HESI RN MED SURG V1, V2, V3 QUESTIONS and
ANSWERS (3 VERSIONS, 560 PLUS Q and A)
(LATEST, 2021)
1. A client with heart failure is prescribed furosemide. Which lab value requires immediate
follow-up?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
A. Loop diuretics cause potassium loss. A K⁺ of 3.0 mEq/L is below normal (3.5–5.0) and
risks dysrhythmias. Sodium, calcium, and magnesium are within normal limits.
2. Which client is at greatest risk for hypocalcemia?
A. Client with chronic kidney disease
B. Client who had a thyroidectomy
C. Client taking thiazide diuretics
D. Client with immobilization
B. Accidental parathyroid removal during thyroidectomy causes hypocalcemia. CKD and
thiazides cause hypercalcemia; immobilization also causes hypercalcemia.
3. A client has ABGs: pH 7.30, PaCO₂ 50 mm Hg, HCO₃ 24 mEq/L. How should the nurse interpret
this?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
B. Low pH + high PaCO₂ + normal HCO₃ = uncompensated respiratory acidosis
(hypoventilation).
4. SATA: Which findings indicate fluid volume deficit? (Select all that apply.)
A. Urine specific gravity 1.035
B. Blood pressure 88/56 mm Hg
C. Heart rate 118 bpm
D. Bounding pulses
,E. Dry mucous membranes
F. Weight gain of 2 kg in 24 hours
A, B, C, E. Hypovolemia causes concentrated urine, hypotension, tachycardia, and dry
mucous membranes. Bounding pulses and rapid weight gain indicate fluid excess.
5. A client receiving IV potassium chloride reports burning at the site. What is the nurse's
priority action?
A. Stop the infusion and notify the provider
B. Slow the rate and assess for phlebitis
C. Apply a warm compress
D. Continue at the same rate
B. KCl is irritating; the rate should not exceed 10 mEq/hr peripherally. Slowing the rate
and assessing the site is appropriate; stopping entirely may be needed if infiltration occurs.
6. Which client is most at risk for hyperkalemia?
A. Client with excessive vomiting
B. Client on furosemide
C. Client with acute kidney injury
D. Client with nasogastric suction
C. The kidneys excrete potassium; AKI causes retention. The other options cause
potassium loss.
7. A client with metabolic alkalosis is likely to exhibit:
A. Kussmaul respirations
B. Hypoventilation and confusion
C. Hyperventilation
D. Warm, flushed skin
B. The body compensates for alkalosis by hypoventilating to retain CO₂. Kussmaul
respirations occur with metabolic acidosis.
8. SATA: Which clients are at risk for fluid volume excess? (Select all that apply.)
A. Client with heart failure
B. Client with cirrhosis
C. Client receiving 0.9% NaCl at 200 mL/hr
D. Client with severe burns
E. Client with Cushing's syndrome
, A, B, C, E. HF, cirrhosis (portal hypertension/ascites), rapid isotonic infusion, and
Cushing's (sodium/water retention) cause excess. Burns cause massive fluid shift and deficit.
9. A client's magnesium level is 1.1 mg/dL. Which assessment finding is most concerning?
A. Constipation
B. Decreased deep tendon reflexes
C. Positive Chvostek's sign
D. Hypertension
C. Hypomagnesemia (normal 1.3–2.1) causes neuromuscular irritability: Chvostek's and
Trousseau's signs, tremors, seizures. Decreased DTRs occur with hypermagnesemia.
10. The nurse is assessing a client with syndrome of inappropriate antidiuretic hormone
(SIADH). Which finding is expected?
A. Serum sodium 122 mEq/L
B. Urine output 3 L/day
C. Serum osmolality 310 mOsm/kg
D. Polyuria
A. SIADH causes water retention, dilutional hyponatremia, concentrated urine, and low
serum osmolality.
11. Which IV solution is isotonic?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. 0.225% NaCl
C. LR and 0.9% NaCl are isotonic. 0.45% and 0.225% are hypotonic; 3% is hypertonic.
12. A client with severe vomiting has a pH of 7.48 and HCO₃ of 30 mEq/L. Which intervention is
priority?
A. Administer sodium bicarbonate
B. Prepare for IV potassium chloride and monitor for hypokalemia
C. Encourage rapid deep breathing
D. Restrict fluids
B. Vomiting causes loss of H⁺ and Cl⁻, leading to metabolic alkalosis with hypokalemia.
Treatment includes KCl replacement and treating the cause; bicarb would worsen alkalosis.
Section 2: Perioperative & Infection Control
ANSWERS (3 VERSIONS, 560 PLUS Q and A)
(LATEST, 2021)
1. A client with heart failure is prescribed furosemide. Which lab value requires immediate
follow-up?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
A. Loop diuretics cause potassium loss. A K⁺ of 3.0 mEq/L is below normal (3.5–5.0) and
risks dysrhythmias. Sodium, calcium, and magnesium are within normal limits.
2. Which client is at greatest risk for hypocalcemia?
A. Client with chronic kidney disease
B. Client who had a thyroidectomy
C. Client taking thiazide diuretics
D. Client with immobilization
B. Accidental parathyroid removal during thyroidectomy causes hypocalcemia. CKD and
thiazides cause hypercalcemia; immobilization also causes hypercalcemia.
3. A client has ABGs: pH 7.30, PaCO₂ 50 mm Hg, HCO₃ 24 mEq/L. How should the nurse interpret
this?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
B. Low pH + high PaCO₂ + normal HCO₃ = uncompensated respiratory acidosis
(hypoventilation).
4. SATA: Which findings indicate fluid volume deficit? (Select all that apply.)
A. Urine specific gravity 1.035
B. Blood pressure 88/56 mm Hg
C. Heart rate 118 bpm
D. Bounding pulses
,E. Dry mucous membranes
F. Weight gain of 2 kg in 24 hours
A, B, C, E. Hypovolemia causes concentrated urine, hypotension, tachycardia, and dry
mucous membranes. Bounding pulses and rapid weight gain indicate fluid excess.
5. A client receiving IV potassium chloride reports burning at the site. What is the nurse's
priority action?
A. Stop the infusion and notify the provider
B. Slow the rate and assess for phlebitis
C. Apply a warm compress
D. Continue at the same rate
B. KCl is irritating; the rate should not exceed 10 mEq/hr peripherally. Slowing the rate
and assessing the site is appropriate; stopping entirely may be needed if infiltration occurs.
6. Which client is most at risk for hyperkalemia?
A. Client with excessive vomiting
B. Client on furosemide
C. Client with acute kidney injury
D. Client with nasogastric suction
C. The kidneys excrete potassium; AKI causes retention. The other options cause
potassium loss.
7. A client with metabolic alkalosis is likely to exhibit:
A. Kussmaul respirations
B. Hypoventilation and confusion
C. Hyperventilation
D. Warm, flushed skin
B. The body compensates for alkalosis by hypoventilating to retain CO₂. Kussmaul
respirations occur with metabolic acidosis.
8. SATA: Which clients are at risk for fluid volume excess? (Select all that apply.)
A. Client with heart failure
B. Client with cirrhosis
C. Client receiving 0.9% NaCl at 200 mL/hr
D. Client with severe burns
E. Client with Cushing's syndrome
, A, B, C, E. HF, cirrhosis (portal hypertension/ascites), rapid isotonic infusion, and
Cushing's (sodium/water retention) cause excess. Burns cause massive fluid shift and deficit.
9. A client's magnesium level is 1.1 mg/dL. Which assessment finding is most concerning?
A. Constipation
B. Decreased deep tendon reflexes
C. Positive Chvostek's sign
D. Hypertension
C. Hypomagnesemia (normal 1.3–2.1) causes neuromuscular irritability: Chvostek's and
Trousseau's signs, tremors, seizures. Decreased DTRs occur with hypermagnesemia.
10. The nurse is assessing a client with syndrome of inappropriate antidiuretic hormone
(SIADH). Which finding is expected?
A. Serum sodium 122 mEq/L
B. Urine output 3 L/day
C. Serum osmolality 310 mOsm/kg
D. Polyuria
A. SIADH causes water retention, dilutional hyponatremia, concentrated urine, and low
serum osmolality.
11. Which IV solution is isotonic?
A. 0.45% NaCl
B. 3% NaCl
C. Lactated Ringer's
D. 0.225% NaCl
C. LR and 0.9% NaCl are isotonic. 0.45% and 0.225% are hypotonic; 3% is hypertonic.
12. A client with severe vomiting has a pH of 7.48 and HCO₃ of 30 mEq/L. Which intervention is
priority?
A. Administer sodium bicarbonate
B. Prepare for IV potassium chloride and monitor for hypokalemia
C. Encourage rapid deep breathing
D. Restrict fluids
B. Vomiting causes loss of H⁺ and Cl⁻, leading to metabolic alkalosis with hypokalemia.
Treatment includes KCl replacement and treating the cause; bicarb would worsen alkalosis.
Section 2: Perioperative & Infection Control
