HESI MS HESI Medical and Surgical Exam - Set 1 - Part 1

Correct Answer: Atrial and ventricular wall stretching from volume overload

BNP is released in response to atrial and ventricular wall stretch caused by volume overload. The higher the level, the more severe the heart failure. A BNP above 100 ng/mL serves as a marker for heart failure and reflects mechanical stress on the myocardium from excessive filling pressures. Option b is incorrect because reduced renal perfusion activates the renin-angiotensin-aldosterone system. That pathway promotes sodium and water retention and operates independently from the myocardial stretch mechanism that triggers BNP secretion. Option c is incorrect because troponin is a biomarker of myocardial cell death released when cardiac muscle is damaged by ischemia. It plays no role in stimulating BNP secretion, which is a volume-sensing peptide response rather than an injury-response pathway. Option d is incorrect because decreased serum sodium in heart failure is a consequence of dilutional water excess, not a stimulus for BNP release. BNP responds to the physical force of chamber dis

Correct Answer: Stop all activity and rest in a sitting or lying position

Stable angina is triggered by exertion and relieved by rest because stopping activity reduces myocardial oxygen demand immediately. Resting is the first intervention before nitroglycerin, as it alone may resolve the episode without medication. Sitting or lying down also prevents syncope if vasodilation occurs. Option a is incorrect because chewing aspirin outdoors while still exerting is premature. Aspirin prevents platelet aggregation but does not relieve the acute oxygen-demand imbalance of exertional angina. Rest is the first step; aspirin may follow as part of chronic antiplatelet management, not as the initial acute intervention. Option b is incorrect because taking a blood pressure reading delays the primary intervention of stopping activity and resting. Blood pressure measurement provides useful data but does not address the acute myocardial oxygen supply-demand mismatch that rest immediately corrects. Option d is incorrect because calling emergency services is appropriate when

Correct Answer: Notify the primary health care provider immediately

Pallor, coolness, and absent pedal pulse after femoral arterial catheterization indicate acute arterial occlusion, likely from thrombus formation at the puncture site. This is a vascular emergency requiring immediate provider notification so that interventions such as embolectomy or thrombolysis can be initiated before the limb becomes ischemic. Option a is incorrect because elevating the leg above heart level reduces arterial perfusion pressure to an extremity that is already compromised by suspected occlusion. Gravity-assisted inflow is needed, and elevation works against it, worsening distal ischemia. Option b is incorrect because applying heat to a limb with impaired or absent arterial flow risks causing a burn. Decreased sensation from ischemia means the client cannot reliably detect dangerous temperatures, and heat does not restore a lost pulse. Option c is incorrect because increasing IV fluids addresses systemic volume status rather than a localized arterial obstruction. Region

Correct Answer: Arterial occlusion from clot formation at the insertion site

Post-cardiac-catheterization nursing includes monitoring for clot formation at the arterial insertion site. Numbness, tingling, a cool extremity, and pallor distal to the insertion site signal arterial occlusion that threatens limb viability and must be reported immediately to the primary health care provider. Option a is incorrect because a vagal response during dye injection produces bradycardia, hypotension, diaphoresis, and nausea — systemic findings during the procedure itself. It does not cause unilateral limb coolness and absent sensation appearing 30 minutes after the catheter is removed. Option c is incorrect because an isolated femoral nerve hematoma produces localized nerve compression symptoms but would not cause the cool, pale extremity that indicates vascular compromise. Neurovascular assessment after arterial procedures monitors for both pulse and sensation changes together. Option d is incorrect because reperfusion after catheter removal restores normal warmth and sensa

Correct Answer: Hold the infusion and notify the provider for a dosage reduction

The therapeutic aPTT range for continuous heparin is 1.5 to 2.5 times the normal value, which equals approximately 45 to 100 seconds. An aPTT of 112 seconds exceeds the upper therapeutic limit, indicating supratherapeutic anticoagulation. The infusion should be held and the provider notified per agency protocol to reduce the dose and prevent bleeding. Option a is incorrect because continuing an infusion when the aPTT already exceeds the therapeutic ceiling further increases bleeding risk without improving anticoagulant benefit. Supratherapeutic levels require dose adjustment, not steady-state maintenance. Option b is incorrect because increasing the infusion rate is the correct action only when the aPTT is below the lower therapeutic boundary, indicating inadequate anticoagulation. Raising the dose when the aPTT is already too high would push the client toward dangerous hemorrhagic levels. Option d is incorrect because protamine sulfate is reserved for life-threatening heparin overdose

Correct Answer: Withhold the dose and notify the primary health care provider

Digoxin slows the heart rate through its negative chronotropic effect. The medication must be withheld and the provider notified when the apical pulse is below 60 beats per minute before a scheduled dose. Administering it at a rate of 54 could lower the rate further into a dangerous bradycardia range. Option a is incorrect because administering digoxin with a pulse already below 60 beats per minute risks clinically significant bradycardia or heart block. Monitoring after the fact does not eliminate the safety concern. The medication must be withheld before the problem is created. Option b is incorrect because orange juice is recommended to supplement potassium in clients on potassium-wasting diuretics, not as a strategy for managing a low pre-dose heart rate. The safety concern of bradycardia takes precedence and is addressed by withholding, not by concurrent food intake. Option c is incorrect because waiting one hour and rechecking without notifying the provider delays the necessary c

Correct Answer: Infective endocarditis with embolic peripheral manifestations

Infective endocarditis in IV drug users presents with fever, new cardiac murmur, and distinctive peripheral embolic signs including Osler nodes (tender reddish finger-pad lesions), Janeway lesions (nontender hemorrhagic palm lesions), and splinter hemorrhages. These findings result from emboli from infected valve vegetations traveling through the arterial circulation. Option b is incorrect because pericarditis causes sharp anterior chest pain aggravated by breathing and relieved by leaning forward, along with a friction rub on auscultation. The peripheral embolic signs — Osler nodes, Janeway lesions, and splinter hemorrhages — are not features of pericardial inflammation. Option c is incorrect because myocarditis produces chest pain, tachycardia, and signs of heart failure such as gallop rhythms and murmurs from functional regurgitation. The specific embolic peripheral findings described here arise from septic emboli originating from valve vegetations, a mechanism unique to endocarditi

Correct Answer: Crackles bilaterally throughout the lung fields

Frothy, blood-tinged sputum and acute dyspnea following MI indicate pulmonary edema from acute left ventricular failure. Fluid flooding the alveoli produces bilateral crackles on auscultation, the hallmark breath sound of pulmonary edema. This reflects the backpressure of a failing left ventricle pushing fluid into the alveolar spaces. Option a is incorrect because bronchial breath sounds heard over anterior lung fields indicate consolidation from pneumonia or atelectasis, not fluid-filled alveoli from cardiac failure. Bronchial sounds are associated with tissue density changes, not the alveolar edema pattern of acute left ventricular failure. Option b is incorrect because stridor is a high-pitched sound produced by upper airway obstruction above or at the larynx, such as from anaphylaxis or croup. It has no relationship to the alveolar fluid accumulation that characterizes pulmonary edema from left ventricular failure. Option d is incorrect because absent breath sounds on one side sug

Correct Answer: 2 grams per day as the recommended therapeutic restriction

Saunders recommends dietary sodium restriction to 2 grams per day as part of nonpharmacological hypertension management. This target reduces fluid retention and blood pressure, particularly in sodium-sensitive individuals, and forms a core component of the lifestyle modification plan before or alongside pharmacological therapy. Option a is incorrect because 5 grams per day is near the average American daily sodium intake and provides no meaningful therapeutic reduction. Hypertension management requires a restriction substantially below typical consumption to reduce cardiovascular strain. Option b is incorrect because 4 grams per day is above the Saunders-specified 2-gram target. While it represents some restriction from typical intake, it does not achieve the therapeutic goal established in standard hypertension management guidelines. Option c is incorrect because a 3-gram daily limit is not the specific restriction outlined in Saunders guidelines for hypertension management. The clini

Correct Answer: Switch the defibrillator to synchronize mode before delivering the shock

Synchronized cardioversion requires the defibrillator to be in synchronize mode so the shock is timed to the QRS complex, avoiding the T-wave vulnerable period. Firing an unsynchronized shock during atrial fibrillation risks R-on-T phenomenon and can trigger ventricular fibrillation. Option a is incorrect because hemodynamic instability does not justify bypassing the synchronize setting for cardioversion of atrial fibrillation. Firing an unsynchronized shock during atrial fibrillation risks R-on-T phenomenon and ventricular fibrillation, creating a more dangerous situation than the original rhythm. Option c is incorrect because administering IV amiodarone before correcting the device setting delays the required safety step. The defibrillator mode must be confirmed in synchronize mode before shock delivery proceeds, regardless of concurrent pharmacological options being considered. Option d is incorrect because an asynchronous shock is defibrillation, used only for pulseless ventricular

Correct Answer: Cardiac tamponade from pericardial blood accumulation blocking tube

Post-CABG cardiac tamponade presents with sudden cessation of mediastinal drainage when blood clots block the tube, jugular venous distention with clear lung sounds, hypotension, and equalization of right atrial pressure with pulmonary artery wedge pressure. Saunders identifies all four findings as the classic post-cardiac-surgery tamponade pattern requiring pericardiocentesis. Option b is incorrect because acute left ventricular failure causes pulmonary congestion with crackles and elevated wedge pressure well above right atrial pressure. This client has clear lungs with equalized pressures, which is the tamponade pattern rather than pump failure from the left side. Option c is incorrect because hypovolemic hemorrhagic shock produces flat neck veins as blood drains away from the venous circulation. Jugular venous distention indicates rising venous backpressure from an obstructive process — the opposite of what fluid loss produces. Option d is incorrect because tension pneumothorax cau

Correct Answer: Transmitter towers and antitheft devices pose risk, but household appliances are generally safe

Saunders states most household electrical appliances are safe for pacemaker clients. The client should avoid transmitter towers and antitheft devices in stores. If any unusual feelings occur near an electrical device, the client should move 5 to 10 feet away and check the pulse. Option a is incorrect because modern pacemakers are shielded against household microwave fields. Permanent avoidance of kitchen microwaves is an outdated restriction no longer applicable to contemporary pacemaker technology, and teaching it would unnecessarily restrict the client's independence. Option b is incorrect because no 3-foot proximity rule is established for household appliances in pacemaker teaching guidelines. This restriction would be impractical, unsupported by clinical evidence, and would prevent normal daily activities without providing a safety benefit. Option c is incorrect because requiring physician clearance for any appliance within 3 feet of the device is not a standard pacemaker teac

Correct Answer: Gravity-assisted arterial inflow improves perfusion to the ischemic tissue

Rest pain in peripheral arterial disease occurs when arterial blood flow is inadequate to meet the metabolic demands of the feet even at rest, typically worsening when the legs are elevated. Hanging the legs over the bed uses gravity to augment arterial inflow to the distal extremities, temporarily improving perfusion and relieving the ischemic burning pain. Option a is incorrect because reducing edema by fluid drainage is a venous mechanism relevant to venous insufficiency, not arterial disease. Rest pain in PAD reflects ischemia from inadequate arterial supply, and the relief comes from improved arterial inflow rather than edema reduction. Option b is incorrect because increasing venous pressure in the dependent position describes a mechanism that would worsen venous congestion, not relieve arterial ischemia. The therapeutic effect of leg dependency in PAD rest pain is arterial, not venous, in origin. Option d is incorrect because neuropathic pain from nerve compression would be alle

Correct Answer: Begin chest compressions and prepare for immediate defibrillation

The described rhythm — chaotic undulations with no identifiable P waves, QRS complexes, or measurable rate in an unresponsive pulseless client — is ventricular fibrillation. VF is fatal without treatment within 3 to 5 minutes. Initiating CPR immediately and preparing for defibrillation are the required priority actions. Option a is incorrect because atropine is used for symptomatic bradycardia to increase the heart rate. It has no effect on ventricular fibrillation, which is a chaotic asystolic state of the ventricles requiring electrical countershock, not a pharmacological rate-increasing agent. Option c is incorrect because obtaining a 12-lead ECG before treating an unresponsive pulseless client wastes critical time. Ventricular fibrillation is identified on the bedside monitor in real time, and every second without CPR and defibrillation decreases survival probability. Option d is incorrect because synchronized cardioversion is used for pulsed tachydysrhythmias such as atrial fibril

Correct Answer: Sitting upright shifts the heart away from the inflamed pericardial surfaces

Pericarditis pain is relieved by sitting upright and leaning forward because this position reduces friction between the inflamed visceral and parietal pericardial layers. The supine position increases direct surface contact between the inflamed membranes, worsening the sharp grating pain characteristic of pericarditis. Option a is incorrect because pericarditis pain does not arise from coronary artery compression. The coronary arteries run within the myocardium and are not compressed by body position. Positional pericarditic pain comes from friction between inflamed pericardial membranes, not from ischemia. Option b is incorrect because the diaphragm does not rise into the pericardial space during the supine position in a clinically meaningful way. Normal respiratory diaphragm excursion does not explain the dramatic positional variation in pericarditis pain, which is caused by friction between inflamed pericardial surfaces rather than diaphragmatic encroachment. Option c is incorrect b

Correct Answer: Notify the provider and implement bleeding precautions immediately

An INR of 4.9 significantly exceeds the therapeutic range of 2.0 to 3.0 and crosses the 3.0 threshold that triggers bleeding precautions. Saunders specifies that when INR exceeds 3.0 during standard warfarin therapy, the nurse initiates bleeding precautions and notifies the provider to guide clinical management and potential dose adjustment. Option b is incorrect because phytonadione is the warfarin antidote reserved for active bleeding or critically elevated INR with high hemorrhage risk. In a clinically stable client without active bleeding, antidote administration requires a provider order and clinical indication, not an independent nursing decision. Option c is incorrect because increasing the warfarin dose when the INR is already dangerously elevated would push anticoagulation further above the therapeutic ceiling. Dose increases apply when INR is below the lower therapeutic boundary, indicating insufficient anticoagulation. Option d is incorrect because independently holding dose

Correct Answer: Right ventricular failure causing systemic venous congestion

Right ventricular failure produces systemic venous congestion with jugular venous distention, hepatomegaly, splenomegaly, ascites, and dependent edema. The absence of pulmonary congestion findings at rest differentiates this from left ventricular failure. Blood backing up behind the right ventricle creates systemic rather than pulmonary backpressure. Option a is incorrect because acute pulmonary edema presents with severe dyspnea at rest, frothy blood-tinged sputum, tachycardia, and bilateral crackles. This client has clear lungs and only exertional dyspnea, which is inconsistent with the acute pulmonary flooding of left ventricular decompensation. Option b is incorrect because cardiogenic shock requires signs of profoundly reduced cardiac output — hypotension, tachycardia, cool clammy skin, altered mentation, and urine output below 30 mL/hour. The client's preserved exercise tolerance without these hemodynamic signs rules out cardiogenic shock. Option d is incorrect because diast

Correct Answer: Ototoxicity and potential permanent hearing loss from rapid injection

Saunders explicitly states that IV furosemide must be administered slowly over 1 to 2 minutes because rapid injection causes ototoxicity, which can result in permanent hearing loss. This is the established safety reason for controlling the rate of IV loop diuretic administration in clinical practice. Option a is incorrect because while orthostatic hypotension is a recognized side effect of loop diuretics, it is not the specific adverse event that determines the slow injection requirement. Orthostatic changes develop over time from volume depletion, not from the rate of IV injection itself. Option b is incorrect because furosemide promotes potassium excretion in the urine, causing hypokalemia rather than hyperkalemia. Rapid injection does not trigger an acute potassium shift, and this electrolyte concern is not the reason behind the slow-administration guideline. Option c is incorrect because loop diuretics do not trigger bronchospasm. Bronchospasm is associated with certain beta-blocke

Correct Answer: Morphine sulfate IV as the first-choice analgesic for acute MI pain

Morphine sulfate IV is the priority analgesic for acute myocardial infarction pain. It reduces pain and anxiety, decreases myocardial oxygen demand by reducing sympathetic activation, and causes vasodilation that lowers preload. Saunders specifies morphine as the first-choice analgesic in acute MI management. Option b is incorrect because aspirin 325 mg chewed is a critical early intervention in acute MI for antiplatelet effect, but its purpose is to inhibit platelet aggregation rather than provide analgesia. Morphine addresses the priority problem of pain, which increases oxygen demand and sympathetic activation. Option c is incorrect because NSAIDs such as ibuprofen are contraindicated in acute myocardial infarction. They increase cardiovascular risk, can worsen myocardial injury, and provide no benefit in the ischemic setting. Their anti-inflammatory mechanism does not address the ischemic pain requiring opioid analgesia. Option d is incorrect because metoprolol IV reduces heart rat

Correct Answer: Do not massage the extremity, as it may dislodge the thrombus and cause a pulmonary embolism

Massaging an extremity with deep vein thrombophlebitis is specifically contraindicated because manipulation of the affected area can dislodge the thrombus, converting it into a pulmonary embolus. Saunders explicitly lists avoidance of massage as a required intervention in DVT management. Option a is incorrect because gentle massage of a DVT-affected limb directly risks embolization, regardless of how gentle the pressure is. Mechanical disruption of an intravascular thrombus can fragment it and send it into the pulmonary circulation, causing a life-threatening pulmonary embolism. Option b is incorrect because the location of massage relative to the clot does not make it safe. Pressure and movement anywhere in the affected extremity can transmit force to the thrombus. The entire limb with DVT must be handled gently, and massage is contraindicated throughout. Option d is incorrect because leg elevation is a therapeutic position that reduces venous pressure and aids return, but elevation d