HESI RN MED-SURG PRACTICE EXAM |
ORIGINAL QUESTIONS AND RATIONALES-
BASED STUDY GUIDE | EXAM PREP | CLINICAL
REASONING PRACTICE TEST
1. A nurse is caring for a patient with heart failure who suddenly develops
shortness of breath and crackles in the lungs. Which action should the nurse
take first?
A. Administer a prescribed diuretic
B. Place the patient in high Fowler’s position
C. Notify the healthcare provider
D. Obtain a chest X-ray
Positioning the patient upright immediately improves lung expansion and
oxygenation, making it the priority intervention before medications or
diagnostics.
2. A patient with diabetes has a blood glucose level of 52 mg/dL. What is the
priority action?
A. Administer insulin
B. Give 15 grams of fast-acting carbohydrate
C. Recheck glucose in 4 hours
D. Restrict oral intake
The patient is hypoglycemic and requires immediate glucose replacement to
prevent neurologic deterioration.
3. A client with chronic kidney disease is prescribed a low-potassium diet.
Which food choice indicates understanding?
A. Bananas
B. Oranges
,C. Apples
D. Potatoes
RApples are low in potassium and safe for patients on potassium-restricted diets,
unlike bananas, oranges, and potatoes which are high in potassium.
4. A nurse is assessing a patient with pneumonia. Which finding requires
immediate intervention?
A. Productive cough
B. Oxygen saturation of 88%
C. Fever of 100.4°F
D. Fatigue
Low oxygen saturation indicates impaired gas exchange and requires immediate
intervention to prevent respiratory compromise.
5. A postoperative patient reports sudden calf pain and swelling. What is the
priority nursing action?
A. Massage the affected leg
B. Encourage ambulation
C. Notify the healthcare provider
D. Apply heat to the area
These are signs of deep vein thrombosis; massaging or applying heat could
dislodge a clot and cause a pulmonary embolism.
6. A nurse is teaching a patient with COPD about oxygen use at home. Which
statement indicates correct understanding?
A. “I will increase oxygen flow if I feel short of breath.”
B. “I will use oxygen continuously as prescribed.”
C. “I can smoke while using oxygen.”
D. “I will stop oxygen when I feel better.”
,COPD patients must use oxygen exactly as prescribed; adjusting flow without
guidance or smoking increases risk of complications.
7. A patient receiving IV potassium reports burning at the infusion site. What
is the nurse’s priority action?
A. Slow the infusion
B. Stop the infusion immediately
C. Apply warm compress
D. Reassure the patient
IV potassium is highly irritating; burning may indicate infiltration or
complications requiring immediate cessation.
8. Which lab value is most concerning in a patient taking warfarin?
A. INR 2.5
B. INR 3.0
C. INR 4.8
D. INR 2.0
An elevated INR significantly increases bleeding risk and requires prompt
intervention or dose adjustment.
9. A nurse is caring for a patient with suspected stroke. What is the priority
action?
A. Administer aspirin
B. Perform a swallowing assessment
C. Obtain a CT scan
D. Check blood pressure
A CT scan is needed urgently to differentiate ischemic from hemorrhagic stroke
before initiating treatment.
, 10. A patient with heart failure is prescribed furosemide. Which finding
indicates the medication is effective?
A. Increased weight
B. Decreased urine output
C. Reduced edema
D. Increased blood pressure
Furosemide is a diuretic that reduces fluid overload; decreased edema indicates
therapeutic effectiveness.
11. A nurse is caring for a patient with asthma experiencing wheezing and
mild respiratory distress. Which medication should the nurse expect to
administer first?
A. Inhaled corticosteroid
B. Long-acting beta agonist (LABA)
C. Short-acting bronchodilator (albuterol)
D. Oral antihistamine
A short-acting beta agonist provides rapid bronchodilation and is the first-line
rescue medication during an acute asthma episode.
12. A patient with chest pain is suspected of having myocardial infarction.
Which lab value is most specific for cardiac damage?
A. Myoglobin
B. Troponin I
C. C-reactive protein
D. Hemoglobin
Troponin is the most specific and sensitive marker for myocardial injury and
remains elevated longer than other markers.
ORIGINAL QUESTIONS AND RATIONALES-
BASED STUDY GUIDE | EXAM PREP | CLINICAL
REASONING PRACTICE TEST
1. A nurse is caring for a patient with heart failure who suddenly develops
shortness of breath and crackles in the lungs. Which action should the nurse
take first?
A. Administer a prescribed diuretic
B. Place the patient in high Fowler’s position
C. Notify the healthcare provider
D. Obtain a chest X-ray
Positioning the patient upright immediately improves lung expansion and
oxygenation, making it the priority intervention before medications or
diagnostics.
2. A patient with diabetes has a blood glucose level of 52 mg/dL. What is the
priority action?
A. Administer insulin
B. Give 15 grams of fast-acting carbohydrate
C. Recheck glucose in 4 hours
D. Restrict oral intake
The patient is hypoglycemic and requires immediate glucose replacement to
prevent neurologic deterioration.
3. A client with chronic kidney disease is prescribed a low-potassium diet.
Which food choice indicates understanding?
A. Bananas
B. Oranges
,C. Apples
D. Potatoes
RApples are low in potassium and safe for patients on potassium-restricted diets,
unlike bananas, oranges, and potatoes which are high in potassium.
4. A nurse is assessing a patient with pneumonia. Which finding requires
immediate intervention?
A. Productive cough
B. Oxygen saturation of 88%
C. Fever of 100.4°F
D. Fatigue
Low oxygen saturation indicates impaired gas exchange and requires immediate
intervention to prevent respiratory compromise.
5. A postoperative patient reports sudden calf pain and swelling. What is the
priority nursing action?
A. Massage the affected leg
B. Encourage ambulation
C. Notify the healthcare provider
D. Apply heat to the area
These are signs of deep vein thrombosis; massaging or applying heat could
dislodge a clot and cause a pulmonary embolism.
6. A nurse is teaching a patient with COPD about oxygen use at home. Which
statement indicates correct understanding?
A. “I will increase oxygen flow if I feel short of breath.”
B. “I will use oxygen continuously as prescribed.”
C. “I can smoke while using oxygen.”
D. “I will stop oxygen when I feel better.”
,COPD patients must use oxygen exactly as prescribed; adjusting flow without
guidance or smoking increases risk of complications.
7. A patient receiving IV potassium reports burning at the infusion site. What
is the nurse’s priority action?
A. Slow the infusion
B. Stop the infusion immediately
C. Apply warm compress
D. Reassure the patient
IV potassium is highly irritating; burning may indicate infiltration or
complications requiring immediate cessation.
8. Which lab value is most concerning in a patient taking warfarin?
A. INR 2.5
B. INR 3.0
C. INR 4.8
D. INR 2.0
An elevated INR significantly increases bleeding risk and requires prompt
intervention or dose adjustment.
9. A nurse is caring for a patient with suspected stroke. What is the priority
action?
A. Administer aspirin
B. Perform a swallowing assessment
C. Obtain a CT scan
D. Check blood pressure
A CT scan is needed urgently to differentiate ischemic from hemorrhagic stroke
before initiating treatment.
, 10. A patient with heart failure is prescribed furosemide. Which finding
indicates the medication is effective?
A. Increased weight
B. Decreased urine output
C. Reduced edema
D. Increased blood pressure
Furosemide is a diuretic that reduces fluid overload; decreased edema indicates
therapeutic effectiveness.
11. A nurse is caring for a patient with asthma experiencing wheezing and
mild respiratory distress. Which medication should the nurse expect to
administer first?
A. Inhaled corticosteroid
B. Long-acting beta agonist (LABA)
C. Short-acting bronchodilator (albuterol)
D. Oral antihistamine
A short-acting beta agonist provides rapid bronchodilation and is the first-line
rescue medication during an acute asthma episode.
12. A patient with chest pain is suspected of having myocardial infarction.
Which lab value is most specific for cardiac damage?
A. Myoglobin
B. Troponin I
C. C-reactive protein
D. Hemoglobin
Troponin is the most specific and sensitive marker for myocardial injury and
remains elevated longer than other markers.
