Level 3 Med-Surg HESI | 2026/2027 Final Exam
Study Guide – Accurate, Exam-Focused Q&A
This study guide prepares students for the Level 3 Med-Surg HESI exam, with focused
questions and answers tailored to exam success in medical-surgical nursing.
Key Words: Med-Surg, HESI, Final Exam, Study Guide, Nursing
Section 1: Cardiovascular & Hematology (Questions 1-20)
1. A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which finding
indicates the medication is effective?
a) Increased urine specific gravity
b) A 2 kg weight loss over 24 hours ✓
c) Heart rate of 110 bpm
d) Respiratory rate of 28 breaths/min
Rationale: Furosemide is a loop diuretic. The primary therapeutic outcome in heart failure is
reduced fluid overload, evidenced by decreased weight (fluid loss).
2. When assessing a client with a suspected myocardial infarction (MI), which symptom is
most commonly reported by female clients?
a) Crushing substernal chest pain
b) Fatigue, shortness of breath, and nausea ✓
c) Left arm radicular pain
d) Syncope
Rationale: Women often present with "atypical" symptoms such as unusual fatigue, dyspnea,
indigestion, and back or jaw pain, rather than classic chest pain.
3. A client with atrial fibrillation is started on warfarin. The nurse understands the goal of
therapy is to achieve an INR within what range?
a) 1.0 - 1.5
b) 2.0 - 3.0 ✓
c) 3.5 - 4.5
,d) > 5.0
*Rationale: For most conditions like atrial fibrillation, the target therapeutic INR for warfarin is
2.0-3.0 to prevent clot formation while minimizing bleeding risk.*
4. The nurse is caring for a client with a new permanent pacemaker. Which instruction is a
priority for discharge teaching?
a) "You can resume using a microwave oven immediately."
b) "Avoid lifting the arm on the pacemaker side above the shoulder for 2 weeks." ✓
c) "Cell phone use must be held to the ear on the pacemaker side."
d) "Airport security gates will not affect the device."
Rationale: This prevents dislodgement of the newly placed lead wire while scar tissue forms.
Other options are incorrect—microwaves are safe, phones should be used on the opposite ear,
and metal detectors should be avoided (walk through, don't linger).
5. A client with deep vein thrombosis (DVT) is on a heparin infusion. Which laboratory value is
critical to monitor?
a) Prothrombin Time (PT)
b) Activated Partial Thromboplastin Time (aPTT) ✓
c) International Normalized Ratio (INR)
d) Platelet count
Rationale: aPTT measures the effectiveness of unfractionated heparin. INR monitors warfarin.
Platelet count is monitored for Heparin-Induced Thrombocytopenia (HIT).
6. A client's cardiac monitor shows a rhythm with no discernible P waves, an irregularly
irregular rhythm, and a variable ventricular rate of 110-150 bpm. This is interpreted as:
a) Sinus tachycardia
b) Ventricular tachycardia
c) Atrial fibrillation with rapid ventricular response ✓
d) Third-degree heart block
Rationale: The hallmark of atrial fibrillation is an irregularly irregular rhythm with no distinct P
waves.
7. The nurse is preparing to administer digoxin 0.125 mg PO. Before administration, the nurse
assesses the apical pulse and finds it to be 52 beats/min. What is the nurse's priority action?
a) Administer the dose as ordered.
b) Withhold the dose and notify the healthcare provider. ✓
c) Recheck the pulse in 30 minutes.
d) Administer the dose with a full glass of water.
Rationale: Digoxin should be withheld and the provider notified for a heart rate below 60 bpm in
an adult due to the risk of exacerbating bradycardia and digoxin toxicity.
,8. Which finding in a client with chronic hypertension requires immediate intervention?
a) Blood pressure of 150/92 mmHg
b) Report of a mild, persistent headache
c) Blood pressure of 210/118 mmHg with confusion ✓
d) +1 pedal edema bilaterally
Rationale: This is a hypertensive emergency (evidence of end-organ damage—confusion). It
requires rapid, controlled lowering of BP to prevent further damage.
9. A client with peripheral arterial disease (PAD) asks about exercise. The nurse's best
recommendation is:
a) "Elevate your legs above your heart when resting."
b) "Walk until you have pain, rest, and then walk again." ✓
c) "Avoid walking to prevent pain and injury."
d) "Engage in high-impact aerobics."
Rationale: For PAD, a structured walking program (start-walk to pain-rest-resume) improves
collateral circulation. Elevation worsens arterial flow.
10. Which laboratory result is most indicative of iron-deficiency anemia?
a) Elevated ferritin
b) Decreased serum iron and elevated TIBC ✓
c) Increased RBC count
d) Elevated Vitamin B12 level
Rationale: In iron-deficiency anemia, serum iron is low, and Total Iron-Binding Capacity (TIBC) is
high as the body tries to transport more available iron.
Section 2: Respiratory (Questions 11-30)
11. A client with COPD is receiving 2 L/min of oxygen via nasal cannula. The client becomes
somnolent and their respiratory rate decreases to 8 breaths/min. The nurse suspects:
a) Hypoxemia
b) Oxygen-induced hypoventilation ✓
c) Pneumothorax
d) Pulmonary embolism
Rationale: In clients with chronic CO2 retention (e.g., COPD), high oxygen levels can decrease the
hypoxic drive to breathe, leading to hypoventilation and CO2 narcosis.
12. Which intervention is most appropriate for a client experiencing an acute asthma attack?
a) Encourage slow, pursed-lip breathing.
, b) Administer a short-acting beta-agonist (albuterol) via nebulizer. ✓
c) Administer IV corticosteroids immediately.
d) Place in a low Fowler's position.
*Rationale: The first-line treatment for acute bronchospasm in asthma is a rapid-acting inhaled
beta-2 agonist to promote bronchodilation.*
13. The nurse is teaching a client with tuberculosis (TB). Which statement by the client
indicates understanding?
a) "I can stop the medication once my symptoms are gone."
b) "My family should start prophylaxis medication."
c) "I must cover my mouth when coughing and dispose of tissues in a closed bag." ✓
d) "I am no longer contagious after 2 weeks of medication."
*Rationale: Strict respiratory isolation precautions (covering mouth, proper disposal) are
required until sputum smears are negative. Treatment is for 6+ months. Family may need
testing/prophylaxis, but not automatically medication.*
14. A client with a chest tube has continuous bubbling in the water seal chamber. The nurse's
initial action is to:
a) Clamp the chest tube.
b) Increase the suction pressure.
c) Check for an air leak in the system. ✓
d) Prepare for a chest x-ray.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which could be
in the system connections or the client's lung. The nurse should assess the system first. Clamping
is dangerous unless ordered for a specific leak check.
15. Which arterial blood gas (ABG) result indicates uncompensated respiratory acidosis?
a) pH 7.35, PaCO2 48 mmHg, HCO3- 26 mEq/L
b) pH 7.28, PaCO2 55 mmHg, HCO3- 24 mEq/L ✓
c) pH 7.48, PaCO2 30 mmHg, HCO3- 24 mEq/L
d) pH 7.32, PaCO2 40 mmHg, HCO3- 18 mEq/L
*Rationale: Uncompensated respiratory acidosis: low pH, high PaCO2 (primary problem),
normal HCO3- (no metabolic compensation yet).*
16. The nurse is assessing a client 24 hours post-lobectomy. Which finding requires immediate
action?
a) Pain at the incision site rated 5/10
b) Serous drainage on the dressing
c) Subcutaneous emphysema around the incision that is increasing ✓
Study Guide – Accurate, Exam-Focused Q&A
This study guide prepares students for the Level 3 Med-Surg HESI exam, with focused
questions and answers tailored to exam success in medical-surgical nursing.
Key Words: Med-Surg, HESI, Final Exam, Study Guide, Nursing
Section 1: Cardiovascular & Hematology (Questions 1-20)
1. A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which finding
indicates the medication is effective?
a) Increased urine specific gravity
b) A 2 kg weight loss over 24 hours ✓
c) Heart rate of 110 bpm
d) Respiratory rate of 28 breaths/min
Rationale: Furosemide is a loop diuretic. The primary therapeutic outcome in heart failure is
reduced fluid overload, evidenced by decreased weight (fluid loss).
2. When assessing a client with a suspected myocardial infarction (MI), which symptom is
most commonly reported by female clients?
a) Crushing substernal chest pain
b) Fatigue, shortness of breath, and nausea ✓
c) Left arm radicular pain
d) Syncope
Rationale: Women often present with "atypical" symptoms such as unusual fatigue, dyspnea,
indigestion, and back or jaw pain, rather than classic chest pain.
3. A client with atrial fibrillation is started on warfarin. The nurse understands the goal of
therapy is to achieve an INR within what range?
a) 1.0 - 1.5
b) 2.0 - 3.0 ✓
c) 3.5 - 4.5
,d) > 5.0
*Rationale: For most conditions like atrial fibrillation, the target therapeutic INR for warfarin is
2.0-3.0 to prevent clot formation while minimizing bleeding risk.*
4. The nurse is caring for a client with a new permanent pacemaker. Which instruction is a
priority for discharge teaching?
a) "You can resume using a microwave oven immediately."
b) "Avoid lifting the arm on the pacemaker side above the shoulder for 2 weeks." ✓
c) "Cell phone use must be held to the ear on the pacemaker side."
d) "Airport security gates will not affect the device."
Rationale: This prevents dislodgement of the newly placed lead wire while scar tissue forms.
Other options are incorrect—microwaves are safe, phones should be used on the opposite ear,
and metal detectors should be avoided (walk through, don't linger).
5. A client with deep vein thrombosis (DVT) is on a heparin infusion. Which laboratory value is
critical to monitor?
a) Prothrombin Time (PT)
b) Activated Partial Thromboplastin Time (aPTT) ✓
c) International Normalized Ratio (INR)
d) Platelet count
Rationale: aPTT measures the effectiveness of unfractionated heparin. INR monitors warfarin.
Platelet count is monitored for Heparin-Induced Thrombocytopenia (HIT).
6. A client's cardiac monitor shows a rhythm with no discernible P waves, an irregularly
irregular rhythm, and a variable ventricular rate of 110-150 bpm. This is interpreted as:
a) Sinus tachycardia
b) Ventricular tachycardia
c) Atrial fibrillation with rapid ventricular response ✓
d) Third-degree heart block
Rationale: The hallmark of atrial fibrillation is an irregularly irregular rhythm with no distinct P
waves.
7. The nurse is preparing to administer digoxin 0.125 mg PO. Before administration, the nurse
assesses the apical pulse and finds it to be 52 beats/min. What is the nurse's priority action?
a) Administer the dose as ordered.
b) Withhold the dose and notify the healthcare provider. ✓
c) Recheck the pulse in 30 minutes.
d) Administer the dose with a full glass of water.
Rationale: Digoxin should be withheld and the provider notified for a heart rate below 60 bpm in
an adult due to the risk of exacerbating bradycardia and digoxin toxicity.
,8. Which finding in a client with chronic hypertension requires immediate intervention?
a) Blood pressure of 150/92 mmHg
b) Report of a mild, persistent headache
c) Blood pressure of 210/118 mmHg with confusion ✓
d) +1 pedal edema bilaterally
Rationale: This is a hypertensive emergency (evidence of end-organ damage—confusion). It
requires rapid, controlled lowering of BP to prevent further damage.
9. A client with peripheral arterial disease (PAD) asks about exercise. The nurse's best
recommendation is:
a) "Elevate your legs above your heart when resting."
b) "Walk until you have pain, rest, and then walk again." ✓
c) "Avoid walking to prevent pain and injury."
d) "Engage in high-impact aerobics."
Rationale: For PAD, a structured walking program (start-walk to pain-rest-resume) improves
collateral circulation. Elevation worsens arterial flow.
10. Which laboratory result is most indicative of iron-deficiency anemia?
a) Elevated ferritin
b) Decreased serum iron and elevated TIBC ✓
c) Increased RBC count
d) Elevated Vitamin B12 level
Rationale: In iron-deficiency anemia, serum iron is low, and Total Iron-Binding Capacity (TIBC) is
high as the body tries to transport more available iron.
Section 2: Respiratory (Questions 11-30)
11. A client with COPD is receiving 2 L/min of oxygen via nasal cannula. The client becomes
somnolent and their respiratory rate decreases to 8 breaths/min. The nurse suspects:
a) Hypoxemia
b) Oxygen-induced hypoventilation ✓
c) Pneumothorax
d) Pulmonary embolism
Rationale: In clients with chronic CO2 retention (e.g., COPD), high oxygen levels can decrease the
hypoxic drive to breathe, leading to hypoventilation and CO2 narcosis.
12. Which intervention is most appropriate for a client experiencing an acute asthma attack?
a) Encourage slow, pursed-lip breathing.
, b) Administer a short-acting beta-agonist (albuterol) via nebulizer. ✓
c) Administer IV corticosteroids immediately.
d) Place in a low Fowler's position.
*Rationale: The first-line treatment for acute bronchospasm in asthma is a rapid-acting inhaled
beta-2 agonist to promote bronchodilation.*
13. The nurse is teaching a client with tuberculosis (TB). Which statement by the client
indicates understanding?
a) "I can stop the medication once my symptoms are gone."
b) "My family should start prophylaxis medication."
c) "I must cover my mouth when coughing and dispose of tissues in a closed bag." ✓
d) "I am no longer contagious after 2 weeks of medication."
*Rationale: Strict respiratory isolation precautions (covering mouth, proper disposal) are
required until sputum smears are negative. Treatment is for 6+ months. Family may need
testing/prophylaxis, but not automatically medication.*
14. A client with a chest tube has continuous bubbling in the water seal chamber. The nurse's
initial action is to:
a) Clamp the chest tube.
b) Increase the suction pressure.
c) Check for an air leak in the system. ✓
d) Prepare for a chest x-ray.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which could be
in the system connections or the client's lung. The nurse should assess the system first. Clamping
is dangerous unless ordered for a specific leak check.
15. Which arterial blood gas (ABG) result indicates uncompensated respiratory acidosis?
a) pH 7.35, PaCO2 48 mmHg, HCO3- 26 mEq/L
b) pH 7.28, PaCO2 55 mmHg, HCO3- 24 mEq/L ✓
c) pH 7.48, PaCO2 30 mmHg, HCO3- 24 mEq/L
d) pH 7.32, PaCO2 40 mmHg, HCO3- 18 mEq/L
*Rationale: Uncompensated respiratory acidosis: low pH, high PaCO2 (primary problem),
normal HCO3- (no metabolic compensation yet).*
16. The nurse is assessing a client 24 hours post-lobectomy. Which finding requires immediate
action?
a) Pain at the incision site rated 5/10
b) Serous drainage on the dressing
c) Subcutaneous emphysema around the incision that is increasing ✓
