HESI MED SURG FINAL EXAM REAL
QUESTIONS AND ANSWER✔✨-S
AND RATIONALES ACTUAL!!! 2026
QUESTION 1
Based on the clinical manifestations of Cushing syndrome, which nursing intervention would be
appropriate for a client who is newly diagnosed with Cushing syndrome?
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu.
ANSWER✔✨-: A. Monitor blood glucose levels daily.
RATIONALE: Cushing syndrome results from hypersecretion of glucocorticoids in the adrenal cortex.
Clients with Cushing syndrome often develop diabetes mellitus due to glucocorticoid-induced insulin
resistance. Monitoring serum glucose levels assesses for increased blood glucose levels so that
treatment can begin early. A common finding in Cushing syndrome is generalized edema, making
sodium restriction rather than sodium enrichment appropriate. While potassium is needed, it is
generally obtained from food intake, not by offering potassium-enhanced fluids. Fatigue is usually not
an overwhelming symptom in early Cushing syndrome compared to other manifestations.
QUESTION 2
,A client with Addison's disease is admitted with weakness, dehydration, and hypotension. Which
laboratory finding would the nurse expect to observe?
A. Serum sodium of 150 mEq/L
B. Serum potassium of 5.8 mEq/L
C. Serum glucose of 180 mg/dL
D. Serum calcium of 8.2 mg/dL
ANSWER✔✨-: B. Serum potassium of 5.8 mEq/L
RATIONALE: Addison's disease (primary adrenal insufficiency) results in decreased aldosterone
production, leading to potassium retention and sodium loss. Hyperkalemia (potassium >5.0 mEq/L) is a
hallmark finding. Hyponatremia (low sodium) would be expected rather than hypernatremia.
Hypoglycemia rather than hyperglycemia occurs due to decreased glucocorticoids. Calcium levels are
typically not directly affected in Addison's disease.
QUESTION 3
A client with diabetes mellitus type 1 is experiencing nausea, vomiting, and abdominal pain. The client's
breath has a fruity odor. Which action should the nurse take first?
A. Administer insulin as prescribed
B. Check blood glucose level
C. Start an IV line
D. Notify the healthcare provider
ANSWER✔✨-: B. Check blood glucose level
RATIONALE: The client is exhibiting signs of diabetic ketoacidosis (DKA) including fruity breath odor,
nausea, vomiting, and abdominal pain. The priority action is to assess the blood glucose level to confirm
hyperglycemia before implementing interventions. While administering insulin, starting an IV, and
,notifying the healthcare provider are all appropriate actions, assessment must precede intervention
according to the nursing process.
QUESTION 4
A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which instruction should the nurse
include in the teaching plan?
A. Take the medication with food to prevent gastrointestinal upset
B. Report any signs of infection, fever, or sore throat immediately
C. Expect weight gain as a therapeutic effect of the medication
D. Discontinue the medication if palpitations occur
ANSWER✔✨-: B. Report any signs of infection, fever, or sore throat immediately
RATIONALE: Propylthiouracil (PTU) can cause agranulocytosis, a serious adverse effect characterized by
a marked decrease in white blood cells. The client should be instructed to report signs of infection
(fever, sore throat, chills) immediately. PTU should be taken consistently, not necessarily with food.
Weight gain is not a therapeutic effect of PTU; the medication reduces thyroid hormone production.
Palpitations should be reported but the medication should not be discontinued without healthcare
provider guidance.
QUESTION 5
A client with hypothyroidism is prescribed levothyroxine. Which assessment finding indicates that the
medication is effective?
A. Increased heart rate from 58 to 72 beats per minute
B. Weight gain of 5 pounds
C. Decreased appetite
D. Cold intolerance
, ANSWER✔✨-: A. Increased heart rate from 58 to 72 beats per minute
RATIONALE: Levothyroxine replaces thyroid hormone in hypothyroid clients. Effective therapy results in
normalization of vital signs including heart rate. An increase in heart rate from bradycardic to normal
range indicates therapeutic effect. Weight loss (not gain) would be expected. Increased appetite
typically occurs with effective treatment. Cold intolerance should resolve, not persist.
QUESTION 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 118
mEq/L. Which nursing intervention is a priority?
A. Restrict oral fluid intake
B. Administer hypertonic saline
C. Encourage oral fluid intake
D. Administer diuretics
ANSWER✔✨-: A. Restrict oral fluid intake
RATIONALE: In SIADH, excessive antidiuretic hormone causes water retention and dilutional
hyponatremia. Fluid restriction is the primary intervention to correct hyponatremia. Hypertonic saline
may be used for severe hyponatremia but is not the first-line intervention. Encouraging fluids would
worsen the condition. Diuretics may be used but are not the priority intervention.
QUESTION 7
A client with diabetes insipidus is receiving desmopressin acetate. Which assessment finding indicates
the medication is effective?
A. Decreased urine output
QUESTIONS AND ANSWER✔✨-S
AND RATIONALES ACTUAL!!! 2026
QUESTION 1
Based on the clinical manifestations of Cushing syndrome, which nursing intervention would be
appropriate for a client who is newly diagnosed with Cushing syndrome?
A. Monitor blood glucose levels daily.
B. Increase intake of fluids high in potassium.
C. Encourage adequate rest between activities.
D. Offer the client a sodium-enriched menu.
ANSWER✔✨-: A. Monitor blood glucose levels daily.
RATIONALE: Cushing syndrome results from hypersecretion of glucocorticoids in the adrenal cortex.
Clients with Cushing syndrome often develop diabetes mellitus due to glucocorticoid-induced insulin
resistance. Monitoring serum glucose levels assesses for increased blood glucose levels so that
treatment can begin early. A common finding in Cushing syndrome is generalized edema, making
sodium restriction rather than sodium enrichment appropriate. While potassium is needed, it is
generally obtained from food intake, not by offering potassium-enhanced fluids. Fatigue is usually not
an overwhelming symptom in early Cushing syndrome compared to other manifestations.
QUESTION 2
,A client with Addison's disease is admitted with weakness, dehydration, and hypotension. Which
laboratory finding would the nurse expect to observe?
A. Serum sodium of 150 mEq/L
B. Serum potassium of 5.8 mEq/L
C. Serum glucose of 180 mg/dL
D. Serum calcium of 8.2 mg/dL
ANSWER✔✨-: B. Serum potassium of 5.8 mEq/L
RATIONALE: Addison's disease (primary adrenal insufficiency) results in decreased aldosterone
production, leading to potassium retention and sodium loss. Hyperkalemia (potassium >5.0 mEq/L) is a
hallmark finding. Hyponatremia (low sodium) would be expected rather than hypernatremia.
Hypoglycemia rather than hyperglycemia occurs due to decreased glucocorticoids. Calcium levels are
typically not directly affected in Addison's disease.
QUESTION 3
A client with diabetes mellitus type 1 is experiencing nausea, vomiting, and abdominal pain. The client's
breath has a fruity odor. Which action should the nurse take first?
A. Administer insulin as prescribed
B. Check blood glucose level
C. Start an IV line
D. Notify the healthcare provider
ANSWER✔✨-: B. Check blood glucose level
RATIONALE: The client is exhibiting signs of diabetic ketoacidosis (DKA) including fruity breath odor,
nausea, vomiting, and abdominal pain. The priority action is to assess the blood glucose level to confirm
hyperglycemia before implementing interventions. While administering insulin, starting an IV, and
,notifying the healthcare provider are all appropriate actions, assessment must precede intervention
according to the nursing process.
QUESTION 4
A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which instruction should the nurse
include in the teaching plan?
A. Take the medication with food to prevent gastrointestinal upset
B. Report any signs of infection, fever, or sore throat immediately
C. Expect weight gain as a therapeutic effect of the medication
D. Discontinue the medication if palpitations occur
ANSWER✔✨-: B. Report any signs of infection, fever, or sore throat immediately
RATIONALE: Propylthiouracil (PTU) can cause agranulocytosis, a serious adverse effect characterized by
a marked decrease in white blood cells. The client should be instructed to report signs of infection
(fever, sore throat, chills) immediately. PTU should be taken consistently, not necessarily with food.
Weight gain is not a therapeutic effect of PTU; the medication reduces thyroid hormone production.
Palpitations should be reported but the medication should not be discontinued without healthcare
provider guidance.
QUESTION 5
A client with hypothyroidism is prescribed levothyroxine. Which assessment finding indicates that the
medication is effective?
A. Increased heart rate from 58 to 72 beats per minute
B. Weight gain of 5 pounds
C. Decreased appetite
D. Cold intolerance
, ANSWER✔✨-: A. Increased heart rate from 58 to 72 beats per minute
RATIONALE: Levothyroxine replaces thyroid hormone in hypothyroid clients. Effective therapy results in
normalization of vital signs including heart rate. An increase in heart rate from bradycardic to normal
range indicates therapeutic effect. Weight loss (not gain) would be expected. Increased appetite
typically occurs with effective treatment. Cold intolerance should resolve, not persist.
QUESTION 6
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 118
mEq/L. Which nursing intervention is a priority?
A. Restrict oral fluid intake
B. Administer hypertonic saline
C. Encourage oral fluid intake
D. Administer diuretics
ANSWER✔✨-: A. Restrict oral fluid intake
RATIONALE: In SIADH, excessive antidiuretic hormone causes water retention and dilutional
hyponatremia. Fluid restriction is the primary intervention to correct hyponatremia. Hypertonic saline
may be used for severe hyponatremia but is not the first-line intervention. Encouraging fluids would
worsen the condition. Diuretics may be used but are not the priority intervention.
QUESTION 7
A client with diabetes insipidus is receiving desmopressin acetate. Which assessment finding indicates
the medication is effective?
A. Decreased urine output
