HESI MED SURG COMPLETE EXIT EXAM PACKAGE 2026/2027 |
Versions 1-5 | 275 Q&A | AGRADE Rationales | HESI Blueprint Aligned
| Pass Guaranteed - A+ Graded
[VERSION 1: HESI Med-Surg Exit Exam – 55 Questions]
[Foundation Level | Cardiovascular & Respiratory Focus | Basic Clinical Reasoning]
Question 1
A 68-year-old client with a history of heart failure presents to the emergency department
with severe dyspnea, orthopnea, and pink frothy sputum. Vital signs: BP 190/110
mmHg, HR 118 bpm, RR 32/min, SpO2 84% on room air. The nurse auscultates bilateral
crackles in the lower lobes. Which action should the nurse take first?
A. Administer furosemide (Lasix) 40 mg IV push
B. Apply oxygen via non-rebreather mask at 15 L/min
C. Insert an indwelling urinary catheter
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale:
Option A: While furosemide is indicated for acute pulmonary edema to reduce fluid
overload, it is not the first priority. The client is experiencing severe hypoxemia (SpO2
84%), and medication administration should follow immediate life-support
,interventions. Additionally, diuretics require adequate renal perfusion and monitoring of
electrolytes.
Option B: [CORRECT] The client exhibits classic signs of acute pulmonary edema with
severe hypoxemia (SpO2 84%). According to the ABCs (Airway, Breathing, Circulation)
priority framework, oxygenation takes precedence. A non-rebreather mask at 15 L/min
delivers the highest concentration of oxygen (60-90%) possible via mask, essential for
this client in acute respiratory distress. This intervention addresses the immediate
life-threatening problem of hypoxemia before other interventions.
Option C: While a urinary catheter may be necessary later to monitor output after
diuretic therapy, it is not a first priority and could delay critical respiratory interventions.
Option D: An ECG is important to identify any cardiac dysrhythmias or ischemia
contributing to the heart failure exacerbation, but it does not address the immediate
hypoxemia threatening the client's life.
Question 2 (SATA)
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who
is receiving oxygen at 2 L/min via nasal cannula. Which assessments indicate the
therapy is effective? Select all that apply.
A. Respiratory rate decreases from 28 to 20 breaths per minute
B. Client reports reduced dyspnea on exertion
C. Oxygen saturation increases from 88% to 92%
D. Client becomes drowsy and less anxious
E. Arterial blood gas shows pH 7.48 and PaCO2 32 mmHg
,F. Sputum production decreases from copious to moderate amounts
Correct Answer: A, B, C
Rationale:
Option A: [CORRECT] A decrease in respiratory rate from 28 to 20 breaths per minute
indicates reduced work of breathing and improved gas exchange. Tachypnea is a
compensatory mechanism for hypoxemia; normalization suggests therapeutic
effectiveness.
Option B: [CORRECT] Reduced dyspnea on exertion demonstrates improved tissue
oxygenation and reduced hypoxic drive. The client's subjective report of easier breathing
is a primary indicator of therapeutic response in COPD management.
Option C: [CORRECT] An increase in SpO2 from 88% (hypoxemic) to 92% (acceptable for
COPD clients) indicates improved oxygenation. Note that for COPD clients, the target
SpO2 is typically 88-92% to avoid suppressing the hypoxic respiratory drive.
Option D: While reduced anxiety may occur with improved oxygenation, drowsiness in a
COPD client receiving oxygen is a red flag indicating possible CO2 narcosis from
oxygen-induced hypoventilation. This requires immediate assessment, not celebration.
Option E: These ABG values indicate respiratory alkalosis (pH elevated, PaCO2
decreased), which is inappropriate for a COPD client who typically retains CO2. This
pattern suggests the client is hyperventilating or receiving excessive oxygen, potentially
dangerous.
Option F: While decreased sputum might seem positive, oxygen therapy does not
directly reduce sputum production. In fact, adequate hydration and chest physiotherapy
, are primary interventions for secretion management. This is not a reliable indicator of
oxygen therapy effectiveness.
Question 3 (Ordered Response)
A client is admitted with acute myocardial infarction (MI) and is scheduled for
emergency percutaneous coronary intervention (PCI). Place the following nursing
actions in the correct priority order:
1. Administer aspirin 325 mg chewable
2. Establish IV access
3. Obtain 12-lead ECG
4. Assess pain level and characteristics
5. Notify the cardiac catheterization team
6. Administer nitroglycerin 0.4 mg sublingual
Correct Order: 3, 4, 2, 1, 6, 5 [CORRECT]
Rationale:
Step 1 (Obtain 12-lead ECG): The 12-lead ECG is the priority because it confirms the
diagnosis of STEMI versus NSTEMI, determines the location of infarction, and guides
immediate treatment decisions. "Time is muscle" in MI management, and ECG must be
obtained within 10 minutes of arrival.
Step 2 (Assess pain): Pain assessment follows ECG because unrelieved pain indicates
ongoing ischemia, increases myocardial oxygen demand, and can trigger dysrhythmias.
Pain characteristics also help confirm the diagnosis.
Step 3 (Establish IV access): IV access is necessary before medication administration
and must be established early for emergency drug delivery and possible complications.
Versions 1-5 | 275 Q&A | AGRADE Rationales | HESI Blueprint Aligned
| Pass Guaranteed - A+ Graded
[VERSION 1: HESI Med-Surg Exit Exam – 55 Questions]
[Foundation Level | Cardiovascular & Respiratory Focus | Basic Clinical Reasoning]
Question 1
A 68-year-old client with a history of heart failure presents to the emergency department
with severe dyspnea, orthopnea, and pink frothy sputum. Vital signs: BP 190/110
mmHg, HR 118 bpm, RR 32/min, SpO2 84% on room air. The nurse auscultates bilateral
crackles in the lower lobes. Which action should the nurse take first?
A. Administer furosemide (Lasix) 40 mg IV push
B. Apply oxygen via non-rebreather mask at 15 L/min
C. Insert an indwelling urinary catheter
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale:
Option A: While furosemide is indicated for acute pulmonary edema to reduce fluid
overload, it is not the first priority. The client is experiencing severe hypoxemia (SpO2
84%), and medication administration should follow immediate life-support
,interventions. Additionally, diuretics require adequate renal perfusion and monitoring of
electrolytes.
Option B: [CORRECT] The client exhibits classic signs of acute pulmonary edema with
severe hypoxemia (SpO2 84%). According to the ABCs (Airway, Breathing, Circulation)
priority framework, oxygenation takes precedence. A non-rebreather mask at 15 L/min
delivers the highest concentration of oxygen (60-90%) possible via mask, essential for
this client in acute respiratory distress. This intervention addresses the immediate
life-threatening problem of hypoxemia before other interventions.
Option C: While a urinary catheter may be necessary later to monitor output after
diuretic therapy, it is not a first priority and could delay critical respiratory interventions.
Option D: An ECG is important to identify any cardiac dysrhythmias or ischemia
contributing to the heart failure exacerbation, but it does not address the immediate
hypoxemia threatening the client's life.
Question 2 (SATA)
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who
is receiving oxygen at 2 L/min via nasal cannula. Which assessments indicate the
therapy is effective? Select all that apply.
A. Respiratory rate decreases from 28 to 20 breaths per minute
B. Client reports reduced dyspnea on exertion
C. Oxygen saturation increases from 88% to 92%
D. Client becomes drowsy and less anxious
E. Arterial blood gas shows pH 7.48 and PaCO2 32 mmHg
,F. Sputum production decreases from copious to moderate amounts
Correct Answer: A, B, C
Rationale:
Option A: [CORRECT] A decrease in respiratory rate from 28 to 20 breaths per minute
indicates reduced work of breathing and improved gas exchange. Tachypnea is a
compensatory mechanism for hypoxemia; normalization suggests therapeutic
effectiveness.
Option B: [CORRECT] Reduced dyspnea on exertion demonstrates improved tissue
oxygenation and reduced hypoxic drive. The client's subjective report of easier breathing
is a primary indicator of therapeutic response in COPD management.
Option C: [CORRECT] An increase in SpO2 from 88% (hypoxemic) to 92% (acceptable for
COPD clients) indicates improved oxygenation. Note that for COPD clients, the target
SpO2 is typically 88-92% to avoid suppressing the hypoxic respiratory drive.
Option D: While reduced anxiety may occur with improved oxygenation, drowsiness in a
COPD client receiving oxygen is a red flag indicating possible CO2 narcosis from
oxygen-induced hypoventilation. This requires immediate assessment, not celebration.
Option E: These ABG values indicate respiratory alkalosis (pH elevated, PaCO2
decreased), which is inappropriate for a COPD client who typically retains CO2. This
pattern suggests the client is hyperventilating or receiving excessive oxygen, potentially
dangerous.
Option F: While decreased sputum might seem positive, oxygen therapy does not
directly reduce sputum production. In fact, adequate hydration and chest physiotherapy
, are primary interventions for secretion management. This is not a reliable indicator of
oxygen therapy effectiveness.
Question 3 (Ordered Response)
A client is admitted with acute myocardial infarction (MI) and is scheduled for
emergency percutaneous coronary intervention (PCI). Place the following nursing
actions in the correct priority order:
1. Administer aspirin 325 mg chewable
2. Establish IV access
3. Obtain 12-lead ECG
4. Assess pain level and characteristics
5. Notify the cardiac catheterization team
6. Administer nitroglycerin 0.4 mg sublingual
Correct Order: 3, 4, 2, 1, 6, 5 [CORRECT]
Rationale:
Step 1 (Obtain 12-lead ECG): The 12-lead ECG is the priority because it confirms the
diagnosis of STEMI versus NSTEMI, determines the location of infarction, and guides
immediate treatment decisions. "Time is muscle" in MI management, and ECG must be
obtained within 10 minutes of arrival.
Step 2 (Assess pain): Pain assessment follows ECG because unrelieved pain indicates
ongoing ischemia, increases myocardial oxygen demand, and can trigger dysrhythmias.
Pain characteristics also help confirm the diagnosis.
Step 3 (Establish IV access): IV access is necessary before medication administration
and must be established early for emergency drug delivery and possible complications.
