Medical-Surgical Nursing II HESI Exam Comprehensive
Study Guide, Practice Questions & Verified Test Bank for
Med Surg 2 HESI Assessment | Advanced Adult Health
Nursing Review, NCLEX-RN Preparation, Priority Nursing
Interventions, Pharmacology, Critical Care & Clinical
Judgment
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV push. Which
assessment finding requires the nurse to hold the medication and notify the provider?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Respiratory rate 18 breaths/min
D. Urine output 40 mL/hr
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, increasing risk for
hypokalemia. A serum potassium of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and
requires intervention before administering additional potassium-wasting diuretics to prevent
cardiac dysrhythmias.
Question 2: Which intervention should the nurse prioritize for a patient experiencing an
acute asthma exacerbation with wheezing and dyspnea?
A. Administer albuterol via nebulizer
B. Obtain a peak flow measurement
C. Position the patient in high Fowler's position
D. Apply oxygen at 2 L/min via nasal cannula
CORRECT ANSWER: A. Administer albuterol via nebulizer
Rationale: During an acute asthma exacerbation, bronchodilation is the priority intervention to
reverse airway constriction. Albuterol, a short-acting beta-2 agonist, provides rapid relief of
bronchospasm. While positioning and oxygen are important, addressing the underlying
pathophysiology takes precedence.
Question 3: A patient with chronic kidney disease has a serum phosphorus level of 6.8 mg/dL.
Which medication should the nurse anticipate administering?
A. Calcium carbonate
B. Epoetin alfa
C. Ferrous sulfate
D. Sodium polystyrene sulfonate
CORRECT ANSWER: A. Calcium carbonate
Rationale: Elevated phosphorus levels in chronic kidney disease require phosphate-binding
agents like calcium carbonate to prevent complications such as secondary hyperparathyroidism
and calcification of soft tissues. Calcium carbonate binds dietary phosphorus in the GI tract,
reducing absorption.
Question 4: The nurse is caring for a postoperative patient who suddenly develops chest pain,
dyspnea, and tachycardia. Which action should the nurse take first?
A. Administer morphine sulfate IV
B. Obtain a 12-lead electrocardiogram
,C. Apply oxygen via non-rebreather mask
D. Notify the rapid response team
CORRECT ANSWER: C. Apply oxygen via non-rebreather mask
Rationale: Following the ABCs (Airway, Breathing, Circulation), ensuring adequate oxygenation
is the priority when a patient exhibits signs of potential pulmonary embolism or myocardial
infarction. Oxygen administration supports tissue perfusion while further assessment and
interventions are initiated.
Question 5: Which finding in a patient with diabetic ketoacidosis indicates that treatment is
effective?
A. Blood glucose 250 mg/dL
B. Serum bicarbonate 18 mEq/L
C. Arterial pH 7.28
D. Urine ketones negative
CORRECT ANSWER: D. Urine ketones negative
Rationale: Resolution of ketonuria indicates that the body has shifted from fat metabolism back
to glucose utilization, reflecting effective insulin therapy and correction of the metabolic
acidosis in diabetic ketoacidosis. While improving glucose and pH are positive signs, absence of
ketones directly confirms resolution of the ketoacidotic state.
Question 6: A patient with a newly placed chest tube for pneumothorax has continuous
bubbling in the water seal chamber. What is the nurse's priority action?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for air leaks
D. Increase suction pressure
CORRECT ANSWER: C. Assess the system for air leaks
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be at the insertion site, tubing connections, or drainage unit. The nurse must
systematically assess for the source of the leak to ensure proper lung re-expansion and prevent
complications. Clamping a chest tube without provider order can cause tension pneumothorax.
Question 7: Which laboratory value should the nurse monitor most closely in a patient
receiving warfarin therapy?
A. Platelet count
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin level
CORRECT ANSWER: B. International normalized ratio (INR)
Rationale: Warfarin affects the vitamin K-dependent clotting factors and is monitored using the
INR to ensure therapeutic anticoagulation (typically 2.0-3.0 for most conditions). The aPTT
monitors heparin therapy, while platelet count and hemoglobin assess for bleeding
complications but do not guide warfarin dosing.
Question 8: A patient with acute pancreatitis reports severe epigastric pain radiating to the
back. Which nursing intervention is most appropriate?
,A. Encourage oral fluids to prevent dehydration
B. Administer morphine sulfate as prescribed
C. Place the patient in supine position
D. Apply a heating pad to the abdomen
CORRECT ANSWER: B. Administer morphine sulfate as prescribed
Rationale: Pain management is a priority in acute pancreatitis. Morphine sulfate is commonly
used, though some providers prefer hydromorphone due to theoretical concerns about
sphincter of Oddi spasm. NPO status is maintained initially, positioning in Fowler's or side-lying
may provide comfort, and heat application is generally avoided due to inflammation.
Question 9: Which assessment finding in a patient with a traumatic brain injury requires
immediate notification of the provider?
A. Pupils equal and reactive at 3 mm
B. Glasgow Coma Scale score decrease from 14 to 10
C. Blood pressure 130/85 mmHg
D. Headache rated 4/10
CORRECT ANSWER: B. Glasgow Coma Scale score decrease from 14 to 10
Rationale: A decreasing Glasgow Coma Scale score indicates neurological deterioration and
possible increased intracranial pressure, requiring immediate intervention to prevent
herniation. Changes in level of consciousness are the earliest and most sensitive indicator of
neurological decline in brain injury.
Question 10: A patient with sickle cell disease is admitted with a vaso-occlusive crisis. Which
intervention should the nurse implement first?
A. Administer IV opioids for pain
B. Initiate IV hydration with normal saline
C. Apply warm compresses to affected joints
D. Administer supplemental oxygen
CORRECT ANSWER: B. Initiate IV hydration with normal saline
Rationale: Hydration is the foundation of managing vaso-occlusive crisis because it reduces
blood viscosity and helps prevent further sickling of red blood cells. While pain management,
warmth, and oxygen are important components of care, establishing adequate IV access and
initiating fluids addresses the underlying pathophysiology first.
Question 11: Which finding indicates that a patient with sepsis is progressing to septic shock?
A. Temperature 38.5°C (101.3°F)
B. Lactate level 4.2 mmol/L
C. Mean arterial pressure 55 mmHg despite fluid resuscitation
D. White blood cell count 18,000/mm³
CORRECT ANSWER: C. Mean arterial pressure 55 mmHg despite fluid resuscitation
Rationale: Septic shock is defined by persistent hypotension (MAP <65 mmHg) requiring
vasopressors despite adequate fluid resuscitation, along with elevated lactate. While elevated
lactate, fever, and leukocytosis indicate sepsis, refractory hypotension specifically defines
progression to septic shock.
, Question 12: The nurse is preparing to administer digoxin 0.125 mg PO to a patient with heart
failure. Which assessment finding requires holding the dose?
A. Apical pulse 58 beats/min
B. Blood pressure 100/60 mmHg
C. Serum sodium 135 mEq/L
D. Potassium 4.0 mEq/L
CORRECT ANSWER: A. Apical pulse 58 beats/min
Rationale: Digoxin slows cardiac conduction and can cause bradycardia. The nurse should hold
digoxin and notify the provider if the apical pulse is below 60 beats/min in adults (or per facility
policy) to prevent severe bradyarrhythmias or heart block.
Question 13: Which intervention is most effective in preventing deep vein thrombosis in a
postoperative patient?
A. Administer enoxaparin as prescribed
B. Encourage early ambulation
C. Apply sequential compression devices
D. Ensure adequate hydration
CORRECT ANSWER: B. Encourage early ambulation
Rationale: Early ambulation is the most effective non-pharmacological intervention for DVT
prevention because muscle contraction promotes venous return and reduces stasis. While
anticoagulants, compression devices, and hydration are important components of a
comprehensive prevention strategy, mobilization addresses the primary pathophysiological
mechanism.
Question 14: A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3 28 mEq/L. How should the nurse
interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Uncompensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The low pH indicates acidosis, elevated PaCO2 indicates respiratory origin, and
elevated bicarbonate shows renal compensation has begun but pH remains abnormal,
indicating partial compensation. This pattern is typical in COPD exacerbations where CO2
retention occurs.
Question 15: Which assessment finding in a patient with Addison's disease requires
immediate intervention?
A. Blood pressure 90/60 mmHg
B. Serum sodium 130 mEq/L
C. Blood glucose 60 mg/dL
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: C. Blood glucose 60 mg/dL
Rationale: Hypoglycemia in Addison's disease indicates adrenal crisis, a life-threatening
emergency requiring immediate glucocorticoid replacement and glucose administration. While
Study Guide, Practice Questions & Verified Test Bank for
Med Surg 2 HESI Assessment | Advanced Adult Health
Nursing Review, NCLEX-RN Preparation, Priority Nursing
Interventions, Pharmacology, Critical Care & Clinical
Judgment
Question 1: A patient with heart failure is prescribed furosemide 40 mg IV push. Which
assessment finding requires the nurse to hold the medication and notify the provider?
A. Blood pressure 110/70 mmHg
B. Serum potassium 3.2 mEq/L
C. Respiratory rate 18 breaths/min
D. Urine output 40 mL/hr
CORRECT ANSWER: B. Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, increasing risk for
hypokalemia. A serum potassium of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and
requires intervention before administering additional potassium-wasting diuretics to prevent
cardiac dysrhythmias.
Question 2: Which intervention should the nurse prioritize for a patient experiencing an
acute asthma exacerbation with wheezing and dyspnea?
A. Administer albuterol via nebulizer
B. Obtain a peak flow measurement
C. Position the patient in high Fowler's position
D. Apply oxygen at 2 L/min via nasal cannula
CORRECT ANSWER: A. Administer albuterol via nebulizer
Rationale: During an acute asthma exacerbation, bronchodilation is the priority intervention to
reverse airway constriction. Albuterol, a short-acting beta-2 agonist, provides rapid relief of
bronchospasm. While positioning and oxygen are important, addressing the underlying
pathophysiology takes precedence.
Question 3: A patient with chronic kidney disease has a serum phosphorus level of 6.8 mg/dL.
Which medication should the nurse anticipate administering?
A. Calcium carbonate
B. Epoetin alfa
C. Ferrous sulfate
D. Sodium polystyrene sulfonate
CORRECT ANSWER: A. Calcium carbonate
Rationale: Elevated phosphorus levels in chronic kidney disease require phosphate-binding
agents like calcium carbonate to prevent complications such as secondary hyperparathyroidism
and calcification of soft tissues. Calcium carbonate binds dietary phosphorus in the GI tract,
reducing absorption.
Question 4: The nurse is caring for a postoperative patient who suddenly develops chest pain,
dyspnea, and tachycardia. Which action should the nurse take first?
A. Administer morphine sulfate IV
B. Obtain a 12-lead electrocardiogram
,C. Apply oxygen via non-rebreather mask
D. Notify the rapid response team
CORRECT ANSWER: C. Apply oxygen via non-rebreather mask
Rationale: Following the ABCs (Airway, Breathing, Circulation), ensuring adequate oxygenation
is the priority when a patient exhibits signs of potential pulmonary embolism or myocardial
infarction. Oxygen administration supports tissue perfusion while further assessment and
interventions are initiated.
Question 5: Which finding in a patient with diabetic ketoacidosis indicates that treatment is
effective?
A. Blood glucose 250 mg/dL
B. Serum bicarbonate 18 mEq/L
C. Arterial pH 7.28
D. Urine ketones negative
CORRECT ANSWER: D. Urine ketones negative
Rationale: Resolution of ketonuria indicates that the body has shifted from fat metabolism back
to glucose utilization, reflecting effective insulin therapy and correction of the metabolic
acidosis in diabetic ketoacidosis. While improving glucose and pH are positive signs, absence of
ketones directly confirms resolution of the ketoacidotic state.
Question 6: A patient with a newly placed chest tube for pneumothorax has continuous
bubbling in the water seal chamber. What is the nurse's priority action?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for air leaks
D. Increase suction pressure
CORRECT ANSWER: C. Assess the system for air leaks
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
which could be at the insertion site, tubing connections, or drainage unit. The nurse must
systematically assess for the source of the leak to ensure proper lung re-expansion and prevent
complications. Clamping a chest tube without provider order can cause tension pneumothorax.
Question 7: Which laboratory value should the nurse monitor most closely in a patient
receiving warfarin therapy?
A. Platelet count
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin level
CORRECT ANSWER: B. International normalized ratio (INR)
Rationale: Warfarin affects the vitamin K-dependent clotting factors and is monitored using the
INR to ensure therapeutic anticoagulation (typically 2.0-3.0 for most conditions). The aPTT
monitors heparin therapy, while platelet count and hemoglobin assess for bleeding
complications but do not guide warfarin dosing.
Question 8: A patient with acute pancreatitis reports severe epigastric pain radiating to the
back. Which nursing intervention is most appropriate?
,A. Encourage oral fluids to prevent dehydration
B. Administer morphine sulfate as prescribed
C. Place the patient in supine position
D. Apply a heating pad to the abdomen
CORRECT ANSWER: B. Administer morphine sulfate as prescribed
Rationale: Pain management is a priority in acute pancreatitis. Morphine sulfate is commonly
used, though some providers prefer hydromorphone due to theoretical concerns about
sphincter of Oddi spasm. NPO status is maintained initially, positioning in Fowler's or side-lying
may provide comfort, and heat application is generally avoided due to inflammation.
Question 9: Which assessment finding in a patient with a traumatic brain injury requires
immediate notification of the provider?
A. Pupils equal and reactive at 3 mm
B. Glasgow Coma Scale score decrease from 14 to 10
C. Blood pressure 130/85 mmHg
D. Headache rated 4/10
CORRECT ANSWER: B. Glasgow Coma Scale score decrease from 14 to 10
Rationale: A decreasing Glasgow Coma Scale score indicates neurological deterioration and
possible increased intracranial pressure, requiring immediate intervention to prevent
herniation. Changes in level of consciousness are the earliest and most sensitive indicator of
neurological decline in brain injury.
Question 10: A patient with sickle cell disease is admitted with a vaso-occlusive crisis. Which
intervention should the nurse implement first?
A. Administer IV opioids for pain
B. Initiate IV hydration with normal saline
C. Apply warm compresses to affected joints
D. Administer supplemental oxygen
CORRECT ANSWER: B. Initiate IV hydration with normal saline
Rationale: Hydration is the foundation of managing vaso-occlusive crisis because it reduces
blood viscosity and helps prevent further sickling of red blood cells. While pain management,
warmth, and oxygen are important components of care, establishing adequate IV access and
initiating fluids addresses the underlying pathophysiology first.
Question 11: Which finding indicates that a patient with sepsis is progressing to septic shock?
A. Temperature 38.5°C (101.3°F)
B. Lactate level 4.2 mmol/L
C. Mean arterial pressure 55 mmHg despite fluid resuscitation
D. White blood cell count 18,000/mm³
CORRECT ANSWER: C. Mean arterial pressure 55 mmHg despite fluid resuscitation
Rationale: Septic shock is defined by persistent hypotension (MAP <65 mmHg) requiring
vasopressors despite adequate fluid resuscitation, along with elevated lactate. While elevated
lactate, fever, and leukocytosis indicate sepsis, refractory hypotension specifically defines
progression to septic shock.
, Question 12: The nurse is preparing to administer digoxin 0.125 mg PO to a patient with heart
failure. Which assessment finding requires holding the dose?
A. Apical pulse 58 beats/min
B. Blood pressure 100/60 mmHg
C. Serum sodium 135 mEq/L
D. Potassium 4.0 mEq/L
CORRECT ANSWER: A. Apical pulse 58 beats/min
Rationale: Digoxin slows cardiac conduction and can cause bradycardia. The nurse should hold
digoxin and notify the provider if the apical pulse is below 60 beats/min in adults (or per facility
policy) to prevent severe bradyarrhythmias or heart block.
Question 13: Which intervention is most effective in preventing deep vein thrombosis in a
postoperative patient?
A. Administer enoxaparin as prescribed
B. Encourage early ambulation
C. Apply sequential compression devices
D. Ensure adequate hydration
CORRECT ANSWER: B. Encourage early ambulation
Rationale: Early ambulation is the most effective non-pharmacological intervention for DVT
prevention because muscle contraction promotes venous return and reduces stasis. While
anticoagulants, compression devices, and hydration are important components of a
comprehensive prevention strategy, mobilization addresses the primary pathophysiological
mechanism.
Question 14: A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.32, PaCO2 58 mmHg, PaO2 62 mmHg, HCO3 28 mEq/L. How should the nurse
interpret these results?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Uncompensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The low pH indicates acidosis, elevated PaCO2 indicates respiratory origin, and
elevated bicarbonate shows renal compensation has begun but pH remains abnormal,
indicating partial compensation. This pattern is typical in COPD exacerbations where CO2
retention occurs.
Question 15: Which assessment finding in a patient with Addison's disease requires
immediate intervention?
A. Blood pressure 90/60 mmHg
B. Serum sodium 130 mEq/L
C. Blood glucose 60 mg/dL
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: C. Blood glucose 60 mg/dL
Rationale: Hypoglycemia in Addison's disease indicates adrenal crisis, a life-threatening
emergency requiring immediate glucocorticoid replacement and glucose administration. While
