HESI MEDICAL-SURGICAL NURSING
ADVANCED PRACTICE QUESTIONS
AND ANSWERS LATEST UPDATE
1. A client is admitted with a suspected myocardial infarction. Which cardiac biomarker is
most specific for myocardial injury and typically elevates within 3 to 6 hours?
A. Myoglobin
B. CK-MB
C. Brain Natriuretic Peptide (BNP)
D. Troponin I
Answer: D
Conceptual Explanation: Troponin I is highly specific to cardiac muscle and is the
preferred marker for diagnosing myocardial infarction. While Myoglobin rises faster, it
lacks specificity.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at
2L/min via nasal cannula. The nurse notes the patient’s respiratory rate has decreased from
18 to 10 breaths/min and the patient is lethargic. What is the priority action?
A. Increase the oxygen flow rate to 4L/min
B. Prepare for endotracheal intubation
,C. Stop or decrease the oxygen therapy
D. Perform chest physiotherapy
Answer: C
Conceptual Explanation: In some COPD patients, high oxygen concentrations can abolish
the hypoxic drive to breathe, leading to carbon dioxide narcosis and respiratory
depression.
3. The nurse is caring for a client in the oliguric phase of Acute Kidney Injury (AKI). Which
electrolyte imbalance is the greatest risk to the client’s safety?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Answer: B
Conceptual Explanation: Hyperkalemia is the most dangerous electrolyte imbalance in
AKI because it can lead to life-threatening cardiac dysrhythmias and arrest.
4. Which clinical manifestation should the nurse expect to see in a client diagnosed with
Cushing’s Syndrome?
A. Hyperpigmentation of the skin
B. Hypoglycemia
, C. Weight loss and tachycardia
D. Central obesity and striae
Answer: D
Conceptual Explanation: Cushing’s Syndrome is characterized by excess cortisol, leading
to truncal obesity, buffalo hump, moon face, and purple striae on the abdomen.
5. A client with Type 1 Diabetes Mellitus presents with deep, rapid respirations and a fruity
breath odor. The nurse should immediately assess for which condition?
A. Diabetic Ketoacidosis (DKA)
B. Hypoglycemic reaction
C. Hyperosmolar Hyperglycemic Syndrome (HHS)
D. Respiratory alkalosis
Answer: A
Conceptual Explanation: Kussmaul respirations (deep and rapid) and fruity breath
(acetone) are classic signs of DKA, caused by the metabolic acidosis resulting from ketone
production.
6. A patient is 24 hours post-thyroidectomy. The nurse notes the patient has positive
Chvostek’s and Trousseau’s signs. What medication should the nurse anticipate
administering?
A. Calcium gluconate
ADVANCED PRACTICE QUESTIONS
AND ANSWERS LATEST UPDATE
1. A client is admitted with a suspected myocardial infarction. Which cardiac biomarker is
most specific for myocardial injury and typically elevates within 3 to 6 hours?
A. Myoglobin
B. CK-MB
C. Brain Natriuretic Peptide (BNP)
D. Troponin I
Answer: D
Conceptual Explanation: Troponin I is highly specific to cardiac muscle and is the
preferred marker for diagnosing myocardial infarction. While Myoglobin rises faster, it
lacks specificity.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at
2L/min via nasal cannula. The nurse notes the patient’s respiratory rate has decreased from
18 to 10 breaths/min and the patient is lethargic. What is the priority action?
A. Increase the oxygen flow rate to 4L/min
B. Prepare for endotracheal intubation
,C. Stop or decrease the oxygen therapy
D. Perform chest physiotherapy
Answer: C
Conceptual Explanation: In some COPD patients, high oxygen concentrations can abolish
the hypoxic drive to breathe, leading to carbon dioxide narcosis and respiratory
depression.
3. The nurse is caring for a client in the oliguric phase of Acute Kidney Injury (AKI). Which
electrolyte imbalance is the greatest risk to the client’s safety?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Answer: B
Conceptual Explanation: Hyperkalemia is the most dangerous electrolyte imbalance in
AKI because it can lead to life-threatening cardiac dysrhythmias and arrest.
4. Which clinical manifestation should the nurse expect to see in a client diagnosed with
Cushing’s Syndrome?
A. Hyperpigmentation of the skin
B. Hypoglycemia
, C. Weight loss and tachycardia
D. Central obesity and striae
Answer: D
Conceptual Explanation: Cushing’s Syndrome is characterized by excess cortisol, leading
to truncal obesity, buffalo hump, moon face, and purple striae on the abdomen.
5. A client with Type 1 Diabetes Mellitus presents with deep, rapid respirations and a fruity
breath odor. The nurse should immediately assess for which condition?
A. Diabetic Ketoacidosis (DKA)
B. Hypoglycemic reaction
C. Hyperosmolar Hyperglycemic Syndrome (HHS)
D. Respiratory alkalosis
Answer: A
Conceptual Explanation: Kussmaul respirations (deep and rapid) and fruity breath
(acetone) are classic signs of DKA, caused by the metabolic acidosis resulting from ketone
production.
6. A patient is 24 hours post-thyroidectomy. The nurse notes the patient has positive
Chvostek’s and Trousseau’s signs. What medication should the nurse anticipate
administering?
A. Calcium gluconate
