HESI RN MEDSURG V2 MULTIPLE-CHOICE, CLINICAL SCENARIOS
AND SET 3 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A nurse is monitoring a client being treated for Infective endocarditis. A client with a prosthetic valve
has persistent fever, a new murmur, fatigue, and splinter hemorrhages. Which finding requires the most
immediate follow-up?
A. New neurologic deficit or acute limb pain suggesting systemic embolization.
B. Progressive motor weakness or paralysis indicating threatened limb viability.
C. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
D. Progressive hypotension with narrowing pulse pressure and altered mental status.
Correct Answer: A. New neurologic deficit or acute limb pain suggesting systemic embolization.
Rationale: In Infective endocarditis, new neurologic deficit or acute limb pain suggesting systemic embolization.
This finding signals a potentially serious complication and warrants immediate assessment or escalation.
2. A client recovering from Pleural effusion requiring thoracentesis is preparing for discharge. Which
statement by the client indicates effective teaching?
A. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
B. Use positive-airway-pressure therapy every sleep period and avoid sedatives/alcohol near bedtime unless
specifically approved.
C. Survivors should expect gradual recovery and report increasing breathlessness or functional decline during
follow-up.
D. Report new shortness of breath or chest pain promptly after the procedure.
Correct Answer: D. Report new shortness of breath or chest pain promptly after the procedure.
Rationale: The key teaching for Pleural effusion requiring thoracentesis is: Report new shortness of breath or
chest pain promptly after the procedure. This reduces preventable complications and helps the client recognize
when follow-up or emergency care is needed.
3. A nurse is monitoring a client being treated for Pericardial tamponade. A client develops hypotension,
jugular venous distention, muffled heart sounds, and worsening dyspnea. Which change most strongly
suggests a serious complication?
A. New focal neurologic deficit suggesting embolic stroke.
B. Increasing respiratory distress with pink frothy sputum suggesting acute pulmonary edema.
C. Progressive hypotension with narrowing pulse pressure and altered mental status.
D. Syncope or hypotension with persistent failure to capture.
Correct Answer: C. Progressive hypotension with narrowing pulse pressure and altered mental status.
Rationale: In Pericardial tamponade, progressive hypotension with narrowing pulse pressure and altered mental
status. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
4. A client recovering from Severe asthma exacerbation is preparing for discharge. Which teaching point is
most important to reinforce?
A. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
B. Use rescue and maintenance inhalers correctly and seek care for rapidly increasing dyspnea or sputum change.
C. Follow the asthma action plan and seek urgent help when rescue medication is ineffective or peak flow is in
the red zone.
D. Use positive-airway-pressure therapy every sleep period and avoid sedatives/alcohol near bedtime unless
specifically approved.
Correct Answer: C. Follow the asthma action plan and seek urgent help when rescue medication is ineffective or
peak flow is in the red zone.
Rationale: The key teaching for Severe asthma exacerbation is: Follow the asthma action plan and seek urgent
help when rescue medication is ineffective or peak flow is in the red zone. This reduces preventable
complications and helps the client recognize when follow-up or emergency care is needed.
5. A nurse is monitoring a client being treated for Peripheral arterial disease. A client reports calf pain
with walking that stops with rest and has cool shiny skin with diminished pedal pulses. Which finding
requires the most immediate follow-up?
,A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Rapidly worsening hypotension, loss of consciousness, and abdominal distention from hemorrhage.
C. Worsening neurologic status, chest pain, pulmonary edema, or falling urine output indicating progressive
target-organ injury.
D. Increasing erythema, warmth, purulent drainage, or fever suggesting ulcer infection.
Correct Answer: A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb
ischemia.
Rationale: In Peripheral arterial disease, rest pain with pallor, coolness, paresthesia, or absent pulses suggesting
acute limb ischemia. This finding signals a potentially serious complication and warrants immediate assessment
or escalation.
6. A client recovering from Increased intracranial pressure is preparing for discharge. Which statement by
the client indicates effective teaching?
A. Keep bladder and bowel programs regular and treat sudden pounding headache with hypertension as an
emergency.
B. Call emergency services for any sudden face, arm, speech, vision, or balance change; time of onset matters.
C. After discharge, report worsening headache, repeated vomiting, confusion, or new weakness immediately.
D. Seek emergency care immediately for sudden severe headache or new neurologic deficit.
Correct Answer: C. After discharge, report worsening headache, repeated vomiting, confusion, or new weakness
immediately.
Rationale: The key teaching for Increased intracranial pressure is: After discharge, report worsening headache,
repeated vomiting, confusion, or new weakness immediately. This reduces preventable complications and helps
the client recognize when follow-up or emergency care is needed.
7. A nurse is monitoring a client being treated for Aortic dissection. A client develops sudden severe tearing
chest pain radiating to the back with unequal arm blood pressures. Which change most strongly suggests a
serious complication?
A. Recurrent chest pain with hypotension and new dysrhythmia suggesting ongoing ischemia or cardiogenic
deterioration.
B. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
C. Rapidly worsening hypotension, loss of consciousness, and abdominal distention from hemorrhage.
D. Abrupt loss of distal pulse, neurologic change, or shock from extension or rupture.
Correct Answer: D. Abrupt loss of distal pulse, neurologic change, or shock from extension or rupture.
Rationale: In Aortic dissection, abrupt loss of distal pulse, neurologic change, or shock from extension or
rupture. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
8. A client recovering from Chest tube air leak is preparing for discharge. Which teaching point is most
important to reinforce?
A. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or persistent fever.
B. Report sudden worsening breathlessness or rapid weight gain before severe pulmonary congestion develops.
C. Avoid clamping or manipulating the chest tube unless specifically instructed by trained clinicians.
D. Survivors should expect gradual recovery and report increasing breathlessness or functional decline during
follow-up.
Correct Answer: C. Avoid clamping or manipulating the chest tube unless specifically instructed by trained
clinicians.
Rationale: The key teaching for Chest tube air leak is: Avoid clamping or manipulating the chest tube unless
specifically instructed by trained clinicians. This reduces preventable complications and helps the client recognize
when follow-up or emergency care is needed.
9. A nurse is monitoring a client being treated for Hepatic encephalopathy. A client with cirrhosis develops
confusion, asterixis, sleep-pattern reversal, and rising ammonia after a GI bleed. Which finding requires
the most immediate follow-up?
A. Shock, recurrent large-volume hematemesis, or worsening mental status.
B. Progressive somnolence with inability to protect the airway.
C. Acute hypoxemic respiratory distress or fever/infiltrate consistent with aspiration pneumonia.
D. Sudden pain relief followed by diffuse abdominal rigidity and fever suggesting perforation.
Correct Answer: B. Progressive somnolence with inability to protect the airway.
, Rationale: In Hepatic encephalopathy, progressive somnolence with inability to protect the airway. This finding
signals a potentially serious complication and warrants immediate assessment or escalation.
10. A client recovering from Community-acquired pneumonia is preparing for discharge. Which statement
by the client indicates effective teaching?
A. Take every antitubercular dose as prescribed and follow public-health instructions for isolation and follow-up
testing.
B. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
C. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or persistent fever.
D. Use prescribed anticoagulation consistently and reduce prolonged immobility.
Correct Answer: C. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or
persistent fever.
Rationale: The key teaching for Community-acquired pneumonia is: Complete antibiotics as prescribed and seek
care for worsening dyspnea, confusion, or persistent fever. This reduces preventable complications and helps the
client recognize when follow-up or emergency care is needed.
11. A nurse is monitoring a client being treated for Acute arterial occlusion. A client suddenly develops a
painful pale cool leg with paresthesia and an absent pedal pulse. Which change most strongly suggests a
serious complication?
A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Syncope or hypotension with persistent failure to capture.
C. Progressive motor weakness or paralysis indicating threatened limb viability.
D. New focal neurologic deficit suggesting embolic stroke.
Correct Answer: C. Progressive motor weakness or paralysis indicating threatened limb viability.
Rationale: In Acute arterial occlusion, progressive motor weakness or paralysis indicating threatened limb
viability. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
12. A client recovering from Diabetes insipidus is preparing for discharge. Which teaching point is most
important to reinforce?
A. Follow prescribed fluid limits and report worsening headache, confusion, or nausea.
B. Take desmopressin exactly as prescribed and monitor for both excessive thirst/urination and fluid overload
symptoms.
C. Do not abruptly stop antithyroid medication and report fever, palpitations, or severe agitation promptly.
D. Take thyroid replacement consistently and seek care for progressive lethargy, cold intolerance, or confusion.
Correct Answer: B. Take desmopressin exactly as prescribed and monitor for both excessive thirst/urination and
fluid overload symptoms.
Rationale: The key teaching for Diabetes insipidus is: Take desmopressin exactly as prescribed and monitor for
both excessive thirst/urination and fluid overload symptoms. This reduces preventable complications and helps
the client recognize when follow-up or emergency care is needed.
13. A nurse is monitoring a client being treated for Cardiogenic shock. Following a large myocardial
infarction, a client has cool clammy skin, confusion, oliguria, pulmonary crackles, and hypotension. Which
finding requires the most immediate follow-up?
A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Increasing respiratory distress with pink frothy sputum suggesting acute pulmonary edema.
C. Progressive hypotension with narrowing pulse pressure and altered mental status.
D. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
Correct Answer: D. Falling urine output, rising lactate, and worsening mental status indicating inadequate
end-organ perfusion.
Rationale: In Cardiogenic shock, falling urine output, rising lactate, and worsening mental status indicating
inadequate end-organ perfusion. This finding signals a potentially serious complication and warrants immediate
assessment or escalation.
14. A client recovering from Acute urinary retention is preparing for discharge. Which statement by the
client indicates effective teaching?
A. Report decreasing urine output, severe headache, or increasing shortness of breath promptly.
B. Report inability to urinate for several hours with increasing lower abdominal pressure.
C. Avoid nonprescribed nephrotoxic drugs and seek care for markedly reduced urine output or rapid swelling.
AND SET 3 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A nurse is monitoring a client being treated for Infective endocarditis. A client with a prosthetic valve
has persistent fever, a new murmur, fatigue, and splinter hemorrhages. Which finding requires the most
immediate follow-up?
A. New neurologic deficit or acute limb pain suggesting systemic embolization.
B. Progressive motor weakness or paralysis indicating threatened limb viability.
C. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
D. Progressive hypotension with narrowing pulse pressure and altered mental status.
Correct Answer: A. New neurologic deficit or acute limb pain suggesting systemic embolization.
Rationale: In Infective endocarditis, new neurologic deficit or acute limb pain suggesting systemic embolization.
This finding signals a potentially serious complication and warrants immediate assessment or escalation.
2. A client recovering from Pleural effusion requiring thoracentesis is preparing for discharge. Which
statement by the client indicates effective teaching?
A. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
B. Use positive-airway-pressure therapy every sleep period and avoid sedatives/alcohol near bedtime unless
specifically approved.
C. Survivors should expect gradual recovery and report increasing breathlessness or functional decline during
follow-up.
D. Report new shortness of breath or chest pain promptly after the procedure.
Correct Answer: D. Report new shortness of breath or chest pain promptly after the procedure.
Rationale: The key teaching for Pleural effusion requiring thoracentesis is: Report new shortness of breath or
chest pain promptly after the procedure. This reduces preventable complications and helps the client recognize
when follow-up or emergency care is needed.
3. A nurse is monitoring a client being treated for Pericardial tamponade. A client develops hypotension,
jugular venous distention, muffled heart sounds, and worsening dyspnea. Which change most strongly
suggests a serious complication?
A. New focal neurologic deficit suggesting embolic stroke.
B. Increasing respiratory distress with pink frothy sputum suggesting acute pulmonary edema.
C. Progressive hypotension with narrowing pulse pressure and altered mental status.
D. Syncope or hypotension with persistent failure to capture.
Correct Answer: C. Progressive hypotension with narrowing pulse pressure and altered mental status.
Rationale: In Pericardial tamponade, progressive hypotension with narrowing pulse pressure and altered mental
status. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
4. A client recovering from Severe asthma exacerbation is preparing for discharge. Which teaching point is
most important to reinforce?
A. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
B. Use rescue and maintenance inhalers correctly and seek care for rapidly increasing dyspnea or sputum change.
C. Follow the asthma action plan and seek urgent help when rescue medication is ineffective or peak flow is in
the red zone.
D. Use positive-airway-pressure therapy every sleep period and avoid sedatives/alcohol near bedtime unless
specifically approved.
Correct Answer: C. Follow the asthma action plan and seek urgent help when rescue medication is ineffective or
peak flow is in the red zone.
Rationale: The key teaching for Severe asthma exacerbation is: Follow the asthma action plan and seek urgent
help when rescue medication is ineffective or peak flow is in the red zone. This reduces preventable
complications and helps the client recognize when follow-up or emergency care is needed.
5. A nurse is monitoring a client being treated for Peripheral arterial disease. A client reports calf pain
with walking that stops with rest and has cool shiny skin with diminished pedal pulses. Which finding
requires the most immediate follow-up?
,A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Rapidly worsening hypotension, loss of consciousness, and abdominal distention from hemorrhage.
C. Worsening neurologic status, chest pain, pulmonary edema, or falling urine output indicating progressive
target-organ injury.
D. Increasing erythema, warmth, purulent drainage, or fever suggesting ulcer infection.
Correct Answer: A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb
ischemia.
Rationale: In Peripheral arterial disease, rest pain with pallor, coolness, paresthesia, or absent pulses suggesting
acute limb ischemia. This finding signals a potentially serious complication and warrants immediate assessment
or escalation.
6. A client recovering from Increased intracranial pressure is preparing for discharge. Which statement by
the client indicates effective teaching?
A. Keep bladder and bowel programs regular and treat sudden pounding headache with hypertension as an
emergency.
B. Call emergency services for any sudden face, arm, speech, vision, or balance change; time of onset matters.
C. After discharge, report worsening headache, repeated vomiting, confusion, or new weakness immediately.
D. Seek emergency care immediately for sudden severe headache or new neurologic deficit.
Correct Answer: C. After discharge, report worsening headache, repeated vomiting, confusion, or new weakness
immediately.
Rationale: The key teaching for Increased intracranial pressure is: After discharge, report worsening headache,
repeated vomiting, confusion, or new weakness immediately. This reduces preventable complications and helps
the client recognize when follow-up or emergency care is needed.
7. A nurse is monitoring a client being treated for Aortic dissection. A client develops sudden severe tearing
chest pain radiating to the back with unequal arm blood pressures. Which change most strongly suggests a
serious complication?
A. Recurrent chest pain with hypotension and new dysrhythmia suggesting ongoing ischemia or cardiogenic
deterioration.
B. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
C. Rapidly worsening hypotension, loss of consciousness, and abdominal distention from hemorrhage.
D. Abrupt loss of distal pulse, neurologic change, or shock from extension or rupture.
Correct Answer: D. Abrupt loss of distal pulse, neurologic change, or shock from extension or rupture.
Rationale: In Aortic dissection, abrupt loss of distal pulse, neurologic change, or shock from extension or
rupture. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
8. A client recovering from Chest tube air leak is preparing for discharge. Which teaching point is most
important to reinforce?
A. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or persistent fever.
B. Report sudden worsening breathlessness or rapid weight gain before severe pulmonary congestion develops.
C. Avoid clamping or manipulating the chest tube unless specifically instructed by trained clinicians.
D. Survivors should expect gradual recovery and report increasing breathlessness or functional decline during
follow-up.
Correct Answer: C. Avoid clamping or manipulating the chest tube unless specifically instructed by trained
clinicians.
Rationale: The key teaching for Chest tube air leak is: Avoid clamping or manipulating the chest tube unless
specifically instructed by trained clinicians. This reduces preventable complications and helps the client recognize
when follow-up or emergency care is needed.
9. A nurse is monitoring a client being treated for Hepatic encephalopathy. A client with cirrhosis develops
confusion, asterixis, sleep-pattern reversal, and rising ammonia after a GI bleed. Which finding requires
the most immediate follow-up?
A. Shock, recurrent large-volume hematemesis, or worsening mental status.
B. Progressive somnolence with inability to protect the airway.
C. Acute hypoxemic respiratory distress or fever/infiltrate consistent with aspiration pneumonia.
D. Sudden pain relief followed by diffuse abdominal rigidity and fever suggesting perforation.
Correct Answer: B. Progressive somnolence with inability to protect the airway.
, Rationale: In Hepatic encephalopathy, progressive somnolence with inability to protect the airway. This finding
signals a potentially serious complication and warrants immediate assessment or escalation.
10. A client recovering from Community-acquired pneumonia is preparing for discharge. Which statement
by the client indicates effective teaching?
A. Take every antitubercular dose as prescribed and follow public-health instructions for isolation and follow-up
testing.
B. Keep prescribed emergency tracheostomy supplies available and perform routine humidification and airway
care.
C. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or persistent fever.
D. Use prescribed anticoagulation consistently and reduce prolonged immobility.
Correct Answer: C. Complete antibiotics as prescribed and seek care for worsening dyspnea, confusion, or
persistent fever.
Rationale: The key teaching for Community-acquired pneumonia is: Complete antibiotics as prescribed and seek
care for worsening dyspnea, confusion, or persistent fever. This reduces preventable complications and helps the
client recognize when follow-up or emergency care is needed.
11. A nurse is monitoring a client being treated for Acute arterial occlusion. A client suddenly develops a
painful pale cool leg with paresthesia and an absent pedal pulse. Which change most strongly suggests a
serious complication?
A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Syncope or hypotension with persistent failure to capture.
C. Progressive motor weakness or paralysis indicating threatened limb viability.
D. New focal neurologic deficit suggesting embolic stroke.
Correct Answer: C. Progressive motor weakness or paralysis indicating threatened limb viability.
Rationale: In Acute arterial occlusion, progressive motor weakness or paralysis indicating threatened limb
viability. This finding signals a potentially serious complication and warrants immediate assessment or escalation.
12. A client recovering from Diabetes insipidus is preparing for discharge. Which teaching point is most
important to reinforce?
A. Follow prescribed fluid limits and report worsening headache, confusion, or nausea.
B. Take desmopressin exactly as prescribed and monitor for both excessive thirst/urination and fluid overload
symptoms.
C. Do not abruptly stop antithyroid medication and report fever, palpitations, or severe agitation promptly.
D. Take thyroid replacement consistently and seek care for progressive lethargy, cold intolerance, or confusion.
Correct Answer: B. Take desmopressin exactly as prescribed and monitor for both excessive thirst/urination and
fluid overload symptoms.
Rationale: The key teaching for Diabetes insipidus is: Take desmopressin exactly as prescribed and monitor for
both excessive thirst/urination and fluid overload symptoms. This reduces preventable complications and helps
the client recognize when follow-up or emergency care is needed.
13. A nurse is monitoring a client being treated for Cardiogenic shock. Following a large myocardial
infarction, a client has cool clammy skin, confusion, oliguria, pulmonary crackles, and hypotension. Which
finding requires the most immediate follow-up?
A. Rest pain with pallor, coolness, paresthesia, or absent pulses suggesting acute limb ischemia.
B. Increasing respiratory distress with pink frothy sputum suggesting acute pulmonary edema.
C. Progressive hypotension with narrowing pulse pressure and altered mental status.
D. Falling urine output, rising lactate, and worsening mental status indicating inadequate end-organ perfusion.
Correct Answer: D. Falling urine output, rising lactate, and worsening mental status indicating inadequate
end-organ perfusion.
Rationale: In Cardiogenic shock, falling urine output, rising lactate, and worsening mental status indicating
inadequate end-organ perfusion. This finding signals a potentially serious complication and warrants immediate
assessment or escalation.
14. A client recovering from Acute urinary retention is preparing for discharge. Which statement by the
client indicates effective teaching?
A. Report decreasing urine output, severe headache, or increasing shortness of breath promptly.
B. Report inability to urinate for several hours with increasing lower abdominal pressure.
C. Avoid nonprescribed nephrotoxic drugs and seek care for markedly reduced urine output or rapid swelling.
