HESI PN Medical-Surgical NGN
Practice Exam: Comprehensive
Questions & Rationales (Version 3)
QUESTION 1
A 58-year-old male client with chronic hypertension is prescribed lisinopril,
an ACE inhibitor. Which assessment finding would indicate a potentially
serious adverse effect of this medication?
A) Blood pressure decrease of 10 mmHg
B) Mild dizziness upon standing
C) Persistent dry cough
D) Decreased appetite
E) Mild headache
CORRECT ANSWER: C) Persistent dry cough
Rationale: ACE inhibitors like lisinopril cause a persistent dry cough in 10-
20% of patients due to inhibition of ACE (which breaks down bradykinin).
While not life-threatening, it is a common and bothersome adverse effect
that may require medication change. A blood pressure decrease of 10
mmHg is therapeutic, dizziness upon standing may be expected initially but
typically resolves, decreased appetite is not typical of ACE inhibitors, and
mild headache is not a characteristic adverse effect.
,QUESTION 2
A 72-year-old female client is admitted with acute coronary syndrome. The
cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
CORRECT ANSWER: B) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, and aVF)
indicates an inferior wall myocardial infarction, most commonly caused by
occlusion of the right coronary artery (RCA), which typically supplies the
inferior wall of the left ventricle in approximately 80% of the population.
The LAD supplies the anterior and anteroseptal walls (shows changes in
leads V1-V4), the left circumflex supplies the lateral walls (changes in leads
I, aVL, V5-V6), and the left main coronary artery occlusion would present
with more extensive ST changes.
QUESTION 3
A 45-year-old male client with COPD is receiving oxygen therapy. Which
oxygen delivery method would be most appropriate if the client requires a
precise FiO2 and needs to perform activities of daily living?
A) Nasal cannula
B) Venturi mask
C) Non-rebreather mask
D) Simple face mask
,CORRECT ANSWER: B) Venturi mask
Rationale: The Venturi mask delivers a precise and predictable FiO2
(typically 24%-50%) through specific air-entrainment ports, making it ideal
for clients who require controlled oxygen therapy, particularly those with
COPD at risk for CO2 retention. While a nasal cannula allows mobility, it
does not deliver a precise FiO2. Non-rebreather masks deliver high
concentrations (80%-95%) but are not precise and restrict activity. The
Venturi mask is the gold standard when precise FiO2 delivery is necessary.
QUESTION 4
A 68-year-old female client with heart failure is prescribed furosemide 40
mg daily. The nurse recognizes that this diuretic works primarily in which
location?
A) Glomerulus
B) Proximal convoluted tubule
C) Loop of Henle
D) Distal convoluted tubule
CORRECT ANSWER: C) Loop of Henle
Rationale: Furosemide is a loop diuretic that acts on the thick ascending
limb of the loop of Henle by inhibiting the Na⁺-K⁺-2Cl⁻ cotransporter. This
potent action blocks sodium and chloride reabsorption, leading to
significant diuresis.
, QUESTION 5
A nurse is caring for a client who is taking lithium and reports persistent
nausea and vomiting for 2 days. Which laboratory value should the nurse
report to the provider?
A) Potassium 4.0 mEq/L
B) Lithium 0.9 mEq/L
C) BUN 12 mg/dL
D) Sodium 132 mEq/L
CORRECT ANSWER: D) Sodium 132 mEq/L
Rationale: A sodium level of 132 mEq/L is below the expected reference
range of 136 to 145 mEq/L, indicating hyponatremia. Hyponatremia can
lead to lithium accumulation because the kidneys retain lithium in response
to low sodium levels, placing the client at risk for lithium toxicity. The nurse
should report this finding to the provider immediately.
QUESTION 6
A nurse is caring for a client who has cancer and has a WBC count of
4,000/mm³. Which of the following actions should the nurse take?
A) Cleanse the client's toothbrush with hydrogen peroxide
B) Instruct the client to use a disposable razor to shave
C) Decrease the client's protein intake
D) Encourage the client to eat unpasteurized dairy products
CORRECT ANSWER: A) Cleanse the client's toothbrush with hydrogen
peroxide
Practice Exam: Comprehensive
Questions & Rationales (Version 3)
QUESTION 1
A 58-year-old male client with chronic hypertension is prescribed lisinopril,
an ACE inhibitor. Which assessment finding would indicate a potentially
serious adverse effect of this medication?
A) Blood pressure decrease of 10 mmHg
B) Mild dizziness upon standing
C) Persistent dry cough
D) Decreased appetite
E) Mild headache
CORRECT ANSWER: C) Persistent dry cough
Rationale: ACE inhibitors like lisinopril cause a persistent dry cough in 10-
20% of patients due to inhibition of ACE (which breaks down bradykinin).
While not life-threatening, it is a common and bothersome adverse effect
that may require medication change. A blood pressure decrease of 10
mmHg is therapeutic, dizziness upon standing may be expected initially but
typically resolves, decreased appetite is not typical of ACE inhibitors, and
mild headache is not a characteristic adverse effect.
,QUESTION 2
A 72-year-old female client is admitted with acute coronary syndrome. The
cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
CORRECT ANSWER: B) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, and aVF)
indicates an inferior wall myocardial infarction, most commonly caused by
occlusion of the right coronary artery (RCA), which typically supplies the
inferior wall of the left ventricle in approximately 80% of the population.
The LAD supplies the anterior and anteroseptal walls (shows changes in
leads V1-V4), the left circumflex supplies the lateral walls (changes in leads
I, aVL, V5-V6), and the left main coronary artery occlusion would present
with more extensive ST changes.
QUESTION 3
A 45-year-old male client with COPD is receiving oxygen therapy. Which
oxygen delivery method would be most appropriate if the client requires a
precise FiO2 and needs to perform activities of daily living?
A) Nasal cannula
B) Venturi mask
C) Non-rebreather mask
D) Simple face mask
,CORRECT ANSWER: B) Venturi mask
Rationale: The Venturi mask delivers a precise and predictable FiO2
(typically 24%-50%) through specific air-entrainment ports, making it ideal
for clients who require controlled oxygen therapy, particularly those with
COPD at risk for CO2 retention. While a nasal cannula allows mobility, it
does not deliver a precise FiO2. Non-rebreather masks deliver high
concentrations (80%-95%) but are not precise and restrict activity. The
Venturi mask is the gold standard when precise FiO2 delivery is necessary.
QUESTION 4
A 68-year-old female client with heart failure is prescribed furosemide 40
mg daily. The nurse recognizes that this diuretic works primarily in which
location?
A) Glomerulus
B) Proximal convoluted tubule
C) Loop of Henle
D) Distal convoluted tubule
CORRECT ANSWER: C) Loop of Henle
Rationale: Furosemide is a loop diuretic that acts on the thick ascending
limb of the loop of Henle by inhibiting the Na⁺-K⁺-2Cl⁻ cotransporter. This
potent action blocks sodium and chloride reabsorption, leading to
significant diuresis.
, QUESTION 5
A nurse is caring for a client who is taking lithium and reports persistent
nausea and vomiting for 2 days. Which laboratory value should the nurse
report to the provider?
A) Potassium 4.0 mEq/L
B) Lithium 0.9 mEq/L
C) BUN 12 mg/dL
D) Sodium 132 mEq/L
CORRECT ANSWER: D) Sodium 132 mEq/L
Rationale: A sodium level of 132 mEq/L is below the expected reference
range of 136 to 145 mEq/L, indicating hyponatremia. Hyponatremia can
lead to lithium accumulation because the kidneys retain lithium in response
to low sodium levels, placing the client at risk for lithium toxicity. The nurse
should report this finding to the provider immediately.
QUESTION 6
A nurse is caring for a client who has cancer and has a WBC count of
4,000/mm³. Which of the following actions should the nurse take?
A) Cleanse the client's toothbrush with hydrogen peroxide
B) Instruct the client to use a disposable razor to shave
C) Decrease the client's protein intake
D) Encourage the client to eat unpasteurized dairy products
CORRECT ANSWER: A) Cleanse the client's toothbrush with hydrogen
peroxide
