HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 68-year-old post-CABG patient suddenly complains of chest pain, and the nurse
notes new ST-segment elevation in leads II, III, and aVF. Which action should the
nurse take first?
A. Administer morphine sulfate IV
B. Obtain a stat 12-lead ECG
C. Notify the cardiac surgery team immediately
D. Check the patient’s most recent troponin level
Correct Answer: C
Rationale: New ST-segment elevation in the inferior leads immediately post-CABG
suggests acute graft occlusion or spasm—an emergency requiring rapid surgical or
interventional re-evaluation. Notifying the team first mobilizes definitive care. A repeat
ECG (B) is useful but should not delay notification. Morphine (A) treats pain but not the
underlying ischemia. Troponin (D) confirms necrosis but is not needed to act on ischemic
ECG changes.
2. The nurse is caring for a mechanically-ventilated ARDS patient whose PaO₂ drops
from 78 mm Hg to 52 mm Hg despite FiO₂ 0.8 and PEEP 16 cm H₂O. Which
ventilator change should the nurse anticipate?
A. Increase PEEP to 20 cm H₂O
B. Switch to airway-pressure-release ventilation (APRV)
,C. Initiate prone-position ventilation protocol
D. Decrease tidal volume to 4 mL/kg IBW
Correct Answer: C
Rationale: Refractory hypoxemia in ARDS warrants prone-position ventilation, which
improves dorsal lung recruitment and V/Q matching. Increasing PEEP (A) risks
barotrauma without proven benefit at extreme levels. APRV (B) is an option but prone is
first-line for severe oxygenation failure. Ultra-low tidal volumes (D) are already standard;
further reduction would cause hypercapnia without correcting hypoxia.
3. A patient in DKA receives an insulin infusion at 0.1 units/kg/hr. Which value best
indicates to the nurse that the insulin dose is effectively suppressing ketogenesis?
A. Serum glucose falling 80 mg/dL/hr
B. Serum bicarbonate rising from 14 to 20 mEq/L
C. Potassium decreasing from 5.2 to 4.0 mEq/L
D. Urine output increasing to 60 mL/hr
Correct Answer: B
Rationale: A rising bicarbonate reflects correction of acidemia and signals slowed ketone
production—the primary goal of insulin in DKA. Glucose drops first but does not
measure ketone suppression. Potassium shifts with insulin but is influenced by many
factors. Urine output lags and may reflect hydration more than metabolic improvement.
4. A patient with a cervical spinal-cord injury at C4 develops bradycardia (HR 38
bpm) and hypotension (BP 82/50 mm Hg). Which intervention is most urgent?
A. Administer atropine 0.5 mg IV
,B. Apply compression stockings
C. Increase IV fluids to 250 mL/hr
D. Place the patient in Trendelenburg position
Correct Answer: A
Rationale: Neurogenic shock after high cervical injury causes loss of sympathetic tone;
atropine reverses vagal bradycardia immediately. Fluids (C) support preload but do not
correct bradycardia. Compression garments (B) help orthostasis later. Trendelenburg (D)
is no longer recommended and may worsen cerebral edema.
5. A patient with liver cirrhosis and ascites develops abdominal pain, fever (38.9 °C),
and a WBC count of 17,000/mm³. Paracentesis fluid shows 420 neutrophils/mm³.
Which order should the nurse implement first?
A. Start ceftriaxone 2 g IV daily
B. Infuse 25 % albumin 1.5 g/kg within 6 h
C. Send fluid for culture and sensitivity
D. Restrict dietary sodium to 2 g/day
Correct Answer: C
Rationale: Culture must precede antibiotics to identify the organism and optimize
therapy. Empiric antibiotics (A) come next. Albumin (B) is given for SBP prevention of
renal impairment but is not the first action. Sodium restriction (D) is chronic
management.
6. A patient with septic shock on norepinephrine has a MAP of 52 mm Hg, urine
output 25 mL/hr, and CVP 4 mm Hg. Which change is most appropriate?
, A. Add vasopressin 0.03 units/min
B. Increase norepinephrine by 5 mcg/min
C. Administer 500 mL normal saline bolus
D. Start dobutamine 5 mcg/kg/min
Correct Answer: C
Rationale: Low CVP and oliguria indicate hypovolemia; fluid resuscitation is first-line to
restore preload. Escalating vasopressors (A, B) without adequate preload can worsen
tissue hypoperfusion. Dobutamine (D) is used for cardiogenic, not hypovolemic, shock.
7. A patient with an ischemic stroke receives alteplase. Twenty minutes into the
infusion the patient develops new dysarthria and left-sided weakness. Which
action is priority?
A. Stop the alteplase infusion immediately
B. Obtain stat non-contrast CT head
C. Administer protamine sulfate
D. Check BP and give labetalol if >185/110 mm Hg
Correct Answer: A
Rationale: New neurologic deficits during tPA suggest intracranial hemorrhage; stopping
the infusion prevents further lysis. CT (B) follows immediately. Protamine (C) reverses
heparin, not tPA. BP control (D) is important but secondary to stopping the drug.
8. A patient with acute adrenal insufficiency has BP 78/46 mm Hg and Na 126
mEq/L. Which IV fluid should the nurse expect to administer first?
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 68-year-old post-CABG patient suddenly complains of chest pain, and the nurse
notes new ST-segment elevation in leads II, III, and aVF. Which action should the
nurse take first?
A. Administer morphine sulfate IV
B. Obtain a stat 12-lead ECG
C. Notify the cardiac surgery team immediately
D. Check the patient’s most recent troponin level
Correct Answer: C
Rationale: New ST-segment elevation in the inferior leads immediately post-CABG
suggests acute graft occlusion or spasm—an emergency requiring rapid surgical or
interventional re-evaluation. Notifying the team first mobilizes definitive care. A repeat
ECG (B) is useful but should not delay notification. Morphine (A) treats pain but not the
underlying ischemia. Troponin (D) confirms necrosis but is not needed to act on ischemic
ECG changes.
2. The nurse is caring for a mechanically-ventilated ARDS patient whose PaO₂ drops
from 78 mm Hg to 52 mm Hg despite FiO₂ 0.8 and PEEP 16 cm H₂O. Which
ventilator change should the nurse anticipate?
A. Increase PEEP to 20 cm H₂O
B. Switch to airway-pressure-release ventilation (APRV)
,C. Initiate prone-position ventilation protocol
D. Decrease tidal volume to 4 mL/kg IBW
Correct Answer: C
Rationale: Refractory hypoxemia in ARDS warrants prone-position ventilation, which
improves dorsal lung recruitment and V/Q matching. Increasing PEEP (A) risks
barotrauma without proven benefit at extreme levels. APRV (B) is an option but prone is
first-line for severe oxygenation failure. Ultra-low tidal volumes (D) are already standard;
further reduction would cause hypercapnia without correcting hypoxia.
3. A patient in DKA receives an insulin infusion at 0.1 units/kg/hr. Which value best
indicates to the nurse that the insulin dose is effectively suppressing ketogenesis?
A. Serum glucose falling 80 mg/dL/hr
B. Serum bicarbonate rising from 14 to 20 mEq/L
C. Potassium decreasing from 5.2 to 4.0 mEq/L
D. Urine output increasing to 60 mL/hr
Correct Answer: B
Rationale: A rising bicarbonate reflects correction of acidemia and signals slowed ketone
production—the primary goal of insulin in DKA. Glucose drops first but does not
measure ketone suppression. Potassium shifts with insulin but is influenced by many
factors. Urine output lags and may reflect hydration more than metabolic improvement.
4. A patient with a cervical spinal-cord injury at C4 develops bradycardia (HR 38
bpm) and hypotension (BP 82/50 mm Hg). Which intervention is most urgent?
A. Administer atropine 0.5 mg IV
,B. Apply compression stockings
C. Increase IV fluids to 250 mL/hr
D. Place the patient in Trendelenburg position
Correct Answer: A
Rationale: Neurogenic shock after high cervical injury causes loss of sympathetic tone;
atropine reverses vagal bradycardia immediately. Fluids (C) support preload but do not
correct bradycardia. Compression garments (B) help orthostasis later. Trendelenburg (D)
is no longer recommended and may worsen cerebral edema.
5. A patient with liver cirrhosis and ascites develops abdominal pain, fever (38.9 °C),
and a WBC count of 17,000/mm³. Paracentesis fluid shows 420 neutrophils/mm³.
Which order should the nurse implement first?
A. Start ceftriaxone 2 g IV daily
B. Infuse 25 % albumin 1.5 g/kg within 6 h
C. Send fluid for culture and sensitivity
D. Restrict dietary sodium to 2 g/day
Correct Answer: C
Rationale: Culture must precede antibiotics to identify the organism and optimize
therapy. Empiric antibiotics (A) come next. Albumin (B) is given for SBP prevention of
renal impairment but is not the first action. Sodium restriction (D) is chronic
management.
6. A patient with septic shock on norepinephrine has a MAP of 52 mm Hg, urine
output 25 mL/hr, and CVP 4 mm Hg. Which change is most appropriate?
, A. Add vasopressin 0.03 units/min
B. Increase norepinephrine by 5 mcg/min
C. Administer 500 mL normal saline bolus
D. Start dobutamine 5 mcg/kg/min
Correct Answer: C
Rationale: Low CVP and oliguria indicate hypovolemia; fluid resuscitation is first-line to
restore preload. Escalating vasopressors (A, B) without adequate preload can worsen
tissue hypoperfusion. Dobutamine (D) is used for cardiogenic, not hypovolemic, shock.
7. A patient with an ischemic stroke receives alteplase. Twenty minutes into the
infusion the patient develops new dysarthria and left-sided weakness. Which
action is priority?
A. Stop the alteplase infusion immediately
B. Obtain stat non-contrast CT head
C. Administer protamine sulfate
D. Check BP and give labetalol if >185/110 mm Hg
Correct Answer: A
Rationale: New neurologic deficits during tPA suggest intracranial hemorrhage; stopping
the infusion prevents further lysis. CT (B) follows immediately. Protamine (C) reverses
heparin, not tPA. BP control (D) is important but secondary to stopping the drug.
8. A patient with acute adrenal insufficiency has BP 78/46 mm Hg and Na 126
mEq/L. Which IV fluid should the nurse expect to administer first?
