1
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Section 1: Core Medical-Surgical Concepts (Questions 1–50)
1. Which acid-base imbalance is most commonly associated with severe, prolonged vomiting?
• A) Metabolic acidosis
• B) Metabolic alkalosis
• C) Respiratory acidosis
• D) Respiratory alkalosis
Answer: B) Metabolic alkalosis
Rationale: Gastric fluid is rich in hydrochloric acid. Loss of gastric acid leads to an increase in serum
bicarbonate, causing metabolic alkalosis.
2. A client with emphysema is receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates an adverse effect of oxygen therapy?
• A) Oxygen saturation of 92%
• B) Respiratory rate of 10 breaths/min
• C) Client reports feeling more rested
• D) Productive cough
Answer: B) Respiratory rate of 10 breaths/min
Rationale: Clients with COPD may rely on a hypoxic drive to breathe. Excessive oxygen can suppress this
drive, leading to respiratory depression, hypercapnia, and acidosis.
3. The nurse is caring for a client who had a total knee replacement 8 hours ago. Which intervention is
most important to prevent venous thromboembolism (VTE)?
• A) Apply sequential compression devices (SCDs)
• B) Administer oral warfarin as prescribed
• C) Encourage isometric quadriceps exercises
,2
• D) Elevate the affected leg on pillows
Answer: A) Apply sequential compression devices (SCDs)
Rationale: SCDs provide mechanical prophylaxis by enhancing venous return and reducing stasis. While
all options may be part of VTE prevention, mechanical devices are often initiated immediately
post-operatively.
4. A client with heart failure reports a weight gain of 5 pounds in 3 days. What is the nurse’s priority
action?
• A) Encourage the client to restrict oral fluids
• B) Assess for peripheral edema and crackles
• C) Notify the healthcare provider immediately
• D) Increase the dose of furosemide
Answer: C) Notify the healthcare provider immediately
Rationale: A rapid weight gain of 2–3 pounds in 24 hours or 5 pounds in 1 week is a sign of worsening
fluid overload. The provider should be notified for potential adjustment of diuretic therapy.
5. The nurse is teaching a client with diabetes about proper foot care. Which statement indicates the
need for further instruction?
• A) “I will wear cotton socks and well-fitting shoes.”
• B) “I will soak my feet daily to keep them soft.”
• C) “I will inspect my feet every day for cuts or blisters.”
• D) “I will apply lotion to my feet but not between my toes.”
Answer: B) “I will soak my feet daily to keep them soft.”
Rationale: Prolonged soaking can macerate the skin, increasing the risk of infection. Daily washing with
mild soap and thorough drying is recommended.
6. A client is receiving a continuous IV infusion of heparin. The nurse notes that the client has
developed epistaxis. What should the nurse do first?
• A) Stop the heparin infusion
• B) Apply direct pressure to the nose
• C) Check the aPTT level
• D) Notify the healthcare provider
,3
Answer: B) Apply direct pressure to the nose
Rationale: Bleeding is a known adverse effect of heparin. The priority is to control the bleeding while
notifying the provider. The heparin may need to be discontinued or the dose adjusted.
7. A client with chronic kidney disease is prescribed epoetin alfa (Epogen). The nurse should monitor
for which therapeutic effect?
• A) Increased white blood cell count
• B) Increased hemoglobin level
• C) Decreased serum creatinine
• D) Decreased blood pressure
Answer: B) Increased hemoglobin level
Rationale: Epoetin alfa stimulates red blood cell production and is used to treat anemia associated with
chronic kidney disease. The desired response is an increase in hemoglobin.
8. A client with a new colostomy asks the nurse, “When will my bowel movements become regular?”
What is the best response?
• A) “Your bowel movements will never be regular with an ostomy.”
• B) “It may take several weeks for your bowel to adjust.”
• C) “You should have a bowel movement every day like before.”
• D) “You will need to irrigate the colostomy daily to maintain regularity.”
Answer: B) “It may take several weeks for your bowel to adjust.”
Rationale: After colostomy formation, the bowel may take several weeks to establish a predictable
pattern. Patients should be reassured and educated about expected changes.
9. The nurse is caring for a client receiving furosemide (Lasix). Which laboratory value should be
monitored most closely?
• A) Serum sodium
• B) Serum potassium
• C) Serum calcium
• D) Serum magnesium
Answer: B) Serum potassium
Rationale: Loop diuretics such as furosemide increase potassium excretion, placing the client at risk for
hypokalemia, which can lead to cardiac dysrhythmias.
, 4
10. A client with a tracheostomy tube has thick, tenacious secretions. What is the most appropriate
intervention?
• A) Instill 5 mL of normal saline into the tracheostomy tube
• B) Increase the humidity of the inspired air
• C) Suction the tracheostomy every 15 minutes
• D) Administer a bronchodilator
Answer: B) Increase the humidity of the inspired air
Rationale: Humidification helps thin respiratory secretions, making them easier to clear. Routine
instillation of normal saline is no longer recommended as it can dislodge bacteria into the lower airways.
11. The nurse is assessing a client with peripheral arterial disease (PAD). Which finding is most
consistent with this diagnosis?
• A) Bilateral lower extremity edema
• B) Shiny, hairless lower extremities
• C) Brownish discoloration around the ankles
• D) Positive Homans’ sign
Answer: B) Shiny, hairless lower extremities
Rationale: Chronic arterial insufficiency leads to trophic skin changes including hair loss, shiny atrophic
skin, and thickened nails. Edema and brownish discoloration are more typical of venous insufficiency.
12. A client with type 2 diabetes is prescribed metformin. The nurse should instruct the client to
report which symptom immediately?
• A) Nausea
• B) Diarrhea
• C) Muscle pain
• D) Metallic taste
Answer: C) Muscle pain
Rationale: Muscle pain, especially when accompanied by malaise or hyperventilation, may be a sign of
lactic acidosis, a rare but serious adverse effect of metformin.
() HESI PN Med-Surg Exam TEST BANK (400+
Ques & Ans) with (NGN-Style Questions & Case
Scenarios), 100% Guarantee Pass
Section 1: Core Medical-Surgical Concepts (Questions 1–50)
1. Which acid-base imbalance is most commonly associated with severe, prolonged vomiting?
• A) Metabolic acidosis
• B) Metabolic alkalosis
• C) Respiratory acidosis
• D) Respiratory alkalosis
Answer: B) Metabolic alkalosis
Rationale: Gastric fluid is rich in hydrochloric acid. Loss of gastric acid leads to an increase in serum
bicarbonate, causing metabolic alkalosis.
2. A client with emphysema is receiving oxygen at 2 L/min via nasal cannula. Which assessment
finding indicates an adverse effect of oxygen therapy?
• A) Oxygen saturation of 92%
• B) Respiratory rate of 10 breaths/min
• C) Client reports feeling more rested
• D) Productive cough
Answer: B) Respiratory rate of 10 breaths/min
Rationale: Clients with COPD may rely on a hypoxic drive to breathe. Excessive oxygen can suppress this
drive, leading to respiratory depression, hypercapnia, and acidosis.
3. The nurse is caring for a client who had a total knee replacement 8 hours ago. Which intervention is
most important to prevent venous thromboembolism (VTE)?
• A) Apply sequential compression devices (SCDs)
• B) Administer oral warfarin as prescribed
• C) Encourage isometric quadriceps exercises
,2
• D) Elevate the affected leg on pillows
Answer: A) Apply sequential compression devices (SCDs)
Rationale: SCDs provide mechanical prophylaxis by enhancing venous return and reducing stasis. While
all options may be part of VTE prevention, mechanical devices are often initiated immediately
post-operatively.
4. A client with heart failure reports a weight gain of 5 pounds in 3 days. What is the nurse’s priority
action?
• A) Encourage the client to restrict oral fluids
• B) Assess for peripheral edema and crackles
• C) Notify the healthcare provider immediately
• D) Increase the dose of furosemide
Answer: C) Notify the healthcare provider immediately
Rationale: A rapid weight gain of 2–3 pounds in 24 hours or 5 pounds in 1 week is a sign of worsening
fluid overload. The provider should be notified for potential adjustment of diuretic therapy.
5. The nurse is teaching a client with diabetes about proper foot care. Which statement indicates the
need for further instruction?
• A) “I will wear cotton socks and well-fitting shoes.”
• B) “I will soak my feet daily to keep them soft.”
• C) “I will inspect my feet every day for cuts or blisters.”
• D) “I will apply lotion to my feet but not between my toes.”
Answer: B) “I will soak my feet daily to keep them soft.”
Rationale: Prolonged soaking can macerate the skin, increasing the risk of infection. Daily washing with
mild soap and thorough drying is recommended.
6. A client is receiving a continuous IV infusion of heparin. The nurse notes that the client has
developed epistaxis. What should the nurse do first?
• A) Stop the heparin infusion
• B) Apply direct pressure to the nose
• C) Check the aPTT level
• D) Notify the healthcare provider
,3
Answer: B) Apply direct pressure to the nose
Rationale: Bleeding is a known adverse effect of heparin. The priority is to control the bleeding while
notifying the provider. The heparin may need to be discontinued or the dose adjusted.
7. A client with chronic kidney disease is prescribed epoetin alfa (Epogen). The nurse should monitor
for which therapeutic effect?
• A) Increased white blood cell count
• B) Increased hemoglobin level
• C) Decreased serum creatinine
• D) Decreased blood pressure
Answer: B) Increased hemoglobin level
Rationale: Epoetin alfa stimulates red blood cell production and is used to treat anemia associated with
chronic kidney disease. The desired response is an increase in hemoglobin.
8. A client with a new colostomy asks the nurse, “When will my bowel movements become regular?”
What is the best response?
• A) “Your bowel movements will never be regular with an ostomy.”
• B) “It may take several weeks for your bowel to adjust.”
• C) “You should have a bowel movement every day like before.”
• D) “You will need to irrigate the colostomy daily to maintain regularity.”
Answer: B) “It may take several weeks for your bowel to adjust.”
Rationale: After colostomy formation, the bowel may take several weeks to establish a predictable
pattern. Patients should be reassured and educated about expected changes.
9. The nurse is caring for a client receiving furosemide (Lasix). Which laboratory value should be
monitored most closely?
• A) Serum sodium
• B) Serum potassium
• C) Serum calcium
• D) Serum magnesium
Answer: B) Serum potassium
Rationale: Loop diuretics such as furosemide increase potassium excretion, placing the client at risk for
hypokalemia, which can lead to cardiac dysrhythmias.
, 4
10. A client with a tracheostomy tube has thick, tenacious secretions. What is the most appropriate
intervention?
• A) Instill 5 mL of normal saline into the tracheostomy tube
• B) Increase the humidity of the inspired air
• C) Suction the tracheostomy every 15 minutes
• D) Administer a bronchodilator
Answer: B) Increase the humidity of the inspired air
Rationale: Humidification helps thin respiratory secretions, making them easier to clear. Routine
instillation of normal saline is no longer recommended as it can dislodge bacteria into the lower airways.
11. The nurse is assessing a client with peripheral arterial disease (PAD). Which finding is most
consistent with this diagnosis?
• A) Bilateral lower extremity edema
• B) Shiny, hairless lower extremities
• C) Brownish discoloration around the ankles
• D) Positive Homans’ sign
Answer: B) Shiny, hairless lower extremities
Rationale: Chronic arterial insufficiency leads to trophic skin changes including hair loss, shiny atrophic
skin, and thickened nails. Edema and brownish discoloration are more typical of venous insufficiency.
12. A client with type 2 diabetes is prescribed metformin. The nurse should instruct the client to
report which symptom immediately?
• A) Nausea
• B) Diarrhea
• C) Muscle pain
• D) Metallic taste
Answer: C) Muscle pain
Rationale: Muscle pain, especially when accompanied by malaise or hyperventilation, may be a sign of
lactic acidosis, a rare but serious adverse effect of metformin.
