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NSG 233 HESI Final Exam 2025/2026 –
Actual Med-Surg II Exam Questions with
Verified Answers | A+ Graded HESI
Fluid and Electrolyte Balance
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of
6.2 mEq/L. Which nursing intervention should the nurse prioritize?
A. Administer oral potassium supplements.
B. Encourage increased fluid intake.
C. Administer insulin and glucose IV as prescribed.
D. Provide a high-potassium diet.
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) requires urgent intervention. Insulin
and glucose shift potassium into cells, temporarily reducing serum levels. Options A and
D would worsen hyperkalemia, and B is inappropriate without addressing potassium first.
2. A nurse is assessing a patient receiving IV normal saline at 125 mL/hr. Which finding
indicates fluid overload?
A. Urine output of 30 mL/hr.
B. Crackles in bilateral lung fields.
C. Serum sodium of 140 mEq/L.
D. Blood pressure of 110/70 mmHg.
Rationale: Crackles indicate pulmonary edema, a sign of fluid overload. Low urine
output (A) may suggest renal issues, normal sodium (C) is expected, and normal BP (D)
does not confirm overload.
3. A patient with heart failure has a serum magnesium level of 1.2 mEq/L. Which
medication should the nurse anticipate administering?
A. Potassium chloride.
B. Magnesium sulfate IV.
C. Sodium bicarbonate.
D. Calcium gluconate.
Rationale: Hypomagnesemia (< 1.5 mEq/L) is treated with magnesium sulfate IV.
Options A, C, and D address other electrolyte imbalances, not magnesium deficiency.
4. A patient with diabetic ketoacidosis (DKA) is receiving IV fluids. Which laboratory
value should the nurse monitor closely to assess fluid therapy effectiveness?
A. Serum potassium.
B. Blood glucose.
C. Serum calcium.
D. Blood urea nitrogen (BUN).
Rationale: In DKA, IV fluids help correct hyperglycemia. Monitoring blood glucose is
critical to assess therapy effectiveness and guide insulin administration. Other values are
relevant but secondary.
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5. A nurse is caring for a patient with hyponatremia (serum sodium 128 mEq/L). Which IV
fluid should the nurse expect to administer?
A. 0.45% sodium chloride.
B. 3% sodium chloride.
C. Dextrose 5% in water (D5W).
D. Lactated Ringer’s.
Rationale: Severe hyponatremia requires hypertonic saline (3% sodium chloride) to
slowly correct sodium levels. Options A and C are hypotonic, and D is isotonic,
unsuitable for rapid correction.
IV Therapy
6. A patient is receiving a blood transfusion and develops a rash and shortness of breath.
What is the nurse’s priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
C. Administer diphenhydramine.
D. Monitor vital signs.
Rationale: A rash and shortness of breath suggest a transfusion reaction, requiring
immediate cessation of the transfusion to prevent further complications. Other actions
follow after stopping the transfusion.
7. A nurse is preparing to administer IV vancomycin for a patient with MRSA. Which
action is essential to prevent complications?
A. Infuse over 30 minutes.
B. Infuse over at least 60 minutes.
C. Administer with a bolus of normal saline.
D. Mix with dextrose 5% in water.
Rationale: Vancomycin must be infused slowly (over 60–120 minutes) to prevent red
man syndrome. Rapid infusion (A) risks toxicity, and C and D are incorrect
administration practices.
8. A patient with hypovolemic shock is receiving IV lactated Ringer’s. Which assessment
finding indicates the therapy is effective?
A. Heart rate of 120 bpm.
B. Urine output of 40 mL/hr.
C. Blood pressure of 90/60 mmHg.
D. Respiratory rate of 28 breaths/min.
Rationale: Adequate urine output (> 30 mL/hr) indicates restored perfusion in
hypovolemic shock. Persistent tachycardia (A), low BP (C), or tachypnea (D) suggest
ongoing hypovolemia.
9. A nurse is managing a peripheral IV site and notes redness and swelling. What is the
priority action?
A. Apply a warm compress.
B. Discontinue the IV and remove the catheter.
C. Elevate the affected limb.
D. Slow the infusion rate.
NSG 233 HESI Final Exam 2025/2026 –
Actual Med-Surg II Exam Questions with
Verified Answers | A+ Graded HESI
Fluid and Electrolyte Balance
1. A patient with chronic kidney disease (CKD) presents with a serum potassium level of
6.2 mEq/L. Which nursing intervention should the nurse prioritize?
A. Administer oral potassium supplements.
B. Encourage increased fluid intake.
C. Administer insulin and glucose IV as prescribed.
D. Provide a high-potassium diet.
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) requires urgent intervention. Insulin
and glucose shift potassium into cells, temporarily reducing serum levels. Options A and
D would worsen hyperkalemia, and B is inappropriate without addressing potassium first.
2. A nurse is assessing a patient receiving IV normal saline at 125 mL/hr. Which finding
indicates fluid overload?
A. Urine output of 30 mL/hr.
B. Crackles in bilateral lung fields.
C. Serum sodium of 140 mEq/L.
D. Blood pressure of 110/70 mmHg.
Rationale: Crackles indicate pulmonary edema, a sign of fluid overload. Low urine
output (A) may suggest renal issues, normal sodium (C) is expected, and normal BP (D)
does not confirm overload.
3. A patient with heart failure has a serum magnesium level of 1.2 mEq/L. Which
medication should the nurse anticipate administering?
A. Potassium chloride.
B. Magnesium sulfate IV.
C. Sodium bicarbonate.
D. Calcium gluconate.
Rationale: Hypomagnesemia (< 1.5 mEq/L) is treated with magnesium sulfate IV.
Options A, C, and D address other electrolyte imbalances, not magnesium deficiency.
4. A patient with diabetic ketoacidosis (DKA) is receiving IV fluids. Which laboratory
value should the nurse monitor closely to assess fluid therapy effectiveness?
A. Serum potassium.
B. Blood glucose.
C. Serum calcium.
D. Blood urea nitrogen (BUN).
Rationale: In DKA, IV fluids help correct hyperglycemia. Monitoring blood glucose is
critical to assess therapy effectiveness and guide insulin administration. Other values are
relevant but secondary.
, 2
5. A nurse is caring for a patient with hyponatremia (serum sodium 128 mEq/L). Which IV
fluid should the nurse expect to administer?
A. 0.45% sodium chloride.
B. 3% sodium chloride.
C. Dextrose 5% in water (D5W).
D. Lactated Ringer’s.
Rationale: Severe hyponatremia requires hypertonic saline (3% sodium chloride) to
slowly correct sodium levels. Options A and C are hypotonic, and D is isotonic,
unsuitable for rapid correction.
IV Therapy
6. A patient is receiving a blood transfusion and develops a rash and shortness of breath.
What is the nurse’s priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
C. Administer diphenhydramine.
D. Monitor vital signs.
Rationale: A rash and shortness of breath suggest a transfusion reaction, requiring
immediate cessation of the transfusion to prevent further complications. Other actions
follow after stopping the transfusion.
7. A nurse is preparing to administer IV vancomycin for a patient with MRSA. Which
action is essential to prevent complications?
A. Infuse over 30 minutes.
B. Infuse over at least 60 minutes.
C. Administer with a bolus of normal saline.
D. Mix with dextrose 5% in water.
Rationale: Vancomycin must be infused slowly (over 60–120 minutes) to prevent red
man syndrome. Rapid infusion (A) risks toxicity, and C and D are incorrect
administration practices.
8. A patient with hypovolemic shock is receiving IV lactated Ringer’s. Which assessment
finding indicates the therapy is effective?
A. Heart rate of 120 bpm.
B. Urine output of 40 mL/hr.
C. Blood pressure of 90/60 mmHg.
D. Respiratory rate of 28 breaths/min.
Rationale: Adequate urine output (> 30 mL/hr) indicates restored perfusion in
hypovolemic shock. Persistent tachycardia (A), low BP (C), or tachypnea (D) suggest
ongoing hypovolemia.
9. A nurse is managing a peripheral IV site and notes redness and swelling. What is the
priority action?
A. Apply a warm compress.
B. Discontinue the IV and remove the catheter.
C. Elevate the affected limb.
D. Slow the infusion rate.
