HESI A2 August 20, 2026 | Comprehensive Exam
Prediction.
SECTION 1: COMPLEX MEDICAL-SURGICAL (Questions 1-25)
Question 1
A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which
laboratory value should the nurse report to the healthcare provider before dialysis?
A. Serum potassium 5.5 mEq/L
B. Serum sodium 138 mEq/L
C. Serum calcium 8.5 mg/dL
D. Serum phosphorus 4.0 mg/dL
Correct Answer: A
,Rationale: Potassium 5.5 mEq/L is elevated (normal 3.5-5.0) and requires immediate
attention before dialysis. Hyperkalemia can cause life-threatening cardiac dysrhythmias.
Dialysis will remove excess potassium, but the provider must be notified. Sodium,
calcium, and phosphorus are within normal limits.
Question 2
A client with a history of deep vein thrombosis (DVT) is prescribed warfarin. The client's
INR is 1.2. Which action should the nurse take?
A. Administer the next dose of warfarin as prescribed
B. Hold the next dose of warfarin and notify the provider
C. Administer vitamin K
D. Increase the warfarin dose
Correct Answer: A
Rationale: INR of 1.2 is below the therapeutic range (2-3 for most indications). The
client is at risk for thrombosis. The nurse should administer the next dose as prescribed
and notify the provider for possible dose adjustment. Vitamin K is given for elevated
INR.
Question 3
The nurse is caring for a client with acute pancreatitis. Which finding indicates a
worsening condition?
A. Serum amylase 300 U/L
B. Epigastric pain radiating to the back
C. Grey-Turner's sign (flank bruising)
D. Nausea and vomiting
Correct Answer: C
Rationale: Grey-Turner's sign (flank bruising) and Cullen's sign (periumbilical bruising)
indicate retroperitoneal bleeding and severe hemorrhagic pancreatitis—a life-
,threatening complication. Elevated amylase, epigastric pain, and nausea are expected
findings in acute pancreatitis, not signs of worsening.
Question 4
A client with a new tracheostomy has thick, tenacious secretions. Which intervention
should the nurse implement first?
A. Increase the client's fluid intake
B. Instill normal saline into the tracheostomy
C. Suction the tracheostomy
D. Notify the healthcare provider
Correct Answer: C
Rationale: Thick secretions can obstruct the airway. Suctioning is the immediate priority
to maintain a patent airway. Increasing fluids and instilling saline are longer-term
interventions. The provider should be notified if suctioning is ineffective.
Question 5
A client with a history of heart failure is admitted with shortness of breath and crackles
in the lungs. The client's weight has increased by 5 lbs in 2 days. Which intervention is a
priority?
A. Administer furosemide as prescribed
B. Place the client in high-Fowler's position
C. Restrict fluid intake to 1,500 mL/day
D. Notify the healthcare provider
Correct Answer: B
Rationale: High-Fowler's position promotes lung expansion and reduces preload,
helping to relieve respiratory distress. While furosemide and fluid restriction are
important, positioning is the immediate priority to improve breathing.
, Question 6
The nurse is caring for a client with a chest tube. Which finding indicates the chest tube
is functioning properly?
A. Continuous bubbling in the water seal chamber
B. Tidaling with respirations
C. No drainage in the collection chamber
D. Subcutaneous emphysema
Correct Answer: B
Rationale: Tidaling (fluctuation with respirations) indicates the chest tube is patent and
functioning. Continuous bubbling indicates an air leak. Subcutaneous emphysema
indicates an air leak. No drainage may indicate obstruction.
Question 7
A client with cirrhosis has an ammonia level of 120 mcg/dL. Which finding is most
concerning?
A. Jaundice
B. Ascites
C. Confusion
D. Spider angiomas
Correct Answer: C
Rationale: Ammonia >80 mcg/dL indicates hepatic encephalopathy. Confusion is the
most concerning finding, indicating cerebral edema and potential progression to coma.
Jaundice, ascites, and spider angiomas are expected findings in cirrhosis but are not
immediately life-threatening.
Prediction.
SECTION 1: COMPLEX MEDICAL-SURGICAL (Questions 1-25)
Question 1
A client with end-stage renal disease (ESRD) is scheduled for hemodialysis. Which
laboratory value should the nurse report to the healthcare provider before dialysis?
A. Serum potassium 5.5 mEq/L
B. Serum sodium 138 mEq/L
C. Serum calcium 8.5 mg/dL
D. Serum phosphorus 4.0 mg/dL
Correct Answer: A
,Rationale: Potassium 5.5 mEq/L is elevated (normal 3.5-5.0) and requires immediate
attention before dialysis. Hyperkalemia can cause life-threatening cardiac dysrhythmias.
Dialysis will remove excess potassium, but the provider must be notified. Sodium,
calcium, and phosphorus are within normal limits.
Question 2
A client with a history of deep vein thrombosis (DVT) is prescribed warfarin. The client's
INR is 1.2. Which action should the nurse take?
A. Administer the next dose of warfarin as prescribed
B. Hold the next dose of warfarin and notify the provider
C. Administer vitamin K
D. Increase the warfarin dose
Correct Answer: A
Rationale: INR of 1.2 is below the therapeutic range (2-3 for most indications). The
client is at risk for thrombosis. The nurse should administer the next dose as prescribed
and notify the provider for possible dose adjustment. Vitamin K is given for elevated
INR.
Question 3
The nurse is caring for a client with acute pancreatitis. Which finding indicates a
worsening condition?
A. Serum amylase 300 U/L
B. Epigastric pain radiating to the back
C. Grey-Turner's sign (flank bruising)
D. Nausea and vomiting
Correct Answer: C
Rationale: Grey-Turner's sign (flank bruising) and Cullen's sign (periumbilical bruising)
indicate retroperitoneal bleeding and severe hemorrhagic pancreatitis—a life-
,threatening complication. Elevated amylase, epigastric pain, and nausea are expected
findings in acute pancreatitis, not signs of worsening.
Question 4
A client with a new tracheostomy has thick, tenacious secretions. Which intervention
should the nurse implement first?
A. Increase the client's fluid intake
B. Instill normal saline into the tracheostomy
C. Suction the tracheostomy
D. Notify the healthcare provider
Correct Answer: C
Rationale: Thick secretions can obstruct the airway. Suctioning is the immediate priority
to maintain a patent airway. Increasing fluids and instilling saline are longer-term
interventions. The provider should be notified if suctioning is ineffective.
Question 5
A client with a history of heart failure is admitted with shortness of breath and crackles
in the lungs. The client's weight has increased by 5 lbs in 2 days. Which intervention is a
priority?
A. Administer furosemide as prescribed
B. Place the client in high-Fowler's position
C. Restrict fluid intake to 1,500 mL/day
D. Notify the healthcare provider
Correct Answer: B
Rationale: High-Fowler's position promotes lung expansion and reduces preload,
helping to relieve respiratory distress. While furosemide and fluid restriction are
important, positioning is the immediate priority to improve breathing.
, Question 6
The nurse is caring for a client with a chest tube. Which finding indicates the chest tube
is functioning properly?
A. Continuous bubbling in the water seal chamber
B. Tidaling with respirations
C. No drainage in the collection chamber
D. Subcutaneous emphysema
Correct Answer: B
Rationale: Tidaling (fluctuation with respirations) indicates the chest tube is patent and
functioning. Continuous bubbling indicates an air leak. Subcutaneous emphysema
indicates an air leak. No drainage may indicate obstruction.
Question 7
A client with cirrhosis has an ammonia level of 120 mcg/dL. Which finding is most
concerning?
A. Jaundice
B. Ascites
C. Confusion
D. Spider angiomas
Correct Answer: C
Rationale: Ammonia >80 mcg/dL indicates hepatic encephalopathy. Confusion is the
most concerning finding, indicating cerebral edema and potential progression to coma.
Jaundice, ascites, and spider angiomas are expected findings in cirrhosis but are not
immediately life-threatening.
