iodinated contrast dye [CORRECT]
Rationale: Shellfish allergy indicates a potential cross-reactivity with iodinated contrast
media used during cardiac catheterization, increasing the risk of anaphylactoid
reactions; aspirin (A), metoprolol (B), and atorvastatin (D) do not contain iodine and are
not contraindicated by shellfish allergy.
"Correct Answer: C"
Q4. A charge nurse on a cardiac step-down unit has an LPN, a UAP, and an RN. Which
task is most appropriate to delegate to the LPN?
,A. Assessing a patient who developed new-onset chest pain 30 minutes ago
B. Administering a scheduled dose of digoxin to a stable patient with atrial fibrillation
C. Developing the discharge teaching plan for a patient post-cardiac catheterization
D. Evaluating the effectiveness of a new nitroglycerin infusion on a patient in heart
failure
B. Administering a scheduled dose of digoxin to a stable patient with atrial fibrillation
[CORRECT]
Rationale: LPN scope of practice includes administering oral medications to stable
patients with predictable outcomes; assessment of new chest pain (A), discharge
teaching plan development (C), and evaluation of IV titration effectiveness (D) require
RN-level judgment and scope.
"Correct Answer: B"
Q5. A patient with a hypertensive emergency (BP 220/130 mmHg) is receiving a
nitroprusside infusion. Which assessment finding requires the most immediate
intervention?
A. Blood pressure decrease to 180/110 mmHg after 15 minutes
B. Development of a thiocyanate level of 80 mcg/mL after 48 hours
C. Acute change in mental status and metabolic acidosis
D. Mild headache reported 1 hour after infusion started
C. Acute change in mental status and metabolic acidosis [CORRECT]
Rationale: Acute mental status changes with metabolic acidosis indicate cyanide
toxicity from nitroprusside metabolism, which is a medical emergency requiring
immediate discontinuation and antidote administration; a BP of 180/110 (A) is still
elevated but not emergent, thiocyanate of 80 mcg/mL (B) is below the 100 mcg/mL
toxic threshold, and mild headache (D) is an expected side effect.
, "Correct Answer: C"
Q6. A patient with newly diagnosed atrial fibrillation is prescribed dabigatran. Which
instruction should the nurse include in the discharge teaching?
A. "You will need to have your INR checked monthly."
B. "You may crush the capsule and mix it with applesauce if swallowing is difficult."
C. "Report any signs of bleeding, including dark tarry stools or unusual bruising."
D. "Take this medication with vitamin K-rich foods to enhance absorption."
C. "Report any signs of bleeding, including dark tarry stools or unusual bruising."
[CORRECT]
Rationale: Dabigatran is a direct thrombin inhibitor with a bleeding risk; patients must
report bleeding promptly. INR monitoring (A) is for warfarin, the capsule must not be
crushed (B) due to increased bioavailability and toxicity, and vitamin K (D) does not
affect dabigatran and is only relevant for warfarin.
"Correct Answer: C"
Q7. Which finding in a patient taking digoxin requires the nurse to withhold the dose and
notify the provider?
A. Serum potassium of 3.8 mEq/L
B. Apical pulse of 58 beats/minute
C. Serum digoxin level of 1.2 ng/mL
D. Mild nausea relieved by eating crackers
B. Apical pulse of 58 beats/minute [CORRECT]
Rationale: Digoxin slows AV nodal conduction and should be withheld if the apical pulse
is below 60 bpm in adults (or per institutional policy) to prevent severe bradycardia or
heart block; potassium 3.8 (A) is low-normal but not an automatic hold, digoxin 1.2
ng/mL (C) is therapeutic, and mild nausea (D) is a common side effect.
Questions & Answers | Complete Q&A for Advanced
Med-Surg | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders (Q1-20)
Q1. A patient admitted with acute decompensated heart failure has crackles in bilateral
lung bases, 3+ pitting edema, and a weight gain of 4.5 kg over 3 days. The provider
orders furosemide 80 mg IV push. Which assessment finding indicates the medication
is achieving the desired therapeutic effect?
A. Decreased blood pressure from 158/92 to 110/68 mmHg
B. Increased urine output of 200 mL/hour for 2 hours
C. Decreased heart rate from 110 to 72 beats/minute
D. Increased serum sodium from 128 to 142 mEq/L
B. Increased urine output of 200 mL/hour for 2 hours [CORRECT]
Rationale: Furosemide is a loop diuretic that promotes diuresis to reduce fluid overload
in heart failure; increased urine output is the direct indicator of therapeutic effect. While
blood pressure may decrease (A) and heart rate may improve (C), these are secondary
effects, and sodium changes (D) are not the primary goal of acute diuretic therapy.
"Correct Answer: B"
Q2. A patient weighs 80 kg and is prescribed a heparin bolus of 80 units/kg followed by
an infusion of 18 units/kg/hour. The pharmacy supplies heparin 25,000 units in 250 mL
D5W. What is the correct bolus dose in units, and what pump rate in mL/hour should the
nurse set?
A. Bolus 6,400 units; infusion rate 14.4 mL/hour
,B. Bolus 6,400 units; infusion rate 28.8 mL/hour
C. Bolus 8,000 units; infusion rate 18.0 mL/hour
D. Bolus 8,000 units; infusion rate 36.0 mL/hour
A. Bolus 6,400 units; infusion rate 14.4 mL/hour [CORRECT]
Rationale: The bolus is 80 units/kg × 80 kg = 6,400 units; the hourly infusion dose is 18
units/kg/hour × 80 kg = 1,440 units/hour, and with a concentration of 100 units/mL
(25,000/250), the pump rate is 14.4 mL/hour. Options B, C, and D miscalculate either the
concentration, the weight-based dose, or the unit conversion.
"Correct Answer: A"
Q3. A patient with a STEMI is being prepared for emergent percutaneous coronary
intervention. Which medication should the nurse question if the patient reports a severe
allergy to shellfish?
A. Aspirin
B. Metoprolol
C. Iodinated contrast dye
D. Atorvastatin
C. Iodinated contrast dye [CORRECT]
Rationale: Shellfish allergy indicates a potential cross-reactivity with iodinated contrast
media used during cardiac catheterization, increasing the risk of anaphylactoid
reactions; aspirin (A), metoprolol (B), and atorvastatin (D) do not contain iodine and are
not contraindicated by shellfish allergy.
"Correct Answer: C"
Q4. A charge nurse on a cardiac step-down unit has an LPN, a UAP, and an RN. Which
task is most appropriate to delegate to the LPN?
,A. Assessing a patient who developed new-onset chest pain 30 minutes ago
B. Administering a scheduled dose of digoxin to a stable patient with atrial fibrillation
C. Developing the discharge teaching plan for a patient post-cardiac catheterization
D. Evaluating the effectiveness of a new nitroglycerin infusion on a patient in heart
failure
B. Administering a scheduled dose of digoxin to a stable patient with atrial fibrillation
[CORRECT]
Rationale: LPN scope of practice includes administering oral medications to stable
patients with predictable outcomes; assessment of new chest pain (A), discharge
teaching plan development (C), and evaluation of IV titration effectiveness (D) require
RN-level judgment and scope.
"Correct Answer: B"
Q5. A patient with a hypertensive emergency (BP 220/130 mmHg) is receiving a
nitroprusside infusion. Which assessment finding requires the most immediate
intervention?
A. Blood pressure decrease to 180/110 mmHg after 15 minutes
B. Development of a thiocyanate level of 80 mcg/mL after 48 hours
C. Acute change in mental status and metabolic acidosis
D. Mild headache reported 1 hour after infusion started
C. Acute change in mental status and metabolic acidosis [CORRECT]
Rationale: Acute mental status changes with metabolic acidosis indicate cyanide
toxicity from nitroprusside metabolism, which is a medical emergency requiring
immediate discontinuation and antidote administration; a BP of 180/110 (A) is still
elevated but not emergent, thiocyanate of 80 mcg/mL (B) is below the 100 mcg/mL
toxic threshold, and mild headache (D) is an expected side effect.
, "Correct Answer: C"
Q6. A patient with newly diagnosed atrial fibrillation is prescribed dabigatran. Which
instruction should the nurse include in the discharge teaching?
A. "You will need to have your INR checked monthly."
B. "You may crush the capsule and mix it with applesauce if swallowing is difficult."
C. "Report any signs of bleeding, including dark tarry stools or unusual bruising."
D. "Take this medication with vitamin K-rich foods to enhance absorption."
C. "Report any signs of bleeding, including dark tarry stools or unusual bruising."
[CORRECT]
Rationale: Dabigatran is a direct thrombin inhibitor with a bleeding risk; patients must
report bleeding promptly. INR monitoring (A) is for warfarin, the capsule must not be
crushed (B) due to increased bioavailability and toxicity, and vitamin K (D) does not
affect dabigatran and is only relevant for warfarin.
"Correct Answer: C"
Q7. Which finding in a patient taking digoxin requires the nurse to withhold the dose and
notify the provider?
A. Serum potassium of 3.8 mEq/L
B. Apical pulse of 58 beats/minute
C. Serum digoxin level of 1.2 ng/mL
D. Mild nausea relieved by eating crackers
B. Apical pulse of 58 beats/minute [CORRECT]
Rationale: Digoxin slows AV nodal conduction and should be withheld if the apical pulse
is below 60 bpm in adults (or per institutional policy) to prevent severe bradycardia or
heart block; potassium 3.8 (A) is low-normal but not an automatic hold, digoxin 1.2
ng/mL (C) is therapeutic, and mild nausea (D) is a common side effect.
