HESI MED SURG ACTUAL FINAL EXAM TEST BANK
2026/2027 PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM REAL QUESTIONS WITH
WELL ELABORATED ANSWERS WITH DETAILED
RATIONALES (RELIABLE SOLUTIONS) CURRENTLY
UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS A+
19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment. No additional history
is available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most
appropriate initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen
C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression.
While a urine drug screen may show positives, it cannot quantitate
the amount of a substance or the time period in which the exposure
occurred so a positive screen may not reflect cause and effect. An
EKG, while a part of a toxicology evaluation, is not an appropriate
initiate screening test for an unstable patient until airway and readily
reversible causes have been addressed.
,A 27 year old is found unresponsive in his car in the hospital parking
lot and brought in by security. During your initial evaluation you find
him to be cyanotic with pulse oximetry reading 82% on room air
with a respiratory rate of 4 breaths per minute. Radial pulses are
present at 120 bpm. Pupils are 1mm bilaterally. Your team is having
difficulty finding a vein for an intravenous line due to extensive
scarring of his arms. You are suspicious of an overdose, which
medication would you want to rapidly administer as a potential
antidote in this situation?
A. Glucose
B. Naloxone
C. Thiamine
D. Flumazenil
B. Naloxone
The patient has stigmata of an opiate overdose with hypopnea,
cyanosis, and miotic pupils. In addition, intravenous drug users often
use up their veins. While hypoglycemia can definitely cause a
depressed mental status and needs to be assessed, it should not
result in respiratory depression or miotic pupils. Thiamine is utilized
to prevent Wernicke's encephalopathy particularly in malnourished
patients who present with hypoglycemia but is not an antidote per
se. Flumazenil can be used to temporarily reverse the respiratory
depression caused by benzodiazepines but also carries with it the
risk of precipitating withdrawal and uncontrollable seizures in
chronic benzodiazepine users. As a result, it is not recommended
for routine use in patients with altered mental status.
,A 53 year-old known alcoholic presents with agitation, vomiting and
altered mental status. His fingerstick glucose is 148. His serum
ethanol level is undetectable and his head CT is normal. An ABG
shows a pH of 7.21, pCO2 of 34, pO2 of 98 on room air. His basic
chemistry panel includes a sodium of 136, potassium 4.1, chloride
108, bicarbonate 14, BUN 12, creatinine 1.1. What substance are you
concerned that he may have ingested:
A. Ethylene glycol
B. Salicylates
C. Isopropyl alcohol
D. Methanoleeette
C. Isopropyl alcohol
The patient is presenting with a non anion gap metabolic acidosis.
Isopropyl alcohol is metabolized via alcohol dehydrogenase to
acetone which accumulates and causes significant ketosis but not an
anion gap. Other toxic alcohols such as methanol and ethylene
glycol are ultimately metabolized to formic and glycolic acids which
cause toxic effects and an anion gap metabolic acidosis. Salicylates
result in an anion gap metabolic acidosis with a superimposed
respiratory alkalosis. The following mnemonic can be used to recall
the common causes of an increased anion gap metabolic acidosis:
CAT MUDPILES;
C - cyanide
A - alcoholic ketoacidosis
T - toluene
M - methanol
U - uremia
D - diabetic ketoacidosis
P - paraldehyde
I - isoniazid/iron
L - lactate
E - ethylene glycol
S - salicylates
Isopropyl alcohol causes a ketosis without an acidosis.
, In treating hepatitis secondary to alcoholic liver disease, all of the
following are true EXCEPT:
A. Treatment is primarily supportive including fluids and electrolyte
correction.
B. Glucose should be administered prior to thiamine to avoid
precipitating acute Wernicke's encephalopathy
C. Magnesium replacement should be initiated empirically except in
the setting of contraindications such as renal failure or
hypermagnesemia.
D. Coexisting gastritis should be sought out and treated
appropriately.
E. Nutritional status should be assessed with attention to possible
protein restriction.
B. Glucose should be administered prior to thiamine to avoid
precipitating acute Wernicke's encephalopathy
Alcoholics often have low thiamine levels due to poor nutrition, and
low glucose levels due to the suppression of gluconeogenesis by
alcohol. However, thiamine should always be replaced prior to
glucose to avoid the potential complication of precipitating
Wernicke's encephalopathy. Magnesium levels may appear normal
on laboratory testing, but alcoholics typically have low magnesium
stores and should be given magnesium empirically unless
contraindications for magnesium exist. Alcoholics should also be
evaluated for gastritis and overall nutritional status and should be
referred appropriately.
2026/2027 PRACTICE QUESTIONS AND STUDY GUIDE
COMPLETE ACCURATE EXAM REAL QUESTIONS WITH
WELL ELABORATED ANSWERS WITH DETAILED
RATIONALES (RELIABLE SOLUTIONS) CURRENTLY
UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS A+
19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment. No additional history
is available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most
appropriate initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen
C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression.
While a urine drug screen may show positives, it cannot quantitate
the amount of a substance or the time period in which the exposure
occurred so a positive screen may not reflect cause and effect. An
EKG, while a part of a toxicology evaluation, is not an appropriate
initiate screening test for an unstable patient until airway and readily
reversible causes have been addressed.
,A 27 year old is found unresponsive in his car in the hospital parking
lot and brought in by security. During your initial evaluation you find
him to be cyanotic with pulse oximetry reading 82% on room air
with a respiratory rate of 4 breaths per minute. Radial pulses are
present at 120 bpm. Pupils are 1mm bilaterally. Your team is having
difficulty finding a vein for an intravenous line due to extensive
scarring of his arms. You are suspicious of an overdose, which
medication would you want to rapidly administer as a potential
antidote in this situation?
A. Glucose
B. Naloxone
C. Thiamine
D. Flumazenil
B. Naloxone
The patient has stigmata of an opiate overdose with hypopnea,
cyanosis, and miotic pupils. In addition, intravenous drug users often
use up their veins. While hypoglycemia can definitely cause a
depressed mental status and needs to be assessed, it should not
result in respiratory depression or miotic pupils. Thiamine is utilized
to prevent Wernicke's encephalopathy particularly in malnourished
patients who present with hypoglycemia but is not an antidote per
se. Flumazenil can be used to temporarily reverse the respiratory
depression caused by benzodiazepines but also carries with it the
risk of precipitating withdrawal and uncontrollable seizures in
chronic benzodiazepine users. As a result, it is not recommended
for routine use in patients with altered mental status.
,A 53 year-old known alcoholic presents with agitation, vomiting and
altered mental status. His fingerstick glucose is 148. His serum
ethanol level is undetectable and his head CT is normal. An ABG
shows a pH of 7.21, pCO2 of 34, pO2 of 98 on room air. His basic
chemistry panel includes a sodium of 136, potassium 4.1, chloride
108, bicarbonate 14, BUN 12, creatinine 1.1. What substance are you
concerned that he may have ingested:
A. Ethylene glycol
B. Salicylates
C. Isopropyl alcohol
D. Methanoleeette
C. Isopropyl alcohol
The patient is presenting with a non anion gap metabolic acidosis.
Isopropyl alcohol is metabolized via alcohol dehydrogenase to
acetone which accumulates and causes significant ketosis but not an
anion gap. Other toxic alcohols such as methanol and ethylene
glycol are ultimately metabolized to formic and glycolic acids which
cause toxic effects and an anion gap metabolic acidosis. Salicylates
result in an anion gap metabolic acidosis with a superimposed
respiratory alkalosis. The following mnemonic can be used to recall
the common causes of an increased anion gap metabolic acidosis:
CAT MUDPILES;
C - cyanide
A - alcoholic ketoacidosis
T - toluene
M - methanol
U - uremia
D - diabetic ketoacidosis
P - paraldehyde
I - isoniazid/iron
L - lactate
E - ethylene glycol
S - salicylates
Isopropyl alcohol causes a ketosis without an acidosis.
, In treating hepatitis secondary to alcoholic liver disease, all of the
following are true EXCEPT:
A. Treatment is primarily supportive including fluids and electrolyte
correction.
B. Glucose should be administered prior to thiamine to avoid
precipitating acute Wernicke's encephalopathy
C. Magnesium replacement should be initiated empirically except in
the setting of contraindications such as renal failure or
hypermagnesemia.
D. Coexisting gastritis should be sought out and treated
appropriately.
E. Nutritional status should be assessed with attention to possible
protein restriction.
B. Glucose should be administered prior to thiamine to avoid
precipitating acute Wernicke's encephalopathy
Alcoholics often have low thiamine levels due to poor nutrition, and
low glucose levels due to the suppression of gluconeogenesis by
alcohol. However, thiamine should always be replaced prior to
glucose to avoid the potential complication of precipitating
Wernicke's encephalopathy. Magnesium levels may appear normal
on laboratory testing, but alcoholics typically have low magnesium
stores and should be given magnesium empirically unless
contraindications for magnesium exist. Alcoholics should also be
evaluated for gastritis and overall nutritional status and should be
referred appropriately.
