HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
A 72-hour post-CABG client has a mediastinal chest-tube output of 140 mL/hr for the
last 3 hours, with blood clots visible in the tubing. BP has dropped from 134/82 to 98/56
mm Hg. Which action should the nurse take FIRST?
A. Milk the tubing toward the collection chamber
B. Increase suction from −20 cm H₂O to −40 cm H₂O
C. Immediately notify the surgeon and prepare for exploration
1. D. Administer protamine sulfate per protocol
Correct Answer: C
Rationale: Hemorrhage exceeding 100–150 mL/hr for 3 consecutive hours, especially
with hemodynamic compromise, indicates surgical bleeding that requires prompt
mediastinal exploration. Milking (A) is only for observable clots and does not address
arterial/graft bleeding. Increasing suction (B) can damage tissue and will not stop active
bleeding. Protamine (D) reverses heparin but is ineffective when chest-tube losses are
primarily surgical.
The nurse is caring for a client with acute decompensated HF who is receiving
dobutamine 5 µg/kg/min. Which hemodynamic parameter BEST reflects a therapeutic
response to the drug?
A. Decrease in SVR from 1 600 to 1 200 dynes/s/cm⁵
B. Increase in CVP from 6 to 10 mm Hg
C. Decrease in urine output from 60 mL/hr to 30 mL/hr
2. D. Increase in PA diastolic from 20 to 26 mm Hg
Correct Answer: A
,Rationale: Dobutamine is a β₁ agonist that improves stroke volume and reduces afterload;
a fall in systemic vascular resistance (SVR) with maintained/improved blood pressure
signals successful forward flow. Rising CVP (B) or PA diastolic (D) would suggest
worsening fluid overload, while falling urine output (C) indicates inadequate renal
perfusion—none of which are therapeutic goals.
A client with newly diagnosed atrial fibrillation is started on dabigatran. Which
laboratory value requires IMMEDIATE follow-up before the next dose?
A. aPTT 80 seconds (normal 25–35)
B. INR 1.8 (goal 2–3)
C. Platelet count 180 000/µL
3. D. Creatinine 0.9 mg/dL
Correct Answer: A
Rationale: Dabigatran prolongs aPTT in a dose-dependent manner; a value more than
double normal suggests accumulation and bleeding risk, necessitating dose reduction or
hold until reviewed. INR (B) is unreliable for dabigatran monitoring, platelets (C) are
normal, and creatinine (D) is within range.
A client with an inferior-wall MI develops sudden bradycardia (38 beats/min) and
hypotension. Which intervention should the nurse prepare FIRST?
A. Transcutaneous pacing
B. Atropine 0.5 mg IV
C. Dopamine 5 µg/kg/min
4. D. Isoproterenol 2 µg/min
Correct Answer: B
Rationale: Inferior MIs often involve RCA-mediated Bezold-Jarisch reflex; atropine
blocks vagal input and is the first-line drug for symptomatic bradycardia per ACLS.
Pacing (A) is reserved for atropine failure or high-grade block. Dopamine (C) and
isoproterenol (D) are second-line and require central access.
,A client with hypertensive crisis (BP 240/130 mm Hg) is begun on nicardipine infusion.
After 30 min BP is 210/110 mm Hg. Which action is appropriate?
A. Increase infusion by 2.5 mg/hr q15 min until DBP <90
B. Switch to sodium nitroprusside 0.3 µg/kg/min
C. Administer IV labetalol 20 mg bolus
5. D. Maintain current rate and recheck in 15 minutes
Correct Answer: A
Rationale: Nicardipine is titrated by 2.5 mg/hr every 5–15 min (max 30 mg/hr) to reduce
mean arterial pressure by 10–20% in the first hour; this gradual decrease prevents
hypoperfusion. Switching agents (B, C) is unnecessary unless maximum dose fails.
Waiting (D) delays control and risks end-organ injury.
A client in the cardiac cath lab suddenly reports chest pressure and shows ST-segment
elevation in leads II, III, aVF. Which priority action should the nurse take?
A. Administer sublingual nitroglycerin
B. Prepare for emergency PCI
C. Give IV metoprolol 5 mg
6. D. Start heparin bolus only
Correct Answer: B
Rationale: New ST-elevation during or after PCI signals acute closure, dissection, or
thrombus; immediate repeat PCI (balloon re-inflation, stenting) is the definitive
treatment. NTG (A) may relieve spasm but does not restore flow. Metoprolol (C) and
heparin (D) are adjunctive only.
A client with HFrEF (EF 25%) has gained 2 kg overnight and has 2+ pedal edema.
Current oral furosemide 40 mg bid is ineffective. Which change is MOST appropriate?
A. Switch to bumetanide 1 mg PO daily
B. Increase furosemide to 80 mg PO bid
C. Change to furosemide 60 mg IV push bid
7. D. Add hydrochlorothiazide 25 mg PO daily
, Correct Answer: C
Rationale: IV administration bypasses gut edema and offers more reliable absorption and
rapid effect. Doubling oral dose (B) may fail if bioavailability is poor. Thiazide addition
(D) is useful for diuretic resistance but should follow IV loop optimization.
A client with a temporary transvenous pacemaker has pacing spikes without capture on
the monitor. Which initial action should the nurse take?
A. Increase output to 15 mA
B. Check connections and turn patient to left side
C. Administer atropine 0.5 mg IV
8. D. Apply transcutaneous pacemaker pads
Correct Answer: B
Rationale: Loss of capture may result from lead dislodgement or loose connections;
verifying cables and repositioning the patient can restore contact. Increasing output (A) is
reasonable but secondary. Atropine (C) and transcutaneous pads (D) are used if capture
cannot be restored quickly.
A client with acute pericarditis develops muffled heart sounds, jugular venous distension,
and pulsus paradoxus of 18 mm Hg. Which intervention is priority?
A. Administer NSAID ibuprofen 600 mg PO
B. Prepare for urgent pericardiocentesis
C. Start colchicine 0.5 mg PO
9. D. Increase IV fluids to 150 mL/hr
Correct Answer: B
Rationale: Clinical picture indicates cardiac tamponade; emergent pericardiocentesis is
life-saving by relieving intrapericardial pressure. NSAIDs/colchicine (A, C) treat
inflammation but do not address acute compression. Fluids (D) may transiently support
preload but are insufficient.
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
A 72-hour post-CABG client has a mediastinal chest-tube output of 140 mL/hr for the
last 3 hours, with blood clots visible in the tubing. BP has dropped from 134/82 to 98/56
mm Hg. Which action should the nurse take FIRST?
A. Milk the tubing toward the collection chamber
B. Increase suction from −20 cm H₂O to −40 cm H₂O
C. Immediately notify the surgeon and prepare for exploration
1. D. Administer protamine sulfate per protocol
Correct Answer: C
Rationale: Hemorrhage exceeding 100–150 mL/hr for 3 consecutive hours, especially
with hemodynamic compromise, indicates surgical bleeding that requires prompt
mediastinal exploration. Milking (A) is only for observable clots and does not address
arterial/graft bleeding. Increasing suction (B) can damage tissue and will not stop active
bleeding. Protamine (D) reverses heparin but is ineffective when chest-tube losses are
primarily surgical.
The nurse is caring for a client with acute decompensated HF who is receiving
dobutamine 5 µg/kg/min. Which hemodynamic parameter BEST reflects a therapeutic
response to the drug?
A. Decrease in SVR from 1 600 to 1 200 dynes/s/cm⁵
B. Increase in CVP from 6 to 10 mm Hg
C. Decrease in urine output from 60 mL/hr to 30 mL/hr
2. D. Increase in PA diastolic from 20 to 26 mm Hg
Correct Answer: A
,Rationale: Dobutamine is a β₁ agonist that improves stroke volume and reduces afterload;
a fall in systemic vascular resistance (SVR) with maintained/improved blood pressure
signals successful forward flow. Rising CVP (B) or PA diastolic (D) would suggest
worsening fluid overload, while falling urine output (C) indicates inadequate renal
perfusion—none of which are therapeutic goals.
A client with newly diagnosed atrial fibrillation is started on dabigatran. Which
laboratory value requires IMMEDIATE follow-up before the next dose?
A. aPTT 80 seconds (normal 25–35)
B. INR 1.8 (goal 2–3)
C. Platelet count 180 000/µL
3. D. Creatinine 0.9 mg/dL
Correct Answer: A
Rationale: Dabigatran prolongs aPTT in a dose-dependent manner; a value more than
double normal suggests accumulation and bleeding risk, necessitating dose reduction or
hold until reviewed. INR (B) is unreliable for dabigatran monitoring, platelets (C) are
normal, and creatinine (D) is within range.
A client with an inferior-wall MI develops sudden bradycardia (38 beats/min) and
hypotension. Which intervention should the nurse prepare FIRST?
A. Transcutaneous pacing
B. Atropine 0.5 mg IV
C. Dopamine 5 µg/kg/min
4. D. Isoproterenol 2 µg/min
Correct Answer: B
Rationale: Inferior MIs often involve RCA-mediated Bezold-Jarisch reflex; atropine
blocks vagal input and is the first-line drug for symptomatic bradycardia per ACLS.
Pacing (A) is reserved for atropine failure or high-grade block. Dopamine (C) and
isoproterenol (D) are second-line and require central access.
,A client with hypertensive crisis (BP 240/130 mm Hg) is begun on nicardipine infusion.
After 30 min BP is 210/110 mm Hg. Which action is appropriate?
A. Increase infusion by 2.5 mg/hr q15 min until DBP <90
B. Switch to sodium nitroprusside 0.3 µg/kg/min
C. Administer IV labetalol 20 mg bolus
5. D. Maintain current rate and recheck in 15 minutes
Correct Answer: A
Rationale: Nicardipine is titrated by 2.5 mg/hr every 5–15 min (max 30 mg/hr) to reduce
mean arterial pressure by 10–20% in the first hour; this gradual decrease prevents
hypoperfusion. Switching agents (B, C) is unnecessary unless maximum dose fails.
Waiting (D) delays control and risks end-organ injury.
A client in the cardiac cath lab suddenly reports chest pressure and shows ST-segment
elevation in leads II, III, aVF. Which priority action should the nurse take?
A. Administer sublingual nitroglycerin
B. Prepare for emergency PCI
C. Give IV metoprolol 5 mg
6. D. Start heparin bolus only
Correct Answer: B
Rationale: New ST-elevation during or after PCI signals acute closure, dissection, or
thrombus; immediate repeat PCI (balloon re-inflation, stenting) is the definitive
treatment. NTG (A) may relieve spasm but does not restore flow. Metoprolol (C) and
heparin (D) are adjunctive only.
A client with HFrEF (EF 25%) has gained 2 kg overnight and has 2+ pedal edema.
Current oral furosemide 40 mg bid is ineffective. Which change is MOST appropriate?
A. Switch to bumetanide 1 mg PO daily
B. Increase furosemide to 80 mg PO bid
C. Change to furosemide 60 mg IV push bid
7. D. Add hydrochlorothiazide 25 mg PO daily
, Correct Answer: C
Rationale: IV administration bypasses gut edema and offers more reliable absorption and
rapid effect. Doubling oral dose (B) may fail if bioavailability is poor. Thiazide addition
(D) is useful for diuretic resistance but should follow IV loop optimization.
A client with a temporary transvenous pacemaker has pacing spikes without capture on
the monitor. Which initial action should the nurse take?
A. Increase output to 15 mA
B. Check connections and turn patient to left side
C. Administer atropine 0.5 mg IV
8. D. Apply transcutaneous pacemaker pads
Correct Answer: B
Rationale: Loss of capture may result from lead dislodgement or loose connections;
verifying cables and repositioning the patient can restore contact. Increasing output (A) is
reasonable but secondary. Atropine (C) and transcutaneous pads (D) are used if capture
cannot be restored quickly.
A client with acute pericarditis develops muffled heart sounds, jugular venous distension,
and pulsus paradoxus of 18 mm Hg. Which intervention is priority?
A. Administer NSAID ibuprofen 600 mg PO
B. Prepare for urgent pericardiocentesis
C. Start colchicine 0.5 mg PO
9. D. Increase IV fluids to 150 mL/hr
Correct Answer: B
Rationale: Clinical picture indicates cardiac tamponade; emergent pericardiocentesis is
life-saving by relieving intrapericardial pressure. NSAIDs/colchicine (A, C) treat
inflammation but do not address acute compression. Fluids (D) may transiently support
preload but are insufficient.
