HESI Medical-Surgical Nursing Exam Questions
with Correct Answers (VerifiedAnswers) Plus
Rationales 2026 Q&A Instant Download PDF
1. A client with acute heart failure suddenly develops severe
dyspnea, crackles throughout both lung fields, and pink, frothy
sputum. Which action should the nurse take first?
A. Obtain the client's daily weight
B. Encourage oral fluids
C. Place the client in high-Fowler's position
D. Administer the scheduled oral diuretic
Correct answer: C. Place the client in high-Fowler's position
Rationale: Acute pulmonary edema is a life-threatening
complication of heart failure caused by fluid accumulation in the
alveoli. High-Fowler's positioning promotes maximal lung
expansion and decreases venous return to the heart, which can
reduce pulmonary congestion. The nurse should simultaneously
prepare to administer prescribed oxygen and emergency
medications. A daily weight is important for monitoring chronic
fluid status but does not address the immediate respiratory
emergency. Encouraging fluids would worsen pulmonary
,congestion, and an oral diuretic may take too long to address
the acute deterioration.
2. A client with chronic obstructive pulmonary disease (COPD)
is receiving oxygen therapy. Which oxygen saturation would
generally be an appropriate target for a client with chronic CO₂
retention?
A. 100%
B. 98%–100%
C. 95%–99%
D. 88%–92%
Correct answer: D. 88%–92%
Rationale: Many clients with COPD who are at risk for chronic
hypercapnia are managed with a target oxygen saturation
around 88%–92%, although the individualized target should
follow the provider's prescription and the client's clinical
condition. Excessive oxygen administration can contribute to
worsening hypercapnia in susceptible clients. The nurse should
carefully titrate oxygen, monitor respiratory status, and
evaluate arterial blood gases when indicated. The goal is
adequate oxygenation without unnecessarily administering
excessive oxygen.
,3. A client with diabetic ketoacidosis (DKA) arrives in the
emergency department with hypotension, tachycardia, and
dry mucous membranes. Which intervention is the priority?
A. Begin isotonic IV fluid replacement
B. Administer long-acting insulin
C. Restrict oral and IV fluids
D. Administer sodium bicarbonate immediately
Correct answer: A. Begin isotonic IV fluid replacement
Rationale: Severe dehydration and intravascular volume
depletion are major problems in DKA. Initial management
generally includes rapid administration of isotonic IV fluids to
restore circulating volume and improve tissue perfusion. Insulin
is essential but is administered after initial fluid assessment and
therapy, with close potassium monitoring. Sodium bicarbonate
is not routinely indicated and is generally reserved for severe
metabolic acidosis under specific circumstances. Fluid restriction
would worsen hypovolemia.
4. A client with hyperkalemia has peaked T waves on the ECG.
Which prescribed medication should the nurse anticipate
administering immediately to stabilize the cardiac membrane?
A. Oral potassium chloride
B. IV calcium gluconate
, C. Spironolactone
D. Sodium-restricted IV fluids
Correct answer: B. IV calcium gluconate
Rationale: Hyperkalemia can produce dangerous cardiac
dysrhythmias. IV calcium gluconate does not remove potassium
from the body, but it rapidly stabilizes the myocardial cell
membrane and decreases the immediate risk of lethal
dysrhythmias. Other therapies such as insulin with glucose,
beta-agonists, potassium-binding agents, or dialysis may be
used to lower serum potassium depending on severity and the
client's condition. Potassium supplementation and potassium-
sparing medications would worsen hyperkalemia.
5. A client reports crushing substernal chest pain radiating to
the left arm and jaw. Which action is the nurse's priority?
A. Ask the client to rate the pain after 30 minutes
B. Obtain a 12-lead ECG promptly
C. Encourage the client to ambulate
D. Give a full meal before diagnostic testing
Correct answer: B. Obtain a 12-lead ECG promptly
Rationale: The client's symptoms are highly concerning for acute
coronary syndrome. A 12-lead ECG should be obtained rapidly
because early identification of myocardial ischemia or infarction
with Correct Answers (VerifiedAnswers) Plus
Rationales 2026 Q&A Instant Download PDF
1. A client with acute heart failure suddenly develops severe
dyspnea, crackles throughout both lung fields, and pink, frothy
sputum. Which action should the nurse take first?
A. Obtain the client's daily weight
B. Encourage oral fluids
C. Place the client in high-Fowler's position
D. Administer the scheduled oral diuretic
Correct answer: C. Place the client in high-Fowler's position
Rationale: Acute pulmonary edema is a life-threatening
complication of heart failure caused by fluid accumulation in the
alveoli. High-Fowler's positioning promotes maximal lung
expansion and decreases venous return to the heart, which can
reduce pulmonary congestion. The nurse should simultaneously
prepare to administer prescribed oxygen and emergency
medications. A daily weight is important for monitoring chronic
fluid status but does not address the immediate respiratory
emergency. Encouraging fluids would worsen pulmonary
,congestion, and an oral diuretic may take too long to address
the acute deterioration.
2. A client with chronic obstructive pulmonary disease (COPD)
is receiving oxygen therapy. Which oxygen saturation would
generally be an appropriate target for a client with chronic CO₂
retention?
A. 100%
B. 98%–100%
C. 95%–99%
D. 88%–92%
Correct answer: D. 88%–92%
Rationale: Many clients with COPD who are at risk for chronic
hypercapnia are managed with a target oxygen saturation
around 88%–92%, although the individualized target should
follow the provider's prescription and the client's clinical
condition. Excessive oxygen administration can contribute to
worsening hypercapnia in susceptible clients. The nurse should
carefully titrate oxygen, monitor respiratory status, and
evaluate arterial blood gases when indicated. The goal is
adequate oxygenation without unnecessarily administering
excessive oxygen.
,3. A client with diabetic ketoacidosis (DKA) arrives in the
emergency department with hypotension, tachycardia, and
dry mucous membranes. Which intervention is the priority?
A. Begin isotonic IV fluid replacement
B. Administer long-acting insulin
C. Restrict oral and IV fluids
D. Administer sodium bicarbonate immediately
Correct answer: A. Begin isotonic IV fluid replacement
Rationale: Severe dehydration and intravascular volume
depletion are major problems in DKA. Initial management
generally includes rapid administration of isotonic IV fluids to
restore circulating volume and improve tissue perfusion. Insulin
is essential but is administered after initial fluid assessment and
therapy, with close potassium monitoring. Sodium bicarbonate
is not routinely indicated and is generally reserved for severe
metabolic acidosis under specific circumstances. Fluid restriction
would worsen hypovolemia.
4. A client with hyperkalemia has peaked T waves on the ECG.
Which prescribed medication should the nurse anticipate
administering immediately to stabilize the cardiac membrane?
A. Oral potassium chloride
B. IV calcium gluconate
, C. Spironolactone
D. Sodium-restricted IV fluids
Correct answer: B. IV calcium gluconate
Rationale: Hyperkalemia can produce dangerous cardiac
dysrhythmias. IV calcium gluconate does not remove potassium
from the body, but it rapidly stabilizes the myocardial cell
membrane and decreases the immediate risk of lethal
dysrhythmias. Other therapies such as insulin with glucose,
beta-agonists, potassium-binding agents, or dialysis may be
used to lower serum potassium depending on severity and the
client's condition. Potassium supplementation and potassium-
sparing medications would worsen hyperkalemia.
5. A client reports crushing substernal chest pain radiating to
the left arm and jaw. Which action is the nurse's priority?
A. Ask the client to rate the pain after 30 minutes
B. Obtain a 12-lead ECG promptly
C. Encourage the client to ambulate
D. Give a full meal before diagnostic testing
Correct answer: B. Obtain a 12-lead ECG promptly
Rationale: The client's symptoms are highly concerning for acute
coronary syndrome. A 12-lead ECG should be obtained rapidly
because early identification of myocardial ischemia or infarction
