HESI Med-Surg II Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 71-year-old post-CABG patient arrives in the CVICU with a right radial arterial
line. The nurse notes a damped waveform and the patient’s hand is cool with
mottled fingertips. Which action is most urgent?
A. Flush the arterial line with 5 mL of heparinized saline
B. Level the transducer to the phlebostatic axis
C. Remove the arterial catheter and assess perfusion
D. Recalibrate the transducer and zero the system
Correct Answer: C
Rationale: Damped waveform plus cool, mottled fingers suggests catheter-induced radial
artery occlusion or severe spasm jeopardizing hand perfusion. Prompt removal allows
reperfusion; delay risks permanent ischemia. Flushing or recalibration will not restore
flow, and leveling addresses accuracy—not damping from mechanical obstruction.
2. A client with ARDS is on APRV (P-high 28, P-low 0, T-high 4.5 s, T-low 0.6 s).
The spontaneous respiratory rate is 32/min and the patient appears agitated. Which
ventilator adjustment is most appropriate?
A. Increase T-high to 5.5 s
B. Decrease P-high to 24 cmH₂O
C. Increase T-low to 0.8 s
,D. Add propofol 20 mg IV bolus
Correct Answer: C
Rationale: Short T-low prevents complete lung emptying, raising auto-PEEP and causing
patient-ventilator dyssynchrony. Lengthening T-low slightly (0.6 → 0.8 s) allows more
release time, reduces auto-PEEP, and lowers respiratory drive without sacrificing mean
airway pressure. Increasing T-high or decreasing P-high would reduce ventilation;
sedation is adjunctive after mechanical optimization.
3. A client in DKA receives an insulin infusion at 0.14 units/kg/hr. After 3 h the
blood glucose drops from 520 to 380 mg/dL, but the bicarbonate remains 14
mEq/L. Which change is indicated?
A. Decrease insulin rate to 0.1 units/kg/hr
B. Add dextrose 5 % to the IV fluids
C. Continue current rate and recheck in 2 h
D. Increase insulin rate to 0.2 units/kg/hr
Correct Answer: C
Rationale: The goal is a glucose decline of 50–75 mg/dL/hr and closure of the anion gap;
the current rate is achieving adequate glucose fall while bicarbonate lags. Maintain the
infusion until the gap closes and bicarbonate ≥18 mEq/L, then add dextrose to prevent
hypoglycemia. Raising the rate risks hypoglycemia; lowering it may slow ketone
clearance.
4. A client with CKD stage 4 is admitted with hyperkalemia (K⁺ 6.3 mEq/L) and
peaked T waves. After calcium gluconate and insulin-dextrose, which additional
therapy provides the most sustained potassium reduction?
,A. Nebulized albuterol 20 mg
B. Sodium polystyrene sulfonate 30 g PO
C. Furosemide 80 mg IV
D. Emergent hemodialysis
Correct Answer: D
Rationale: While albuterol and kayexalate shift or bind potassium, the client with CKD
cannot excrete the ion—dialysis is definitive and sustained. Diuresis is ineffective in
oliguric renal failure. Therefore, arrange urgent dialysis after stabilization.
5. A client with a subarachnoid hemorrhage (WFNS grade 3) develops sudden onset
of left-sided weakness and a drop in Glasgow Coma Scale from 14 to 10. Which
complication is most likely?
A. Re-bleeding
B. Cerebral vasospasm
C. Hydrocephalus
D. Seizure with post-ictal state
Correct Answer: B
Rationale: New focal deficit and decreased level of consciousness between days 3–10
strongly suggest vasospasm causing delayed cerebral ischemia. Re-bleeding is usually
within 24 h; hydrocephalus presents with headache and bilateral slowing; seizures would
show tonic-clonic activity or EEG correlate. Urgent CT angiography and augmentation of
cerebral perfusion are indicated.
, 6. A client with septic shock on norepinephrine 0.3 mcg/kg/min has MAP 54 mmHg,
CVP 12 mmHg, and ScvO₂ 65 %. Which inotropic agent is most appropriate to
add?
A. Dobutamine 5 mcg/kg/min
B. Vasopressin 0.04 units/min
C. Phenylephrine 100 mcg/min
D. Epinephrine 0.05 mcg/kg/min
Correct Answer: A
Rationale: Despite adequate filling (CVP 12) and vasoconstriction, ScvO₂ <70 %
indicates inadequate oxygen delivery—dobutamine’s beta-1 effect boosts cardiac output
and improves tissue perfusion. Vasopressin or phenylephrine increases MAP without
augmenting flow; epinephrine is acceptable but causes more tachycardia and lactate
elevation.
7. A client with adrenal insufficiency receives hydrocortisone 100 mg IV q8h. Which
laboratory finding best reflects adequate glucocorticoid replacement?
A. Morning cortisol 18 mcg/dL
B. Random glucose 140 mg/dL
C. Sodium 138 mEq/L
D. Lactate 1.2 mmol/L
Correct Answer: A
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 71-year-old post-CABG patient arrives in the CVICU with a right radial arterial
line. The nurse notes a damped waveform and the patient’s hand is cool with
mottled fingertips. Which action is most urgent?
A. Flush the arterial line with 5 mL of heparinized saline
B. Level the transducer to the phlebostatic axis
C. Remove the arterial catheter and assess perfusion
D. Recalibrate the transducer and zero the system
Correct Answer: C
Rationale: Damped waveform plus cool, mottled fingers suggests catheter-induced radial
artery occlusion or severe spasm jeopardizing hand perfusion. Prompt removal allows
reperfusion; delay risks permanent ischemia. Flushing or recalibration will not restore
flow, and leveling addresses accuracy—not damping from mechanical obstruction.
2. A client with ARDS is on APRV (P-high 28, P-low 0, T-high 4.5 s, T-low 0.6 s).
The spontaneous respiratory rate is 32/min and the patient appears agitated. Which
ventilator adjustment is most appropriate?
A. Increase T-high to 5.5 s
B. Decrease P-high to 24 cmH₂O
C. Increase T-low to 0.8 s
,D. Add propofol 20 mg IV bolus
Correct Answer: C
Rationale: Short T-low prevents complete lung emptying, raising auto-PEEP and causing
patient-ventilator dyssynchrony. Lengthening T-low slightly (0.6 → 0.8 s) allows more
release time, reduces auto-PEEP, and lowers respiratory drive without sacrificing mean
airway pressure. Increasing T-high or decreasing P-high would reduce ventilation;
sedation is adjunctive after mechanical optimization.
3. A client in DKA receives an insulin infusion at 0.14 units/kg/hr. After 3 h the
blood glucose drops from 520 to 380 mg/dL, but the bicarbonate remains 14
mEq/L. Which change is indicated?
A. Decrease insulin rate to 0.1 units/kg/hr
B. Add dextrose 5 % to the IV fluids
C. Continue current rate and recheck in 2 h
D. Increase insulin rate to 0.2 units/kg/hr
Correct Answer: C
Rationale: The goal is a glucose decline of 50–75 mg/dL/hr and closure of the anion gap;
the current rate is achieving adequate glucose fall while bicarbonate lags. Maintain the
infusion until the gap closes and bicarbonate ≥18 mEq/L, then add dextrose to prevent
hypoglycemia. Raising the rate risks hypoglycemia; lowering it may slow ketone
clearance.
4. A client with CKD stage 4 is admitted with hyperkalemia (K⁺ 6.3 mEq/L) and
peaked T waves. After calcium gluconate and insulin-dextrose, which additional
therapy provides the most sustained potassium reduction?
,A. Nebulized albuterol 20 mg
B. Sodium polystyrene sulfonate 30 g PO
C. Furosemide 80 mg IV
D. Emergent hemodialysis
Correct Answer: D
Rationale: While albuterol and kayexalate shift or bind potassium, the client with CKD
cannot excrete the ion—dialysis is definitive and sustained. Diuresis is ineffective in
oliguric renal failure. Therefore, arrange urgent dialysis after stabilization.
5. A client with a subarachnoid hemorrhage (WFNS grade 3) develops sudden onset
of left-sided weakness and a drop in Glasgow Coma Scale from 14 to 10. Which
complication is most likely?
A. Re-bleeding
B. Cerebral vasospasm
C. Hydrocephalus
D. Seizure with post-ictal state
Correct Answer: B
Rationale: New focal deficit and decreased level of consciousness between days 3–10
strongly suggest vasospasm causing delayed cerebral ischemia. Re-bleeding is usually
within 24 h; hydrocephalus presents with headache and bilateral slowing; seizures would
show tonic-clonic activity or EEG correlate. Urgent CT angiography and augmentation of
cerebral perfusion are indicated.
, 6. A client with septic shock on norepinephrine 0.3 mcg/kg/min has MAP 54 mmHg,
CVP 12 mmHg, and ScvO₂ 65 %. Which inotropic agent is most appropriate to
add?
A. Dobutamine 5 mcg/kg/min
B. Vasopressin 0.04 units/min
C. Phenylephrine 100 mcg/min
D. Epinephrine 0.05 mcg/kg/min
Correct Answer: A
Rationale: Despite adequate filling (CVP 12) and vasoconstriction, ScvO₂ <70 %
indicates inadequate oxygen delivery—dobutamine’s beta-1 effect boosts cardiac output
and improves tissue perfusion. Vasopressin or phenylephrine increases MAP without
augmenting flow; epinephrine is acceptable but causes more tachycardia and lactate
elevation.
7. A client with adrenal insufficiency receives hydrocortisone 100 mg IV q8h. Which
laboratory finding best reflects adequate glucocorticoid replacement?
A. Morning cortisol 18 mcg/dL
B. Random glucose 140 mg/dL
C. Sodium 138 mEq/L
D. Lactate 1.2 mmol/L
Correct Answer: A
