HESI Medical-Surgical Nursing Test | ACTUAL
EXAM | Complete Questions & Verified Answers |
Latest Comprehensive Exam
1.
A 68-year-old man is admitted with acute coronary syndrome. He reports chest pain that
radiates to his left arm and jaw. Which action should the nurse take first?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG within 10 minutes
C. Give aspirin 325 mg chewed
D. Start IV morphine for pain
Correct Answer: B. Obtain a 12-lead ECG within 10 minutes
Rationale: Current guidelines require a 12-lead ECG within 10 minutes of symptom
onset to identify STEMI and guide reperfusion therapy. While aspirin (C) and
nitroglycerin (A) are critical, they follow ECG acquisition. Morphine (D) is used if pain
persists after nitrates.
2.
A client with heart failure is prescribed furosemide 40 mg IV BID. Which laboratory value
requires immediate notification of the provider?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L
,C. Creatinine 1.1 mg/dL
D. Chloride 100 mEq/L
Correct Answer: B. Potassium 3.0 mEq/L
Rationale: Loop diuretics cause potassium wasting; levels <3.2 mEq/L increase the risk
of ventricular arrhythmias. Sodium (A) and chloride (D) are within normal limits.
Creatinine (C) is normal and does not require immediate action.
3.
A postoperative client suddenly becomes dyspneic and tachycardic. A blood gas shows
PaO₂ 52 mm Hg, PaCO₂ 30 mm Hg, and pH 7.49. Which condition is most likely?
A. Acute asthma exacerbation
B. Pulmonary embolism
C. Acute respiratory failure
D. Congestive heart failure
Correct Answer: B. Pulmonary embolism
Rationale: The combination of hypoxemia, respiratory alkalosis, and tachycardia is
classic for pulmonary embolism due to hyperventilation and V/Q mismatch. Asthma (A)
typically shows hypercarbia. Acute respiratory failure (C) requires PaO₂ <60 mm Hg with
normal or elevated PaCO₂. CHF (D) would show pulmonary edema and normal/low
PaCO₂.
4.
,A client with type 1 diabetes reports feeling shaky and sweaty. Blood glucose is 48
mg/dL. Which is the priority action?
A. Give 15 g simple carbohydrate
B. Administer 1 mg glucagon IM
C. Start D5W IV
D. Recheck glucose in 1 hour
Correct Answer: A. Give 15 g simple carbohydrate
Rationale: Conscious hypoglycemic clients should consume 15 g rapid-acting carbs (4
oz juice). Glucagon (B) is for unconscious patients. D5W (C) is used for persistent
hypoglycemia. Recheck (D) is done in 15 minutes, not 1 hour.
5.
A client receiving total parenteral nutrition (TPN) develops sudden fever, chills, and
glucose >400 mg/dL. Which complication is suspected?
A. Catheter-related bloodstream infection
B. Fatty liver infiltration
C. Refeeding syndrome
D. Hyperchloremic metabolic acidosis
Correct Answer: A. Catheter-related bloodstream infection
Rationale: Fever plus hyperglycemia suggests sepsis, often catheter-related, because
infection increases insulin resistance. Fatty liver (B) is gradual. Refeeding syndrome (C)
presents with hypophosphatemia. Acidosis (D) does not cause fever.
, 6.
A client with cirrhosis develops asterixis and a serum ammonia of 110 μmol/L. Which
dietary modification is most appropriate?
A. High-protein diet to promote healing
B. Moderate protein with vegetable and dairy sources
C. Low-sodium diet to prevent ascites
D. High-calorie diet with added branched-chain amino acids
Correct Answer: B. Moderate protein with vegetable and dairy sources
Rationale: Vegetable and dairy proteins generate less ammonia than animal proteins
and help prevent hepatic encephalopathy. High protein (A) worsens encephalopathy.
Low sodium (C) is for ascites but does not address ammonia. High calories (D) are
important but BCAA supplementation is adjunctive.
7.
A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa. Which
laboratory value best indicates a therapeutic response?
A. Hemoglobin increase of 2 g/dL within 4 weeks
B. Ferritin rise to 800 ng/mL
C. Platelet count doubling
D. Serum creatinine decrease by 0.3 mg/dL
Correct Answer: A. Hemoglobin increase of 2 g/dL within 4 weeks
EXAM | Complete Questions & Verified Answers |
Latest Comprehensive Exam
1.
A 68-year-old man is admitted with acute coronary syndrome. He reports chest pain that
radiates to his left arm and jaw. Which action should the nurse take first?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG within 10 minutes
C. Give aspirin 325 mg chewed
D. Start IV morphine for pain
Correct Answer: B. Obtain a 12-lead ECG within 10 minutes
Rationale: Current guidelines require a 12-lead ECG within 10 minutes of symptom
onset to identify STEMI and guide reperfusion therapy. While aspirin (C) and
nitroglycerin (A) are critical, they follow ECG acquisition. Morphine (D) is used if pain
persists after nitrates.
2.
A client with heart failure is prescribed furosemide 40 mg IV BID. Which laboratory value
requires immediate notification of the provider?
A. Sodium 138 mEq/L
B. Potassium 3.0 mEq/L
,C. Creatinine 1.1 mg/dL
D. Chloride 100 mEq/L
Correct Answer: B. Potassium 3.0 mEq/L
Rationale: Loop diuretics cause potassium wasting; levels <3.2 mEq/L increase the risk
of ventricular arrhythmias. Sodium (A) and chloride (D) are within normal limits.
Creatinine (C) is normal and does not require immediate action.
3.
A postoperative client suddenly becomes dyspneic and tachycardic. A blood gas shows
PaO₂ 52 mm Hg, PaCO₂ 30 mm Hg, and pH 7.49. Which condition is most likely?
A. Acute asthma exacerbation
B. Pulmonary embolism
C. Acute respiratory failure
D. Congestive heart failure
Correct Answer: B. Pulmonary embolism
Rationale: The combination of hypoxemia, respiratory alkalosis, and tachycardia is
classic for pulmonary embolism due to hyperventilation and V/Q mismatch. Asthma (A)
typically shows hypercarbia. Acute respiratory failure (C) requires PaO₂ <60 mm Hg with
normal or elevated PaCO₂. CHF (D) would show pulmonary edema and normal/low
PaCO₂.
4.
,A client with type 1 diabetes reports feeling shaky and sweaty. Blood glucose is 48
mg/dL. Which is the priority action?
A. Give 15 g simple carbohydrate
B. Administer 1 mg glucagon IM
C. Start D5W IV
D. Recheck glucose in 1 hour
Correct Answer: A. Give 15 g simple carbohydrate
Rationale: Conscious hypoglycemic clients should consume 15 g rapid-acting carbs (4
oz juice). Glucagon (B) is for unconscious patients. D5W (C) is used for persistent
hypoglycemia. Recheck (D) is done in 15 minutes, not 1 hour.
5.
A client receiving total parenteral nutrition (TPN) develops sudden fever, chills, and
glucose >400 mg/dL. Which complication is suspected?
A. Catheter-related bloodstream infection
B. Fatty liver infiltration
C. Refeeding syndrome
D. Hyperchloremic metabolic acidosis
Correct Answer: A. Catheter-related bloodstream infection
Rationale: Fever plus hyperglycemia suggests sepsis, often catheter-related, because
infection increases insulin resistance. Fatty liver (B) is gradual. Refeeding syndrome (C)
presents with hypophosphatemia. Acidosis (D) does not cause fever.
, 6.
A client with cirrhosis develops asterixis and a serum ammonia of 110 μmol/L. Which
dietary modification is most appropriate?
A. High-protein diet to promote healing
B. Moderate protein with vegetable and dairy sources
C. Low-sodium diet to prevent ascites
D. High-calorie diet with added branched-chain amino acids
Correct Answer: B. Moderate protein with vegetable and dairy sources
Rationale: Vegetable and dairy proteins generate less ammonia than animal proteins
and help prevent hepatic encephalopathy. High protein (A) worsens encephalopathy.
Low sodium (C) is for ascites but does not address ammonia. High calories (D) are
important but BCAA supplementation is adjunctive.
7.
A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa. Which
laboratory value best indicates a therapeutic response?
A. Hemoglobin increase of 2 g/dL within 4 weeks
B. Ferritin rise to 800 ng/mL
C. Platelet count doubling
D. Serum creatinine decrease by 0.3 mg/dL
Correct Answer: A. Hemoglobin increase of 2 g/dL within 4 weeks
