HESI MED-SURG II RETAKE 2026/2027 | Questions &
Answers | Verified Answers Edition | Retake Prep Guide |
Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD CONTENT REVIEW
30 Questions Focusing on Commonly Missed Concepts
Q1: A 68-year-old patient is admitted with septic shock from a urinary tract infection.
The nurse notes the following vital signs: BP 82/48 mmHg, HR 118 bpm, RR 28
breaths/min, Temp 38.9°C (102°F), SpO2 89% on 2L NC. Which hemodynamic
parameter best indicates the effectiveness of tissue perfusion?
A. Mean arterial pressure (MAP) >65 mmHg
B. Lactate clearance >10% within 6 hours [CORRECT]
C. Central venous pressure (CVP) 8-12 mmHg
D. Systemic vascular resistance (SVR) >1200 dynes/sec/cm⁻⁵
Correct Answer: B
Rationale: While MAP >65 mmHg is the initial target for blood pressure support, lactate
clearance is the gold standard for assessing tissue perfusion adequacy in septic shock.
Elevated lactate indicates anaerobic metabolism from poor tissue oxygenation. The
Surviving Sepsis Campaign recommends lactate remeasurement within 2-4 hours with
goal of normalization or >10% clearance.
Why others are incorrect:
, ● A: MAP >65 is a pressure target, not a perfusion marker; patients can have
adequate MAP with poor microcirculatory perfusion
● C: CVP is a preload marker, unreliable in sepsis due to venodilation and capillary
leak; not used as endpoint
● D: SVR is typically decreased in septic shock (distributive); targeting high SVR
would worsen perfusion
HESI Retake Tip: When asked about "effectiveness of tissue perfusion," always look for
lactate or urine output as answers, not blood pressure alone.
Q2: [SELECT ALL THAT APPLY] A patient with acute decompensated heart failure is
receiving IV furosemide 80mg BID. Which assessment findings indicate the medication
is achieving the desired therapeutic effect?
A. Weight decrease of 2 kg over 24 hours [CORRECT]
B. Decreased dyspnea with improved SpO2 [CORRECT]
C. Decreased jugular venous distension [CORRECT]
D. Increased serum creatinine from 1.0 to 1.8 mg/dL
E. Decreased peripheral edema [CORRECT]
Correct Answer: A, B, C, E
Rationale: Furosemide is a loop diuretic that reduces preload and afterload in heart
failure. Therapeutic effects include:
● Weight loss: 1 kg ≈ 1 liter fluid loss; 2 kg/24 hours is appropriate goal
● Symptom improvement: Reduced pulmonary congestion (dyspnea, SpO2)
● Reduced JVD: Decreased right atrial pressure
● Edema reduction: Decreased interstitial fluid
,Why D is incorrect: Rising creatinine indicates prerenal azotemia from over-diuresis and
hypovolemia, not therapeutic effect. This requires dose reduction or hold.
HESI Retake Tip: In SATA questions, look for positive outcomes (improvements) vs.
adverse effects (worsening labs).
Q3: A patient with type 1 diabetes presents with DKA: pH 7.22, glucose 485 mg/dL,
ketones positive. Insulin infusion is started at 0.1 units/kg/hr. Two hours later, glucose
is 250 mg/dL. What is the priority nursing intervention?
A. Add dextrose to IV fluids and continue insulin infusion [CORRECT]
B. Stop insulin infusion to prevent hypoglycemia
C. Increase insulin infusion rate to 0.2 units/kg/hr
D. Transition to subcutaneous insulin immediately
Correct Answer: A
Rationale: In DKA management, the goal is to close the anion gap and clear ketones, not
just normalize glucose. When glucose reaches 200-250 mg/dL, add dextrose (D5 or
D10) to prevent hypoglycemia while continuing insulin to suppress ketogenesis and
promote glucose utilization. Stopping insulin or transitioning too early causes rebound
DKA.
Why others are incorrect:
● B: Stopping insulin causes ketone recurrence; glucose will rise from
counter-regulatory hormones
● C: Increasing insulin risks hypoglycemia without dextrose; rate should not
increase
, ● D: SC insulin requires 1-2 hour overlap with IV insulin after anion gap closes; too
early
HESI Retake Tip: In DKA, remember: "Don't stop the insulin, just add sugar."
Q4: A patient with a spinal cord injury at T4 level reports severe headache, nasal
congestion, and "goosebumps." Vital signs: BP 186/112, HR 52 bpm. What condition is
occurring?
A. Autonomic dysreflexia [CORRECT]
B. Neurogenic shock
C. Spinal shock
D. Malignant hypertension
Correct Answer: A
Rationale: Autonomic dysreflexia is a life-threatening emergency in patients with T6 or
higher spinal cord injuries. Triggered by noxious stimulus below injury level (commonly
bladder distention, bowel impaction). Pathophysiology: Unopposed sympathetic
response below injury causes hypertension (risk of stroke, seizure, death); baroreceptor
reflex causes bradycardia above injury.
Immediate action: Sit patient upright (lower BP), remove stimulus (catheterize, check
bowel), antihypertensives if needed (nitrates, hydralazine).
Why others are incorrect:
● B: Neurogenic shock causes hypotension and bradycardia (loss of sympathetic
tone); occurs acutely post-injury
● C: Spinal shock = flaccid paralysis, areflexia below injury; temporary
● D: Secondary diagnosis; this is specifically autonomic dysreflexia in SCI patient
Answers | Verified Answers Edition | Retake Prep Guide |
Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD CONTENT REVIEW
30 Questions Focusing on Commonly Missed Concepts
Q1: A 68-year-old patient is admitted with septic shock from a urinary tract infection.
The nurse notes the following vital signs: BP 82/48 mmHg, HR 118 bpm, RR 28
breaths/min, Temp 38.9°C (102°F), SpO2 89% on 2L NC. Which hemodynamic
parameter best indicates the effectiveness of tissue perfusion?
A. Mean arterial pressure (MAP) >65 mmHg
B. Lactate clearance >10% within 6 hours [CORRECT]
C. Central venous pressure (CVP) 8-12 mmHg
D. Systemic vascular resistance (SVR) >1200 dynes/sec/cm⁻⁵
Correct Answer: B
Rationale: While MAP >65 mmHg is the initial target for blood pressure support, lactate
clearance is the gold standard for assessing tissue perfusion adequacy in septic shock.
Elevated lactate indicates anaerobic metabolism from poor tissue oxygenation. The
Surviving Sepsis Campaign recommends lactate remeasurement within 2-4 hours with
goal of normalization or >10% clearance.
Why others are incorrect:
, ● A: MAP >65 is a pressure target, not a perfusion marker; patients can have
adequate MAP with poor microcirculatory perfusion
● C: CVP is a preload marker, unreliable in sepsis due to venodilation and capillary
leak; not used as endpoint
● D: SVR is typically decreased in septic shock (distributive); targeting high SVR
would worsen perfusion
HESI Retake Tip: When asked about "effectiveness of tissue perfusion," always look for
lactate or urine output as answers, not blood pressure alone.
Q2: [SELECT ALL THAT APPLY] A patient with acute decompensated heart failure is
receiving IV furosemide 80mg BID. Which assessment findings indicate the medication
is achieving the desired therapeutic effect?
A. Weight decrease of 2 kg over 24 hours [CORRECT]
B. Decreased dyspnea with improved SpO2 [CORRECT]
C. Decreased jugular venous distension [CORRECT]
D. Increased serum creatinine from 1.0 to 1.8 mg/dL
E. Decreased peripheral edema [CORRECT]
Correct Answer: A, B, C, E
Rationale: Furosemide is a loop diuretic that reduces preload and afterload in heart
failure. Therapeutic effects include:
● Weight loss: 1 kg ≈ 1 liter fluid loss; 2 kg/24 hours is appropriate goal
● Symptom improvement: Reduced pulmonary congestion (dyspnea, SpO2)
● Reduced JVD: Decreased right atrial pressure
● Edema reduction: Decreased interstitial fluid
,Why D is incorrect: Rising creatinine indicates prerenal azotemia from over-diuresis and
hypovolemia, not therapeutic effect. This requires dose reduction or hold.
HESI Retake Tip: In SATA questions, look for positive outcomes (improvements) vs.
adverse effects (worsening labs).
Q3: A patient with type 1 diabetes presents with DKA: pH 7.22, glucose 485 mg/dL,
ketones positive. Insulin infusion is started at 0.1 units/kg/hr. Two hours later, glucose
is 250 mg/dL. What is the priority nursing intervention?
A. Add dextrose to IV fluids and continue insulin infusion [CORRECT]
B. Stop insulin infusion to prevent hypoglycemia
C. Increase insulin infusion rate to 0.2 units/kg/hr
D. Transition to subcutaneous insulin immediately
Correct Answer: A
Rationale: In DKA management, the goal is to close the anion gap and clear ketones, not
just normalize glucose. When glucose reaches 200-250 mg/dL, add dextrose (D5 or
D10) to prevent hypoglycemia while continuing insulin to suppress ketogenesis and
promote glucose utilization. Stopping insulin or transitioning too early causes rebound
DKA.
Why others are incorrect:
● B: Stopping insulin causes ketone recurrence; glucose will rise from
counter-regulatory hormones
● C: Increasing insulin risks hypoglycemia without dextrose; rate should not
increase
, ● D: SC insulin requires 1-2 hour overlap with IV insulin after anion gap closes; too
early
HESI Retake Tip: In DKA, remember: "Don't stop the insulin, just add sugar."
Q4: A patient with a spinal cord injury at T4 level reports severe headache, nasal
congestion, and "goosebumps." Vital signs: BP 186/112, HR 52 bpm. What condition is
occurring?
A. Autonomic dysreflexia [CORRECT]
B. Neurogenic shock
C. Spinal shock
D. Malignant hypertension
Correct Answer: A
Rationale: Autonomic dysreflexia is a life-threatening emergency in patients with T6 or
higher spinal cord injuries. Triggered by noxious stimulus below injury level (commonly
bladder distention, bowel impaction). Pathophysiology: Unopposed sympathetic
response below injury causes hypertension (risk of stroke, seizure, death); baroreceptor
reflex causes bradycardia above injury.
Immediate action: Sit patient upright (lower BP), remove stimulus (catheterize, check
bowel), antihypertensives if needed (nitrates, hydralazine).
Why others are incorrect:
● B: Neurogenic shock causes hypotension and bradycardia (loss of sympathetic
tone); occurs acutely post-injury
● C: Spinal shock = flaccid paralysis, areflexia below injury; temporary
● D: Secondary diagnosis; this is specifically autonomic dysreflexia in SCI patient
