MED-SURG II HESI 200 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST 2026 ALREADY
GRADED A+
This comprehensive set of 200 unique questions covers the Med-Surg II HESI
exam content across all major body systems. Topics include respiratory
(COPD, pneumonia, TB, chest tubes, mechanical ventilation), cardiovascular
(heart failure, MI, DVT, PE, anticoagulants), endocrine (diabetes, DKA,
thyroid disorders, adrenal insufficiency), renal (AKI, CKD, electrolyte
imbalances), gastrointestinal (pancreatitis, cirrhosis, hepatic encephalopathy,
colostomies, ileostomies), neurological (spinal cord injury, autonomic
dysreflexia, stroke, seizures), musculoskeletal (hip fractures, compartment
syndrome, traction), and critical care (shock, burns, transfusion reactions).
Each question includes a correct answer and detailed rationale for effective
exam preparation.
1. The nurse assesses a patient with shortness of breath for evidence of long-
standing hypoxemia by inspecting which of the following?
A) Chest excursion
B) Spinal curvatures
C) The respiratory pattern
D) The fingernail and its base
Answer: D
Rationale: Clubbing, characterized by an increased angle between the nail base and
finger, is a classic sign of chronic hypoxemia. It develops over time due to tissue
hypoxia and is visible on physical examination.
2. The nurse is caring for a patient with COPD and pneumonia who has an order
for arterial blood gases. What is the minimum length of time the nurse should plan
to hold pressure on the puncture site?
A) 2 minutes
B) 5 minutes
C) 10 minutes
D) 15 minutes
Answer: B
,Rationale: After an arterial puncture, firm pressure must be held for a full 5
minutes to prevent bleeding and hematoma formation. Patients on anticoagulants
may require longer pressure.
3. A client with COPD becomes short of breath while ambulating. Which action
should the nurse take first?
A) Increase oxygen flow rate
B) Place client in high-Fowler's position
C) Instruct pursed-lip breathing
D) Encourage fluid intake
Answer: C
Rationale: Pursed-lip breathing prolongs exhalation, reduces air trapping, and
quickly relieves dyspnea by keeping airways open. It is an immediate, independent
nursing intervention for COPD patients.
4. A client with COPD has an oxygen saturation of 88% on room air. The nurse
initiates oxygen at 2 L/min via nasal cannula. Which finding would indicate an
adverse reaction to oxygen therapy?
A) Respiratory rate increases from 22 to 26/min
B) The client reports less dyspnea
C) Oxygen saturation rises to 92%
D) The client becomes drowsy and lethargic
Answer: D
Rationale: COPD patients may retain CO₂ and rely on hypoxic drive. Excessive O₂
can cause hypoventilation, CO₂ narcosis, and drowsiness or lethargy. This is a sign
of impending respiratory failure.
5. For thick, tenacious sputum in pneumonia, the most effective intervention to
loosen secretions is:
A) Limit fluid intake
B) Increase oral fluids
C) Encourage bedrest
D) Offer a low-sodium diet
Answer: B
Rationale: Adequate hydration thins respiratory secretions, making them easier to
expectorate. Increasing oral fluids is the most effective independent nursing
measure for thick sputum.
,6. A client with severe asthma is receiving albuterol nebulizer treatments. The
nurse notes the client's heart rate has increased from 88 to 120/min. What is the
best action?
A) Stop the albuterol immediately
B) Continue the treatment as ordered
C) Hold the treatment and notify the provider
D) Administer a beta-blocker
Answer: B
Rationale: Tachycardia is a common side effect of albuterol due to beta-2
adrenergic stimulation. The bronchodilator effect is needed for the asthma
exacerbation; continue treatment and monitor.
7. A client is prescribed enoxaparin (Lovenox) postoperatively. Which instruction
is most important for the nurse to include in the teaching?
A) "Report any unusual bleeding or bruising."
B) "Take this medication with food."
C) "You will need weekly lab tests."
D) "This medication dissolves existing clots."
Answer: A
Rationale: Enoxaparin is an anticoagulant that increases bleeding risk. Clients
should be taught to report signs of bleeding such as bruising, hematuria, or melena.
It does not dissolve existing clots but prevents new ones.
8. A patient with Chronic Kidney Disease (CKD) is prescribed Spironolactone.
Which lab value is the priority for the nurse to monitor?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) Glucose 110 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. In CKD, the kidneys
cannot excrete potassium effectively, placing the patient at high risk for life-
threatening hyperkalemia.
9. A nurse is caring for a patient post-TURP with continuous bladder irrigation
(CBI). The nurse notes the return is dark red with multiple large clots. What is the
priority action?
A) Document the findings
B) Decrease the irrigation rate
C) Increase the irrigation rate
, D) Notify the provider for immediate surgery
Answer: C
Rationale: To keep the catheter patent and prevent total occlusion by clots, the
irrigation rate must be increased until the drainage turns light pink. This is the
immediate nursing action.
10. Which assessment finding is the most critical for a patient who just returned
from a thyroidectomy?
A) Complaints of mild throat pain
B) Difficulty swallowing water
C) Laryngeal stridor and hoarseness
D) A heart rate of 88 bpm
Answer: C
Rationale: Stridor indicates an airway obstruction, likely due to laryngeal nerve
damage or edema. This is a medical emergency requiring immediate intervention.
11. A patient is prescribed Apixaban (Eliquis) for Atrial Fibrillation. Which
symptom should the nurse instruct the patient to report immediately?
A) Dry mouth
B) Increased appetite
C) Frequent nosebleeds (epistaxis)
D) Occasional mild headaches
Answer: C
Rationale: Apixaban is an anticoagulant. Epistaxis, hematuria, or bruising are signs
of excessive bleeding that require immediate intervention.
12. A patient presents to the ER with symptoms of a stroke. What is the first
diagnostic test the nurse anticipates?
A) MRI of the brain
B) Non-contrast CT scan of the head
C) Lumbar puncture
D) EEG
Answer: B
Rationale: A CT scan is the fastest way to differentiate between an ischemic and a
hemorrhagic stroke, which determines whether tPA can be given. It is the priority
diagnostic test.
13. Which medication order should a nurse question for a patient with a history of
a Gastrointestinal (GI) bleed?
A) Acetaminophen
ANSWERS WITH RATIONALE LATEST 2026 ALREADY
GRADED A+
This comprehensive set of 200 unique questions covers the Med-Surg II HESI
exam content across all major body systems. Topics include respiratory
(COPD, pneumonia, TB, chest tubes, mechanical ventilation), cardiovascular
(heart failure, MI, DVT, PE, anticoagulants), endocrine (diabetes, DKA,
thyroid disorders, adrenal insufficiency), renal (AKI, CKD, electrolyte
imbalances), gastrointestinal (pancreatitis, cirrhosis, hepatic encephalopathy,
colostomies, ileostomies), neurological (spinal cord injury, autonomic
dysreflexia, stroke, seizures), musculoskeletal (hip fractures, compartment
syndrome, traction), and critical care (shock, burns, transfusion reactions).
Each question includes a correct answer and detailed rationale for effective
exam preparation.
1. The nurse assesses a patient with shortness of breath for evidence of long-
standing hypoxemia by inspecting which of the following?
A) Chest excursion
B) Spinal curvatures
C) The respiratory pattern
D) The fingernail and its base
Answer: D
Rationale: Clubbing, characterized by an increased angle between the nail base and
finger, is a classic sign of chronic hypoxemia. It develops over time due to tissue
hypoxia and is visible on physical examination.
2. The nurse is caring for a patient with COPD and pneumonia who has an order
for arterial blood gases. What is the minimum length of time the nurse should plan
to hold pressure on the puncture site?
A) 2 minutes
B) 5 minutes
C) 10 minutes
D) 15 minutes
Answer: B
,Rationale: After an arterial puncture, firm pressure must be held for a full 5
minutes to prevent bleeding and hematoma formation. Patients on anticoagulants
may require longer pressure.
3. A client with COPD becomes short of breath while ambulating. Which action
should the nurse take first?
A) Increase oxygen flow rate
B) Place client in high-Fowler's position
C) Instruct pursed-lip breathing
D) Encourage fluid intake
Answer: C
Rationale: Pursed-lip breathing prolongs exhalation, reduces air trapping, and
quickly relieves dyspnea by keeping airways open. It is an immediate, independent
nursing intervention for COPD patients.
4. A client with COPD has an oxygen saturation of 88% on room air. The nurse
initiates oxygen at 2 L/min via nasal cannula. Which finding would indicate an
adverse reaction to oxygen therapy?
A) Respiratory rate increases from 22 to 26/min
B) The client reports less dyspnea
C) Oxygen saturation rises to 92%
D) The client becomes drowsy and lethargic
Answer: D
Rationale: COPD patients may retain CO₂ and rely on hypoxic drive. Excessive O₂
can cause hypoventilation, CO₂ narcosis, and drowsiness or lethargy. This is a sign
of impending respiratory failure.
5. For thick, tenacious sputum in pneumonia, the most effective intervention to
loosen secretions is:
A) Limit fluid intake
B) Increase oral fluids
C) Encourage bedrest
D) Offer a low-sodium diet
Answer: B
Rationale: Adequate hydration thins respiratory secretions, making them easier to
expectorate. Increasing oral fluids is the most effective independent nursing
measure for thick sputum.
,6. A client with severe asthma is receiving albuterol nebulizer treatments. The
nurse notes the client's heart rate has increased from 88 to 120/min. What is the
best action?
A) Stop the albuterol immediately
B) Continue the treatment as ordered
C) Hold the treatment and notify the provider
D) Administer a beta-blocker
Answer: B
Rationale: Tachycardia is a common side effect of albuterol due to beta-2
adrenergic stimulation. The bronchodilator effect is needed for the asthma
exacerbation; continue treatment and monitor.
7. A client is prescribed enoxaparin (Lovenox) postoperatively. Which instruction
is most important for the nurse to include in the teaching?
A) "Report any unusual bleeding or bruising."
B) "Take this medication with food."
C) "You will need weekly lab tests."
D) "This medication dissolves existing clots."
Answer: A
Rationale: Enoxaparin is an anticoagulant that increases bleeding risk. Clients
should be taught to report signs of bleeding such as bruising, hematuria, or melena.
It does not dissolve existing clots but prevents new ones.
8. A patient with Chronic Kidney Disease (CKD) is prescribed Spironolactone.
Which lab value is the priority for the nurse to monitor?
A) Sodium 135 mEq/L
B) Potassium 5.8 mEq/L
C) Glucose 110 mg/dL
D) Magnesium 2.0 mEq/L
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. In CKD, the kidneys
cannot excrete potassium effectively, placing the patient at high risk for life-
threatening hyperkalemia.
9. A nurse is caring for a patient post-TURP with continuous bladder irrigation
(CBI). The nurse notes the return is dark red with multiple large clots. What is the
priority action?
A) Document the findings
B) Decrease the irrigation rate
C) Increase the irrigation rate
, D) Notify the provider for immediate surgery
Answer: C
Rationale: To keep the catheter patent and prevent total occlusion by clots, the
irrigation rate must be increased until the drainage turns light pink. This is the
immediate nursing action.
10. Which assessment finding is the most critical for a patient who just returned
from a thyroidectomy?
A) Complaints of mild throat pain
B) Difficulty swallowing water
C) Laryngeal stridor and hoarseness
D) A heart rate of 88 bpm
Answer: C
Rationale: Stridor indicates an airway obstruction, likely due to laryngeal nerve
damage or edema. This is a medical emergency requiring immediate intervention.
11. A patient is prescribed Apixaban (Eliquis) for Atrial Fibrillation. Which
symptom should the nurse instruct the patient to report immediately?
A) Dry mouth
B) Increased appetite
C) Frequent nosebleeds (epistaxis)
D) Occasional mild headaches
Answer: C
Rationale: Apixaban is an anticoagulant. Epistaxis, hematuria, or bruising are signs
of excessive bleeding that require immediate intervention.
12. A patient presents to the ER with symptoms of a stroke. What is the first
diagnostic test the nurse anticipates?
A) MRI of the brain
B) Non-contrast CT scan of the head
C) Lumbar puncture
D) EEG
Answer: B
Rationale: A CT scan is the fastest way to differentiate between an ischemic and a
hemorrhagic stroke, which determines whether tPA can be given. It is the priority
diagnostic test.
13. Which medication order should a nurse question for a patient with a history of
a Gastrointestinal (GI) bleed?
A) Acetaminophen
