HESI Medical-Surgical Nursing Exam
Questions And Answers Plus Rationales | Qs
& Ans 2026 | Instant Pdf Download
1. A 68-year-old male with heart failure (HFrEF) is admitted with
dyspnea, crackles in both lung bases, and jugular venous distension.
His current medications include lisinopril, furosemide, and
carvedilol. Which assessment finding indicates that the furosemide
is effective?
A. Blood pressure 100/70 mmHg
B. Daily weight decreased by 2 kg in 24 hours
C. Serum potassium 4.0 mEq/L
D. Heart rate 88 bpm
Answer: B
Rationale: Furosemide is a loop diuretic; effectiveness is best measured
by weight loss (diuresis). A 1–2 kg/day loss indicates successful reduction
of fluid overload.
2. A 55-year-old with type 2 diabetes is postoperative day 1 after a
right total knee arthroplasty. He reports sudden onset of sharp
chest pain and dyspnea. His oxygen saturation is 88% on room air.
Which action should the nurse take first?
A. Administer oxygen via nasal cannula at 4 L/min
B. Obtain a stat ECG and troponin
,C. Apply sequential compression devices to both legs
D. Prepare for chest tube insertion
Answer: A
Rationale: First, correct hypoxemia with supplemental oxygen. Then
assess for pulmonary embolism (common post-op) or MI. ABCs
(airway/breathing) come first.
3. A 72-year-old female with chronic kidney disease stage 4 has a
serum potassium of 6.8 mEq/L. Her ECG shows peaked T waves.
Which intervention should the nurse implement first?
A. Administer calcium gluconate IV
B. Give sodium polystyrene sulfonate (Kayexalate) orally
C. Start insulin with dextrose IV
D. Prepare for emergent hemodialysis
Answer: A
Rationale: Calcium gluconate stabilizes cardiac membranes and is first
for severe hyperkalemia with ECG changes. Insulin/dextrose and
Kayexalate lower potassium but take longer.
4. A patient with acute pancreatitis has a nasogastric tube set to low
intermittent suction. Which laboratory finding would the nurse
expect?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
,C. Metabolic alkalosis
D. Hyperglycemia
Answer: C
Rationale: NG suction removes gastric acid (HCl), leading to loss of
hydrogen ions and chloride, causing metabolic alkalosis (increased pH,
increased HCO3).
5. A 45-year-old male with cirrhosis and ascites has an abdominal
paracentesis. After removal of 5 L of fluid, he becomes dizzy and
hypotensive. Which complication is most likely?
A. Bowel perforation
B. Hemorrhage
C. Hypovolemic shock from rapid fluid shift
D. Spontaneous bacterial peritonitis
Answer: C
Rationale: Large-volume paracentesis (>5 L) can cause intravascular
volume depletion and hypotension. Intravenous albumin may be given
to prevent this.
6. A 60-year-old with COPD (GOLD stage 3) has an oxygen
saturation of 88% on 2 L/min via nasal cannula. The nurse increases
oxygen to 4 L/min. Thirty minutes later, the patient is lethargic and
has a respiratory rate of 8 breaths/min. Which pathophysiological
mechanism explains this?
A. Oxygen-induced hypoventilation due to loss of hypoxic drive
, B. Carbon dioxide narcosis from worsening V/Q mismatch
C. Pulmonary edema from high FiO2
D. Absorption atelectasis
Answer: A
Rationale: Chronic CO2 retainers rely on hypoxic drive. Excessive oxygen
removes hypoxic stimulus, leading to hypoventilation and hypercapnia.
7. A patient with heart failure is receiving IV furosemide. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum glucose
Answer: B
Rationale: Loop diuretics (furosemide) cause potassium wasting in the
distal tubule, leading to hypokalemia, which increases risk of digoxin
toxicity and arrhythmias.
8. A 35-year-old female with systemic lupus erythematosus (SLE)
reports a new malar rash, oral ulcers, and joint pain. Which
medication is most commonly used for acute flares?
A. Hydroxychloroquine
B. Prednisone
C. Methotrexate
D. Cyclophosphamide
Questions And Answers Plus Rationales | Qs
& Ans 2026 | Instant Pdf Download
1. A 68-year-old male with heart failure (HFrEF) is admitted with
dyspnea, crackles in both lung bases, and jugular venous distension.
His current medications include lisinopril, furosemide, and
carvedilol. Which assessment finding indicates that the furosemide
is effective?
A. Blood pressure 100/70 mmHg
B. Daily weight decreased by 2 kg in 24 hours
C. Serum potassium 4.0 mEq/L
D. Heart rate 88 bpm
Answer: B
Rationale: Furosemide is a loop diuretic; effectiveness is best measured
by weight loss (diuresis). A 1–2 kg/day loss indicates successful reduction
of fluid overload.
2. A 55-year-old with type 2 diabetes is postoperative day 1 after a
right total knee arthroplasty. He reports sudden onset of sharp
chest pain and dyspnea. His oxygen saturation is 88% on room air.
Which action should the nurse take first?
A. Administer oxygen via nasal cannula at 4 L/min
B. Obtain a stat ECG and troponin
,C. Apply sequential compression devices to both legs
D. Prepare for chest tube insertion
Answer: A
Rationale: First, correct hypoxemia with supplemental oxygen. Then
assess for pulmonary embolism (common post-op) or MI. ABCs
(airway/breathing) come first.
3. A 72-year-old female with chronic kidney disease stage 4 has a
serum potassium of 6.8 mEq/L. Her ECG shows peaked T waves.
Which intervention should the nurse implement first?
A. Administer calcium gluconate IV
B. Give sodium polystyrene sulfonate (Kayexalate) orally
C. Start insulin with dextrose IV
D. Prepare for emergent hemodialysis
Answer: A
Rationale: Calcium gluconate stabilizes cardiac membranes and is first
for severe hyperkalemia with ECG changes. Insulin/dextrose and
Kayexalate lower potassium but take longer.
4. A patient with acute pancreatitis has a nasogastric tube set to low
intermittent suction. Which laboratory finding would the nurse
expect?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
,C. Metabolic alkalosis
D. Hyperglycemia
Answer: C
Rationale: NG suction removes gastric acid (HCl), leading to loss of
hydrogen ions and chloride, causing metabolic alkalosis (increased pH,
increased HCO3).
5. A 45-year-old male with cirrhosis and ascites has an abdominal
paracentesis. After removal of 5 L of fluid, he becomes dizzy and
hypotensive. Which complication is most likely?
A. Bowel perforation
B. Hemorrhage
C. Hypovolemic shock from rapid fluid shift
D. Spontaneous bacterial peritonitis
Answer: C
Rationale: Large-volume paracentesis (>5 L) can cause intravascular
volume depletion and hypotension. Intravenous albumin may be given
to prevent this.
6. A 60-year-old with COPD (GOLD stage 3) has an oxygen
saturation of 88% on 2 L/min via nasal cannula. The nurse increases
oxygen to 4 L/min. Thirty minutes later, the patient is lethargic and
has a respiratory rate of 8 breaths/min. Which pathophysiological
mechanism explains this?
A. Oxygen-induced hypoventilation due to loss of hypoxic drive
, B. Carbon dioxide narcosis from worsening V/Q mismatch
C. Pulmonary edema from high FiO2
D. Absorption atelectasis
Answer: A
Rationale: Chronic CO2 retainers rely on hypoxic drive. Excessive oxygen
removes hypoxic stimulus, leading to hypoventilation and hypercapnia.
7. A patient with heart failure is receiving IV furosemide. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum glucose
Answer: B
Rationale: Loop diuretics (furosemide) cause potassium wasting in the
distal tubule, leading to hypokalemia, which increases risk of digoxin
toxicity and arrhythmias.
8. A 35-year-old female with systemic lupus erythematosus (SLE)
reports a new malar rash, oral ulcers, and joint pain. Which
medication is most commonly used for acute flares?
A. Hydroxychloroquine
B. Prednisone
C. Methotrexate
D. Cyclophosphamide
