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NSG 233 Medical-Surgical Nursing II HESI
Final Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
ABOUT THIS EXAMINATION
This comprehensive HESI Final Examination is designed to evaluate the senior nursing
student's mastery of Medical-Surgical Nursing II concepts. The exam emphasizes:
• Clinical Judgment: Application of the nursing process to complex, multi-system
patient scenarios
• Pharmacology: Safe medication administration, side effects monitoring, and
therapeutic responses
• Pathophysiology: Understanding disease processes to anticipate complications
• Priority Setting: Utilizing the ABCs (Airway, Breathing, Circulation) and Maslow's
Hierarchy
• Delegation & Leadership: Appropriate assignment of tasks to unlicensed
assistive personnel
• Legal/Ethical Issues: Informed consent, advanced directives, and patient
advocacy
100% Verified Content: This examination has been cross-referenced with current HESI
blueprints, NCLEX-RN test plans, and leading medical-surgical nursing textbooks (Lewis,
Brunner & Suddarth, and Ignatavicius) to ensure accuracy and relevance
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-72)
Question 1
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A nurse is assessing a client with heart failure who is receiving a continuous IV
infusion of dobutamine. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A. Decreased blood pressure
B. Increased heart rate
C. Increased cardiac output
D. Decreased urine output
Correct Answer: C. Increased cardiac output
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases the force of
myocardial contraction (positive inotrope), leading to increased stroke volume and
cardiac output. This improves perfusion to vital organs.
Why Other Options Are Wrong:
A. Decreased blood pressure: Dobutamine typically increases or maintains blood
pressure by improving cardiac output. A significant drop indicates an adverse effect
or worsening condition.
B. Increased heart rate: While tachycardia is a side effect (due to beta-1
stimulation), it is not the desired primary effect. The goal is improved contractility,
not rate.
D. Decreased urine output: This indicates poor renal perfusion. Effective
dobutamine therapy should increase urine output due to improved renal blood flow.
Question 2
The nurse is caring for a client diagnosed with a pulmonary embolism. Which
arterial blood gas (ABG) value would the nurse most expect to find?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 26
C. pH 7.48, PaCO2 45, HCO3 32
D. pH 7.32, PaCO2 38, HCO3 19
Correct Answer: A. pH 7.50, PaCO2 30, HCO3 24
Rationale: A pulmonary embolism causes a ventilation-perfusion (V/Q) mismatch.
The embolus blocks perfusion to a lung segment, but ventilation continues. This
creates "dead space" and leads to respiratory alkalosis initially due to
hyperventilation (blowing off CO2). ABG shows pH > 7.45, PaCO2 < 35.
Why Other Options Are Wrong:
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B. pH 7.30, PaCO2 50, HCO3 26: This indicates respiratory acidosis (CO2
retention), seen in conditions like COPD exacerbation or severe asthma, not a PE.
C. pH 7.48, PaCO2 45, HCO3 32: This indicates metabolic alkalosis (high HCO3).
This is not typical of an acute PE.
D. pH 7.32, PaCO2 38, HCO3 19: This indicates metabolic acidosis, seen in DKA or
renal failure. While possible in massive PE causing shock (lactic acidosis), the most
expected early finding is respiratory alkalosis.
Question 3
A client with a history of peptic ulcer disease (PUD) is admitted with severe
abdominal pain, vomiting, and a rigid, board-like abdomen. Which action should the
nurse take first?
A. Administer prescribed IV pain medication.
B. Insert a nasogastric (NG) tube to low intermittent suction.
C. Prepare the client for emergency surgery.
D. Place the client in a high-Fowler's position.
Correct Answer: C. Prepare the client for emergency surgery.
Rationale: A rigid, board-like abdomen with severe pain in a patient with PUD
indicates a perforated ulcer. This is a surgical emergency requiring immediate
surgical repair to prevent peritonitis and sepsis. The nurse must prepare the client
for the OR.
Why Other Options Are Wrong:
A. Administer prescribed IV pain medication: Pain relief is important, but the
priority is surgical intervention. Morphine may mask symptoms and delay
diagnosis.
B. Insert a NG tube to low intermittent suction: This is a supportive intervention to
decompress the stomach and prevent further spillage, but it is done after the
decision to proceed to surgery, or concurrently. It is not the first priority; the
surgeon needs to be notified immediately.
D. Place the client in a high-Fowler's position: While positioning helps breathing, it
does not address the life-threatening peritoneal contamination.
Question 4
, 4|Page
A nurse is reviewing the lab results for a client who is receiving heparin therapy.
Which lab value requires the nurse to notify the healthcare provider immediately?
A. aPTT of 68 seconds
B. Platelet count of 90,000/mm³
C. Hemoglobin of 12 g/dL
D. Potassium of 3.8 mEq/L
Correct Answer: B. Platelet count of 90,000/mm³
Rationale: Heparin-induced thrombocytopenia (HIT) is a life-threatening
complication characterized by a significant drop in platelet count (usually below
100,000/mm³ or a 50% decrease). It can lead to paradoxical thrombosis. The nurse
must hold heparin and notify the provider.
Why Other Options Are Wrong:
A. aPTT of 68 seconds: The therapeutic range for aPTT on heparin is typically 1.5–
2.5 times the normal control (usually 60–80 seconds). 68 seconds is within
therapeutic range.
C. Hemoglobin of 12 g/dL: This is a normal hemoglobin value.
D. Potassium of 3.8 mEq/L: This is a normal potassium value.
Question 5
A client is admitted with diabetic ketoacidosis (DKA). The nurse anticipates the
physician will order which initial fluid resuscitation?
A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. D5 ½ Normal Saline
Correct Answer: A. 0.9% Normal Saline
Rationale: DKA clients have a profound fluid deficit (dehydration) and
hyperosmolarity. The initial fluid of choice is isotonic 0.9% Normal Saline to rapidly
expand intravascular volume and restore blood pressure and perfusion.
Why Other Options Are Wrong:
B. D5W: This contains dextrose. It would raise the blood glucose further and is
contraindicated as initial fluid. It is used later when blood glucose approaches 250
mg/dL to prevent hypoglycemia.
NSG 233 Medical-Surgical Nursing II HESI
Final Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified – Pass
Guaranteed – A+ Graded
ABOUT THIS EXAMINATION
This comprehensive HESI Final Examination is designed to evaluate the senior nursing
student's mastery of Medical-Surgical Nursing II concepts. The exam emphasizes:
• Clinical Judgment: Application of the nursing process to complex, multi-system
patient scenarios
• Pharmacology: Safe medication administration, side effects monitoring, and
therapeutic responses
• Pathophysiology: Understanding disease processes to anticipate complications
• Priority Setting: Utilizing the ABCs (Airway, Breathing, Circulation) and Maslow's
Hierarchy
• Delegation & Leadership: Appropriate assignment of tasks to unlicensed
assistive personnel
• Legal/Ethical Issues: Informed consent, advanced directives, and patient
advocacy
100% Verified Content: This examination has been cross-referenced with current HESI
blueprints, NCLEX-RN test plans, and leading medical-surgical nursing textbooks (Lewis,
Brunner & Suddarth, and Ignatavicius) to ensure accuracy and relevance
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-72)
Question 1
,2|Page
A nurse is assessing a client with heart failure who is receiving a continuous IV
infusion of dobutamine. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A. Decreased blood pressure
B. Increased heart rate
C. Increased cardiac output
D. Decreased urine output
Correct Answer: C. Increased cardiac output
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases the force of
myocardial contraction (positive inotrope), leading to increased stroke volume and
cardiac output. This improves perfusion to vital organs.
Why Other Options Are Wrong:
A. Decreased blood pressure: Dobutamine typically increases or maintains blood
pressure by improving cardiac output. A significant drop indicates an adverse effect
or worsening condition.
B. Increased heart rate: While tachycardia is a side effect (due to beta-1
stimulation), it is not the desired primary effect. The goal is improved contractility,
not rate.
D. Decreased urine output: This indicates poor renal perfusion. Effective
dobutamine therapy should increase urine output due to improved renal blood flow.
Question 2
The nurse is caring for a client diagnosed with a pulmonary embolism. Which
arterial blood gas (ABG) value would the nurse most expect to find?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 26
C. pH 7.48, PaCO2 45, HCO3 32
D. pH 7.32, PaCO2 38, HCO3 19
Correct Answer: A. pH 7.50, PaCO2 30, HCO3 24
Rationale: A pulmonary embolism causes a ventilation-perfusion (V/Q) mismatch.
The embolus blocks perfusion to a lung segment, but ventilation continues. This
creates "dead space" and leads to respiratory alkalosis initially due to
hyperventilation (blowing off CO2). ABG shows pH > 7.45, PaCO2 < 35.
Why Other Options Are Wrong:
,3|Page
B. pH 7.30, PaCO2 50, HCO3 26: This indicates respiratory acidosis (CO2
retention), seen in conditions like COPD exacerbation or severe asthma, not a PE.
C. pH 7.48, PaCO2 45, HCO3 32: This indicates metabolic alkalosis (high HCO3).
This is not typical of an acute PE.
D. pH 7.32, PaCO2 38, HCO3 19: This indicates metabolic acidosis, seen in DKA or
renal failure. While possible in massive PE causing shock (lactic acidosis), the most
expected early finding is respiratory alkalosis.
Question 3
A client with a history of peptic ulcer disease (PUD) is admitted with severe
abdominal pain, vomiting, and a rigid, board-like abdomen. Which action should the
nurse take first?
A. Administer prescribed IV pain medication.
B. Insert a nasogastric (NG) tube to low intermittent suction.
C. Prepare the client for emergency surgery.
D. Place the client in a high-Fowler's position.
Correct Answer: C. Prepare the client for emergency surgery.
Rationale: A rigid, board-like abdomen with severe pain in a patient with PUD
indicates a perforated ulcer. This is a surgical emergency requiring immediate
surgical repair to prevent peritonitis and sepsis. The nurse must prepare the client
for the OR.
Why Other Options Are Wrong:
A. Administer prescribed IV pain medication: Pain relief is important, but the
priority is surgical intervention. Morphine may mask symptoms and delay
diagnosis.
B. Insert a NG tube to low intermittent suction: This is a supportive intervention to
decompress the stomach and prevent further spillage, but it is done after the
decision to proceed to surgery, or concurrently. It is not the first priority; the
surgeon needs to be notified immediately.
D. Place the client in a high-Fowler's position: While positioning helps breathing, it
does not address the life-threatening peritoneal contamination.
Question 4
, 4|Page
A nurse is reviewing the lab results for a client who is receiving heparin therapy.
Which lab value requires the nurse to notify the healthcare provider immediately?
A. aPTT of 68 seconds
B. Platelet count of 90,000/mm³
C. Hemoglobin of 12 g/dL
D. Potassium of 3.8 mEq/L
Correct Answer: B. Platelet count of 90,000/mm³
Rationale: Heparin-induced thrombocytopenia (HIT) is a life-threatening
complication characterized by a significant drop in platelet count (usually below
100,000/mm³ or a 50% decrease). It can lead to paradoxical thrombosis. The nurse
must hold heparin and notify the provider.
Why Other Options Are Wrong:
A. aPTT of 68 seconds: The therapeutic range for aPTT on heparin is typically 1.5–
2.5 times the normal control (usually 60–80 seconds). 68 seconds is within
therapeutic range.
C. Hemoglobin of 12 g/dL: This is a normal hemoglobin value.
D. Potassium of 3.8 mEq/L: This is a normal potassium value.
Question 5
A client is admitted with diabetic ketoacidosis (DKA). The nurse anticipates the
physician will order which initial fluid resuscitation?
A. 0.9% Normal Saline
B. D5W
C. 0.45% Normal Saline
D. D5 ½ Normal Saline
Correct Answer: A. 0.9% Normal Saline
Rationale: DKA clients have a profound fluid deficit (dehydration) and
hyperosmolarity. The initial fluid of choice is isotonic 0.9% Normal Saline to rapidly
expand intravascular volume and restore blood pressure and perfusion.
Why Other Options Are Wrong:
B. D5W: This contains dextrose. It would raise the blood glucose further and is
contraindicated as initial fluid. It is used later when blood glucose approaches 250
mg/dL to prevent hypoglycemia.
