HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A client with aortic stenosis develops hypotension and chest pain after
receiving IV morphine for dyspnea. Which pathophysiologic mechanism is
the most likely cause?
A. Decreased systemic vascular resistance
B. Increased left-ventricular afterload
C. Bradycardia-induced reduced cardiac output
D. Pulmonary embolus
Correct Answer: A
Rationale: Morphine causes venodilation and decreased SVR, which can
precipitate hypotension in patients with fixed cardiac output states such as critical
aortic stenosis. The fall in preload and afterload reduces coronary perfusion
pressure, producing chest pain. Bradycardia (C) is possible but not the primary
mechanism described. Afterload (B) is actually decreased, not increased. PE (D) is
unrelated to morphine administration.
2. The nurse is managing a mechanically ventilated client with ARDS. Which
ventilator setting change best indicates that the open-lung protective strategy
is being maintained?
A. Increase in PEEP from 10 to 14 cm H₂O with unchanged FiO₂
,B. Increase in tidal volume from 6 to 10 mL/kg
C. Decrease in PEEP from 12 to 8 cm H₂O while increasing FiO₂
D. Addition of pressure-support ventilation
Correct Answer: A
Rationale: ARDSNet open-lung protective strategy pairs low tidal volumes (6
mL/kg) with incremental PEEP to prevent cyclic atelectasis and barotrauma.
Raising PEEP while keeping FiO₂ constant (A) recruits collapsed alveoli without
increasing oxygen toxicity. Increasing tidal volume (B) violates lung-protection.
Lowering PEEP (C) promotes derecruitment. Pressure support (D) aids
spontaneous breathing but does not reflect lung-protection.
3. A client with CKD stage 4 (eGFR 22 mL/min) presents with K⁺ 6.3 mEq/L,
peaked T waves, and BP 88/50 mmHg. Which order should the nurse
implement first?
A. 10 units regular insulin + 25 g dextrose IV push
B. Calcium gluconate 1 g IV over 5 min
C. Albuterol 20 mg nebulized
D. Sodium polystyrene sulfonate 30 g PO
Correct Answer: B
Rationale: Severe hyperkalemia with ECG changes is a cardiac emergency;
calcium gluconate stabilizes the myocardium within 1–3 min and is given first.
,Insulin-dextrose (A) and albuterol (C) shift potassium intracellularly but do not
protect the heart. Kayexalate (D) removes potassium but acts too slowly (>2 h).
4. A post-CABG client’s PA catheter shows CVP 14 mmHg, PAOP 26 mmHg,
CI 1.8 L/min/m², SVR 1800 dynes·s/cm⁵. Which intervention is most
appropriate?
A. Administer dobutamine 5 mcg/kg/min
B. Give 500 mL normal saline bolus
C. Start nitroprusside infusion
D. Increase PEEP to 16 cm H₂O
Correct Answer: A
Rationale: Low cardiac index, high PAOP, and elevated SVR indicate cardiogenic
shock with inadequate contractility. Dobutamine provides inotropic support and
afterload reduction. Fluids (B) would worsen pulmonary congestion. Nitroprusside
(C) may drop BP dangerously. Increasing PEEP (D) reduces venous return and
further lowers CI.
5. A client with DKA has been receiving an insulin infusion for 4 hours.
Current labs: pH 7.28, HCO₃ 16 mEq/L, anion gap 18, glucose 210 mg/dL.
Which action is indicated?
A. Continue insulin and start D5W
B. Stop insulin and give 2 L NS bolus
C. Switch to subcutaneous insulin glargine
, D. Add sodium bicarbonate IV
Correct Answer: A
Rationale: The anion gap is still elevated (gap > 12), indicating ongoing
ketogenesis; insulin must continue to close the gap. Glucose 210 mandates adding
dextrose to prevent hypoglycemia while ketones clear. Bicarbonate (D) is not used
unless pH < 6.9. Switching to SQ (C) too early risks rebound ketosis.
6. A client with thyroid storm develops hyperthermia (40.5 °C). Which cooling
method is most effective and physiologically appropriate?
A. Ice-water immersion
B. Cooling blanket plus chilled saline IV
C. Tepid water spray with fan evaporation
D. Alcohol sponge bath
Correct Answer: C
Rationale: Evaporative cooling (tepid spray + fan) is rapid, safe, and avoids
peripheral vasoconstriction that limits heat loss. Ice-water (A) causes shivering and
vasoconstriction. Cooling blankets (B) are adjuncts but slower. Alcohol sponges
(D) risk toxicity and shivering.
7. A client with acute adrenal crisis is hypotensive despite 3 L crystalloid. BP
70/40 mmHg, K⁺ 5.8 mEq/L, glucose 54 mg/dL. Which vasopressor is most
appropriate?
A. Norepinephrine
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A client with aortic stenosis develops hypotension and chest pain after
receiving IV morphine for dyspnea. Which pathophysiologic mechanism is
the most likely cause?
A. Decreased systemic vascular resistance
B. Increased left-ventricular afterload
C. Bradycardia-induced reduced cardiac output
D. Pulmonary embolus
Correct Answer: A
Rationale: Morphine causes venodilation and decreased SVR, which can
precipitate hypotension in patients with fixed cardiac output states such as critical
aortic stenosis. The fall in preload and afterload reduces coronary perfusion
pressure, producing chest pain. Bradycardia (C) is possible but not the primary
mechanism described. Afterload (B) is actually decreased, not increased. PE (D) is
unrelated to morphine administration.
2. The nurse is managing a mechanically ventilated client with ARDS. Which
ventilator setting change best indicates that the open-lung protective strategy
is being maintained?
A. Increase in PEEP from 10 to 14 cm H₂O with unchanged FiO₂
,B. Increase in tidal volume from 6 to 10 mL/kg
C. Decrease in PEEP from 12 to 8 cm H₂O while increasing FiO₂
D. Addition of pressure-support ventilation
Correct Answer: A
Rationale: ARDSNet open-lung protective strategy pairs low tidal volumes (6
mL/kg) with incremental PEEP to prevent cyclic atelectasis and barotrauma.
Raising PEEP while keeping FiO₂ constant (A) recruits collapsed alveoli without
increasing oxygen toxicity. Increasing tidal volume (B) violates lung-protection.
Lowering PEEP (C) promotes derecruitment. Pressure support (D) aids
spontaneous breathing but does not reflect lung-protection.
3. A client with CKD stage 4 (eGFR 22 mL/min) presents with K⁺ 6.3 mEq/L,
peaked T waves, and BP 88/50 mmHg. Which order should the nurse
implement first?
A. 10 units regular insulin + 25 g dextrose IV push
B. Calcium gluconate 1 g IV over 5 min
C. Albuterol 20 mg nebulized
D. Sodium polystyrene sulfonate 30 g PO
Correct Answer: B
Rationale: Severe hyperkalemia with ECG changes is a cardiac emergency;
calcium gluconate stabilizes the myocardium within 1–3 min and is given first.
,Insulin-dextrose (A) and albuterol (C) shift potassium intracellularly but do not
protect the heart. Kayexalate (D) removes potassium but acts too slowly (>2 h).
4. A post-CABG client’s PA catheter shows CVP 14 mmHg, PAOP 26 mmHg,
CI 1.8 L/min/m², SVR 1800 dynes·s/cm⁵. Which intervention is most
appropriate?
A. Administer dobutamine 5 mcg/kg/min
B. Give 500 mL normal saline bolus
C. Start nitroprusside infusion
D. Increase PEEP to 16 cm H₂O
Correct Answer: A
Rationale: Low cardiac index, high PAOP, and elevated SVR indicate cardiogenic
shock with inadequate contractility. Dobutamine provides inotropic support and
afterload reduction. Fluids (B) would worsen pulmonary congestion. Nitroprusside
(C) may drop BP dangerously. Increasing PEEP (D) reduces venous return and
further lowers CI.
5. A client with DKA has been receiving an insulin infusion for 4 hours.
Current labs: pH 7.28, HCO₃ 16 mEq/L, anion gap 18, glucose 210 mg/dL.
Which action is indicated?
A. Continue insulin and start D5W
B. Stop insulin and give 2 L NS bolus
C. Switch to subcutaneous insulin glargine
, D. Add sodium bicarbonate IV
Correct Answer: A
Rationale: The anion gap is still elevated (gap > 12), indicating ongoing
ketogenesis; insulin must continue to close the gap. Glucose 210 mandates adding
dextrose to prevent hypoglycemia while ketones clear. Bicarbonate (D) is not used
unless pH < 6.9. Switching to SQ (C) too early risks rebound ketosis.
6. A client with thyroid storm develops hyperthermia (40.5 °C). Which cooling
method is most effective and physiologically appropriate?
A. Ice-water immersion
B. Cooling blanket plus chilled saline IV
C. Tepid water spray with fan evaporation
D. Alcohol sponge bath
Correct Answer: C
Rationale: Evaporative cooling (tepid spray + fan) is rapid, safe, and avoids
peripheral vasoconstriction that limits heat loss. Ice-water (A) causes shivering and
vasoconstriction. Cooling blankets (B) are adjuncts but slower. Alcohol sponges
(D) risk toxicity and shivering.
7. A client with acute adrenal crisis is hypotensive despite 3 L crystalloid. BP
70/40 mmHg, K⁺ 5.8 mEq/L, glucose 54 mg/dL. Which vasopressor is most
appropriate?
A. Norepinephrine
