HESI PN ADVANCED MEDICAL-SURGICAL NURSING
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
1. A client with heart failure is prescribed furosemide. Which assessment finding
indicates that the medication is having the desired therapeutic effect?
A. Increased jugular venous distension
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
Correct Answer: B
**Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in
heart failure. The desired therapeutic effect is a reduction in extracellular fluid,
evidenced by decreased peripheral edema, decreased pulmonary congestion, and
weight loss. Jugular venous distension would decrease, blood pressure may
decrease due to reduced preload, and urine output should increase. **
,2. A client with chronic obstructive pulmonary disease has an arterial blood gas
result showing pH 7.30, PaCO2 55 mm Hg, and HCO3- 30 mEq/L. The nurse
interprets these findings as indicative of:
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic alkalosis
Correct Answer: B
**Rationale: The pH is below normal (7.35-7.45), indicating acidosis. The PaCO2 is
elevated (>45 mm Hg), indicating a respiratory cause. The HCO3- is elevated (>26
mEq/L), indicating metabolic compensation. Because the pH is still abnormal,
compensation is only partial. Fully compensated would show a normal pH. **
3. The nurse is caring for a client with diabetes mellitus who is exhibiting rapid
breathing, fruity breath, and confusion. Which intervention should the nurse
implement first?
A. Administer regular insulin intravenously
B. Initiate fluid resuscitation with normal saline
C. Check serum potassium level
D. Insert a nasogastric tube
Correct Answer: B
**Rationale: The client is likely in diabetic ketoacidosis. The priority intervention is
fluid resuscitation to correct dehydration and hypovolemia, which improves tissue
perfusion and reduces blood glucose concentration. While insulin administration is
critical, fluids are initiated first to prevent cardiovascular collapse. Potassium
levels should be monitored, but fluid resuscitation is the priority. **
4. A postoperative client reports sudden onset of sharp chest pain and dyspnea.
The nurse notes tachycardia and hypoxia. Which condition should the nurse
suspect?
A. Atelectasis
,B. Pulmonary embolism
C. Pneumothorax
D. Myocardial infarction
Correct Answer: B
**Rationale: The sudden onset of chest pain, dyspnea, tachycardia, and hypoxia in
a postoperative client is highly suspicious for a pulmonary embolism, often
resulting from a deep vein thrombosis that has dislodged. Atelectasis typically
presents more gradually. Pneumothorax is often associated with trauma or
procedures. Myocardial infarction pain is typically described differently and may
not include sudden hypoxia. **
5. The nurse is preparing to administer a blood transfusion to a client. Which
action is most important to prevent a transfusion reaction?
A. Verify client identification using two unique identifiers
B. Premedicate with diphenhydramine
C. Infuse the blood over 4 hours
D. Check vital signs every 15 minutes for the first hour
Correct Answer: A
**Rationale: The most important action to prevent a transfusion reaction is
accurate client identification. This involves verifying the client's name and
identification number with the blood product label and using two unique
identifiers. While premedication, infusion rate, and vital sign monitoring are
important, they do not prevent reactions as effectively as proper identification. **
6. A client with end-stage renal disease is scheduled for hemodialysis. Which
medication should the nurse hold on the morning of dialysis?
A. Furosemide
B. Epoetin alfa
C. Calcium acetate
D. Sevelamer
Correct Answer: A
**Rationale: Furosemide, a loop diuretic, should be held on the morning of
, hemodialysis because the client will be undergoing fluid removal during dialysis
and the medication could cause excessive fluid loss or electrolyte imbalances.
Epoetin alfa is administered to stimulate red blood cell production and is not held.
Phosphate binders like calcium acetate and sevelamer are usually given with
meals and may be held if the client is fasting before dialysis, but furosemide is the
most critical to hold. **
7. The nurse is assessing a client with acute pancreatitis. Which finding indicates a
potentially life-threatening complication?
A. Epigastric pain radiating to the back
B. Nausea and vomiting
C. Cullen's sign
D. Hypoactive bowel sounds
Correct Answer: C
**Rationale: Cullen's sign, which is periumbilical ecchymosis, indicates
retroperitoneal hemorrhage and is a sign of severe, potentially life-threatening
hemorrhagic pancreatitis. Epigastric pain, nausea, vomiting, and hypoactive
bowel sounds are common manifestations of acute pancreatitis but do not
indicate the same level of severity as Cullen's sign. **
8. A client with a tracheostomy tube is being discharged. Which instruction is most
important for the nurse to include in the discharge teaching?
A. "Clean the inner cannula with hydrogen peroxide."
B. "Keep an obturator and an extra tracheostomy tube at the bedside."
C. "Use a cotton-tipped applicator to clean around the stoma."
D. "Change the tracheostomy ties every week."
Correct Answer: B
**Rationale: The most important safety instruction is to keep an obturator and an
extra tracheostomy tube at the bedside at all times. This ensures that if the tube
becomes dislodged or obstructed, the client or caregiver can reinsert a new tube
or use the obturator to guide the tube back in. This is a life-saving measure. The
other options represent routine care but are not as critical. **
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
1. A client with heart failure is prescribed furosemide. Which assessment finding
indicates that the medication is having the desired therapeutic effect?
A. Increased jugular venous distension
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
Correct Answer: B
**Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in
heart failure. The desired therapeutic effect is a reduction in extracellular fluid,
evidenced by decreased peripheral edema, decreased pulmonary congestion, and
weight loss. Jugular venous distension would decrease, blood pressure may
decrease due to reduced preload, and urine output should increase. **
,2. A client with chronic obstructive pulmonary disease has an arterial blood gas
result showing pH 7.30, PaCO2 55 mm Hg, and HCO3- 30 mEq/L. The nurse
interprets these findings as indicative of:
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic alkalosis
Correct Answer: B
**Rationale: The pH is below normal (7.35-7.45), indicating acidosis. The PaCO2 is
elevated (>45 mm Hg), indicating a respiratory cause. The HCO3- is elevated (>26
mEq/L), indicating metabolic compensation. Because the pH is still abnormal,
compensation is only partial. Fully compensated would show a normal pH. **
3. The nurse is caring for a client with diabetes mellitus who is exhibiting rapid
breathing, fruity breath, and confusion. Which intervention should the nurse
implement first?
A. Administer regular insulin intravenously
B. Initiate fluid resuscitation with normal saline
C. Check serum potassium level
D. Insert a nasogastric tube
Correct Answer: B
**Rationale: The client is likely in diabetic ketoacidosis. The priority intervention is
fluid resuscitation to correct dehydration and hypovolemia, which improves tissue
perfusion and reduces blood glucose concentration. While insulin administration is
critical, fluids are initiated first to prevent cardiovascular collapse. Potassium
levels should be monitored, but fluid resuscitation is the priority. **
4. A postoperative client reports sudden onset of sharp chest pain and dyspnea.
The nurse notes tachycardia and hypoxia. Which condition should the nurse
suspect?
A. Atelectasis
,B. Pulmonary embolism
C. Pneumothorax
D. Myocardial infarction
Correct Answer: B
**Rationale: The sudden onset of chest pain, dyspnea, tachycardia, and hypoxia in
a postoperative client is highly suspicious for a pulmonary embolism, often
resulting from a deep vein thrombosis that has dislodged. Atelectasis typically
presents more gradually. Pneumothorax is often associated with trauma or
procedures. Myocardial infarction pain is typically described differently and may
not include sudden hypoxia. **
5. The nurse is preparing to administer a blood transfusion to a client. Which
action is most important to prevent a transfusion reaction?
A. Verify client identification using two unique identifiers
B. Premedicate with diphenhydramine
C. Infuse the blood over 4 hours
D. Check vital signs every 15 minutes for the first hour
Correct Answer: A
**Rationale: The most important action to prevent a transfusion reaction is
accurate client identification. This involves verifying the client's name and
identification number with the blood product label and using two unique
identifiers. While premedication, infusion rate, and vital sign monitoring are
important, they do not prevent reactions as effectively as proper identification. **
6. A client with end-stage renal disease is scheduled for hemodialysis. Which
medication should the nurse hold on the morning of dialysis?
A. Furosemide
B. Epoetin alfa
C. Calcium acetate
D. Sevelamer
Correct Answer: A
**Rationale: Furosemide, a loop diuretic, should be held on the morning of
, hemodialysis because the client will be undergoing fluid removal during dialysis
and the medication could cause excessive fluid loss or electrolyte imbalances.
Epoetin alfa is administered to stimulate red blood cell production and is not held.
Phosphate binders like calcium acetate and sevelamer are usually given with
meals and may be held if the client is fasting before dialysis, but furosemide is the
most critical to hold. **
7. The nurse is assessing a client with acute pancreatitis. Which finding indicates a
potentially life-threatening complication?
A. Epigastric pain radiating to the back
B. Nausea and vomiting
C. Cullen's sign
D. Hypoactive bowel sounds
Correct Answer: C
**Rationale: Cullen's sign, which is periumbilical ecchymosis, indicates
retroperitoneal hemorrhage and is a sign of severe, potentially life-threatening
hemorrhagic pancreatitis. Epigastric pain, nausea, vomiting, and hypoactive
bowel sounds are common manifestations of acute pancreatitis but do not
indicate the same level of severity as Cullen's sign. **
8. A client with a tracheostomy tube is being discharged. Which instruction is most
important for the nurse to include in the discharge teaching?
A. "Clean the inner cannula with hydrogen peroxide."
B. "Keep an obturator and an extra tracheostomy tube at the bedside."
C. "Use a cotton-tipped applicator to clean around the stoma."
D. "Change the tracheostomy ties every week."
Correct Answer: B
**Rationale: The most important safety instruction is to keep an obturator and an
extra tracheostomy tube at the bedside at all times. This ensures that if the tube
becomes dislodged or obstructed, the client or caregiver can reinsert a new tube
or use the obturator to guide the tube back in. This is a life-saving measure. The
other options represent routine care but are not as critical. **
