NSG 223 MED SURG 2 HESI FINAL EXAM –
COMPREHENSIVE TEST BANK HERZING UNIVERSITY| ALL
PRACTICE Q&A 2026/2027 | A+ GRADED |
COMPREHENSIVE EXAM GUIDE 2026&2027
1. A client with heart failure reports increasing shortness of breath and a 2-kg (4.4-lb)
weight gain over the past 3 days. Which assessment finding should the nurse recognize as
most concerning?
A. Heart rate of 88/min
B. Bilateral crackles at the lung bases
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Bilateral crackles indicate pulmonary fluid accumulation, which can occur with worsening
heart failure and impaired gas exchange. The rapid weight gain also suggests fluid retention.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which nursing action is most appropriate?
A. Maintain oxygen at the lowest level that achieves the prescribed target saturation
B. Increase oxygen flow rapidly whenever the client reports dyspnea
C. Withhold oxygen if the respiratory rate decreases
D. Encourage the client to breathe rapidly to eliminate carbon dioxide
Clients with COPD require carefully titrated oxygen therapy. The nurse should maintain the
prescribed oxygen saturation target while monitoring respiratory status rather than
administering excessive oxygen without an order.
3. A client receiving furosemide for heart failure has a potassium level of 2.9 mEq/L. Which
assessment finding requires immediate attention?
A. Increased urinary output
B. Mild thirst
C. Muscle weakness with an irregular pulse
D. Blood pressure of 104/68 mm Hg
Significant hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. An irregular pulse requires prompt assessment and intervention.
4. A client with suspected myocardial infarction reports crushing substernal chest pain
radiating to the left arm. Which action should the nurse take first?
,A. Obtain a detailed dietary history
B. Place the client in a supine position
C. Encourage ambulation to assess exercise tolerance
D. Assess vital signs and initiate immediate cardiac assessment
Acute chest pain suggestive of myocardial infarction requires immediate assessment of
airway, breathing, circulation, vital signs, and cardiac status while emergency treatment is
initiated.
5. A client prescribed sublingual nitroglycerin for angina states that the first tablet did not
relieve the chest pain after 5 minutes. What should the nurse instruct the client to do?
A. Take all remaining tablets at once
B. Call emergency medical services and follow the prescribed emergency instructions
C. Wait 30 minutes before taking another dose
D. Drink water and lie down
Persistent chest pain after the initial prescribed nitroglycerin dose may indicate acute
coronary syndrome. Emergency evaluation is required rather than delaying care.
6. A nurse is caring for a client with atrial fibrillation who is receiving warfarin. Which
laboratory test is most important for monitoring therapeutic effect?
A. Serum sodium
B. Activated partial thromboplastin time
C. International normalized ratio
D. Serum creatinine kinase
Warfarin therapy is monitored using the INR. Maintaining the INR within the prescribed
therapeutic range helps reduce thromboembolic risk while limiting bleeding risk.
7. A client with peripheral arterial disease reports severe calf pain when walking that
resolves after resting. Which intervention is most appropriate?
A. Encourage a supervised walking program as prescribed
B. Elevate the legs above the level of the heart
C. Apply a heating pad to the lower legs
D. Restrict all physical activity
A structured walking program can improve circulation and functional capacity in peripheral
arterial disease. Heat and excessive elevation can be harmful because arterial perfusion is
already compromised.
8. A client with deep vein thrombosis suddenly develops dyspnea, pleuritic chest pain, and
tachycardia. Which complication should the nurse suspect?
,A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
D. Pulmonary embolism
A pulmonary embolism can occur when a thrombus dislodges and travels to the pulmonary
circulation. Sudden dyspnea, pleuritic chest pain, and tachycardia are classic warning signs.
9. A client is admitted with an acute exacerbation of asthma. Which assessment finding
indicates severe airway obstruction?
A. Expiratory wheezing
B. Productive cough
C. Diminished or absent breath sounds
D. Respiratory rate of 20/min
Markedly diminished or absent breath sounds in a client with severe asthma can indicate
minimal airflow, sometimes called a silent chest, and is an emergency finding.
10. A client with pneumonia has a temperature of 39.2°C (102.6°F), respiratory rate of
30/min, and oxygen saturation of 88%. Which action should the nurse prioritize?
A. Encourage oral fluids
B. Administer prescribed oxygen and reassess respiratory status
C. Obtain a complete dietary history
D. Place the client flat in bed
The oxygen saturation and tachypnea indicate impaired oxygenation. Supporting
oxygenation is a priority while additional treatment is provided.
11. A client with bacterial pneumonia asks why a sputum specimen is collected before
antibiotics are started. Which response is most accurate?
A. It determines the client's nutritional status
B. It confirms whether the client has heart failure
C. It identifies the causative organism and helps guide antimicrobial therapy
D. It determines whether oxygen therapy is necessary
A properly collected sputum culture can help identify the infectious organism and determine
antimicrobial susceptibility, allowing treatment to be appropriately targeted.
12. A client with COPD is learning pursed-lip breathing. Which statement indicates correct
understanding?
A. "I should inhale through pursed lips and exhale through my nose."
B. "I should hold my breath as long as possible."
, C. "I should inhale quickly and forcefully."
D. "I should inhale through my nose and slowly exhale through pursed lips."
Pursed-lip breathing involves inhaling through the nose and slowly exhaling through partially
closed lips. This helps prolong exhalation and reduce air trapping.
13. A client with a chest tube connected to a water-seal drainage system has continuous
bubbling in the water-seal chamber. What should the nurse do first?
A. Clamp the chest tube immediately
B. Assess the system for an air leak
C. Disconnect the drainage system
D. Remove the chest tube
Continuous bubbling in the water-seal chamber can indicate an air leak. The nurse should
assess the tubing, connections, and insertion site to identify the source.
14. A client develops sudden dyspnea and decreased breath sounds on one side after central
venous catheter placement. Which complication should the nurse suspect?
A. Pneumothorax
B. Pulmonary edema
C. Pleural effusion from heart failure
D. Bronchitis
Central venous catheter insertion can inadvertently puncture the pleura, causing
pneumothorax. Sudden unilateral decreased breath sounds and dyspnea are concerning
findings.
15. A client with tuberculosis is admitted to the hospital. Which infection-control measure
is required?
A. Standard precautions only
B. Contact precautions
C. Airborne precautions in an appropriate negative-pressure room
D. Droplet precautions only
Pulmonary tuberculosis requires airborne precautions because Mycobacterium tuberculosis
can remain suspended in small airborne particles.
16. A client with acute respiratory distress is unable to speak in complete sentences. Which
finding requires the nurse's immediate attention?
A. Mild anxiety
B. Respiratory rate of 22/min
COMPREHENSIVE TEST BANK HERZING UNIVERSITY| ALL
PRACTICE Q&A 2026/2027 | A+ GRADED |
COMPREHENSIVE EXAM GUIDE 2026&2027
1. A client with heart failure reports increasing shortness of breath and a 2-kg (4.4-lb)
weight gain over the past 3 days. Which assessment finding should the nurse recognize as
most concerning?
A. Heart rate of 88/min
B. Bilateral crackles at the lung bases
C. Blood pressure of 128/76 mm Hg
D. Respiratory rate of 18/min
Bilateral crackles indicate pulmonary fluid accumulation, which can occur with worsening
heart failure and impaired gas exchange. The rapid weight gain also suggests fluid retention.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which nursing action is most appropriate?
A. Maintain oxygen at the lowest level that achieves the prescribed target saturation
B. Increase oxygen flow rapidly whenever the client reports dyspnea
C. Withhold oxygen if the respiratory rate decreases
D. Encourage the client to breathe rapidly to eliminate carbon dioxide
Clients with COPD require carefully titrated oxygen therapy. The nurse should maintain the
prescribed oxygen saturation target while monitoring respiratory status rather than
administering excessive oxygen without an order.
3. A client receiving furosemide for heart failure has a potassium level of 2.9 mEq/L. Which
assessment finding requires immediate attention?
A. Increased urinary output
B. Mild thirst
C. Muscle weakness with an irregular pulse
D. Blood pressure of 104/68 mm Hg
Significant hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias. An irregular pulse requires prompt assessment and intervention.
4. A client with suspected myocardial infarction reports crushing substernal chest pain
radiating to the left arm. Which action should the nurse take first?
,A. Obtain a detailed dietary history
B. Place the client in a supine position
C. Encourage ambulation to assess exercise tolerance
D. Assess vital signs and initiate immediate cardiac assessment
Acute chest pain suggestive of myocardial infarction requires immediate assessment of
airway, breathing, circulation, vital signs, and cardiac status while emergency treatment is
initiated.
5. A client prescribed sublingual nitroglycerin for angina states that the first tablet did not
relieve the chest pain after 5 minutes. What should the nurse instruct the client to do?
A. Take all remaining tablets at once
B. Call emergency medical services and follow the prescribed emergency instructions
C. Wait 30 minutes before taking another dose
D. Drink water and lie down
Persistent chest pain after the initial prescribed nitroglycerin dose may indicate acute
coronary syndrome. Emergency evaluation is required rather than delaying care.
6. A nurse is caring for a client with atrial fibrillation who is receiving warfarin. Which
laboratory test is most important for monitoring therapeutic effect?
A. Serum sodium
B. Activated partial thromboplastin time
C. International normalized ratio
D. Serum creatinine kinase
Warfarin therapy is monitored using the INR. Maintaining the INR within the prescribed
therapeutic range helps reduce thromboembolic risk while limiting bleeding risk.
7. A client with peripheral arterial disease reports severe calf pain when walking that
resolves after resting. Which intervention is most appropriate?
A. Encourage a supervised walking program as prescribed
B. Elevate the legs above the level of the heart
C. Apply a heating pad to the lower legs
D. Restrict all physical activity
A structured walking program can improve circulation and functional capacity in peripheral
arterial disease. Heat and excessive elevation can be harmful because arterial perfusion is
already compromised.
8. A client with deep vein thrombosis suddenly develops dyspnea, pleuritic chest pain, and
tachycardia. Which complication should the nurse suspect?
,A. Pulmonary edema
B. Pneumothorax
C. Cardiac tamponade
D. Pulmonary embolism
A pulmonary embolism can occur when a thrombus dislodges and travels to the pulmonary
circulation. Sudden dyspnea, pleuritic chest pain, and tachycardia are classic warning signs.
9. A client is admitted with an acute exacerbation of asthma. Which assessment finding
indicates severe airway obstruction?
A. Expiratory wheezing
B. Productive cough
C. Diminished or absent breath sounds
D. Respiratory rate of 20/min
Markedly diminished or absent breath sounds in a client with severe asthma can indicate
minimal airflow, sometimes called a silent chest, and is an emergency finding.
10. A client with pneumonia has a temperature of 39.2°C (102.6°F), respiratory rate of
30/min, and oxygen saturation of 88%. Which action should the nurse prioritize?
A. Encourage oral fluids
B. Administer prescribed oxygen and reassess respiratory status
C. Obtain a complete dietary history
D. Place the client flat in bed
The oxygen saturation and tachypnea indicate impaired oxygenation. Supporting
oxygenation is a priority while additional treatment is provided.
11. A client with bacterial pneumonia asks why a sputum specimen is collected before
antibiotics are started. Which response is most accurate?
A. It determines the client's nutritional status
B. It confirms whether the client has heart failure
C. It identifies the causative organism and helps guide antimicrobial therapy
D. It determines whether oxygen therapy is necessary
A properly collected sputum culture can help identify the infectious organism and determine
antimicrobial susceptibility, allowing treatment to be appropriately targeted.
12. A client with COPD is learning pursed-lip breathing. Which statement indicates correct
understanding?
A. "I should inhale through pursed lips and exhale through my nose."
B. "I should hold my breath as long as possible."
, C. "I should inhale quickly and forcefully."
D. "I should inhale through my nose and slowly exhale through pursed lips."
Pursed-lip breathing involves inhaling through the nose and slowly exhaling through partially
closed lips. This helps prolong exhalation and reduce air trapping.
13. A client with a chest tube connected to a water-seal drainage system has continuous
bubbling in the water-seal chamber. What should the nurse do first?
A. Clamp the chest tube immediately
B. Assess the system for an air leak
C. Disconnect the drainage system
D. Remove the chest tube
Continuous bubbling in the water-seal chamber can indicate an air leak. The nurse should
assess the tubing, connections, and insertion site to identify the source.
14. A client develops sudden dyspnea and decreased breath sounds on one side after central
venous catheter placement. Which complication should the nurse suspect?
A. Pneumothorax
B. Pulmonary edema
C. Pleural effusion from heart failure
D. Bronchitis
Central venous catheter insertion can inadvertently puncture the pleura, causing
pneumothorax. Sudden unilateral decreased breath sounds and dyspnea are concerning
findings.
15. A client with tuberculosis is admitted to the hospital. Which infection-control measure
is required?
A. Standard precautions only
B. Contact precautions
C. Airborne precautions in an appropriate negative-pressure room
D. Droplet precautions only
Pulmonary tuberculosis requires airborne precautions because Mycobacterium tuberculosis
can remain suspended in small airborne particles.
16. A client with acute respiratory distress is unable to speak in complete sentences. Which
finding requires the nurse's immediate attention?
A. Mild anxiety
B. Respiratory rate of 22/min
