HESI MED SURG V4 EXIT EXAM
PREPARATION QUESTIONS AND
ANSWERS LATEST UPDATE
1. A client with Chronic Obstructive Pulmonary Disease (COPD) presents with a pH of 7.30,
PaCO2 of 52 mmHg, and HCO3 of 28 mEq/L. Which acid-base imbalance is the client
experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis, partially compensated
C. Respiratory Alkalosis
D. Metabolic Alkalosis, fully compensated
Answer: B
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is elevated as the kidneys attempt to compensate, but the pH has not yet
returned to normal range, indicating partial compensation.
2. A nurse is assessing a client with right-sided heart failure. Which clinical manifestation
should the nurse expect to find?
A. Crackles in the lung bases
B. Jugular venous distention
,C. Orthopnea
D. Frothy pink-tinged sputum
Answer: B
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as jugular venous distention, peripheral edema, and hepatomegaly. The other
options are signs of left-sided heart failure.
3. A client is admitted with a suspected diagnosis of Diabetes Insipidus (DI). Which laboratory
finding supports this diagnosis?
A. Blood glucose of 250 mg/dL
B. Serum sodium of 130 mEq/L
C. Urine osmolality of 1200 mOsm/kg
D. Urine specific gravity of 1.002
Answer: D
Conceptual Explanation: DI is characterized by a deficiency in ADH, leading to the
excretion of large amounts of dilute urine with a low specific gravity (typically less than
1.005).
4. Which assessment finding in a client with a long bone fracture is most suggestive of a fat
embolism syndrome?
A. Severe pain at the fracture site
, B. Bounding peripheral pulses
C. Increased urinary output
D. Petechiae on the chest and axilla
Answer: D
Conceptual Explanation: Petechiae over the upper torso and axilla are a classic, late sign
of fat embolism syndrome, resulting from microvascular occlusion by fat globules.
5. A nurse is caring for a client who is 1 day postoperative following a thyroidectomy. The
client reports tingling in the fingers. Which action is the priority?
A. Administer an analgesic
B. Check for Chvostek’s sign
C. Encourage deep breathing exercises
D. Check the surgical dressing for bleeding
Answer: B
Conceptual Explanation: Tingling in the fingers (paresthesia) is a sign of hypocalcemia,
which can occur if the parathyroid glands are accidentally damaged or removed during
thyroidectomy. Chvostek’s sign helps confirm hypocalcemia.
6. A client with acute pancreatitis has been NPO for 48 hours. Which laboratory value should
the nurse monitor most closely for a common complication?
A. White blood cell count
PREPARATION QUESTIONS AND
ANSWERS LATEST UPDATE
1. A client with Chronic Obstructive Pulmonary Disease (COPD) presents with a pH of 7.30,
PaCO2 of 52 mmHg, and HCO3 of 28 mEq/L. Which acid-base imbalance is the client
experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis, partially compensated
C. Respiratory Alkalosis
D. Metabolic Alkalosis, fully compensated
Answer: B
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is elevated as the kidneys attempt to compensate, but the pH has not yet
returned to normal range, indicating partial compensation.
2. A nurse is assessing a client with right-sided heart failure. Which clinical manifestation
should the nurse expect to find?
A. Crackles in the lung bases
B. Jugular venous distention
,C. Orthopnea
D. Frothy pink-tinged sputum
Answer: B
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as jugular venous distention, peripheral edema, and hepatomegaly. The other
options are signs of left-sided heart failure.
3. A client is admitted with a suspected diagnosis of Diabetes Insipidus (DI). Which laboratory
finding supports this diagnosis?
A. Blood glucose of 250 mg/dL
B. Serum sodium of 130 mEq/L
C. Urine osmolality of 1200 mOsm/kg
D. Urine specific gravity of 1.002
Answer: D
Conceptual Explanation: DI is characterized by a deficiency in ADH, leading to the
excretion of large amounts of dilute urine with a low specific gravity (typically less than
1.005).
4. Which assessment finding in a client with a long bone fracture is most suggestive of a fat
embolism syndrome?
A. Severe pain at the fracture site
, B. Bounding peripheral pulses
C. Increased urinary output
D. Petechiae on the chest and axilla
Answer: D
Conceptual Explanation: Petechiae over the upper torso and axilla are a classic, late sign
of fat embolism syndrome, resulting from microvascular occlusion by fat globules.
5. A nurse is caring for a client who is 1 day postoperative following a thyroidectomy. The
client reports tingling in the fingers. Which action is the priority?
A. Administer an analgesic
B. Check for Chvostek’s sign
C. Encourage deep breathing exercises
D. Check the surgical dressing for bleeding
Answer: B
Conceptual Explanation: Tingling in the fingers (paresthesia) is a sign of hypocalcemia,
which can occur if the parathyroid glands are accidentally damaged or removed during
thyroidectomy. Chvostek’s sign helps confirm hypocalcemia.
6. A client with acute pancreatitis has been NPO for 48 hours. Which laboratory value should
the nurse monitor most closely for a common complication?
A. White blood cell count
