HESI MEDICAL-SURGICAL NURSING
MASTERY EXAM 2026/2027 QUESTIONS
AND ANSWERS LATEST UPDATE
1. A client with acute exacerbation of heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding most indicates that the medication has been effective?
A. Decreased peripheral edema in lower extremities
B. Reduced crackles upon lung auscultation
C. Increased urinary output of 1000 mL in 4 hours
D. Weight loss of 2 pounds since previous day
Answer: B
Conceptual Explanation: While increased urine output and weight loss occur, the most
critical indicator of effectiveness in acute heart failure is the improvement of gas exchange,
evidenced by reduced pulmonary congestion (crackles).
2. A nurse is caring for a client with a history of COPD who is receiving oxygen at 2 L/min via
nasal cannula. The client’s SpO2 is 89% and the client is increasingly lethargic. What is the
nurse’s priority action?
A. Obtain an arterial blood gas (ABG) sample
B. Increase oxygen flow to 4 L/min
,C. Perform a rapid neurological assessment
D. Check the client’s capnography (EtCO2) levels
Answer: A
Conceptual Explanation: Lethargy in a COPD client receiving oxygen can indicate CO2
narcosis. An ABG is the gold standard to assess for respiratory acidosis and hypercapnia.
3. A client is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following
laboratory values should the nurse expect?
A. Serum glucose 550 mg/dL, pH 7.50, HCO3 30 mEq/L
B. Serum glucose 800 mg/dL, pH 7.40, HCO3 24 mEq/L
C. Serum glucose 300 mg/dL, pH 7.35, HCO3 22 mEq/L
D. Serum glucose 450 mg/dL, pH 7.25, HCO3 14 mEq/L
Answer: D
Conceptual Explanation: DKA is characterized by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH < 7.30), and low bicarbonate (<18 mEq/L).
4. Which clinical manifestation is a hallmark sign of a tension pneumothorax?
A. Dullness on percussion of the affected side
B. Hypertension and bradycardia
C. Tracheal deviation toward the unaffected side
, D. Vesicular breath sounds over the apex
Answer: C
Conceptual Explanation: In a tension pneumothorax, air accumulation causes a
mediastinal shift, pushing the trachea away from the affected side, which is a life-
threatening emergency.
5. The nurse is monitoring a client post-thyroidectomy. The client reports tingling in the
fingers and around the mouth. Which medication should the nurse have readily available?
A. Potassium chloride
B. Calcium gluconate
C. Levothyroxine
D. Sodium nitroprusside
Answer: B
Conceptual Explanation: Tingling (paresthesia) indicates hypocalcemia, which can occur
if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
Calcium gluconate is the antidote.
6. A client with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L. What
is the priority nursing intervention?
A. Administer sodium polystyrene sulfonate orally
B. Prepare the client for emergency hemodialysis
MASTERY EXAM 2026/2027 QUESTIONS
AND ANSWERS LATEST UPDATE
1. A client with acute exacerbation of heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding most indicates that the medication has been effective?
A. Decreased peripheral edema in lower extremities
B. Reduced crackles upon lung auscultation
C. Increased urinary output of 1000 mL in 4 hours
D. Weight loss of 2 pounds since previous day
Answer: B
Conceptual Explanation: While increased urine output and weight loss occur, the most
critical indicator of effectiveness in acute heart failure is the improvement of gas exchange,
evidenced by reduced pulmonary congestion (crackles).
2. A nurse is caring for a client with a history of COPD who is receiving oxygen at 2 L/min via
nasal cannula. The client’s SpO2 is 89% and the client is increasingly lethargic. What is the
nurse’s priority action?
A. Obtain an arterial blood gas (ABG) sample
B. Increase oxygen flow to 4 L/min
,C. Perform a rapid neurological assessment
D. Check the client’s capnography (EtCO2) levels
Answer: A
Conceptual Explanation: Lethargy in a COPD client receiving oxygen can indicate CO2
narcosis. An ABG is the gold standard to assess for respiratory acidosis and hypercapnia.
3. A client is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which of the following
laboratory values should the nurse expect?
A. Serum glucose 550 mg/dL, pH 7.50, HCO3 30 mEq/L
B. Serum glucose 800 mg/dL, pH 7.40, HCO3 24 mEq/L
C. Serum glucose 300 mg/dL, pH 7.35, HCO3 22 mEq/L
D. Serum glucose 450 mg/dL, pH 7.25, HCO3 14 mEq/L
Answer: D
Conceptual Explanation: DKA is characterized by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH < 7.30), and low bicarbonate (<18 mEq/L).
4. Which clinical manifestation is a hallmark sign of a tension pneumothorax?
A. Dullness on percussion of the affected side
B. Hypertension and bradycardia
C. Tracheal deviation toward the unaffected side
, D. Vesicular breath sounds over the apex
Answer: C
Conceptual Explanation: In a tension pneumothorax, air accumulation causes a
mediastinal shift, pushing the trachea away from the affected side, which is a life-
threatening emergency.
5. The nurse is monitoring a client post-thyroidectomy. The client reports tingling in the
fingers and around the mouth. Which medication should the nurse have readily available?
A. Potassium chloride
B. Calcium gluconate
C. Levothyroxine
D. Sodium nitroprusside
Answer: B
Conceptual Explanation: Tingling (paresthesia) indicates hypocalcemia, which can occur
if the parathyroid glands are accidentally damaged or removed during a thyroidectomy.
Calcium gluconate is the antidote.
6. A client with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L. What
is the priority nursing intervention?
A. Administer sodium polystyrene sulfonate orally
B. Prepare the client for emergency hemodialysis
