HESI PN Med-Surg TEST BANK (NGN-
Style Questions & Case Scenarios) Qs &
Ans to Pass the Exam
Case Study 1: Client with COPD Exacerbation
Mr. J, 68 years old, arrives at the emergency department with increasing shortness
of breath, use of accessory muscles, and a productive cough with green sputum.
He has a 45-pack-year smoking history. Vital signs: BP 148/88, HR 102, RR 28,
SpO₂ 86% on room air. Lung sounds reveal diffuse expiratory wheezes and
diminished breath sounds in the bases.
1. The nurse places the client on oxygen. What is the most appropriate initial
oxygen delivery device?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Venturi mask at 28%
D. Nasal cannula at 2 L/min
Answer: C
Rationale: In COPD with hypoxemia, controlled low-flow oxygen is critical to
prevent depressing the hypoxic drive. A Venturi mask delivers a precise FiO₂ (28%)
and reduces risk of CO₂ retention. A nasal cannula can be used but Venturi ensures
exact concentration. Non-rebreather and high-flow masks may cause CO₂
narcosis.
2. The provider orders arterial blood gases (ABGs). Which results would the
nurse expect with an acute COPD exacerbation?
,A. pH 7.32, PaCO₂ 60, HCO₃ 28
B. pH 7.48, PaCO₂ 30, HCO₃ 24
C. pH 7.40, PaCO₂ 40, HCO₃ 24
D. pH 7.30, PaCO₂ 50, HCO₃ 20
Answer: A
Rationale: In acute exacerbation, CO₂ retention leads to respiratory acidosis (pH
<7.35, PaCO₂ >45). The HCO₃ may be elevated if some compensation is present.
Option A indicates uncompensated respiratory acidosis with slightly elevated
HCO₃ (chronic component). B is respiratory alkalosis. D is metabolic acidosis with
some respiratory acidosis.
3. The nurse assesses the client’s oxygenation status after 30 minutes. The
SpO₂ is 92% and the client is less dyspneic. Which additional finding is most
important to report?
A. Expectoration of thick, green sputum
B. Client states, “I’m feeling very sleepy now”
C. Heart rate decreased to 94 bpm
D. Use of pursed-lip breathing
Answer: B
Rationale: Increased somnolence or lethargy can signal CO₂ narcosis from
excessive oxygen administration or worsening respiratory failure. The nurse must
report this immediately. Thick green sputum (A) is expected, improvement in HR (C)
is positive, and pursed-lip breathing (D) is a self-management strategy.
4. The practical nurse is reinforcing teaching with a client after a total hip
replacement. Which statement indicates the client needs further instruction?
A. “I will use a long-handled reacher to pick up things from the floor.”
,B. “I can cross my ankles when I’m sitting in a chair.”
C. “I will sit in a raised chair with arms.”
D. “I will not bend forward more than 90 degrees at the hips.”
Answer: B
Rationale: After total hip arthroplasty, hip adduction and internal rotation must be
avoided to prevent dislocation. Crossing ankles (adduction) is unsafe. Using a
reacher (A), raised chair with arms (C), and avoiding hip flexion >90° (D) are all
correct precautions.
5. A client with chronic kidney disease (CKD) is prescribed a low-potassium
diet. Which food choice would the PN teach the client to avoid?
A. Applesauce
B. Bananas
C. White rice
D. Green beans
Answer: B
Rationale: Bananas are high in potassium and should be limited or avoided in CKD.
Applesauce, white rice, and green beans are lower in potassium.
6. The PN is caring for a client with a chest tube to water seal drainage. The
water seal chamber shows continuous bubbling. What action should the PN
take first?
A. Clamp the chest tube close to the insertion site
B. Notify the registered nurse (RN) or provider
C. Assess the drainage system for an air leak
D. Document the finding as expected
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
PN should first check the system from the insertion site to the collection unit to
locate the leak (loose connections, etc.). After checking, report to RN/provider if
, unresolved. Clamping without an order is not within PN scope and may cause
tension pneumothorax.
7. A client with type 2 diabetes mellitus asks, “Why do I need to check my feet
every day?” Which response by the PN is best?
A. “Diabetes causes poor circulation, and you may not feel injuries due to nerve
damage.”
B. “Checking your feet helps prevent ingrown toenails.”
C. “You only need to check if you have pain or swelling.”
D. “Daily inspection is required because your blood sugar affects foot odor.”
Answer: A
Rationale: Peripheral neuropathy and vascular insufficiency increase risk of injury,
infection, and non-healing wounds. Sensation loss means injuries may go
unnoticed. Option B is not the primary reason; C is dangerous; D is inaccurate.
8. The PN is collecting data on a client with suspected fluid volume deficit.
Which finding is the earliest indicator?
A. Orthostatic hypotension
B. Dry mucous membranes
C. Flat neck veins when supine
D. Oliguria
Answer: A
Rationale: Orthostatic hypotension (a drop in BP and rise in HR upon standing) is an
early, sensitive sign of fluid volume deficit. Dry mucous membranes (B), flat neck
veins (C), and oliguria (D) appear as deficit progresses.
9. A client receiving furosemide 40 mg IV push for heart failure has a potassium
level of 3.2 mEq/L. The nurse would anticipate which action?
A. Hold the furosemide and notify the provider
B. Administer the furosemide as prescribed
Style Questions & Case Scenarios) Qs &
Ans to Pass the Exam
Case Study 1: Client with COPD Exacerbation
Mr. J, 68 years old, arrives at the emergency department with increasing shortness
of breath, use of accessory muscles, and a productive cough with green sputum.
He has a 45-pack-year smoking history. Vital signs: BP 148/88, HR 102, RR 28,
SpO₂ 86% on room air. Lung sounds reveal diffuse expiratory wheezes and
diminished breath sounds in the bases.
1. The nurse places the client on oxygen. What is the most appropriate initial
oxygen delivery device?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Venturi mask at 28%
D. Nasal cannula at 2 L/min
Answer: C
Rationale: In COPD with hypoxemia, controlled low-flow oxygen is critical to
prevent depressing the hypoxic drive. A Venturi mask delivers a precise FiO₂ (28%)
and reduces risk of CO₂ retention. A nasal cannula can be used but Venturi ensures
exact concentration. Non-rebreather and high-flow masks may cause CO₂
narcosis.
2. The provider orders arterial blood gases (ABGs). Which results would the
nurse expect with an acute COPD exacerbation?
,A. pH 7.32, PaCO₂ 60, HCO₃ 28
B. pH 7.48, PaCO₂ 30, HCO₃ 24
C. pH 7.40, PaCO₂ 40, HCO₃ 24
D. pH 7.30, PaCO₂ 50, HCO₃ 20
Answer: A
Rationale: In acute exacerbation, CO₂ retention leads to respiratory acidosis (pH
<7.35, PaCO₂ >45). The HCO₃ may be elevated if some compensation is present.
Option A indicates uncompensated respiratory acidosis with slightly elevated
HCO₃ (chronic component). B is respiratory alkalosis. D is metabolic acidosis with
some respiratory acidosis.
3. The nurse assesses the client’s oxygenation status after 30 minutes. The
SpO₂ is 92% and the client is less dyspneic. Which additional finding is most
important to report?
A. Expectoration of thick, green sputum
B. Client states, “I’m feeling very sleepy now”
C. Heart rate decreased to 94 bpm
D. Use of pursed-lip breathing
Answer: B
Rationale: Increased somnolence or lethargy can signal CO₂ narcosis from
excessive oxygen administration or worsening respiratory failure. The nurse must
report this immediately. Thick green sputum (A) is expected, improvement in HR (C)
is positive, and pursed-lip breathing (D) is a self-management strategy.
4. The practical nurse is reinforcing teaching with a client after a total hip
replacement. Which statement indicates the client needs further instruction?
A. “I will use a long-handled reacher to pick up things from the floor.”
,B. “I can cross my ankles when I’m sitting in a chair.”
C. “I will sit in a raised chair with arms.”
D. “I will not bend forward more than 90 degrees at the hips.”
Answer: B
Rationale: After total hip arthroplasty, hip adduction and internal rotation must be
avoided to prevent dislocation. Crossing ankles (adduction) is unsafe. Using a
reacher (A), raised chair with arms (C), and avoiding hip flexion >90° (D) are all
correct precautions.
5. A client with chronic kidney disease (CKD) is prescribed a low-potassium
diet. Which food choice would the PN teach the client to avoid?
A. Applesauce
B. Bananas
C. White rice
D. Green beans
Answer: B
Rationale: Bananas are high in potassium and should be limited or avoided in CKD.
Applesauce, white rice, and green beans are lower in potassium.
6. The PN is caring for a client with a chest tube to water seal drainage. The
water seal chamber shows continuous bubbling. What action should the PN
take first?
A. Clamp the chest tube close to the insertion site
B. Notify the registered nurse (RN) or provider
C. Assess the drainage system for an air leak
D. Document the finding as expected
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. The
PN should first check the system from the insertion site to the collection unit to
locate the leak (loose connections, etc.). After checking, report to RN/provider if
, unresolved. Clamping without an order is not within PN scope and may cause
tension pneumothorax.
7. A client with type 2 diabetes mellitus asks, “Why do I need to check my feet
every day?” Which response by the PN is best?
A. “Diabetes causes poor circulation, and you may not feel injuries due to nerve
damage.”
B. “Checking your feet helps prevent ingrown toenails.”
C. “You only need to check if you have pain or swelling.”
D. “Daily inspection is required because your blood sugar affects foot odor.”
Answer: A
Rationale: Peripheral neuropathy and vascular insufficiency increase risk of injury,
infection, and non-healing wounds. Sensation loss means injuries may go
unnoticed. Option B is not the primary reason; C is dangerous; D is inaccurate.
8. The PN is collecting data on a client with suspected fluid volume deficit.
Which finding is the earliest indicator?
A. Orthostatic hypotension
B. Dry mucous membranes
C. Flat neck veins when supine
D. Oliguria
Answer: A
Rationale: Orthostatic hypotension (a drop in BP and rise in HR upon standing) is an
early, sensitive sign of fluid volume deficit. Dry mucous membranes (B), flat neck
veins (C), and oliguria (D) appear as deficit progresses.
9. A client receiving furosemide 40 mg IV push for heart failure has a potassium
level of 3.2 mEq/L. The nurse would anticipate which action?
A. Hold the furosemide and notify the provider
B. Administer the furosemide as prescribed
