NSG 223 MED SURG 2 HESI FINAL EXAM –
COMPREHENSIVE TEST BANK Herzing
University | 2026/2027 Updated | 200+
Questions with Correct Answers & Rationales
1. A client with heart failure has an ejection fraction of 25%. Which medication is first-line to
reduce mortality?
A) Furosemide
B) *Metoprolol succinate
C) Digoxin
D) Hydralazine
Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF.
2. A client with COPD has a new prescription for home oxygen. Which instruction is most
important?
A) Clean the nasal cannula weekly with soap
B) *Do not smoke or allow anyone to smoke near the oxygen
C) Keep oxygen cylinders lying flat on the floor
D) Adjust the flow rate based on activity level
Answer: B
Rationale: Oxygen supports combustion; smoking is a fire hazard.
3. A client with CKD has a potassium level of 6.2 mEq/L. Which ECG change does the nurse expect?
A) Hyporeflexia
B) *Peaked T waves
C) Prolonged PR interval
,D) Flaccid paralysis
Answer: B
Rationale: Hyperkalemia causes peaked T waves, then wide QRS, and eventually sine wave.
4. A client with DKA has a blood glucose of 350 mg/dL, urine ketones large, and Kussmaul
respirations. Which intervention first?
A) Administer regular insulin IV
B) *Start an IV line with normal saline
C) Apply oxygen via nasal cannula
D) Notify the provider
Answer: B
Rationale: Fluid resuscitation is first to correct dehydration and improve perfusion.
5. A client 2 days post-op after bowel resection reports sudden chest pain and dyspnea. SpO2 88%.
What is priority?
A) Apply oxygen at 2 L/min via nasal cannula
B) *Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer aspirin 325 mg
D) Prepare for a stat chest X-ray
Answer: B
Rationale: Suspected PE requires immediate high-flow oxygen and positioning.
6. A client with cirrhosis has ascites. Paracentesis fluid shows WBC 500/mm³ and cloudy. What is
this?
A) Clear, straw-colored fluid
B) *Spontaneous bacterial peritonitis (SBP)
C) Albumin level 2.5 g/dL
D) Protein level 1.0 g/dL
2
,Answer: B
Rationale: PMN count >250/mm³ suggests SBP.
7. A client with stroke has left-sided neglect. Which nursing intervention is most appropriate?
A) Place all personal items on the client's right side
B) *Approach the client from the left side and remind to scan to the left
C) Restrain the right arm to encourage use of the left arm
D) Keep the room dark and quiet
Answer: B
Rationale: Encourage attention to the neglected side with verbal cues.
8. A client with pneumonia has fever 39°C and pleuritic chest pain. Which first?
A) Administer acetaminophen as ordered
B) *Position in semi-Fowler's and encourage deep breathing
C) Apply a cold compress to the forehead
D) Notify the provider of the fever
Answer: B
Rationale: Positioning optimizes ventilation; deep breathing helps expand lungs.
9. A client with Graves' disease is prescribed PTU. Which adverse effect requires immediate
discontinuation?
A) Mild rash
B) *Agranulocytosis (fever, sore throat)
C) Weight gain
D) Diarrhea
Answer: B
Rationale: PTU can cause agranulocytosis; any fever or sore throat warrants CBC.
3
, 10. A client with recent MI develops crackles, S3 gallop, and SpO2 90%. Which complication?
A) Cardiogenic shock
B) *Acute heart failure (pulmonary edema)
C) Pericarditis
D) Recurrent infarction
Answer: B
Rationale: Crackles, S3, and hypoxemia indicate left ventricular failure.
11. A client with CKD on hemodialysis has an AV fistula in left arm. Which finding requires
immediate action?
A) Palpable thrill and audible bruit
B) *Absence of thrill and bruit with arm swelling
C) Mild erythema at the needle site
D) Small hematoma at the access site
Answer: B
Rationale: Loss of thrill/bruit suggests thrombosis; notify provider immediately.
12. A client with head injury has a GCS of 8. Which action first?
A) Notify the neurosurgeon
B) *Assess the client's airway and breathing
C) Prepare for a CT scan
D) Administer mannitol as ordered
Answer: B
Rationale: GCS ≤8 indicates severe brain injury; airway protection is priority.
13. A client with type 2 diabetes is prescribed metformin. Which condition is a contraindication?
A) Hypertension
4
COMPREHENSIVE TEST BANK Herzing
University | 2026/2027 Updated | 200+
Questions with Correct Answers & Rationales
1. A client with heart failure has an ejection fraction of 25%. Which medication is first-line to
reduce mortality?
A) Furosemide
B) *Metoprolol succinate
C) Digoxin
D) Hydralazine
Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF.
2. A client with COPD has a new prescription for home oxygen. Which instruction is most
important?
A) Clean the nasal cannula weekly with soap
B) *Do not smoke or allow anyone to smoke near the oxygen
C) Keep oxygen cylinders lying flat on the floor
D) Adjust the flow rate based on activity level
Answer: B
Rationale: Oxygen supports combustion; smoking is a fire hazard.
3. A client with CKD has a potassium level of 6.2 mEq/L. Which ECG change does the nurse expect?
A) Hyporeflexia
B) *Peaked T waves
C) Prolonged PR interval
,D) Flaccid paralysis
Answer: B
Rationale: Hyperkalemia causes peaked T waves, then wide QRS, and eventually sine wave.
4. A client with DKA has a blood glucose of 350 mg/dL, urine ketones large, and Kussmaul
respirations. Which intervention first?
A) Administer regular insulin IV
B) *Start an IV line with normal saline
C) Apply oxygen via nasal cannula
D) Notify the provider
Answer: B
Rationale: Fluid resuscitation is first to correct dehydration and improve perfusion.
5. A client 2 days post-op after bowel resection reports sudden chest pain and dyspnea. SpO2 88%.
What is priority?
A) Apply oxygen at 2 L/min via nasal cannula
B) *Elevate the head of the bed and apply oxygen at 10 L/min via non-rebreather
C) Administer aspirin 325 mg
D) Prepare for a stat chest X-ray
Answer: B
Rationale: Suspected PE requires immediate high-flow oxygen and positioning.
6. A client with cirrhosis has ascites. Paracentesis fluid shows WBC 500/mm³ and cloudy. What is
this?
A) Clear, straw-colored fluid
B) *Spontaneous bacterial peritonitis (SBP)
C) Albumin level 2.5 g/dL
D) Protein level 1.0 g/dL
2
,Answer: B
Rationale: PMN count >250/mm³ suggests SBP.
7. A client with stroke has left-sided neglect. Which nursing intervention is most appropriate?
A) Place all personal items on the client's right side
B) *Approach the client from the left side and remind to scan to the left
C) Restrain the right arm to encourage use of the left arm
D) Keep the room dark and quiet
Answer: B
Rationale: Encourage attention to the neglected side with verbal cues.
8. A client with pneumonia has fever 39°C and pleuritic chest pain. Which first?
A) Administer acetaminophen as ordered
B) *Position in semi-Fowler's and encourage deep breathing
C) Apply a cold compress to the forehead
D) Notify the provider of the fever
Answer: B
Rationale: Positioning optimizes ventilation; deep breathing helps expand lungs.
9. A client with Graves' disease is prescribed PTU. Which adverse effect requires immediate
discontinuation?
A) Mild rash
B) *Agranulocytosis (fever, sore throat)
C) Weight gain
D) Diarrhea
Answer: B
Rationale: PTU can cause agranulocytosis; any fever or sore throat warrants CBC.
3
, 10. A client with recent MI develops crackles, S3 gallop, and SpO2 90%. Which complication?
A) Cardiogenic shock
B) *Acute heart failure (pulmonary edema)
C) Pericarditis
D) Recurrent infarction
Answer: B
Rationale: Crackles, S3, and hypoxemia indicate left ventricular failure.
11. A client with CKD on hemodialysis has an AV fistula in left arm. Which finding requires
immediate action?
A) Palpable thrill and audible bruit
B) *Absence of thrill and bruit with arm swelling
C) Mild erythema at the needle site
D) Small hematoma at the access site
Answer: B
Rationale: Loss of thrill/bruit suggests thrombosis; notify provider immediately.
12. A client with head injury has a GCS of 8. Which action first?
A) Notify the neurosurgeon
B) *Assess the client's airway and breathing
C) Prepare for a CT scan
D) Administer mannitol as ordered
Answer: B
Rationale: GCS ≤8 indicates severe brain injury; airway protection is priority.
13. A client with type 2 diabetes is prescribed metformin. Which condition is a contraindication?
A) Hypertension
4
