HESI RN PHYSIOLOGICAL ADAPTATION ACCURATE
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium level of 118 mEq/L. Which assessment finding requires the most
immediate nursing intervention?
A. Lethargy and confusion
B. Dry mucous membranes
C. Orthostatic hypotension
D. Thirst and polyuria
Rationale: Severe hyponatremia (sodium below 120 mEq/L) causes cerebral
edema, leading to lethargy, confusion, seizures, and coma. This neurological
deterioration requires immediate intervention, including possible hypertonic
saline administration. Dry mucous membranes, orthostatic hypotension, thirst,
and polyuria are associated with hypernatremia or fluid volume deficit, not
SIADH.
2. A client with heart failure is receiving furosemide. Which laboratory value
indicates a therapeutic response to this medication?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 4.2 mEq/L
, C. Serum magnesium of 1.8 mg/dL
D. Serum calcium of 10.2 mg/dL
Rationale: Furosemide is a loop diuretic that promotes excretion of sodium,
water, and potassium. While monitoring electrolytes is essential, a serum
potassium level of 4.2 mEq/L is within normal range (3.5-5.0 mEq/L) and
indicates the patient is not experiencing hypokalemia, a common adverse
effect. Therapeutic response is primarily measured by reduced edema and
improved symptoms, but among these options, normal potassium reflects safe
diuretic use.
3. A client with chronic kidney disease has a potassium level of 6.5 mEq/L.
Which electrocardiogram (ECG) change is most characteristic of this
electrolyte imbalance?
A. Prolonged PR interval
B. Tall, peaked T waves
C. Widened QRS complex
D. ST segment depression
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) produces characteristic ECG
changes, with tall, peaked T waves being the earliest and most specific finding.
As potassium rises further, the PR interval prolongs, QRS widens, and eventually
ventricular fibrillation may occur. ST segment depression is seen in hypokalemia
or myocardial ischemia.
4. A client is admitted with diabetic ketoacidosis (DKA). Which arterial blood
gas (ABG) result supports this diagnosis?
A. pH 7.38, PaCO2 45, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 20
C. pH 7.25, PaCO2 30, HCO3 14
D. pH 7.45, PaCO2 48, HCO3 28
Rationale: DKA is characterized by metabolic acidosis with an anion gap. The
ABG shows low pH (acidemia), low HCO3 (metabolic acidosis), and low PaCO2 as
respiratory compensation (Kussmaul respirations). Option C reflects this
pattern. Option A is normal; Option B indicates respiratory acidosis; Option D
suggests metabolic alkalosis.
, 5. A client with a chest tube has continuous bubbling in the water seal
chamber. What action should the nurse take first?
A. Clamp the chest tube and notify the provider
B. Assess the system for an air leak
C. Increase the suction pressure
D. Strip the chest tube to clear the drainage
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.
The nurse should first assess the system to locate the source (e.g., loose
connections, open clamps, or a patient wound leak). Clamping is not
recommended due to tension pneumothorax risk; increasing suction will not fix
a leak; stripping is not indicated and can damage tissue.
6. A client with severe burns develops a urine output of 20 mL/hr over 2
hours. Which intervention should the nurse anticipate?
A. Administer a diuretic
B. Increase the intravenous fluid rate
C. Insert a Foley catheter
D. Monitor intake and output only
Rationale: In the early resuscitation phase of burn injury, adequate urine output
(0.5-1.0 mL/kg/hr) indicates sufficient fluid resuscitation. A urine output of 20
mL/hr is below target for most adults. The priority is to increase IV fluid rate to
improve renal perfusion and prevent acute kidney injury. Diuretics are not first-
line; a Foley is likely already in place; simply monitoring is insufficient.
7. A client with pneumonia has a pulse oximetry reading of 88% on room air.
Which action should the nurse take first?
A. Administer oxygen via nasal cannula at 2 L/min
B. Place the client in high Fowler's position
C. Notify the healthcare provider
D. Obtain an arterial blood gas
Rationale: The nurse should first position the client in high Fowler's position to
maximize lung expansion and improve oxygenation. This is a noninvasive,
immediate intervention. While administering oxygen is also important,
positioning should be done first or simultaneously. Notifying the provider and
obtaining ABGs are later steps; the client needs immediate intervention.
, 8. A client with cirrhosis develops ascites. Which dietary modification is most
important for the nurse to emphasize?
A. High-protein, high-calorie diet
B. Sodium restriction to 2 g/day
C. Increased potassium intake
D. Fluid restriction to 1 L/day
Rationale: Ascites in cirrhosis results from portal hypertension and
hypoalbuminemia, leading to fluid shift into the peritoneal cavity. Sodium
restriction (2 g/day) is the cornerstone of management to reduce fluid
retention. Fluid restriction may be needed if hyponatremia occurs, but sodium
restriction is primary. High protein is generally encouraged unless
encephalopathy is present; potassium may be needed if diuretics are used but is
not the primary dietary modification.
9. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22
mm Hg. Which nursing intervention is most appropriate?
A. Place the client in the Trendelenburg position
B. Suction the airway frequently
C. Elevate the head of the bed to 30 degrees
D. Administer a bolus of normal saline
Rationale: Normal ICP is 5-15 mm Hg; 22 mm Hg is elevated. Elevating the head
of the bed to 30 degrees promotes venous drainage from the brain, reducing
ICP. Trendelenburg increases ICP; suctioning can also increase ICP if done
aggressively; fluid boluses may be given in hypovolemia but are not first-line for
elevated ICP.
10. A client with hypothyroidism is prescribed levothyroxine. Which instruction
should the nurse include in the teaching plan?
A. Take the medication with food to reduce gastric upset
B. Take the medication on an empty stomach in the morning
C. Expect immediate improvement in symptoms
D. Discontinue the medication if palpitations occur
Rationale: Levothyroxine should be taken on an empty stomach, ideally 30-60
minutes before breakfast, to maximize absorption. Food, calcium, iron, and
antacids can interfere with absorption. Improvement is gradual over weeks;
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
A client with syndrome of inappropriate antidiuretic hormone (SIADH) has a
serum sodium level of 118 mEq/L. Which assessment finding requires the most
immediate nursing intervention?
A. Lethargy and confusion
B. Dry mucous membranes
C. Orthostatic hypotension
D. Thirst and polyuria
Rationale: Severe hyponatremia (sodium below 120 mEq/L) causes cerebral
edema, leading to lethargy, confusion, seizures, and coma. This neurological
deterioration requires immediate intervention, including possible hypertonic
saline administration. Dry mucous membranes, orthostatic hypotension, thirst,
and polyuria are associated with hypernatremia or fluid volume deficit, not
SIADH.
2. A client with heart failure is receiving furosemide. Which laboratory value
indicates a therapeutic response to this medication?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 4.2 mEq/L
, C. Serum magnesium of 1.8 mg/dL
D. Serum calcium of 10.2 mg/dL
Rationale: Furosemide is a loop diuretic that promotes excretion of sodium,
water, and potassium. While monitoring electrolytes is essential, a serum
potassium level of 4.2 mEq/L is within normal range (3.5-5.0 mEq/L) and
indicates the patient is not experiencing hypokalemia, a common adverse
effect. Therapeutic response is primarily measured by reduced edema and
improved symptoms, but among these options, normal potassium reflects safe
diuretic use.
3. A client with chronic kidney disease has a potassium level of 6.5 mEq/L.
Which electrocardiogram (ECG) change is most characteristic of this
electrolyte imbalance?
A. Prolonged PR interval
B. Tall, peaked T waves
C. Widened QRS complex
D. ST segment depression
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) produces characteristic ECG
changes, with tall, peaked T waves being the earliest and most specific finding.
As potassium rises further, the PR interval prolongs, QRS widens, and eventually
ventricular fibrillation may occur. ST segment depression is seen in hypokalemia
or myocardial ischemia.
4. A client is admitted with diabetic ketoacidosis (DKA). Which arterial blood
gas (ABG) result supports this diagnosis?
A. pH 7.38, PaCO2 45, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 20
C. pH 7.25, PaCO2 30, HCO3 14
D. pH 7.45, PaCO2 48, HCO3 28
Rationale: DKA is characterized by metabolic acidosis with an anion gap. The
ABG shows low pH (acidemia), low HCO3 (metabolic acidosis), and low PaCO2 as
respiratory compensation (Kussmaul respirations). Option C reflects this
pattern. Option A is normal; Option B indicates respiratory acidosis; Option D
suggests metabolic alkalosis.
, 5. A client with a chest tube has continuous bubbling in the water seal
chamber. What action should the nurse take first?
A. Clamp the chest tube and notify the provider
B. Assess the system for an air leak
C. Increase the suction pressure
D. Strip the chest tube to clear the drainage
Rationale: Continuous bubbling in the water seal chamber indicates an air leak.
The nurse should first assess the system to locate the source (e.g., loose
connections, open clamps, or a patient wound leak). Clamping is not
recommended due to tension pneumothorax risk; increasing suction will not fix
a leak; stripping is not indicated and can damage tissue.
6. A client with severe burns develops a urine output of 20 mL/hr over 2
hours. Which intervention should the nurse anticipate?
A. Administer a diuretic
B. Increase the intravenous fluid rate
C. Insert a Foley catheter
D. Monitor intake and output only
Rationale: In the early resuscitation phase of burn injury, adequate urine output
(0.5-1.0 mL/kg/hr) indicates sufficient fluid resuscitation. A urine output of 20
mL/hr is below target for most adults. The priority is to increase IV fluid rate to
improve renal perfusion and prevent acute kidney injury. Diuretics are not first-
line; a Foley is likely already in place; simply monitoring is insufficient.
7. A client with pneumonia has a pulse oximetry reading of 88% on room air.
Which action should the nurse take first?
A. Administer oxygen via nasal cannula at 2 L/min
B. Place the client in high Fowler's position
C. Notify the healthcare provider
D. Obtain an arterial blood gas
Rationale: The nurse should first position the client in high Fowler's position to
maximize lung expansion and improve oxygenation. This is a noninvasive,
immediate intervention. While administering oxygen is also important,
positioning should be done first or simultaneously. Notifying the provider and
obtaining ABGs are later steps; the client needs immediate intervention.
, 8. A client with cirrhosis develops ascites. Which dietary modification is most
important for the nurse to emphasize?
A. High-protein, high-calorie diet
B. Sodium restriction to 2 g/day
C. Increased potassium intake
D. Fluid restriction to 1 L/day
Rationale: Ascites in cirrhosis results from portal hypertension and
hypoalbuminemia, leading to fluid shift into the peritoneal cavity. Sodium
restriction (2 g/day) is the cornerstone of management to reduce fluid
retention. Fluid restriction may be needed if hyponatremia occurs, but sodium
restriction is primary. High protein is generally encouraged unless
encephalopathy is present; potassium may be needed if diuretics are used but is
not the primary dietary modification.
9. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22
mm Hg. Which nursing intervention is most appropriate?
A. Place the client in the Trendelenburg position
B. Suction the airway frequently
C. Elevate the head of the bed to 30 degrees
D. Administer a bolus of normal saline
Rationale: Normal ICP is 5-15 mm Hg; 22 mm Hg is elevated. Elevating the head
of the bed to 30 degrees promotes venous drainage from the brain, reducing
ICP. Trendelenburg increases ICP; suctioning can also increase ICP if done
aggressively; fluid boluses may be given in hypovolemia but are not first-line for
elevated ICP.
10. A client with hypothyroidism is prescribed levothyroxine. Which instruction
should the nurse include in the teaching plan?
A. Take the medication with food to reduce gastric upset
B. Take the medication on an empty stomach in the morning
C. Expect immediate improvement in symptoms
D. Discontinue the medication if palpitations occur
Rationale: Levothyroxine should be taken on an empty stomach, ideally 30-60
minutes before breakfast, to maximize absorption. Food, calcium, iron, and
antacids can interfere with absorption. Improvement is gradual over weeks;
