HESI RN MEDSURG V2 MULTIPLE-CHOICE, CLINICAL SCENARIOS
AND SET 2 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A client with Pericardial tamponade is being cared for on an adult medical-surgical unit. A client
develops hypotension, jugular venous distention, muffled heart sounds, and worsening dyspnea. Which
action should the nurse take first?
A. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
B. Recognize obstructive shock, support oxygenation, notify the rapid response/provider, and prepare for urgent
pericardial drainage.
C. Treat as a vascular emergency, keep the limb protected and at a neutral/dependent position, and prepare for
urgent anticoagulation/revascularization.
D. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
Correct Answer: B. Recognize obstructive shock, support oxygenation, notify the rapid response/provider, and
prepare for urgent pericardial drainage.
Rationale: For Pericardial tamponade, the priority is to recognize obstructive shock, support oxygenation, notify
the rapid response/provider, and prepare for urgent pericardial drainage. This targets the most immediate threat
while allowing subsequent definitive treatment and monitoring.
2. A client with Pleural effusion requiring thoracentesis is being cared for on an adult medical-surgical
unit. A client has progressive dyspnea, decreased breath sounds, dullness to percussion, and a large
unilateral pleural fluid collection. Which intervention is the priority?
A. Position as directed for thoracentesis, monitor oxygenation, and observe closely afterward for pneumothorax
or bleeding.
B. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
C. Use lung-protective ventilation strategies as ordered, optimize oxygenation including appropriate PEEP, and
treat the underlying cause.
D. Obtain ordered cultures when appropriate, start timely antibiotics, support oxygenation/hydration, and
encourage pulmonary hygiene.
Correct Answer: A. Position as directed for thoracentesis, monitor oxygenation, and observe closely afterward
for pneumothorax or bleeding.
Rationale: For Pleural effusion requiring thoracentesis, the priority is to position as directed for thoracentesis,
monitor oxygenation, and observe closely afterward for pneumothorax or bleeding. This targets the most
immediate threat while allowing subsequent definitive treatment and monitoring.
3. A client with Cardiogenic shock is being cared for on an adult medical-surgical unit. Following a large
myocardial infarction, a client has cool clammy skin, confusion, oliguria, pulmonary crackles, and
hypotension. What is the most appropriate immediate nursing response?
A. Activate emergency surgical management, maintain large-bore IV access, and support circulation without
delaying definitive care.
B. Support oxygenation and perfusion, obtain continuous hemodynamic monitoring, and prepare for ordered
vasoactive/inotropic and reperfusion therapy.
C. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
D. Treat as a vascular emergency, keep the limb protected and at a neutral/dependent position, and prepare for
urgent anticoagulation/revascularization.
Correct Answer: B. Support oxygenation and perfusion, obtain continuous hemodynamic monitoring, and
prepare for ordered vasoactive/inotropic and reperfusion therapy.
Rationale: For Cardiogenic shock, the priority is to support oxygenation and perfusion, obtain continuous
hemodynamic monitoring, and prepare for ordered vasoactive/inotropic and reperfusion therapy. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
4. A client with COPD exacerbation is being cared for on an adult medical-surgical unit. A client with
COPD has increased dyspnea, wheezing, and increased sputum volume with falling oxygen saturation.
Which plan best addresses the client's immediate risk?
A. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
,B. Assess airway patency immediately, remove/replace the inner cannula if appropriate, suction, oxygenate, and
escalate if obstruction persists.
C. Sit the client upright, support oxygenation/ventilation, and administer prescribed diuretic and
afterload-reducing therapy while monitoring hemodynamics.
D. Titrate oxygen to the prescribed target, give short-acting bronchodilators and systemic corticosteroid therapy
as ordered, and reassess work of breathing.
Correct Answer: D. Titrate oxygen to the prescribed target, give short-acting bronchodilators and systemic
corticosteroid therapy as ordered, and reassess work of breathing.
Rationale: For COPD exacerbation, the priority is to titrate oxygen to the prescribed target, give short-acting
bronchodilators and systemic corticosteroid therapy as ordered, and reassess work of breathing. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
5. A client with Hypertensive emergency is being cared for on an adult medical-surgical unit. A client has
severely elevated blood pressure with confusion, papilledema, and acute kidney injury. Which action is
most important at this time?
A. Assess limb perfusion, protect the extremity from injury, and support a supervised walking and
risk-factor-reduction plan.
B. Promote venous return with prescribed compression when arterial flow is adequate, leg elevation, activity, and
wound care.
C. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
D. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as ordered, reducing
pressure in a controlled manner.
Correct Answer: D. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as
ordered, reducing pressure in a controlled manner.
Rationale: For Hypertensive emergency, the priority is to initiate continuous monitoring and administer titratable
IV antihypertensive therapy as ordered, reducing pressure in a controlled manner. This targets the most immediate
threat while allowing subsequent definitive treatment and monitoring.
6. A client with Tension pneumothorax is being cared for on an adult medical-surgical unit. After
central-line placement, a client develops severe dyspnea, unilateral absent breath sounds, hypotension, and
tracheal deviation. Which action should the nurse take first?
A. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
B. Recognize a life-threatening tension pneumothorax and prepare for immediate decompression followed by
chest-tube placement.
C. Sit the client upright, support oxygenation/ventilation, and administer prescribed diuretic and
afterload-reducing therapy while monitoring hemodynamics.
D. Initiate airborne precautions in a negative-pressure room and obtain appropriate respiratory specimens while
treatment is arranged.
Correct Answer: B. Recognize a life-threatening tension pneumothorax and prepare for immediate
decompression followed by chest-tube placement.
Rationale: For Tension pneumothorax, the priority is to recognize a life-threatening tension pneumothorax and
prepare for immediate decompression followed by chest-tube placement. This targets the most immediate threat
while allowing subsequent definitive treatment and monitoring.
7. A client with Aortic dissection is being cared for on an adult medical-surgical unit. A client develops
sudden severe tearing chest pain radiating to the back with unequal arm blood pressures. Which
intervention is the priority?
A. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as ordered, reducing
pressure in a controlled manner.
B. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
C. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
D. Obtain ordered blood cultures before antibiotics when feasible and begin prolonged targeted antimicrobial
therapy as prescribed.
, Correct Answer: C. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
Rationale: For Aortic dissection, the priority is to treat as an emergency: maintain strict hemodynamic
monitoring and prepare for rapid blood-pressure/heart-rate control and definitive management. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
8. A client with Severe hypocalcemia after thyroid surgery is being cared for on an adult medical-surgical
unit. After thyroidectomy, a client develops perioral tingling, carpopedal spasm, and a prolonged QT
interval. What is the most appropriate immediate nursing response?
A. Give rapid parenteral glucose or glucagon per protocol and recheck glucose promptly, then provide
longer-acting carbohydrate when safe.
B. Implement ordered fluid restriction, frequent neurologic checks, and cautious sodium correction; use
hypertonic saline only when indicated.
C. Assess airway, place on cardiac monitoring, check calcium, and prepare to give IV calcium for symptomatic
severe hypocalcemia.
D. Begin isotonic fluid resuscitation, then IV insulin with close potassium and glucose monitoring according to
protocol.
Correct Answer: C. Assess airway, place on cardiac monitoring, check calcium, and prepare to give IV calcium
for symptomatic severe hypocalcemia.
Rationale: For Severe hypocalcemia after thyroid surgery, the priority is to assess airway, place on cardiac
monitoring, check calcium, and prepare to give IV calcium for symptomatic severe hypocalcemia. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
9. A client with Enteral feeding aspiration risk is being cared for on an adult medical-surgical unit. A
neurologically impaired client receiving tube feeding develops coughing, decreased oxygen saturation, and
coarse breath sounds during the infusion. Which plan best addresses the client's immediate risk?
A. Keep NPO, avoid laxatives/enemas, provide ordered fluids/analgesia/antibiotics, and prepare for
appendectomy.
B. Treat as an emergency, stop agents that slow gut motility, provide intensive monitoring/support, and obtain
urgent surgical consultation.
C. Stop the feeding, assess airway/oxygenation, verify tube position and aspiration risk, and resume only after the
cause is addressed.
D. Monitor weight, sodium/fluid plan, diuretic response, renal function, and prepare for paracentesis when
indicated.
Correct Answer: C. Stop the feeding, assess airway/oxygenation, verify tube position and aspiration risk, and
resume only after the cause is addressed.
Rationale: For Enteral feeding aspiration risk, the priority is to stop the feeding, assess airway/oxygenation,
verify tube position and aspiration risk, and resume only after the cause is addressed. This targets the most
immediate threat while allowing subsequent definitive treatment and monitoring.
10. A client with Myxedema coma is being cared for on an adult medical-surgical unit. An older adult with
hypothyroidism becomes hypothermic, bradycardic, hypotensive, hyponatremic, and progressively
obtunded. Which action is most important at this time?
A. Monitor infection, glucose, blood pressure, skin integrity, and bone health; taper exogenous steroids only
under prescriber direction.
B. Support airway/ventilation, warm cautiously, and administer IV thyroid hormone and stress-dose corticosteroid
as ordered.
C. Give rapid isotonic fluids, IV glucocorticoid, and glucose/electrolyte management as ordered.
D. Give rapid parenteral glucose or glucagon per protocol and recheck glucose promptly, then provide
longer-acting carbohydrate when safe.
Correct Answer: B. Support airway/ventilation, warm cautiously, and administer IV thyroid hormone and
stress-dose corticosteroid as ordered.
Rationale: For Myxedema coma, the priority is to support airway/ventilation, warm cautiously, and administer
IV thyroid hormone and stress-dose corticosteroid as ordered. This targets the most immediate threat while
allowing subsequent definitive treatment and monitoring.
11. A client with Intracerebral hemorrhage is being cared for on an adult medical-surgical unit. A client
develops sudden severe headache, vomiting, very high blood pressure, and rapidly declining level of
AND SET 2 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A client with Pericardial tamponade is being cared for on an adult medical-surgical unit. A client
develops hypotension, jugular venous distention, muffled heart sounds, and worsening dyspnea. Which
action should the nurse take first?
A. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
B. Recognize obstructive shock, support oxygenation, notify the rapid response/provider, and prepare for urgent
pericardial drainage.
C. Treat as a vascular emergency, keep the limb protected and at a neutral/dependent position, and prepare for
urgent anticoagulation/revascularization.
D. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
Correct Answer: B. Recognize obstructive shock, support oxygenation, notify the rapid response/provider, and
prepare for urgent pericardial drainage.
Rationale: For Pericardial tamponade, the priority is to recognize obstructive shock, support oxygenation, notify
the rapid response/provider, and prepare for urgent pericardial drainage. This targets the most immediate threat
while allowing subsequent definitive treatment and monitoring.
2. A client with Pleural effusion requiring thoracentesis is being cared for on an adult medical-surgical
unit. A client has progressive dyspnea, decreased breath sounds, dullness to percussion, and a large
unilateral pleural fluid collection. Which intervention is the priority?
A. Position as directed for thoracentesis, monitor oxygenation, and observe closely afterward for pneumothorax
or bleeding.
B. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
C. Use lung-protective ventilation strategies as ordered, optimize oxygenation including appropriate PEEP, and
treat the underlying cause.
D. Obtain ordered cultures when appropriate, start timely antibiotics, support oxygenation/hydration, and
encourage pulmonary hygiene.
Correct Answer: A. Position as directed for thoracentesis, monitor oxygenation, and observe closely afterward
for pneumothorax or bleeding.
Rationale: For Pleural effusion requiring thoracentesis, the priority is to position as directed for thoracentesis,
monitor oxygenation, and observe closely afterward for pneumothorax or bleeding. This targets the most
immediate threat while allowing subsequent definitive treatment and monitoring.
3. A client with Cardiogenic shock is being cared for on an adult medical-surgical unit. Following a large
myocardial infarction, a client has cool clammy skin, confusion, oliguria, pulmonary crackles, and
hypotension. What is the most appropriate immediate nursing response?
A. Activate emergency surgical management, maintain large-bore IV access, and support circulation without
delaying definitive care.
B. Support oxygenation and perfusion, obtain continuous hemodynamic monitoring, and prepare for ordered
vasoactive/inotropic and reperfusion therapy.
C. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
D. Treat as a vascular emergency, keep the limb protected and at a neutral/dependent position, and prepare for
urgent anticoagulation/revascularization.
Correct Answer: B. Support oxygenation and perfusion, obtain continuous hemodynamic monitoring, and
prepare for ordered vasoactive/inotropic and reperfusion therapy.
Rationale: For Cardiogenic shock, the priority is to support oxygenation and perfusion, obtain continuous
hemodynamic monitoring, and prepare for ordered vasoactive/inotropic and reperfusion therapy. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
4. A client with COPD exacerbation is being cared for on an adult medical-surgical unit. A client with
COPD has increased dyspnea, wheezing, and increased sputum volume with falling oxygen saturation.
Which plan best addresses the client's immediate risk?
A. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
,B. Assess airway patency immediately, remove/replace the inner cannula if appropriate, suction, oxygenate, and
escalate if obstruction persists.
C. Sit the client upright, support oxygenation/ventilation, and administer prescribed diuretic and
afterload-reducing therapy while monitoring hemodynamics.
D. Titrate oxygen to the prescribed target, give short-acting bronchodilators and systemic corticosteroid therapy
as ordered, and reassess work of breathing.
Correct Answer: D. Titrate oxygen to the prescribed target, give short-acting bronchodilators and systemic
corticosteroid therapy as ordered, and reassess work of breathing.
Rationale: For COPD exacerbation, the priority is to titrate oxygen to the prescribed target, give short-acting
bronchodilators and systemic corticosteroid therapy as ordered, and reassess work of breathing. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
5. A client with Hypertensive emergency is being cared for on an adult medical-surgical unit. A client has
severely elevated blood pressure with confusion, papilledema, and acute kidney injury. Which action is
most important at this time?
A. Assess limb perfusion, protect the extremity from injury, and support a supervised walking and
risk-factor-reduction plan.
B. Promote venous return with prescribed compression when arterial flow is adequate, leg elevation, activity, and
wound care.
C. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
D. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as ordered, reducing
pressure in a controlled manner.
Correct Answer: D. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as
ordered, reducing pressure in a controlled manner.
Rationale: For Hypertensive emergency, the priority is to initiate continuous monitoring and administer titratable
IV antihypertensive therapy as ordered, reducing pressure in a controlled manner. This targets the most immediate
threat while allowing subsequent definitive treatment and monitoring.
6. A client with Tension pneumothorax is being cared for on an adult medical-surgical unit. After
central-line placement, a client develops severe dyspnea, unilateral absent breath sounds, hypotension, and
tracheal deviation. Which action should the nurse take first?
A. Promote diagnostic sleep evaluation and reinforce consistent prescribed positive-airway-pressure therapy.
B. Recognize a life-threatening tension pneumothorax and prepare for immediate decompression followed by
chest-tube placement.
C. Sit the client upright, support oxygenation/ventilation, and administer prescribed diuretic and
afterload-reducing therapy while monitoring hemodynamics.
D. Initiate airborne precautions in a negative-pressure room and obtain appropriate respiratory specimens while
treatment is arranged.
Correct Answer: B. Recognize a life-threatening tension pneumothorax and prepare for immediate
decompression followed by chest-tube placement.
Rationale: For Tension pneumothorax, the priority is to recognize a life-threatening tension pneumothorax and
prepare for immediate decompression followed by chest-tube placement. This targets the most immediate threat
while allowing subsequent definitive treatment and monitoring.
7. A client with Aortic dissection is being cared for on an adult medical-surgical unit. A client develops
sudden severe tearing chest pain radiating to the back with unequal arm blood pressures. Which
intervention is the priority?
A. Initiate continuous monitoring and administer titratable IV antihypertensive therapy as ordered, reducing
pressure in a controlled manner.
B. Assess hemodynamic stability first; if unstable, prepare for synchronized cardioversion, and if stable, follow
rate-control and anticoagulation orders.
C. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
D. Obtain ordered blood cultures before antibiotics when feasible and begin prolonged targeted antimicrobial
therapy as prescribed.
, Correct Answer: C. Treat as an emergency: maintain strict hemodynamic monitoring and prepare for rapid
blood-pressure/heart-rate control and definitive management.
Rationale: For Aortic dissection, the priority is to treat as an emergency: maintain strict hemodynamic
monitoring and prepare for rapid blood-pressure/heart-rate control and definitive management. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
8. A client with Severe hypocalcemia after thyroid surgery is being cared for on an adult medical-surgical
unit. After thyroidectomy, a client develops perioral tingling, carpopedal spasm, and a prolonged QT
interval. What is the most appropriate immediate nursing response?
A. Give rapid parenteral glucose or glucagon per protocol and recheck glucose promptly, then provide
longer-acting carbohydrate when safe.
B. Implement ordered fluid restriction, frequent neurologic checks, and cautious sodium correction; use
hypertonic saline only when indicated.
C. Assess airway, place on cardiac monitoring, check calcium, and prepare to give IV calcium for symptomatic
severe hypocalcemia.
D. Begin isotonic fluid resuscitation, then IV insulin with close potassium and glucose monitoring according to
protocol.
Correct Answer: C. Assess airway, place on cardiac monitoring, check calcium, and prepare to give IV calcium
for symptomatic severe hypocalcemia.
Rationale: For Severe hypocalcemia after thyroid surgery, the priority is to assess airway, place on cardiac
monitoring, check calcium, and prepare to give IV calcium for symptomatic severe hypocalcemia. This targets the
most immediate threat while allowing subsequent definitive treatment and monitoring.
9. A client with Enteral feeding aspiration risk is being cared for on an adult medical-surgical unit. A
neurologically impaired client receiving tube feeding develops coughing, decreased oxygen saturation, and
coarse breath sounds during the infusion. Which plan best addresses the client's immediate risk?
A. Keep NPO, avoid laxatives/enemas, provide ordered fluids/analgesia/antibiotics, and prepare for
appendectomy.
B. Treat as an emergency, stop agents that slow gut motility, provide intensive monitoring/support, and obtain
urgent surgical consultation.
C. Stop the feeding, assess airway/oxygenation, verify tube position and aspiration risk, and resume only after the
cause is addressed.
D. Monitor weight, sodium/fluid plan, diuretic response, renal function, and prepare for paracentesis when
indicated.
Correct Answer: C. Stop the feeding, assess airway/oxygenation, verify tube position and aspiration risk, and
resume only after the cause is addressed.
Rationale: For Enteral feeding aspiration risk, the priority is to stop the feeding, assess airway/oxygenation,
verify tube position and aspiration risk, and resume only after the cause is addressed. This targets the most
immediate threat while allowing subsequent definitive treatment and monitoring.
10. A client with Myxedema coma is being cared for on an adult medical-surgical unit. An older adult with
hypothyroidism becomes hypothermic, bradycardic, hypotensive, hyponatremic, and progressively
obtunded. Which action is most important at this time?
A. Monitor infection, glucose, blood pressure, skin integrity, and bone health; taper exogenous steroids only
under prescriber direction.
B. Support airway/ventilation, warm cautiously, and administer IV thyroid hormone and stress-dose corticosteroid
as ordered.
C. Give rapid isotonic fluids, IV glucocorticoid, and glucose/electrolyte management as ordered.
D. Give rapid parenteral glucose or glucagon per protocol and recheck glucose promptly, then provide
longer-acting carbohydrate when safe.
Correct Answer: B. Support airway/ventilation, warm cautiously, and administer IV thyroid hormone and
stress-dose corticosteroid as ordered.
Rationale: For Myxedema coma, the priority is to support airway/ventilation, warm cautiously, and administer
IV thyroid hormone and stress-dose corticosteroid as ordered. This targets the most immediate threat while
allowing subsequent definitive treatment and monitoring.
11. A client with Intracerebral hemorrhage is being cared for on an adult medical-surgical unit. A client
develops sudden severe headache, vomiting, very high blood pressure, and rapidly declining level of
