MED SURG HESI V2 2026/2027 | Questions & Answers |
Verified Answers Edition | Version 2 Exam Prep | Pass
Guaranteed - A+ Graded
SECTION 1: FOUNDATIONAL MED-SURG CONCEPTS (Questions 1-25)
Q1: A patient with heart failure is prescribed enalapril (Vasotec) 5 mg PO daily. Which
assessment finding requires the nurse to withhold the medication and notify the
physician?
A. Blood pressure 138/86 mmHg
B. Serum potassium 5.8 mEq/L
C. Heart rate 68 bpm
D. Creatinine 1.1 mg/dL (baseline 1.0 mg/dL)
Correct Answer: B [CORRECT]
Rationale: ACE inhibitors (enalapril) cause potassium retention by inhibiting aldosterone
secretion. Hyperkalemia >5.5 mEq/L is a contraindication to continued ACE inhibitor
therapy due to risk of cardiac arrhythmias (peaked T waves, QRS widening, asystole).
The nurse must hold the dose and notify the physician for possible discontinuation or
dose reduction.
Why A is wrong: BP 138/86 is acceptable; ACE inhibitors are continued unless
symptomatic hypotension (SBP <90) or acute kidney injury occurs.
Why C is wrong: Heart rate 68 bpm is normal; ACE inhibitors do not significantly affect
heart rate.
,Why D is wrong: Creatinine increase of 0.1 mg/dL is insignificant; ACE inhibitors may
cause up to 30% creatinine rise that stabilizes; hold only if >30% increase or
hyperkalemia develops.
Test-Taking Tip: For ACE inhibitors/ARBs, always check potassium and creatinine. The
"lethal duo" in heart failure pharmacology is hyperkalemia + ACE inhibitor.
Q2: A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas
results: pH 7.34, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3- 32 mEq/L. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Mixed acid-base disorder
Correct Answer: B [CORRECT]
Rationale: pH 7.34 (slightly low, normal is 7.35-7.45), PaCO2 58 (elevated, primary
respiratory problem), HCO3- 32 (elevated, metabolic compensation). This is
compensated respiratory acidosis—the kidneys have retained bicarbonate to partially
correct pH. This is expected for chronic COPD with CO2 retention; pH near normal
indicates chronic compensation.
Why A is wrong: Uncompensated would show normal HCO3- (22-26) with low pH; here
HCO3- is elevated showing compensation.
Why C is wrong: Primary problem is respiratory (elevated CO2), not metabolic;
bicarbonate is compensatory, not primary.
,Why D is wrong: No evidence of second primary disorder; this is simple compensated
respiratory acidosis typical of chronic COPD.
Test-Taking Tip: In COPD, "CO2 is high, pH is low, bicarb is high" = compensated
respiratory acidosis. The body adapts to chronic CO2 retention.
Q3: [Select All That Apply] A patient with a new ileostomy is being discharged. Which
statements by the patient indicate understanding of self-care?
☐ A. "I should empty the pouch when it is one-third to one-half full"
☐ B. "I can apply the skin barrier directly to broken or irritated skin"
☐ C. "I need to increase my fluid intake to 2-3 liters daily"
☐ D. "I should expect paste-like, formed stool from my stoma"
☐ E. "I need to chew my food thoroughly to prevent blockage"
Correct Answers: A, C, E [CORRECT]
Rationale: Ileostomy care: Empty at 1/3-1/2 full (A) prevents leakage and weight-related
detachment. High fluid intake (C) compensates for high-output losses (1000-1500
mL/day) preventing dehydration. Chewing thoroughly (E) prevents obstruction from
high-fiber foods (popcorn, nuts, corn, raw vegetables).
Why B is wrong: Skin barrier should never be applied to broken skin; must treat irritation
first (stoma powder, skin sealant).
Why D is wrong: Ileostomy output is liquid to paste-like (small intestine contents), not
formed; colostomy output may be formed.
, Test-Taking Tip: Ileostomy = high output, liquid, right side; Colostomy = formed stool,
left side. Fluid management is critical for ileostomy patients.
Q4: A patient with type 1 diabetes has a blood glucose of 48 mg/dL, is diaphoretic, and
reports palpitations. The patient is alert and oriented. Which action should the nurse
take first?
A. Administer 1 mg glucagon subcutaneously
B. Give 15 grams of fast-acting carbohydrate
C. Start an IV infusion of D5W at 125 mL/hr
D. Recheck blood glucose in 15 minutes
Correct Answer: B [CORRECT]
Rationale: Conscious patient with hypoglycemia: 15-15 rule—give 15 g fast-acting
carbohydrate (4 glucose tablets, 4 oz juice, 6 oz regular soda, 1 tbsp honey), then
recheck in 15 minutes. Repeat if still <70 mg/dL. This is rapid, effective, and
non-invasive.
Why A is wrong: Glucagon is for unconscious patients or those unable to swallow;
inappropriate for alert patient.
Why C is wrong: IV dextrose is invasive and reserved for severe hypoglycemia or altered
consciousness; oral treatment is first-line if patient can swallow.
Why D is wrong: Rechecking without treatment delays correction of neuroglycopenic
symptoms; always treat first.
Verified Answers Edition | Version 2 Exam Prep | Pass
Guaranteed - A+ Graded
SECTION 1: FOUNDATIONAL MED-SURG CONCEPTS (Questions 1-25)
Q1: A patient with heart failure is prescribed enalapril (Vasotec) 5 mg PO daily. Which
assessment finding requires the nurse to withhold the medication and notify the
physician?
A. Blood pressure 138/86 mmHg
B. Serum potassium 5.8 mEq/L
C. Heart rate 68 bpm
D. Creatinine 1.1 mg/dL (baseline 1.0 mg/dL)
Correct Answer: B [CORRECT]
Rationale: ACE inhibitors (enalapril) cause potassium retention by inhibiting aldosterone
secretion. Hyperkalemia >5.5 mEq/L is a contraindication to continued ACE inhibitor
therapy due to risk of cardiac arrhythmias (peaked T waves, QRS widening, asystole).
The nurse must hold the dose and notify the physician for possible discontinuation or
dose reduction.
Why A is wrong: BP 138/86 is acceptable; ACE inhibitors are continued unless
symptomatic hypotension (SBP <90) or acute kidney injury occurs.
Why C is wrong: Heart rate 68 bpm is normal; ACE inhibitors do not significantly affect
heart rate.
,Why D is wrong: Creatinine increase of 0.1 mg/dL is insignificant; ACE inhibitors may
cause up to 30% creatinine rise that stabilizes; hold only if >30% increase or
hyperkalemia develops.
Test-Taking Tip: For ACE inhibitors/ARBs, always check potassium and creatinine. The
"lethal duo" in heart failure pharmacology is hyperkalemia + ACE inhibitor.
Q2: A patient with chronic obstructive pulmonary disease (COPD) has arterial blood gas
results: pH 7.34, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3- 32 mEq/L. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Mixed acid-base disorder
Correct Answer: B [CORRECT]
Rationale: pH 7.34 (slightly low, normal is 7.35-7.45), PaCO2 58 (elevated, primary
respiratory problem), HCO3- 32 (elevated, metabolic compensation). This is
compensated respiratory acidosis—the kidneys have retained bicarbonate to partially
correct pH. This is expected for chronic COPD with CO2 retention; pH near normal
indicates chronic compensation.
Why A is wrong: Uncompensated would show normal HCO3- (22-26) with low pH; here
HCO3- is elevated showing compensation.
Why C is wrong: Primary problem is respiratory (elevated CO2), not metabolic;
bicarbonate is compensatory, not primary.
,Why D is wrong: No evidence of second primary disorder; this is simple compensated
respiratory acidosis typical of chronic COPD.
Test-Taking Tip: In COPD, "CO2 is high, pH is low, bicarb is high" = compensated
respiratory acidosis. The body adapts to chronic CO2 retention.
Q3: [Select All That Apply] A patient with a new ileostomy is being discharged. Which
statements by the patient indicate understanding of self-care?
☐ A. "I should empty the pouch when it is one-third to one-half full"
☐ B. "I can apply the skin barrier directly to broken or irritated skin"
☐ C. "I need to increase my fluid intake to 2-3 liters daily"
☐ D. "I should expect paste-like, formed stool from my stoma"
☐ E. "I need to chew my food thoroughly to prevent blockage"
Correct Answers: A, C, E [CORRECT]
Rationale: Ileostomy care: Empty at 1/3-1/2 full (A) prevents leakage and weight-related
detachment. High fluid intake (C) compensates for high-output losses (1000-1500
mL/day) preventing dehydration. Chewing thoroughly (E) prevents obstruction from
high-fiber foods (popcorn, nuts, corn, raw vegetables).
Why B is wrong: Skin barrier should never be applied to broken skin; must treat irritation
first (stoma powder, skin sealant).
Why D is wrong: Ileostomy output is liquid to paste-like (small intestine contents), not
formed; colostomy output may be formed.
, Test-Taking Tip: Ileostomy = high output, liquid, right side; Colostomy = formed stool,
left side. Fluid management is critical for ileostomy patients.
Q4: A patient with type 1 diabetes has a blood glucose of 48 mg/dL, is diaphoretic, and
reports palpitations. The patient is alert and oriented. Which action should the nurse
take first?
A. Administer 1 mg glucagon subcutaneously
B. Give 15 grams of fast-acting carbohydrate
C. Start an IV infusion of D5W at 125 mL/hr
D. Recheck blood glucose in 15 minutes
Correct Answer: B [CORRECT]
Rationale: Conscious patient with hypoglycemia: 15-15 rule—give 15 g fast-acting
carbohydrate (4 glucose tablets, 4 oz juice, 6 oz regular soda, 1 tbsp honey), then
recheck in 15 minutes. Repeat if still <70 mg/dL. This is rapid, effective, and
non-invasive.
Why A is wrong: Glucagon is for unconscious patients or those unable to swallow;
inappropriate for alert patient.
Why C is wrong: IV dextrose is invasive and reserved for severe hypoglycemia or altered
consciousness; oral treatment is first-line if patient can swallow.
Why D is wrong: Rechecking without treatment delays correction of neuroglycopenic
symptoms; always treat first.
