Official Med-Surg II HESI Exam
Complete Test Bank (2026/2027) –
150 Expert Practice Questions &
Detailed Rationales | Level 3 Pass
Study Guide (Graded A+)
Elevate your advanced nursing performance and
lock in a Level 3 pass with this premium, high-yield
practice test bank meticulously curated for the 2026
Med-Surg II HESI Examination. Spanning 150
comprehensive multiple-choice questions—including
Next Generation NCLEX (NGN) evaluation items—
this resource focuses on critical care mechanics,
fluid/electrolyte emergencies, acid-base dynamics,
and complex endocrine or renal disorders. Sharply
formatted for seamless digital review or a polished
Stuvia upload, every item provides an explicitly
highlighted correct answer and an in-depth clinical
rationale to supercharge your active recall and
maximize your test scores.
, 1.The nurse is completing a health assessment of a 42-year-old female with suspected
Graves' Disease. The nurse should assess this client for:
A) anorexia
B) tachycardia
C) weight gain
D) cold skin
Correct Answer: B) tachycardia
Rationale: Graves' disease, the most common type of thyrotoxicosis, is a state of
hypermetabolism. The increased metabolic rate generates heat and produces
tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss
of weight, despite a good appetite and adequate caloric intake, is a common feature of
hyperthyroidism. Cold skin is associated with hypothyroidism.
2. When conducting a health history with a female client with thyrotoxicosis, the nurse
should ask about which of the following changes in the menstrual cycle?
A) menorrhagia
B) oligomenorrhea or amenorrhea
C) dysmenorrhea
D) metrorrhagia
Correct Answer: B) oligomenorrhea or amenorrhea
Rationale: Increased levels of thyroid hormones alter the hypothalamic-pituitary-ovarian
axis, leading to oligomenorrhea (scanty or infrequent menses) or amenorrhea in women
with thyrotoxicosis. Menorrhagia (excessive menstrual bleeding) is commonly seen in
women with hypothyroidism.
3. A nurse is assessing a client who has a chest tube connected to a water-seal drainage
system. The nurse notes continuous, rapid bubbling within the water-seal chamber.
How should the nurse interpret this finding?
A) The client's lung has completely re-expanded.
B) This is an expected finding when wall suction is applied.
C) There is an air leak present in the drainage system or connections.
D) The chest tube is obstructed by a large blood clot.
Correct Answer: C) There is an air leak present in the drainage system or
connections.
Rationale: Intermittent bubbling in the water-seal chamber is normal during exhalation,
coughing, or sneezing while air is being cleared from the pleural space. However,
persistent, continuous bubbling indicates a breach or air leak somewhere within the
system loop, the tubing connections, or at the insertion site, which requires immediate
troubleshooting.
,4. A nurse is reviewing the arterial blood gas (ABG) results of a client who has acute
respiratory distress syndrome (ARDS) and is receiving mechanical ventilation. The
results are: pH 7.28, \(PaCO_{2}\) 54 mm Hg, \(HCO_{3}^{-}\) 24 mEq/L, and
\(PaO_{2}\) 58 mm Hg despite high concentrations of fraction of inspired oxygen
(\(FiO_{2}\)). Which of the following conditions is the client experiencing?
A) Compensated metabolic alkalosis
B) Uncompensated respiratory acidosis with refractory hypoxemia
C) Uncompensated metabolic acidosis with adequate tissue perfusion
D) Fully compensated respiratory alkalosis
Correct Answer: B) Uncompensated respiratory acidosis with refractory
hypoxemia
Rationale: The pH is below 7.35, indicating acidosis. The \(PaCO_{2}\) is elevated
above 45 mm Hg, which demonstrates a respiratory cause, while the \(HCO_{3}^{-}\) is
within the normal reference range (22–26 mEq/L), meaning the condition is
uncompensated. The \(PaO_{2}\) remains severely low (below 60 mm Hg) despite
receiving supplemental oxygen therapy, which is the precise clinical definition of
refractory hypoxemia, a classic hallmark of ARDS.
5. A nurse is caring for a client who is 12 hours postoperative following a subtotal
thyroidectomy. The client reports a tingling sensation in their fingers and toes, and the
nurse notes muscle twitching during a blood pressure assessment. Which of the
following medications should the nurse prepare to administer?
A) Potassium chloride IV infusion
B) Calcium gluconate IV injection
C) Magnesium sulfate intramuscularly
D) Sodium bicarbonate IV bolus
Correct Answer: B) Calcium gluconate IV injection
Rationale: Tingling around the mouth and extremities, muscle twitching, and carpopedal
spasms during blood pressure cuff inflation (Trousseau's sign) are manifestations of
acute hypocalcemia. This is a potential complication of a thyroidectomy if the
parathyroid glands are accidentally damaged or excised. Intravenous calcium gluconate
must be administered immediately to stabilize neuromuscular excitability.
6. A nurse is evaluating a client who has advanced liver cirrhosis and develops severe
hepatic encephalopathy. Which of the following laboratory values is directly responsible
for this neurological complication, and what medication should the nurse anticipate
administering?
A) Serum bilirubin; administer vitamin K
B) Serum ammonia; administer lactulose
C) Blood urea nitrogen (BUN); administer epoetin alfa
D) Ionized calcium; administer calcitonin
Correct Answer: B) Serum ammonia; administer lactulose
Rationale: In advanced cirrhosis, the failing liver cannot convert ammonia (a byproduct
of protein metabolism) into urea for excretion. Elevated ammonia levels cross the blood-
brain barrier, causing toxic encephalopathy (altered mental status, asterixis, confusion).
, Lactulose works by acidifying the colon contents, trapping ammonia as ammonium ions,
and promoting its rapid evacuation through loose bowel movements.
7. A nurse in the emergency department is assessing a client who has an acute
myocardial infarction (AMI). The client's cardiac monitor displays a total absence of P
waves, an irregularly irregular ventricular rhythm, and narrow QRS complexes. The
nurse should identify this rhythm as:
A) Ventricular tachycardia
B) Atrial fibrillation
C) Third-degree atrioventricular (AV) block
D) Premature ventricular contractions
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by rapid, disorganized electrical activity in
the atria, resulting in an absent P wave pattern, a wavy or fibrillatory baseline, and a
highly irregular ventricular response (irregularly irregular R-R intervals). The QRS
complexes typically remain narrow because ventricular conduction follows normal
pathways once past the AV node.
8. A nurse is providing discharge teaching to a client who has a new diagnosis of
peripheral arterial disease (PAD). Which of the following instructions should the nurse
include?
A) Apply a commercial heating pad directly to your feet to promote vasodilation at night.
B) Elevate your legs above the level of your heart while resting in bed.
C) Avoid crossing your legs at the knees and allow them to hang in a dependent
position when sitting.
D) Wear tight, restrictive knee-high compression stockings during daytime ambulation.
Correct Answer: C) Avoid crossing your legs at the knees and allow them to hang
in a dependent position when sitting.
Rationale: In PAD, arterial blood flow to the lower extremities is impaired. Positioning
the legs in a dependent (hanging down) position uses gravity to pull blood into the
ischemic lower tissues. Elevating legs above the heart or wearing tight, restrictive
garments further reduces arterial perfusion. Heating pads are contraindicated due to
peripheral neuropathy and high burn risks.
9. A nurse is monitoring a client who has a head injury and notes a widening pulse
pressure, a slow heart rate (bradycardia), and an irregular respiratory pattern. The
nurse should recognize these findings as indicating which of the following conditions?
A) Hypovolemic shock state
B) Beck's triad, indicating cardiac tamponade
C) Cushing's triad, indicating increased intracranial pressure (ICP)
D) Virchow's triad, indicating deep vein thrombosis
Correct Answer: C) Cushing's triad, indicating increased intracranial pressure
(ICP)
Rationale: Cushing's triad is a late sign of increased ICP indicating that brainstem
herniation is imminent. It consists of three specific physiological changes: bradycardia,
irregular or altered respirations (such as Cheyne-Stokes), and a widening pulse
Complete Test Bank (2026/2027) –
150 Expert Practice Questions &
Detailed Rationales | Level 3 Pass
Study Guide (Graded A+)
Elevate your advanced nursing performance and
lock in a Level 3 pass with this premium, high-yield
practice test bank meticulously curated for the 2026
Med-Surg II HESI Examination. Spanning 150
comprehensive multiple-choice questions—including
Next Generation NCLEX (NGN) evaluation items—
this resource focuses on critical care mechanics,
fluid/electrolyte emergencies, acid-base dynamics,
and complex endocrine or renal disorders. Sharply
formatted for seamless digital review or a polished
Stuvia upload, every item provides an explicitly
highlighted correct answer and an in-depth clinical
rationale to supercharge your active recall and
maximize your test scores.
, 1.The nurse is completing a health assessment of a 42-year-old female with suspected
Graves' Disease. The nurse should assess this client for:
A) anorexia
B) tachycardia
C) weight gain
D) cold skin
Correct Answer: B) tachycardia
Rationale: Graves' disease, the most common type of thyrotoxicosis, is a state of
hypermetabolism. The increased metabolic rate generates heat and produces
tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss
of weight, despite a good appetite and adequate caloric intake, is a common feature of
hyperthyroidism. Cold skin is associated with hypothyroidism.
2. When conducting a health history with a female client with thyrotoxicosis, the nurse
should ask about which of the following changes in the menstrual cycle?
A) menorrhagia
B) oligomenorrhea or amenorrhea
C) dysmenorrhea
D) metrorrhagia
Correct Answer: B) oligomenorrhea or amenorrhea
Rationale: Increased levels of thyroid hormones alter the hypothalamic-pituitary-ovarian
axis, leading to oligomenorrhea (scanty or infrequent menses) or amenorrhea in women
with thyrotoxicosis. Menorrhagia (excessive menstrual bleeding) is commonly seen in
women with hypothyroidism.
3. A nurse is assessing a client who has a chest tube connected to a water-seal drainage
system. The nurse notes continuous, rapid bubbling within the water-seal chamber.
How should the nurse interpret this finding?
A) The client's lung has completely re-expanded.
B) This is an expected finding when wall suction is applied.
C) There is an air leak present in the drainage system or connections.
D) The chest tube is obstructed by a large blood clot.
Correct Answer: C) There is an air leak present in the drainage system or
connections.
Rationale: Intermittent bubbling in the water-seal chamber is normal during exhalation,
coughing, or sneezing while air is being cleared from the pleural space. However,
persistent, continuous bubbling indicates a breach or air leak somewhere within the
system loop, the tubing connections, or at the insertion site, which requires immediate
troubleshooting.
,4. A nurse is reviewing the arterial blood gas (ABG) results of a client who has acute
respiratory distress syndrome (ARDS) and is receiving mechanical ventilation. The
results are: pH 7.28, \(PaCO_{2}\) 54 mm Hg, \(HCO_{3}^{-}\) 24 mEq/L, and
\(PaO_{2}\) 58 mm Hg despite high concentrations of fraction of inspired oxygen
(\(FiO_{2}\)). Which of the following conditions is the client experiencing?
A) Compensated metabolic alkalosis
B) Uncompensated respiratory acidosis with refractory hypoxemia
C) Uncompensated metabolic acidosis with adequate tissue perfusion
D) Fully compensated respiratory alkalosis
Correct Answer: B) Uncompensated respiratory acidosis with refractory
hypoxemia
Rationale: The pH is below 7.35, indicating acidosis. The \(PaCO_{2}\) is elevated
above 45 mm Hg, which demonstrates a respiratory cause, while the \(HCO_{3}^{-}\) is
within the normal reference range (22–26 mEq/L), meaning the condition is
uncompensated. The \(PaO_{2}\) remains severely low (below 60 mm Hg) despite
receiving supplemental oxygen therapy, which is the precise clinical definition of
refractory hypoxemia, a classic hallmark of ARDS.
5. A nurse is caring for a client who is 12 hours postoperative following a subtotal
thyroidectomy. The client reports a tingling sensation in their fingers and toes, and the
nurse notes muscle twitching during a blood pressure assessment. Which of the
following medications should the nurse prepare to administer?
A) Potassium chloride IV infusion
B) Calcium gluconate IV injection
C) Magnesium sulfate intramuscularly
D) Sodium bicarbonate IV bolus
Correct Answer: B) Calcium gluconate IV injection
Rationale: Tingling around the mouth and extremities, muscle twitching, and carpopedal
spasms during blood pressure cuff inflation (Trousseau's sign) are manifestations of
acute hypocalcemia. This is a potential complication of a thyroidectomy if the
parathyroid glands are accidentally damaged or excised. Intravenous calcium gluconate
must be administered immediately to stabilize neuromuscular excitability.
6. A nurse is evaluating a client who has advanced liver cirrhosis and develops severe
hepatic encephalopathy. Which of the following laboratory values is directly responsible
for this neurological complication, and what medication should the nurse anticipate
administering?
A) Serum bilirubin; administer vitamin K
B) Serum ammonia; administer lactulose
C) Blood urea nitrogen (BUN); administer epoetin alfa
D) Ionized calcium; administer calcitonin
Correct Answer: B) Serum ammonia; administer lactulose
Rationale: In advanced cirrhosis, the failing liver cannot convert ammonia (a byproduct
of protein metabolism) into urea for excretion. Elevated ammonia levels cross the blood-
brain barrier, causing toxic encephalopathy (altered mental status, asterixis, confusion).
, Lactulose works by acidifying the colon contents, trapping ammonia as ammonium ions,
and promoting its rapid evacuation through loose bowel movements.
7. A nurse in the emergency department is assessing a client who has an acute
myocardial infarction (AMI). The client's cardiac monitor displays a total absence of P
waves, an irregularly irregular ventricular rhythm, and narrow QRS complexes. The
nurse should identify this rhythm as:
A) Ventricular tachycardia
B) Atrial fibrillation
C) Third-degree atrioventricular (AV) block
D) Premature ventricular contractions
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by rapid, disorganized electrical activity in
the atria, resulting in an absent P wave pattern, a wavy or fibrillatory baseline, and a
highly irregular ventricular response (irregularly irregular R-R intervals). The QRS
complexes typically remain narrow because ventricular conduction follows normal
pathways once past the AV node.
8. A nurse is providing discharge teaching to a client who has a new diagnosis of
peripheral arterial disease (PAD). Which of the following instructions should the nurse
include?
A) Apply a commercial heating pad directly to your feet to promote vasodilation at night.
B) Elevate your legs above the level of your heart while resting in bed.
C) Avoid crossing your legs at the knees and allow them to hang in a dependent
position when sitting.
D) Wear tight, restrictive knee-high compression stockings during daytime ambulation.
Correct Answer: C) Avoid crossing your legs at the knees and allow them to hang
in a dependent position when sitting.
Rationale: In PAD, arterial blood flow to the lower extremities is impaired. Positioning
the legs in a dependent (hanging down) position uses gravity to pull blood into the
ischemic lower tissues. Elevating legs above the heart or wearing tight, restrictive
garments further reduces arterial perfusion. Heating pads are contraindicated due to
peripheral neuropathy and high burn risks.
9. A nurse is monitoring a client who has a head injury and notes a widening pulse
pressure, a slow heart rate (bradycardia), and an irregular respiratory pattern. The
nurse should recognize these findings as indicating which of the following conditions?
A) Hypovolemic shock state
B) Beck's triad, indicating cardiac tamponade
C) Cushing's triad, indicating increased intracranial pressure (ICP)
D) Virchow's triad, indicating deep vein thrombosis
Correct Answer: C) Cushing's triad, indicating increased intracranial pressure
(ICP)
Rationale: Cushing's triad is a late sign of increased ICP indicating that brainstem
herniation is imminent. It consists of three specific physiological changes: bradycardia,
irregular or altered respirations (such as Cheyne-Stokes), and a widening pulse
