MED SURG HESI V2 ACTUAL EXAM 2026/2027 | Version 2
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Graded
[Section 1: Cardiovascular & Peripheral Vascular (Q1-18)]
Q1. A patient returns to the unit after a cardiac catheterization with femoral artery
access. Which action is the nurse's priority?
A. Ambulate the patient to the bathroom to prevent urinary retention.
B. Assess the puncture site and distal pulses for hematoma, bleeding, or loss of
circulation. [CORRECT]
C. Remove the arterial sheath immediately to prevent infection.
D. Administer a rapid IV fluid bolus without assessing the insertion site.
Rationale: Post-cath priority is monitoring the vascular access site and distal
neurovascular status; ambulation and unsupervised sheath removal are contraindicated
for several hours.
Correct Answer: B
Q2. A patient with a drug-eluting stent placed 2 months ago asks to stop clopidogrel
before a dental extraction. What is the nurse's best response?
A. Advise the patient to stop both aspirin and clopidogrel 5 days before the procedure.
B. Tell the patient to stop aspirin but continue clopidogrel.
C. Instruct the patient to contact the cardiologist before stopping dual antiplatelet
therapy due to stent thrombosis risk. [CORRECT]
D. Stop clopidogrel but continue aspirin indefinitely without notifying the provider.
,Rationale: Premature discontinuation of DAPT after DES significantly increases stent
thrombosis and MI risk; the cardiologist must evaluate bleeding vs thrombosis risk
before any interruption.
Correct Answer: C
Q3. A nurse is reviewing heart failure pathophysiology. Which combination of
statements accurately differentiates HFpEF and HFrEF?
1. HFpEF is defined by an ejection fraction ≥50%.
2. HFrEF is defined by an ejection fraction ≤40%.
3. HFpEF is caused primarily by ventricular stiffness and impaired relaxation.
A. Statement 1 only
B. Statements 1 and 2 only
C. Statements 1, 2, and 3 [CORRECT]
D. Statements 2 and 3 only
Rationale: HFpEF (EF ≥50%) involves diastolic dysfunction and ventricular stiffness,
while HFrEF (EF ≤40%) involves systolic dysfunction; all three statements are accurate.
Correct Answer: C
Q4. A patient with an acute STEMI underwent primary PCI. Which assessment finding
indicates successful reperfusion?
A. Resolution of chest pain and ST-segment elevation. [CORRECT]
B. Development of a new systolic murmur.
C. Increased ventricular ectopy without pain change.
D. Persistent ST elevation with worsening dyspnea.
Rationale: Successful PCI is confirmed by symptom resolution and ECG improvement
(ST resolution); new murmurs and persistent ST changes indicate complications.
Correct Answer: A
,Q5. A patient with diabetes has an ankle-brachial index (ABI) of 1.6. The nurse interprets
this as:
A. Normal arterial flow.
B. Non-compressible calcified vessels suggesting medial arterial calcification.
[CORRECT]
C. Severe peripheral arterial obstruction.
D. Venous insufficiency.
Rationale: ABI >1.4 indicates non-compressible calcified arteries (common in diabetes),
falsely elevating pressures; normal is 1.0–1.4, and <0.9 indicates PAD.
Correct Answer: B
Q6. A patient with nonvalvular atrial fibrillation has a CHA₂DS₂-VASc score of 4.
According to 2026 guidelines, which therapy is first-line for stroke prevention?
A. Warfarin with a target INR of 1.5–2.0.
B. Apixaban 5 mg twice daily unless contraindicated. [CORRECT]
C. Aspirin 81 mg daily as monotherapy.
D. Heparin drip for 48 hours only.
Rationale: DOACs (apixaban, rivaroxaban) are first-line for nonvalvular AFib stroke
prevention due to superior safety profiles and no INR monitoring; aspirin monotherapy is
insufficient for moderate-to-high risk.
Correct Answer: B
Q7. A patient presents with a blood pressure of 220/130 mmHg, severe headache, and
blurred vision but no acute target organ damage on initial workup. Which intervention is
most appropriate?
A. Administer sublingual nifedipine for rapid reduction.
B. Reduce MAP by no more than 25% over the first hour using IV labetalol or nicardipine
with continuous monitoring. [CORRECT]
, C. Lower BP to 140/90 within 15 minutes.
D. Place the patient in Trendelenburg position.
Rationale: Hypertensive emergency requires controlled reduction (not >25% in the first
hour) with IV agents to prevent cerebral, coronary, and renal hypoperfusion from overly
aggressive lowering.
Correct Answer: B
Q8. A patient with a prosthetic heart valve presents with fever and chills. Which action is
the nurse's priority?
A. Obtain blood cultures from two different sites before initiating antibiotics. [CORRECT]
B. Start empiric vancomycin immediately without drawing cultures.
C. Place the patient in droplet isolation.
D. Schedule immediate valve replacement surgery.
Rationale: Blood cultures (2–3 sets) must be obtained before antibiotics to identify the
organism and guide therapy; empiric therapy follows culture collection.
Correct Answer: A
Q9. Five days after an anterior wall MI, a patient develops a new holosystolic murmur,
acute pulmonary edema, and cardiogenic shock. The nurse recognizes this as:
A. Ventricular septal defect.
B. Papillary muscle rupture with acute mitral regurgitation. [CORRECT]
C. Dressler syndrome.
D. Left ventricular aneurysm.
Rationale: Papillary muscle rupture typically occurs 2–7 days post-MI, causing acute
severe mitral regurgitation and flash pulmonary edema; VSD presents with a harsh
holosystolic murmur and right-sided heart catheterization oxygen step-up.
Verified Q&A | Complete Test Bank | Pass Guaranteed - A+
Graded
[Section 1: Cardiovascular & Peripheral Vascular (Q1-18)]
Q1. A patient returns to the unit after a cardiac catheterization with femoral artery
access. Which action is the nurse's priority?
A. Ambulate the patient to the bathroom to prevent urinary retention.
B. Assess the puncture site and distal pulses for hematoma, bleeding, or loss of
circulation. [CORRECT]
C. Remove the arterial sheath immediately to prevent infection.
D. Administer a rapid IV fluid bolus without assessing the insertion site.
Rationale: Post-cath priority is monitoring the vascular access site and distal
neurovascular status; ambulation and unsupervised sheath removal are contraindicated
for several hours.
Correct Answer: B
Q2. A patient with a drug-eluting stent placed 2 months ago asks to stop clopidogrel
before a dental extraction. What is the nurse's best response?
A. Advise the patient to stop both aspirin and clopidogrel 5 days before the procedure.
B. Tell the patient to stop aspirin but continue clopidogrel.
C. Instruct the patient to contact the cardiologist before stopping dual antiplatelet
therapy due to stent thrombosis risk. [CORRECT]
D. Stop clopidogrel but continue aspirin indefinitely without notifying the provider.
,Rationale: Premature discontinuation of DAPT after DES significantly increases stent
thrombosis and MI risk; the cardiologist must evaluate bleeding vs thrombosis risk
before any interruption.
Correct Answer: C
Q3. A nurse is reviewing heart failure pathophysiology. Which combination of
statements accurately differentiates HFpEF and HFrEF?
1. HFpEF is defined by an ejection fraction ≥50%.
2. HFrEF is defined by an ejection fraction ≤40%.
3. HFpEF is caused primarily by ventricular stiffness and impaired relaxation.
A. Statement 1 only
B. Statements 1 and 2 only
C. Statements 1, 2, and 3 [CORRECT]
D. Statements 2 and 3 only
Rationale: HFpEF (EF ≥50%) involves diastolic dysfunction and ventricular stiffness,
while HFrEF (EF ≤40%) involves systolic dysfunction; all three statements are accurate.
Correct Answer: C
Q4. A patient with an acute STEMI underwent primary PCI. Which assessment finding
indicates successful reperfusion?
A. Resolution of chest pain and ST-segment elevation. [CORRECT]
B. Development of a new systolic murmur.
C. Increased ventricular ectopy without pain change.
D. Persistent ST elevation with worsening dyspnea.
Rationale: Successful PCI is confirmed by symptom resolution and ECG improvement
(ST resolution); new murmurs and persistent ST changes indicate complications.
Correct Answer: A
,Q5. A patient with diabetes has an ankle-brachial index (ABI) of 1.6. The nurse interprets
this as:
A. Normal arterial flow.
B. Non-compressible calcified vessels suggesting medial arterial calcification.
[CORRECT]
C. Severe peripheral arterial obstruction.
D. Venous insufficiency.
Rationale: ABI >1.4 indicates non-compressible calcified arteries (common in diabetes),
falsely elevating pressures; normal is 1.0–1.4, and <0.9 indicates PAD.
Correct Answer: B
Q6. A patient with nonvalvular atrial fibrillation has a CHA₂DS₂-VASc score of 4.
According to 2026 guidelines, which therapy is first-line for stroke prevention?
A. Warfarin with a target INR of 1.5–2.0.
B. Apixaban 5 mg twice daily unless contraindicated. [CORRECT]
C. Aspirin 81 mg daily as monotherapy.
D. Heparin drip for 48 hours only.
Rationale: DOACs (apixaban, rivaroxaban) are first-line for nonvalvular AFib stroke
prevention due to superior safety profiles and no INR monitoring; aspirin monotherapy is
insufficient for moderate-to-high risk.
Correct Answer: B
Q7. A patient presents with a blood pressure of 220/130 mmHg, severe headache, and
blurred vision but no acute target organ damage on initial workup. Which intervention is
most appropriate?
A. Administer sublingual nifedipine for rapid reduction.
B. Reduce MAP by no more than 25% over the first hour using IV labetalol or nicardipine
with continuous monitoring. [CORRECT]
, C. Lower BP to 140/90 within 15 minutes.
D. Place the patient in Trendelenburg position.
Rationale: Hypertensive emergency requires controlled reduction (not >25% in the first
hour) with IV agents to prevent cerebral, coronary, and renal hypoperfusion from overly
aggressive lowering.
Correct Answer: B
Q8. A patient with a prosthetic heart valve presents with fever and chills. Which action is
the nurse's priority?
A. Obtain blood cultures from two different sites before initiating antibiotics. [CORRECT]
B. Start empiric vancomycin immediately without drawing cultures.
C. Place the patient in droplet isolation.
D. Schedule immediate valve replacement surgery.
Rationale: Blood cultures (2–3 sets) must be obtained before antibiotics to identify the
organism and guide therapy; empiric therapy follows culture collection.
Correct Answer: A
Q9. Five days after an anterior wall MI, a patient develops a new holosystolic murmur,
acute pulmonary edema, and cardiogenic shock. The nurse recognizes this as:
A. Ventricular septal defect.
B. Papillary muscle rupture with acute mitral regurgitation. [CORRECT]
C. Dressler syndrome.
D. Left ventricular aneurysm.
Rationale: Papillary muscle rupture typically occurs 2–7 days post-MI, causing acute
severe mitral regurgitation and flash pulmonary edema; VSD presents with a harsh
holosystolic murmur and right-sided heart catheterization oxygen step-up.
