HESI MED SURG FINAL EXAM 2026/2027 | Questions & Answers
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Guaranteed - A+ Graded
Q1: A 68-year-old male is admitted with acute decompensated heart failure. Vital signs:
BP 92/58 mmHg, HR 118 bpm (irregular), RR 28/min, SpO2 88% on room air.
Assessment reveals crackles bilaterally, jugular venous distension at 6 cm, and 3+
pitting edema in lower extremities. Which intervention should the nurse prioritize?
A. Administer IV furosemide 40 mg as ordered
B. Apply oxygen via nasal cannula at 2 L/min
C. Obtain a 12-lead ECG
D. Insert a Foley catheter for strict intake and output
Correct Answer: B [CORRECT]
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the
patient's SpO2 of 88% indicates significant hypoxemia requiring immediate oxygen
supplementation. While all options are appropriate for heart failure management,
oxygenation takes precedence over diuresis, diagnostic testing, or monitoring. The
respiratory rate of 28/min and crackles indicate pulmonary edema compromising gas
exchange.
Why A is wrong: Furosemide is important for fluid removal but does not address
immediate life-threatening hypoxemia; diuresis can wait until oxygenation is stabilized.
Why C is wrong: ECG is important given irregular rhythm but is not emergent when
airway/breathing are compromised.
,Why D is wrong: Strict I&O monitoring is important but is a lower priority than
addressing hypoxemia; this is an implementation intervention, not an emergency action.
Q2: A patient with type 2 diabetes presents with blood glucose of 48 mg/dL,
diaphoresis, tremors, and confusion. The patient is alert and able to swallow. What is
the nurse's first action?
A. Administer 1 mg glucagon subcutaneously
B. Give 15 grams of fast-acting carbohydrate
C. Start D5W IV infusion at 125 mL/hr
D. Recheck blood glucose in 15 minutes
Correct Answer: B [CORRECT]
Rationale: For conscious patients with hypoglycemia who can swallow, the 15-15 rule
applies: give 15 grams of fast-acting carbohydrate (glucose tablets, 4 oz juice, regular
soda, honey), then recheck in 15 minutes. This rapidly raises blood glucose through oral
absorption. Glucagon is reserved for unconscious patients or those unable to swallow.
Why A is wrong: Glucagon is for severe hypoglycemia with altered consciousness or
inability to swallow; this patient is alert and can take PO.
Why C is wrong: IV dextrose is appropriate for unconscious patients or severe
hypoglycemia not responding to oral treatment; oral treatment is less invasive and
appropriate here.
Why D is wrong: Rechecking without treatment delays correction of dangerous
hypoglycemia; treat first, then recheck.
,Q3: A patient 24 hours post-MI develops sudden onset of dyspnea, tachypnea (RR 32),
and oxygen saturation drops from 94% to 84%. Heart rate is 110 bpm, BP 100/60
mmHg. Breath sounds are clear. Which complication should the nurse suspect?
A. Cardiogenic shock
B. Papillary muscle rupture
C. Pulmonary embolism
D. Ventricular septal defect
Correct Answer: C [CORRECT]
Rationale: The presentation of sudden dyspnea, tachypnea, hypoxemia, and clear breath
sounds in a post-MI patient is classic for pulmonary embolism (PE). Immobility post-MI
creates venous stasis and clot formation risk. The clear lung fields distinguish PE from
pulmonary edema (which would show crackles). Tachycardia and hypotension suggest
massive PE with hemodynamic compromise.
Why A is wrong: Cardiogenic shock would present with hypotension, poor perfusion, and
pulmonary congestion (crackles), not clear lungs with isolated respiratory distress.
Why B is wrong: Papillary muscle rupture causes acute mitral regurgitation with new
murmur and pulmonary edema (crackles), not clear lungs.
Why D is wrong: Ventricular septal defect causes new harsh holosystolic murmur,
biventricular failure, and pulmonary edema, not isolated respiratory distress with clear
lungs.
, Q4: The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD)
who is receiving oxygen at 2 L/min via nasal cannula. Arterial blood gas results: pH
7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3- 32 mEq/L. Which action should the
nurse take?
A. Increase oxygen flow to 4 L/min to improve PaO2
B. Maintain current oxygen therapy and notify the physician
C. Decrease oxygen to 1 L/min to prevent CO2 retention
D. Prepare for immediate intubation and mechanical ventilation
Correct Answer: B [CORRECT]
Rationale: This ABG shows compensated respiratory acidosis (pH 7.32, elevated PaCO2
58, elevated HCO3- 32) typical of chronic COPD with CO2 retention. The PaO2 of 62
mmHg is acceptable for COPD patients (target 88-92% or PaO2 55-60 mmHg). The
patient is compensated (pH near normal due to renal bicarbonate retention). Increasing
oxygen risks suppressing hypoxic drive; decreasing oxygen is unnecessary and unsafe.
Current therapy is appropriate with physician notification for continued monitoring.
Why A is wrong: Increasing oxygen in chronic CO2 retainers can suppress hypoxic
respiratory drive, causing worsening respiratory acidosis and CO2 narcosis.
Why C is wrong: Decreasing oxygen is unnecessary; current PaO2 is at acceptable lower
limit for COPD, and reduction could cause significant hypoxemia.
Why D is wrong: Intubation is not indicated; pH >7.30 with compensation indicates
stable chronic state, not acute respiratory failure requiring mechanical ventilation.
| Verified w/ Comprehensive Rationales | Latest Update | Pass
Guaranteed - A+ Graded
Q1: A 68-year-old male is admitted with acute decompensated heart failure. Vital signs:
BP 92/58 mmHg, HR 118 bpm (irregular), RR 28/min, SpO2 88% on room air.
Assessment reveals crackles bilaterally, jugular venous distension at 6 cm, and 3+
pitting edema in lower extremities. Which intervention should the nurse prioritize?
A. Administer IV furosemide 40 mg as ordered
B. Apply oxygen via nasal cannula at 2 L/min
C. Obtain a 12-lead ECG
D. Insert a Foley catheter for strict intake and output
Correct Answer: B [CORRECT]
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, the
patient's SpO2 of 88% indicates significant hypoxemia requiring immediate oxygen
supplementation. While all options are appropriate for heart failure management,
oxygenation takes precedence over diuresis, diagnostic testing, or monitoring. The
respiratory rate of 28/min and crackles indicate pulmonary edema compromising gas
exchange.
Why A is wrong: Furosemide is important for fluid removal but does not address
immediate life-threatening hypoxemia; diuresis can wait until oxygenation is stabilized.
Why C is wrong: ECG is important given irregular rhythm but is not emergent when
airway/breathing are compromised.
,Why D is wrong: Strict I&O monitoring is important but is a lower priority than
addressing hypoxemia; this is an implementation intervention, not an emergency action.
Q2: A patient with type 2 diabetes presents with blood glucose of 48 mg/dL,
diaphoresis, tremors, and confusion. The patient is alert and able to swallow. What is
the nurse's first action?
A. Administer 1 mg glucagon subcutaneously
B. Give 15 grams of fast-acting carbohydrate
C. Start D5W IV infusion at 125 mL/hr
D. Recheck blood glucose in 15 minutes
Correct Answer: B [CORRECT]
Rationale: For conscious patients with hypoglycemia who can swallow, the 15-15 rule
applies: give 15 grams of fast-acting carbohydrate (glucose tablets, 4 oz juice, regular
soda, honey), then recheck in 15 minutes. This rapidly raises blood glucose through oral
absorption. Glucagon is reserved for unconscious patients or those unable to swallow.
Why A is wrong: Glucagon is for severe hypoglycemia with altered consciousness or
inability to swallow; this patient is alert and can take PO.
Why C is wrong: IV dextrose is appropriate for unconscious patients or severe
hypoglycemia not responding to oral treatment; oral treatment is less invasive and
appropriate here.
Why D is wrong: Rechecking without treatment delays correction of dangerous
hypoglycemia; treat first, then recheck.
,Q3: A patient 24 hours post-MI develops sudden onset of dyspnea, tachypnea (RR 32),
and oxygen saturation drops from 94% to 84%. Heart rate is 110 bpm, BP 100/60
mmHg. Breath sounds are clear. Which complication should the nurse suspect?
A. Cardiogenic shock
B. Papillary muscle rupture
C. Pulmonary embolism
D. Ventricular septal defect
Correct Answer: C [CORRECT]
Rationale: The presentation of sudden dyspnea, tachypnea, hypoxemia, and clear breath
sounds in a post-MI patient is classic for pulmonary embolism (PE). Immobility post-MI
creates venous stasis and clot formation risk. The clear lung fields distinguish PE from
pulmonary edema (which would show crackles). Tachycardia and hypotension suggest
massive PE with hemodynamic compromise.
Why A is wrong: Cardiogenic shock would present with hypotension, poor perfusion, and
pulmonary congestion (crackles), not clear lungs with isolated respiratory distress.
Why B is wrong: Papillary muscle rupture causes acute mitral regurgitation with new
murmur and pulmonary edema (crackles), not clear lungs.
Why D is wrong: Ventricular septal defect causes new harsh holosystolic murmur,
biventricular failure, and pulmonary edema, not isolated respiratory distress with clear
lungs.
, Q4: The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD)
who is receiving oxygen at 2 L/min via nasal cannula. Arterial blood gas results: pH
7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3- 32 mEq/L. Which action should the
nurse take?
A. Increase oxygen flow to 4 L/min to improve PaO2
B. Maintain current oxygen therapy and notify the physician
C. Decrease oxygen to 1 L/min to prevent CO2 retention
D. Prepare for immediate intubation and mechanical ventilation
Correct Answer: B [CORRECT]
Rationale: This ABG shows compensated respiratory acidosis (pH 7.32, elevated PaCO2
58, elevated HCO3- 32) typical of chronic COPD with CO2 retention. The PaO2 of 62
mmHg is acceptable for COPD patients (target 88-92% or PaO2 55-60 mmHg). The
patient is compensated (pH near normal due to renal bicarbonate retention). Increasing
oxygen risks suppressing hypoxic drive; decreasing oxygen is unnecessary and unsafe.
Current therapy is appropriate with physician notification for continued monitoring.
Why A is wrong: Increasing oxygen in chronic CO2 retainers can suppress hypoxic
respiratory drive, causing worsening respiratory acidosis and CO2 narcosis.
Why C is wrong: Decreasing oxygen is unnecessary; current PaO2 is at acceptable lower
limit for COPD, and reduction could cause significant hypoxemia.
Why D is wrong: Intubation is not indicated; pH >7.30 with compensation indicates
stable chronic state, not acute respiratory failure requiring mechanical ventilation.
