NSG HESI Comprehensive Exam 3 | 126
Questions and Answers | 2026 Update |
100% Correct.
SECTION 1: ACUTE CARE & MEDICAL-SURGICAL
Question 1:
A nurse is caring for a client with heart failure who reports sudden onset of dyspnea and
coughing up pink, frothy sputum. Which action should the nurse take first?
A) Administer morphine sulfate IV push
B) Place the client in high-Fowler's position
C) Apply a non-rebreather mask at 15 L/min
D) Notify the healthcare provider stat
Answer: B
Rationale: High-Fowler's position uses gravity to reduce venous return and pulmonary
congestion. This is the immediate priority before administering oxygen or medications.
Morphine and oxygen are important, but positioning comes first in acute pulmonary
edema .
Question 2:
A client with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing pH 7.32, PaCO₂ 58 mmHg, and HCO₃⁻ 30 mEq/L. The nurse interprets this
as:
A) Uncompensated respiratory acidosis
, B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Metabolic alkalosis with respiratory compensation
Answer: B
Rationale: The pH is low (acidosis), PaCO₂ is high (respiratory cause), and HCO₃⁻ is
elevated (metabolic compensation). Since the pH is still abnormal (not fully normalized),
compensation is only partial. Fully compensated respiratory acidosis would have a
normal pH (7.35-7.45) .
Question 3:
On the second day after admission, a client with a fractured pelvis develops chest pain,
tachypnea, and tachycardia. Which additional finding should the nurse identify that is
most likely related to a fat embolism?
A) Hemoptysis
B) Cyanosis of the nail beds
C) Petechiae of the anterior chest wall
D) Jugular venous distention
Answer: C
Rationale: The pathophysiology of fat embolism syndrome (FES) after fracture involves
release of bone marrow fat globules into venous circulation, followed by platelet
aggregation. Fat emboli lodge in the pulmonary vasculature, causing tissue hypoxia, and
manifest as petechiae on the neck, anterior chest wall, axilla, buccal membrane, and
conjunctiva .
Question 4:
A client is prescribed a STAT dose of IV insulin. Which vial should the nurse select to
prepare the dose?
A) Insulin glulisine
B) Insulin regular (Humulin R)
C) Insulin detemir
Questions and Answers | 2026 Update |
100% Correct.
SECTION 1: ACUTE CARE & MEDICAL-SURGICAL
Question 1:
A nurse is caring for a client with heart failure who reports sudden onset of dyspnea and
coughing up pink, frothy sputum. Which action should the nurse take first?
A) Administer morphine sulfate IV push
B) Place the client in high-Fowler's position
C) Apply a non-rebreather mask at 15 L/min
D) Notify the healthcare provider stat
Answer: B
Rationale: High-Fowler's position uses gravity to reduce venous return and pulmonary
congestion. This is the immediate priority before administering oxygen or medications.
Morphine and oxygen are important, but positioning comes first in acute pulmonary
edema .
Question 2:
A client with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing pH 7.32, PaCO₂ 58 mmHg, and HCO₃⁻ 30 mEq/L. The nurse interprets this
as:
A) Uncompensated respiratory acidosis
, B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Metabolic alkalosis with respiratory compensation
Answer: B
Rationale: The pH is low (acidosis), PaCO₂ is high (respiratory cause), and HCO₃⁻ is
elevated (metabolic compensation). Since the pH is still abnormal (not fully normalized),
compensation is only partial. Fully compensated respiratory acidosis would have a
normal pH (7.35-7.45) .
Question 3:
On the second day after admission, a client with a fractured pelvis develops chest pain,
tachypnea, and tachycardia. Which additional finding should the nurse identify that is
most likely related to a fat embolism?
A) Hemoptysis
B) Cyanosis of the nail beds
C) Petechiae of the anterior chest wall
D) Jugular venous distention
Answer: C
Rationale: The pathophysiology of fat embolism syndrome (FES) after fracture involves
release of bone marrow fat globules into venous circulation, followed by platelet
aggregation. Fat emboli lodge in the pulmonary vasculature, causing tissue hypoxia, and
manifest as petechiae on the neck, anterior chest wall, axilla, buccal membrane, and
conjunctiva .
Question 4:
A client is prescribed a STAT dose of IV insulin. Which vial should the nurse select to
prepare the dose?
A) Insulin glulisine
B) Insulin regular (Humulin R)
C) Insulin detemir
