OBJECTIVE ASSESSMENT - EXAM
Med Surg
Final Exam
HESI | Latest Q&As
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Musculoskeletal & Integumentary Disorders
Gastrointestinal & Renal Conditions Perioperative & Emergency Nursing Care
Neurologic & Endocrine Dysfunction
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | HESI Med Surg Final Exam 2026/2027
Q1 Question 1 of 100
A 67-year-old patient presents to the emergency department with crushing substernal chest pain radiating to the
left arm, diaphoresis, and nausea for the past 45 minutes. The 12-lead ECG shows ST-segment elevation in leads
V1 through V4. The nurse anticipates that the primary treatment goal for this patient is immediate reperfusion
therapy. Which intervention should the nurse prepare to implement first?
A. Schedule a coronary artery bypass graft for the following day
B. Initiate beta-blocker therapy to reduce myocardial oxygen demand
C. Prepare for percutaneous coronary intervention within 90 minutes of arrival
D. Administer thrombolytic therapy within 30 minutes of arrival
Correct Answer: C
Rationale:
For ST-elevation myocardial infarction (STEMI), the gold standard is percutaneous coronary intervention (PCI) within
90 minutes of hospital arrival, as it achieves higher reperfusion rates than thrombolytics with lower bleeding risk.
Thrombolytics are used when PCI is not available within the guideline window. Beta-blockers and CABG are important
but not the immediate first-line reperfusion strategy.
Q2 Question 2 of 100
A 72-year-old patient with a history of heart failure has been taking furosemide 80 mg daily for three weeks. The
nurse observes that the patient is now experiencing muscle weakness, hypotension, and frequent premature
ventricular contractions. A basic metabolic panel is most likely to reveal which critical electrolyte imbalance?
A. Hypomagnesemia from enhanced magnesium conservation
B. Hypernatremia from excessive sodium retention
C. Hypokalemia from loop diuretic-induced potassium wasting
D. Hypercalcemia from increased calcium reabsorption
Correct Answer: C
Rationale:
Furosemide is a loop diuretic that causes significant potassium wasting by inhibiting sodium-potassium-chloride
cotransport in the thick ascending limb of Henle. Hypokalemia leads to muscle weakness, hypotension, and cardiac
dysrhythmias including PVCs. Loop diuretics also waste magnesium, but hypokalemia is the most common and
immediately dangerous imbalance in this scenario.
Q3 Question 3 of 100
A 58-year-old patient with chronic heart failure is prescribed lisinopril. The nurse teaches the patient about the
medication and monitors for adverse effects. One week later, the patient reports persistent dry cough and mild
swelling of the lips. The nurse recognizes these findings are most consistent with which mechanism of action of
ACE inhibitors?
A. Stimulation of aldosterone secretion promoting fluid retention
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 1 of 42
, B. Enhancement of sympathetic nervous system activity causing bronchospasm
C. Inhibition of bradykinin breakdown leading to increased bradykinin in the lungs
D. Blockade of angiotensin II receptors causing vasodilation
Correct Answer: C
Rationale:
ACE inhibitors block the conversion of angiotensin I to angiotensin II, but they also inhibit the degradation of bradykinin.
Accumulation of bradykinin in the respiratory tract causes the characteristic dry cough, and bradykinin-mediated
angioedema accounts for the lip swelling. ARBs block angiotensin II at the receptor level without affecting bradykinin,
which is why they do not typically cause cough.
Q4 Question 4 of 100
A 65-year-old patient with a history of atrial fibrillation is taking warfarin 5 mg daily. The patient's INR is 5.2, and
there is evidence of active gum bleeding. The nurse anticipates that the provider will order which immediate
intervention to reverse the anticoagulant effect?
A. Administer fresh frozen plasma and increase warfarin dose
B. Administer protamine sulfate intravenously
C. Administer vitamin K (phytonadione) intravenously or orally
D. Discontinue warfarin and observe for 48 hours
Correct Answer: C
Rationale:
Vitamin K is the specific antidote for warfarin toxicity because warfarin works by inhibiting vitamin K-dependent
synthesis of clotting factors II, VII, IX, and X. Administering vitamin K reverses this inhibition and allows the liver to
resume producing these clotting factors. Protamine sulfate is the antidote for heparin, not warfarin. Simply observing
would delay reversal in an actively bleeding patient.
Q5 Question 5 of 100
A 55-year-old patient is admitted with acute decompensated heart failure. Assessment reveals bilateral crackles
throughout the lung fields, jugular venous distension, and 3+ pitting edema in both lower extremities. The nurse
understands that these findings represent which pathophysiologic process?
A. Left-sided heart failure with pulmonary congestion and forward failure
B. Biventricular failure with both pulmonary and systemic congestion
C. Isolated diastolic dysfunction with preserved ejection fraction
D. Right-sided heart failure with systemic venous congestion
Correct Answer: B
Rationale:
The bilateral crackles indicate pulmonary congestion from left ventricular failure, while the jugular venous distension
and peripheral edema indicate systemic venous congestion from right ventricular failure. The combination of both
pulmonary and systemic signs indicates biventricular failure. Isolated right-sided failure would not produce pulmonary
crackles, and isolated left-sided failure would not cause significant JVD or peripheral edema.
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 2 of 42
, Q6 Question 6 of 100
A 48-year-old patient with deep vein thrombosis is started on a heparin infusion. Six hours after initiation, the
nurse draws blood for an activated partial thromboplastin time (aPTT) test. The target therapeutic range for aPTT
in heparin therapy is typically 1.5 to 2.5 times the control value. The nurse understands that this laboratory test
monitors which aspect of the coagulation cascade?
A. Platelet count and platelet function
B. Fibrinogen levels and fibrin degradation products
C. The extrinsic pathway measured by prothrombin time
D. The intrinsic pathway and common pathway of coagulation
Correct Answer: D
Rationale:
The aPTT measures the intrinsic pathway and common pathway of the coagulation cascade, which is the pathway that
heparin primarily affects by enhancing antithrombin III activity. The extrinsic pathway is measured by PT/INR, which is
used to monitor warfarin therapy. Platelet count and fibrinogen levels assess different components of hemostasis that
are not the primary target of heparin monitoring.
Q7 Question 7 of 100
A 70-year-old patient with a mechanical mitral valve replacement is prescribed lifelong anticoagulation. The nurse
teaches the patient about dietary considerations while taking warfarin. The patient asks about eating green leafy
vegetables. Which response by the nurse is most accurate?
A. Avoid all green leafy vegetables completely while on warfarin
B. Consume a consistent amount of vitamin K-rich foods daily rather than varying intake
C. Increase green leafy vegetable intake to improve warfarin effectiveness
D. Take a vitamin K supplement to stabilize your INR readings
Correct Answer: B
Rationale:
Warfarin works by inhibiting vitamin K-dependent clotting factor synthesis. Sudden changes in dietary vitamin K intake
can cause INR fluctuations, making anticoagulation difficult to control. The key is consistency rather than avoidance,
because completely eliminating vitamin K foods is unnecessary and can make INR management harder. The goal is
maintaining a stable, predictable dietary vitamin K intake.
Q8 Question 8 of 100
A 62-year-old patient presents with sudden onset of severe dyspnea, pleuritic chest pain, and hemoptysis three
days after undergoing abdominal surgery. The nurse notes tachycardia and a low-grade fever. Based on these
findings, the nurse suspects a pulmonary embolism. Which diagnostic test provides the most definitive diagnosis?
A. D-dimer assay to rule out venous thromboembolism
B. Computed tomography pulmonary angiography (CTPA)
C. Ventilation-perfusion (V/Q) scan to identify mismatched defects
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 3 of 42
Med Surg
Final Exam
HESI | Latest Q&As
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders Musculoskeletal & Integumentary Disorders
Gastrointestinal & Renal Conditions Perioperative & Emergency Nursing Care
Neurologic & Endocrine Dysfunction
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | HESI Med Surg Final Exam 2026/2027
Q1 Question 1 of 100
A 67-year-old patient presents to the emergency department with crushing substernal chest pain radiating to the
left arm, diaphoresis, and nausea for the past 45 minutes. The 12-lead ECG shows ST-segment elevation in leads
V1 through V4. The nurse anticipates that the primary treatment goal for this patient is immediate reperfusion
therapy. Which intervention should the nurse prepare to implement first?
A. Schedule a coronary artery bypass graft for the following day
B. Initiate beta-blocker therapy to reduce myocardial oxygen demand
C. Prepare for percutaneous coronary intervention within 90 minutes of arrival
D. Administer thrombolytic therapy within 30 minutes of arrival
Correct Answer: C
Rationale:
For ST-elevation myocardial infarction (STEMI), the gold standard is percutaneous coronary intervention (PCI) within
90 minutes of hospital arrival, as it achieves higher reperfusion rates than thrombolytics with lower bleeding risk.
Thrombolytics are used when PCI is not available within the guideline window. Beta-blockers and CABG are important
but not the immediate first-line reperfusion strategy.
Q2 Question 2 of 100
A 72-year-old patient with a history of heart failure has been taking furosemide 80 mg daily for three weeks. The
nurse observes that the patient is now experiencing muscle weakness, hypotension, and frequent premature
ventricular contractions. A basic metabolic panel is most likely to reveal which critical electrolyte imbalance?
A. Hypomagnesemia from enhanced magnesium conservation
B. Hypernatremia from excessive sodium retention
C. Hypokalemia from loop diuretic-induced potassium wasting
D. Hypercalcemia from increased calcium reabsorption
Correct Answer: C
Rationale:
Furosemide is a loop diuretic that causes significant potassium wasting by inhibiting sodium-potassium-chloride
cotransport in the thick ascending limb of Henle. Hypokalemia leads to muscle weakness, hypotension, and cardiac
dysrhythmias including PVCs. Loop diuretics also waste magnesium, but hypokalemia is the most common and
immediately dangerous imbalance in this scenario.
Q3 Question 3 of 100
A 58-year-old patient with chronic heart failure is prescribed lisinopril. The nurse teaches the patient about the
medication and monitors for adverse effects. One week later, the patient reports persistent dry cough and mild
swelling of the lips. The nurse recognizes these findings are most consistent with which mechanism of action of
ACE inhibitors?
A. Stimulation of aldosterone secretion promoting fluid retention
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 1 of 42
, B. Enhancement of sympathetic nervous system activity causing bronchospasm
C. Inhibition of bradykinin breakdown leading to increased bradykinin in the lungs
D. Blockade of angiotensin II receptors causing vasodilation
Correct Answer: C
Rationale:
ACE inhibitors block the conversion of angiotensin I to angiotensin II, but they also inhibit the degradation of bradykinin.
Accumulation of bradykinin in the respiratory tract causes the characteristic dry cough, and bradykinin-mediated
angioedema accounts for the lip swelling. ARBs block angiotensin II at the receptor level without affecting bradykinin,
which is why they do not typically cause cough.
Q4 Question 4 of 100
A 65-year-old patient with a history of atrial fibrillation is taking warfarin 5 mg daily. The patient's INR is 5.2, and
there is evidence of active gum bleeding. The nurse anticipates that the provider will order which immediate
intervention to reverse the anticoagulant effect?
A. Administer fresh frozen plasma and increase warfarin dose
B. Administer protamine sulfate intravenously
C. Administer vitamin K (phytonadione) intravenously or orally
D. Discontinue warfarin and observe for 48 hours
Correct Answer: C
Rationale:
Vitamin K is the specific antidote for warfarin toxicity because warfarin works by inhibiting vitamin K-dependent
synthesis of clotting factors II, VII, IX, and X. Administering vitamin K reverses this inhibition and allows the liver to
resume producing these clotting factors. Protamine sulfate is the antidote for heparin, not warfarin. Simply observing
would delay reversal in an actively bleeding patient.
Q5 Question 5 of 100
A 55-year-old patient is admitted with acute decompensated heart failure. Assessment reveals bilateral crackles
throughout the lung fields, jugular venous distension, and 3+ pitting edema in both lower extremities. The nurse
understands that these findings represent which pathophysiologic process?
A. Left-sided heart failure with pulmonary congestion and forward failure
B. Biventricular failure with both pulmonary and systemic congestion
C. Isolated diastolic dysfunction with preserved ejection fraction
D. Right-sided heart failure with systemic venous congestion
Correct Answer: B
Rationale:
The bilateral crackles indicate pulmonary congestion from left ventricular failure, while the jugular venous distension
and peripheral edema indicate systemic venous congestion from right ventricular failure. The combination of both
pulmonary and systemic signs indicates biventricular failure. Isolated right-sided failure would not produce pulmonary
crackles, and isolated left-sided failure would not cause significant JVD or peripheral edema.
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 2 of 42
, Q6 Question 6 of 100
A 48-year-old patient with deep vein thrombosis is started on a heparin infusion. Six hours after initiation, the
nurse draws blood for an activated partial thromboplastin time (aPTT) test. The target therapeutic range for aPTT
in heparin therapy is typically 1.5 to 2.5 times the control value. The nurse understands that this laboratory test
monitors which aspect of the coagulation cascade?
A. Platelet count and platelet function
B. Fibrinogen levels and fibrin degradation products
C. The extrinsic pathway measured by prothrombin time
D. The intrinsic pathway and common pathway of coagulation
Correct Answer: D
Rationale:
The aPTT measures the intrinsic pathway and common pathway of the coagulation cascade, which is the pathway that
heparin primarily affects by enhancing antithrombin III activity. The extrinsic pathway is measured by PT/INR, which is
used to monitor warfarin therapy. Platelet count and fibrinogen levels assess different components of hemostasis that
are not the primary target of heparin monitoring.
Q7 Question 7 of 100
A 70-year-old patient with a mechanical mitral valve replacement is prescribed lifelong anticoagulation. The nurse
teaches the patient about dietary considerations while taking warfarin. The patient asks about eating green leafy
vegetables. Which response by the nurse is most accurate?
A. Avoid all green leafy vegetables completely while on warfarin
B. Consume a consistent amount of vitamin K-rich foods daily rather than varying intake
C. Increase green leafy vegetable intake to improve warfarin effectiveness
D. Take a vitamin K supplement to stabilize your INR readings
Correct Answer: B
Rationale:
Warfarin works by inhibiting vitamin K-dependent clotting factor synthesis. Sudden changes in dietary vitamin K intake
can cause INR fluctuations, making anticoagulation difficult to control. The key is consistency rather than avoidance,
because completely eliminating vitamin K foods is unnecessary and can make INR management harder. The goal is
maintaining a stable, predictable dietary vitamin K intake.
Q8 Question 8 of 100
A 62-year-old patient presents with sudden onset of severe dyspnea, pleuritic chest pain, and hemoptysis three
days after undergoing abdominal surgery. The nurse notes tachycardia and a low-grade fever. Based on these
findings, the nurse suspects a pulmonary embolism. Which diagnostic test provides the most definitive diagnosis?
A. D-dimer assay to rule out venous thromboembolism
B. Computed tomography pulmonary angiography (CTPA)
C. Ventilation-perfusion (V/Q) scan to identify mismatched defects
HESI Med Surg Final Exam - 2026/2027 | Passing Score: 75% | Page 3 of 42
