HESI MED-SURG EXAM QUESTIONS AND ANSWERS 2026/2027 | 150
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Question 1:
A 68-year-old male is admitted with acute decompensated heart failure (ADHF)
secondary to left ventricular systolic dysfunction. His vital signs are: BP 92/64 mmHg,
HR 118 bpm (irregularly irregular), RR 28/min, SpO₂ 88% on room air. He has 3+ pitting
edema in bilateral lower extremities, crackles auscultated in bilateral lung bases, and
reports severe dyspnea. Which intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Apply supplemental oxygen via non-rebreather mask
C. Insert indwelling urinary catheter
D. Obtain 12-lead ECG
Correct Answer: B
Rationale:
Option A: While furosemide is indicated for fluid overload in ADHF, diuretic
administration is not the priority when the patient is experiencing acute hypoxemia
(SpO₂ 88%). Additionally, the patient is hypotensive (BP 92/64), and aggressive diuresis
could worsen perfusion. This intervention follows oxygenation and hemodynamic
stabilization.
Option B: [CORRECT] The patient is severely hypoxemic (SpO₂ 88%) with signs of
pulmonary edema (crackles, dyspnea). Applying high-flow oxygen via non-rebreather
,mask addresses the immediate life-threatening problem of hypoxia, following the ABC
priority framework. Oxygenation must be established before other interventions. The 15
L/min flow rate and reservoir bag deliver the highest possible FiO₂ (approximately
90-100%) for acute respiratory distress.
Option C: Urinary catheterization facilitates accurate intake/output monitoring and
prevents skin breakdown from diuresis, but it is not an immediate priority when the
patient is hypoxic and in respiratory distress. This is a secondary intervention following
stabilization.
Option D: While the irregularly irregular rhythm warrants ECG evaluation (likely atrial
fibrillation), obtaining a 12-lead ECG does not address the immediate oxygenation
deficit. The ECG can be obtained after initial stabilization and oxygen administration.
Question 2 (SATA):
A nurse is caring for a client with type 1 diabetes mellitus who is admitted with diabetic
ketoacidosis (DKA). Which assessment findings support this diagnosis? Select all that
apply.
A. Blood glucose 485 mg/dL
B. Arterial blood gas pH 7.28
C. Serum bicarbonate 28 mEq/L
D. Urine positive for ketones
E. Kussmaul respirations
F. Serum potassium 5.8 mEq/L
Correct Answer: A, B, D, E, F
,Rationale:
Option A: [CORRECT] Blood glucose >250 mg/dL is a diagnostic criterion for DKA. The
severe hyperglycemia (485 mg/dL) results from absolute insulin deficiency, leading to
cellular starvation and counter-regulatory hormone release.
Option B: [CORRECT] Metabolic acidosis with pH <7.30 is diagnostic for DKA. The pH of
7.28 reflects accumulation of ketoacids and lactic acid from altered metabolism.
Option C: Incorrect. Serum bicarbonate is typically decreased (<18 mEq/L) in DKA due
to buffering of metabolic acids. A level of 28 mEq/L is elevated and inconsistent with
DKA; this value suggests metabolic alkalosis or compensated acidosis.
Option D: [CORRECT] Ketonuria is pathognomonic for DKA. Ketones
(beta-hydroxybutyrate, acetoacetate, acetone) are produced when fatty acids are
metabolized for energy in the absence of insulin.
Option E: [CORRECT] Kussmaul respirations (deep, rapid, labored breathing) represent
respiratory compensation for metabolic acidosis. The body attempts to blow off CO₂ to
raise pH.
Option F: [CORRECT] Hyperkalemia (5.8 mEq/L) occurs in DKA despite total body
potassium depletion. Acidosis drives potassium extracellularly, and insulin deficiency
prevents cellular uptake. However, potassium levels drop rapidly with insulin therapy,
requiring careful monitoring.
Question 3:
A client with chronic obstructive pulmonary disease (COPD) is prescribed home oxygen
therapy at 2 L/min via nasal cannula. The client asks, "Why can't I turn up the oxygen
when I feel short of breath?" Which response by the nurse demonstrates the best
understanding of COPD pathophysiology?
, A. "Higher oxygen levels will make you feel more energetic and less short of breath"
B. "Your breathing is triggered by low oxygen levels rather than high carbon dioxide
levels"
C. "High oxygen concentrations can suppress your breathing drive and cause carbon
dioxide retention"
D. "The insurance company only covers oxygen at 2 liters per minute"
Correct Answer: C
Rationale:
Option A: This statement is dangerous and incorrect. Higher oxygen levels in COPD
patients do not improve energy and can precipitate respiratory failure. The nurse must
provide accurate physiological education, not false reassurance.
Option B: This describes the hypoxic drive theory but is incomplete and potentially
misleading. While some COPD patients do rely partially on hypoxic drive, the primary
concern with high-flow oxygen is the reversal of hypoxic pulmonary vasoconstriction
leading to V/Q mismatch and CO₂ retention, not merely drive suppression.
Option C: [CORRECT] This accurately explains the primary risk of uncontrolled oxygen
therapy in COPD. High oxygen concentrations (typically >28-30% or >2-3 L/min) can: (1)
suppress the hypoxic ventilatory drive in the minority of patients who retain CO₂, (2)
reverse hypoxic pulmonary vasoconstriction, causing increased perfusion to poorly
ventilated alveoli (V/Q mismatch), and (3) cause absorption atelectasis. The Haldane
effect (oxygen displacing CO₂ from hemoglobin) also contributes to CO₂ retention. The
target SpO₂ for COPD patients is typically 88-92%.
Q&A | Graded A+ | Latest Update | NCLEX-RN Aligned | Pass
Guaranteed - A+ Graded
Question 1:
A 68-year-old male is admitted with acute decompensated heart failure (ADHF)
secondary to left ventricular systolic dysfunction. His vital signs are: BP 92/64 mmHg,
HR 118 bpm (irregularly irregular), RR 28/min, SpO₂ 88% on room air. He has 3+ pitting
edema in bilateral lower extremities, crackles auscultated in bilateral lung bases, and
reports severe dyspnea. Which intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Apply supplemental oxygen via non-rebreather mask
C. Insert indwelling urinary catheter
D. Obtain 12-lead ECG
Correct Answer: B
Rationale:
Option A: While furosemide is indicated for fluid overload in ADHF, diuretic
administration is not the priority when the patient is experiencing acute hypoxemia
(SpO₂ 88%). Additionally, the patient is hypotensive (BP 92/64), and aggressive diuresis
could worsen perfusion. This intervention follows oxygenation and hemodynamic
stabilization.
Option B: [CORRECT] The patient is severely hypoxemic (SpO₂ 88%) with signs of
pulmonary edema (crackles, dyspnea). Applying high-flow oxygen via non-rebreather
,mask addresses the immediate life-threatening problem of hypoxia, following the ABC
priority framework. Oxygenation must be established before other interventions. The 15
L/min flow rate and reservoir bag deliver the highest possible FiO₂ (approximately
90-100%) for acute respiratory distress.
Option C: Urinary catheterization facilitates accurate intake/output monitoring and
prevents skin breakdown from diuresis, but it is not an immediate priority when the
patient is hypoxic and in respiratory distress. This is a secondary intervention following
stabilization.
Option D: While the irregularly irregular rhythm warrants ECG evaluation (likely atrial
fibrillation), obtaining a 12-lead ECG does not address the immediate oxygenation
deficit. The ECG can be obtained after initial stabilization and oxygen administration.
Question 2 (SATA):
A nurse is caring for a client with type 1 diabetes mellitus who is admitted with diabetic
ketoacidosis (DKA). Which assessment findings support this diagnosis? Select all that
apply.
A. Blood glucose 485 mg/dL
B. Arterial blood gas pH 7.28
C. Serum bicarbonate 28 mEq/L
D. Urine positive for ketones
E. Kussmaul respirations
F. Serum potassium 5.8 mEq/L
Correct Answer: A, B, D, E, F
,Rationale:
Option A: [CORRECT] Blood glucose >250 mg/dL is a diagnostic criterion for DKA. The
severe hyperglycemia (485 mg/dL) results from absolute insulin deficiency, leading to
cellular starvation and counter-regulatory hormone release.
Option B: [CORRECT] Metabolic acidosis with pH <7.30 is diagnostic for DKA. The pH of
7.28 reflects accumulation of ketoacids and lactic acid from altered metabolism.
Option C: Incorrect. Serum bicarbonate is typically decreased (<18 mEq/L) in DKA due
to buffering of metabolic acids. A level of 28 mEq/L is elevated and inconsistent with
DKA; this value suggests metabolic alkalosis or compensated acidosis.
Option D: [CORRECT] Ketonuria is pathognomonic for DKA. Ketones
(beta-hydroxybutyrate, acetoacetate, acetone) are produced when fatty acids are
metabolized for energy in the absence of insulin.
Option E: [CORRECT] Kussmaul respirations (deep, rapid, labored breathing) represent
respiratory compensation for metabolic acidosis. The body attempts to blow off CO₂ to
raise pH.
Option F: [CORRECT] Hyperkalemia (5.8 mEq/L) occurs in DKA despite total body
potassium depletion. Acidosis drives potassium extracellularly, and insulin deficiency
prevents cellular uptake. However, potassium levels drop rapidly with insulin therapy,
requiring careful monitoring.
Question 3:
A client with chronic obstructive pulmonary disease (COPD) is prescribed home oxygen
therapy at 2 L/min via nasal cannula. The client asks, "Why can't I turn up the oxygen
when I feel short of breath?" Which response by the nurse demonstrates the best
understanding of COPD pathophysiology?
, A. "Higher oxygen levels will make you feel more energetic and less short of breath"
B. "Your breathing is triggered by low oxygen levels rather than high carbon dioxide
levels"
C. "High oxygen concentrations can suppress your breathing drive and cause carbon
dioxide retention"
D. "The insurance company only covers oxygen at 2 liters per minute"
Correct Answer: C
Rationale:
Option A: This statement is dangerous and incorrect. Higher oxygen levels in COPD
patients do not improve energy and can precipitate respiratory failure. The nurse must
provide accurate physiological education, not false reassurance.
Option B: This describes the hypoxic drive theory but is incomplete and potentially
misleading. While some COPD patients do rely partially on hypoxic drive, the primary
concern with high-flow oxygen is the reversal of hypoxic pulmonary vasoconstriction
leading to V/Q mismatch and CO₂ retention, not merely drive suppression.
Option C: [CORRECT] This accurately explains the primary risk of uncontrolled oxygen
therapy in COPD. High oxygen concentrations (typically >28-30% or >2-3 L/min) can: (1)
suppress the hypoxic ventilatory drive in the minority of patients who retain CO₂, (2)
reverse hypoxic pulmonary vasoconstriction, causing increased perfusion to poorly
ventilated alveoli (V/Q mismatch), and (3) cause absorption atelectasis. The Haldane
effect (oxygen displacing CO₂ from hemoglobin) also contributes to CO₂ retention. The
target SpO₂ for COPD patients is typically 88-92%.
