HESI Case Studies — Exam Questions with
Correct Answers (verifiedanswers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Heart Failure
1. A 72-year-old patient with a history of heart failure reports
worsening dyspnea, a 3-kg weight gain over 4 days, and bilateral
crackles. Which assessment finding requires the nurse's
immediate action?
A. Mild bilateral ankle edema
B. Blood pressure of 148/86 mm Hg
C. Oxygen saturation of 84% on room air
D. Heart rate of 96/min
Correct answer: C. Oxygen saturation of 84% on room air
An oxygen saturation of 84% indicates significant hypoxemia
and takes priority because impaired oxygenation can rapidly
become life-threatening. The nurse should position the patient
upright, provide supplemental oxygen as prescribed, assess
respiratory status, and promptly escalate care. The weight gain,
edema, and crackles support fluid overload, but severe
hypoxemia requires the most immediate intervention.
,2. The provider prescribes IV furosemide. Which finding best
indicates that the medication is producing the intended effect?
A. Serum potassium rises from 3.4 to 4.8 mEq/L
B. Urine output increases and dyspnea improves
C. Heart rate increases to 118/min
D. Weight increases by 1 kg
Correct answer: B. Urine output increases and dyspnea
improves
Furosemide is a loop diuretic that promotes sodium and water
excretion. Increased urine output accompanied by improved
dyspnea indicates that excess fluid is being removed and
pulmonary congestion is improving. The nurse should continue
monitoring daily weight, blood pressure, renal function, and
electrolytes because excessive diuresis can cause dehydration,
hypotension, and electrolyte abnormalities.
3. Which patient statement demonstrates correct
understanding of daily weight monitoring for heart failure?
A. “I will weigh myself after breakfast each day.”
B. “I will weigh myself at the same time each morning using
the same scale.”
,C. “I only need to weigh myself when my ankles swell.”
D. “I will compare my weight with my monthly clinic weight.”
Correct answer: B. “I will weigh myself at the same time each
morning using the same scale.”
Daily weight is one of the most sensitive methods for detecting
fluid retention in heart failure. For accurate comparison, the
patient should use the same scale, preferably at approximately
the same time each morning, after voiding and before eating,
with similar clothing. A rapid increase in weight can indicate
fluid accumulation before severe respiratory symptoms develop.
4. Which laboratory result is most important for the nurse to
report after several doses of furosemide?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Glucose 102 mg/dL
D. Calcium 9.1 mg/dL
Correct answer: B. Potassium 2.9 mEq/L
Loop diuretics increase urinary potassium loss. A potassium
level of 2.9 mEq/L represents significant hypokalemia and
increases the risk of cardiac dysrhythmias, muscle weakness,
and other complications. The nurse should promptly notify the
, provider and anticipate potassium replacement or adjustment
of therapy based on the patient's overall clinical condition.
5. The patient asks why sodium restriction is recommended.
Which response is best?
A. “Sodium directly increases your heart rate.”
B. “Sodium causes your kidneys to retain water, which can
worsen fluid overload.”
C. “Sodium prevents your diuretic from working.”
D. “Sodium lowers your blood glucose.”
Correct answer: B. “Sodium causes your kidneys to retain
water, which can worsen fluid overload.”
Sodium promotes water retention, increasing circulating and
interstitial fluid volume. In heart failure, excess fluid can worsen
peripheral edema and pulmonary congestion and increase the
workload of the heart. Teaching should include reading food
labels, limiting processed foods, and following the prescribed
sodium restriction rather than focusing only on table salt.
Case Study 2: Diabetic Ketoacidosis
6. A 19-year-old patient with type 1 diabetes has nausea,
abdominal pain, deep rapid respirations, glucose 480 mg/dL,
and positive serum ketones. Which problem is the priority?
Correct Answers (verifiedanswers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Heart Failure
1. A 72-year-old patient with a history of heart failure reports
worsening dyspnea, a 3-kg weight gain over 4 days, and bilateral
crackles. Which assessment finding requires the nurse's
immediate action?
A. Mild bilateral ankle edema
B. Blood pressure of 148/86 mm Hg
C. Oxygen saturation of 84% on room air
D. Heart rate of 96/min
Correct answer: C. Oxygen saturation of 84% on room air
An oxygen saturation of 84% indicates significant hypoxemia
and takes priority because impaired oxygenation can rapidly
become life-threatening. The nurse should position the patient
upright, provide supplemental oxygen as prescribed, assess
respiratory status, and promptly escalate care. The weight gain,
edema, and crackles support fluid overload, but severe
hypoxemia requires the most immediate intervention.
,2. The provider prescribes IV furosemide. Which finding best
indicates that the medication is producing the intended effect?
A. Serum potassium rises from 3.4 to 4.8 mEq/L
B. Urine output increases and dyspnea improves
C. Heart rate increases to 118/min
D. Weight increases by 1 kg
Correct answer: B. Urine output increases and dyspnea
improves
Furosemide is a loop diuretic that promotes sodium and water
excretion. Increased urine output accompanied by improved
dyspnea indicates that excess fluid is being removed and
pulmonary congestion is improving. The nurse should continue
monitoring daily weight, blood pressure, renal function, and
electrolytes because excessive diuresis can cause dehydration,
hypotension, and electrolyte abnormalities.
3. Which patient statement demonstrates correct
understanding of daily weight monitoring for heart failure?
A. “I will weigh myself after breakfast each day.”
B. “I will weigh myself at the same time each morning using
the same scale.”
,C. “I only need to weigh myself when my ankles swell.”
D. “I will compare my weight with my monthly clinic weight.”
Correct answer: B. “I will weigh myself at the same time each
morning using the same scale.”
Daily weight is one of the most sensitive methods for detecting
fluid retention in heart failure. For accurate comparison, the
patient should use the same scale, preferably at approximately
the same time each morning, after voiding and before eating,
with similar clothing. A rapid increase in weight can indicate
fluid accumulation before severe respiratory symptoms develop.
4. Which laboratory result is most important for the nurse to
report after several doses of furosemide?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Glucose 102 mg/dL
D. Calcium 9.1 mg/dL
Correct answer: B. Potassium 2.9 mEq/L
Loop diuretics increase urinary potassium loss. A potassium
level of 2.9 mEq/L represents significant hypokalemia and
increases the risk of cardiac dysrhythmias, muscle weakness,
and other complications. The nurse should promptly notify the
, provider and anticipate potassium replacement or adjustment
of therapy based on the patient's overall clinical condition.
5. The patient asks why sodium restriction is recommended.
Which response is best?
A. “Sodium directly increases your heart rate.”
B. “Sodium causes your kidneys to retain water, which can
worsen fluid overload.”
C. “Sodium prevents your diuretic from working.”
D. “Sodium lowers your blood glucose.”
Correct answer: B. “Sodium causes your kidneys to retain
water, which can worsen fluid overload.”
Sodium promotes water retention, increasing circulating and
interstitial fluid volume. In heart failure, excess fluid can worsen
peripheral edema and pulmonary congestion and increase the
workload of the heart. Teaching should include reading food
labels, limiting processed foods, and following the prescribed
sodium restriction rather than focusing only on table salt.
Case Study 2: Diabetic Ketoacidosis
6. A 19-year-old patient with type 1 diabetes has nausea,
abdominal pain, deep rapid respirations, glucose 480 mg/dL,
and positive serum ketones. Which problem is the priority?
