HESI MED-SURG II TEST BANK 2026/2027 | Questions &
Answers | Verified Edition | Advanced Med-Surg Prep | Pass
Guaranteed - A+ Graded
Q1: A 68-year-old male is admitted with a ruptured abdominal aortic aneurysm (AAA)
and is hemodynamically unstable. The nurse notes the following: BP 78/52 mmHg, HR
128 bpm, RR 28, SpO₂ 89% on 6L NC, cool clammy skin, and decreasing level of
consciousness. The provider orders a stat CT angiography. What is the nurse's priority
action?
A. Prepare the patient for immediate transport to CT scan
B. Insert a large-bore IV and begin fluid resuscitation with lactated Ringer's [CORRECT]
C. Administer morphine 4mg IV for pain management
D. Apply supplemental oxygen via non-rebreather mask
Correct Answer: B
Rationale: This patient presents with classic signs of hemorrhagic shock secondary to
ruptured AAA: hypotension (SBP <90), tachycardia, tachypnea, hypoxemia, and altered
mental status. The priority is immediate vascular access and aggressive fluid
resuscitation to maintain end-organ perfusion while preparing for emergent surgical
intervention. While CT scan (Option A) is needed for definitive diagnosis, the patient is
too unstable for transport without initial resuscitation; this represents a "scoop and run"
versus "stay and play" scenario where minimal stabilization is required. Option C
(morphine) is contraindicated in hemodynamic instability as it causes vasodilation and
further hypotension. Option D (oxygen) is appropriate but secondary to fluid
resuscitation; the patient already has oxygen ordered and the saturation, while low, is
not the immediate life threat compared to circulatory collapse.
,Q2: A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with the following settings: AC/VC, TV 6 mL/kg (IBW), PEEP 12 cm H₂O, FiO₂
60%. The nurse notes increasing peak airway pressures and the patient appears
agitated with asynchronous breathing. Arterial blood gas shows: pH 7.28, PaCO₂ 55
mmHg, PaO₂ 58 mmHg, HCO₃⁻ 24 mEq/L. What ventilator adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg to improve CO₂ clearance
B. Increase PEEP to 16 cm H₂O to improve oxygenation
C. Switch to pressure control ventilation with inverse ratio [CORRECT]
D. Decrease FiO₂ to 40% to reduce oxygen toxicity
Correct Answer: C
Rationale: The patient demonstrates refractory hypoxemia (PaO₂/FiO₂ ratio = 58/0.6 =
97, indicating severe ARDS) with respiratory acidosis and high airway pressures. ARDS
management follows the ARDSNet protocol with lung-protective ventilation (low tidal
volume 6 mL/kg), but this patient has developed ventilator dyssynchrony and
inadequate gas exchange. Pressure control ventilation with inverse ratio (prolonged
inspiratory time) allows for recruitment of alveoli, improved oxygenation through
increased mean airway pressure, and reduced peak pressures compared to volume
control. Option A violates lung-protective strategy and risks volutrauma. Option B may
help oxygenation but further increases pressure and doesn't address the dyssynchrony.
Option D would worsen hypoxemia (PaO₂ is already critically low).
Q3: Select all that apply regarding early signs of increased intracranial pressure (ICP):
A. Restlessness and confusion [CORRECT]
B. Widening pulse pressure
C. Decreased responsiveness to painful stimuli [CORRECT]
D. Projectile vomiting [CORRECT]
,E. Cushing's triad (bradycardia, hypertension, irregular respirations)
Correct Answer: A, C, D
Rationale: Early signs of increased ICP include subtle behavioral changes (restlessness,
confusion, decreased level of consciousness), pupillary changes (sluggish response),
and vomiting (often projectile, not preceded by nausea due to brainstem compression).
Option B (widening pulse pressure) and Option E (Cushing's triad) are late signs of
brainstem herniation indicating decompensation, not early warning signs. The nurse
must recognize early subtle changes before irreversible herniation occurs.
Q4: A patient with Guillain-Barré syndrome is admitted to the ICU. The nurse notes
declining vital capacity (VC) measurements: 1200 mL, 900 mL, 650 mL on consecutive
assessments. The patient's current VC is 18 mL/kg (patient weight 70 kg). What is the
priority nursing action?
A. Continue hourly VC monitoring and reassess in 2 hours
B. Prepare for emergent intubation and mechanical ventilation [CORRECT]
C. Administer IVIG infusion more rapidly
D. Initiate chest physiotherapy and incentive spirometry
Correct Answer: B
Rationale: In Guillain-Barré syndrome, respiratory failure occurs due to progressive
diaphragmatic and intercostal muscle weakness. Critical thresholds for intubation
include: Vital capacity <15-20 mL/kg (this patient at 18 mL/kg and declining rapidly),
negative inspiratory force (NIF) <30 cm H₂O, or PaO₂ <70 mmHg on room air. The rapid
decline from 1200 to 650 mL indicates impending respiratory failure. Option A delays
critical intervention. Option C (IVIG rate) does not address acute respiratory
compromise. Option D is contraindicated as the patient lacks respiratory reserve for
these efforts.
, Q5: A patient with end-stage renal disease on hemodialysis develops chest pain,
hypotension, and confusion 30 minutes into treatment. The nurse notes the venous
pressure alarm is elevated and the blood lines appear dark. What complication is
occurring?
A. Air embolism
B. Hemolysis due to incorrect dialysate composition [CORRECT]
C. Disequilibrium syndrome
D. Hypovolemia from excessive ultrafiltration
Correct Answer: B
Rationale: The triad of chest pain, hypotension, and confusion during dialysis with
dark-colored blood (free hemoglobin) and elevated venous pressure indicates acute
hemolysis, typically from incorrect dialysate composition (hypotonic solution causing
osmotic hemolysis) or overheated dialysate. This is a life-threatening emergency
requiring immediate cessation of dialysis and blood salvage. Option A (air embolism)
presents with dyspnea, chest pain, and "millwheel" murmur. Option C (disequilibrium)
presents with headache, nausea, seizures post-dialysis due to cerebral edema. Option D
would cause hypotension but not the specific findings of hemolysis (dark blood, chest
pain from hemoglobin-related vasoconstriction).
Q6: A patient with septic shock has the following parameters: MAP 58 mmHg, CVP 4
mmHg, ScvO₂ 58%, lactate 4.8 mmol/L. Following 30 mL/kg crystalloid administration,
the MAP remains 62 mmHg, CVP 8 mmHg, and urine output 0.3 mL/kg/hr. What is the
next appropriate intervention according to Surviving Sepsis Campaign guidelines?
A. Administer additional 30 mL/kg fluid bolus
B. Initiate norepinephrine to maintain MAP ≥65 mmHg [CORRECT]
C. Begin dobutamine to improve ScvO₂
D. Administer hydrocortisone 50mg IV immediately
Answers | Verified Edition | Advanced Med-Surg Prep | Pass
Guaranteed - A+ Graded
Q1: A 68-year-old male is admitted with a ruptured abdominal aortic aneurysm (AAA)
and is hemodynamically unstable. The nurse notes the following: BP 78/52 mmHg, HR
128 bpm, RR 28, SpO₂ 89% on 6L NC, cool clammy skin, and decreasing level of
consciousness. The provider orders a stat CT angiography. What is the nurse's priority
action?
A. Prepare the patient for immediate transport to CT scan
B. Insert a large-bore IV and begin fluid resuscitation with lactated Ringer's [CORRECT]
C. Administer morphine 4mg IV for pain management
D. Apply supplemental oxygen via non-rebreather mask
Correct Answer: B
Rationale: This patient presents with classic signs of hemorrhagic shock secondary to
ruptured AAA: hypotension (SBP <90), tachycardia, tachypnea, hypoxemia, and altered
mental status. The priority is immediate vascular access and aggressive fluid
resuscitation to maintain end-organ perfusion while preparing for emergent surgical
intervention. While CT scan (Option A) is needed for definitive diagnosis, the patient is
too unstable for transport without initial resuscitation; this represents a "scoop and run"
versus "stay and play" scenario where minimal stabilization is required. Option C
(morphine) is contraindicated in hemodynamic instability as it causes vasodilation and
further hypotension. Option D (oxygen) is appropriate but secondary to fluid
resuscitation; the patient already has oxygen ordered and the saturation, while low, is
not the immediate life threat compared to circulatory collapse.
,Q2: A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with the following settings: AC/VC, TV 6 mL/kg (IBW), PEEP 12 cm H₂O, FiO₂
60%. The nurse notes increasing peak airway pressures and the patient appears
agitated with asynchronous breathing. Arterial blood gas shows: pH 7.28, PaCO₂ 55
mmHg, PaO₂ 58 mmHg, HCO₃⁻ 24 mEq/L. What ventilator adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg to improve CO₂ clearance
B. Increase PEEP to 16 cm H₂O to improve oxygenation
C. Switch to pressure control ventilation with inverse ratio [CORRECT]
D. Decrease FiO₂ to 40% to reduce oxygen toxicity
Correct Answer: C
Rationale: The patient demonstrates refractory hypoxemia (PaO₂/FiO₂ ratio = 58/0.6 =
97, indicating severe ARDS) with respiratory acidosis and high airway pressures. ARDS
management follows the ARDSNet protocol with lung-protective ventilation (low tidal
volume 6 mL/kg), but this patient has developed ventilator dyssynchrony and
inadequate gas exchange. Pressure control ventilation with inverse ratio (prolonged
inspiratory time) allows for recruitment of alveoli, improved oxygenation through
increased mean airway pressure, and reduced peak pressures compared to volume
control. Option A violates lung-protective strategy and risks volutrauma. Option B may
help oxygenation but further increases pressure and doesn't address the dyssynchrony.
Option D would worsen hypoxemia (PaO₂ is already critically low).
Q3: Select all that apply regarding early signs of increased intracranial pressure (ICP):
A. Restlessness and confusion [CORRECT]
B. Widening pulse pressure
C. Decreased responsiveness to painful stimuli [CORRECT]
D. Projectile vomiting [CORRECT]
,E. Cushing's triad (bradycardia, hypertension, irregular respirations)
Correct Answer: A, C, D
Rationale: Early signs of increased ICP include subtle behavioral changes (restlessness,
confusion, decreased level of consciousness), pupillary changes (sluggish response),
and vomiting (often projectile, not preceded by nausea due to brainstem compression).
Option B (widening pulse pressure) and Option E (Cushing's triad) are late signs of
brainstem herniation indicating decompensation, not early warning signs. The nurse
must recognize early subtle changes before irreversible herniation occurs.
Q4: A patient with Guillain-Barré syndrome is admitted to the ICU. The nurse notes
declining vital capacity (VC) measurements: 1200 mL, 900 mL, 650 mL on consecutive
assessments. The patient's current VC is 18 mL/kg (patient weight 70 kg). What is the
priority nursing action?
A. Continue hourly VC monitoring and reassess in 2 hours
B. Prepare for emergent intubation and mechanical ventilation [CORRECT]
C. Administer IVIG infusion more rapidly
D. Initiate chest physiotherapy and incentive spirometry
Correct Answer: B
Rationale: In Guillain-Barré syndrome, respiratory failure occurs due to progressive
diaphragmatic and intercostal muscle weakness. Critical thresholds for intubation
include: Vital capacity <15-20 mL/kg (this patient at 18 mL/kg and declining rapidly),
negative inspiratory force (NIF) <30 cm H₂O, or PaO₂ <70 mmHg on room air. The rapid
decline from 1200 to 650 mL indicates impending respiratory failure. Option A delays
critical intervention. Option C (IVIG rate) does not address acute respiratory
compromise. Option D is contraindicated as the patient lacks respiratory reserve for
these efforts.
, Q5: A patient with end-stage renal disease on hemodialysis develops chest pain,
hypotension, and confusion 30 minutes into treatment. The nurse notes the venous
pressure alarm is elevated and the blood lines appear dark. What complication is
occurring?
A. Air embolism
B. Hemolysis due to incorrect dialysate composition [CORRECT]
C. Disequilibrium syndrome
D. Hypovolemia from excessive ultrafiltration
Correct Answer: B
Rationale: The triad of chest pain, hypotension, and confusion during dialysis with
dark-colored blood (free hemoglobin) and elevated venous pressure indicates acute
hemolysis, typically from incorrect dialysate composition (hypotonic solution causing
osmotic hemolysis) or overheated dialysate. This is a life-threatening emergency
requiring immediate cessation of dialysis and blood salvage. Option A (air embolism)
presents with dyspnea, chest pain, and "millwheel" murmur. Option C (disequilibrium)
presents with headache, nausea, seizures post-dialysis due to cerebral edema. Option D
would cause hypotension but not the specific findings of hemolysis (dark blood, chest
pain from hemoglobin-related vasoconstriction).
Q6: A patient with septic shock has the following parameters: MAP 58 mmHg, CVP 4
mmHg, ScvO₂ 58%, lactate 4.8 mmol/L. Following 30 mL/kg crystalloid administration,
the MAP remains 62 mmHg, CVP 8 mmHg, and urine output 0.3 mL/kg/hr. What is the
next appropriate intervention according to Surviving Sepsis Campaign guidelines?
A. Administer additional 30 mL/kg fluid bolus
B. Initiate norepinephrine to maintain MAP ≥65 mmHg [CORRECT]
C. Begin dobutamine to improve ScvO₂
D. Administer hydrocortisone 50mg IV immediately
