NSG 223 MED SURG 2 HESI FINAL EXAM
2026/2027 QUESTIONS AND ANSWERS
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
ventilator setting includes high levels of Positive End-Expiratory Pressure (PEEP). What is the
primary physiological risk of high PEEP?
A. Decreased cardiac output
B. Increased alveolar collapse
C. Decreased intracranial pressure
D. Increased renal perfusion
Answer: A
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can decrease
venous return to the heart, leading to reduced preload and decreased cardiac output.
2. A client is experiencing an Addisonian Crisis. Which laboratory result should the nurse
expect to find?
A. Hypernatremia and Hypokalemia
B. Hyperglycemia and Hypernatremia
,C. Hyponatremia and Hyperkalemia
D. Hypocalcemia and Hypokalemia
Answer: C
Conceptual Explanation: Addisonian crisis involves a severe deficiency in cortisol and
aldosterone, leading to the loss of sodium (hyponatremia) and the retention of potassium
(hyperkalemia).
3. The nurse is caring for a client with a C6 spinal cord injury. The client reports a sudden,
severe headache and has a blood pressure of 190/100 mmHg. What is the priority nursing
action?
A. Administer prescribed antihypertensive medication
B. Perform a digital rectal exam to check for impaction
C. Raise the head of the bed to a sitting position
D. Check the patency of the urinary catheter
Answer: C
Conceptual Explanation: These are symptoms of Autonomic Dysreflexia. The immediate
priority is to sit the patient up to utilize orthostatic pressure to lower BP while searching
for the noxious stimulus.
, 4. Which assessment finding is most indicative of Cardiac Tamponade in a patient following
open-heart surgery?
A. Widening pulse pressure
B. Tachycardia and hypertension
C. Muffled heart sounds
D. Decreased Central Venous Pressure (CVP)
Answer: C
Conceptual Explanation: Beck’s triad for cardiac tamponade includes muffled heart
sounds, jugular venous distention, and hypotension (with narrowing pulse pressure).
5. A nurse is reviewing the arterial blood gas (ABG) results of a client with Diabetic
Ketoacidosis (DKA). Which results are consistent with this condition?
A. pH 7.30, PaCO2 30, HCO3 18
B. pH 7.50, PaCO2 35, HCO3 32
C. pH 7.32, PaCO2 50, HCO3 26
D. pH 7.48, PaCO2 28, HCO3 22
Answer: A
Conceptual Explanation: DKA causes Metabolic Acidosis. A low pH (<7.35) and low HCO3
(<22) indicate metabolic acidosis, often with partial respiratory compensation (low
PaCO2).
2026/2027 QUESTIONS AND ANSWERS
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
ventilator setting includes high levels of Positive End-Expiratory Pressure (PEEP). What is the
primary physiological risk of high PEEP?
A. Decreased cardiac output
B. Increased alveolar collapse
C. Decreased intracranial pressure
D. Increased renal perfusion
Answer: A
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can decrease
venous return to the heart, leading to reduced preload and decreased cardiac output.
2. A client is experiencing an Addisonian Crisis. Which laboratory result should the nurse
expect to find?
A. Hypernatremia and Hypokalemia
B. Hyperglycemia and Hypernatremia
,C. Hyponatremia and Hyperkalemia
D. Hypocalcemia and Hypokalemia
Answer: C
Conceptual Explanation: Addisonian crisis involves a severe deficiency in cortisol and
aldosterone, leading to the loss of sodium (hyponatremia) and the retention of potassium
(hyperkalemia).
3. The nurse is caring for a client with a C6 spinal cord injury. The client reports a sudden,
severe headache and has a blood pressure of 190/100 mmHg. What is the priority nursing
action?
A. Administer prescribed antihypertensive medication
B. Perform a digital rectal exam to check for impaction
C. Raise the head of the bed to a sitting position
D. Check the patency of the urinary catheter
Answer: C
Conceptual Explanation: These are symptoms of Autonomic Dysreflexia. The immediate
priority is to sit the patient up to utilize orthostatic pressure to lower BP while searching
for the noxious stimulus.
, 4. Which assessment finding is most indicative of Cardiac Tamponade in a patient following
open-heart surgery?
A. Widening pulse pressure
B. Tachycardia and hypertension
C. Muffled heart sounds
D. Decreased Central Venous Pressure (CVP)
Answer: C
Conceptual Explanation: Beck’s triad for cardiac tamponade includes muffled heart
sounds, jugular venous distention, and hypotension (with narrowing pulse pressure).
5. A nurse is reviewing the arterial blood gas (ABG) results of a client with Diabetic
Ketoacidosis (DKA). Which results are consistent with this condition?
A. pH 7.30, PaCO2 30, HCO3 18
B. pH 7.50, PaCO2 35, HCO3 32
C. pH 7.32, PaCO2 50, HCO3 26
D. pH 7.48, PaCO2 28, HCO3 22
Answer: A
Conceptual Explanation: DKA causes Metabolic Acidosis. A low pH (<7.35) and low HCO3
(<22) indicate metabolic acidosis, often with partial respiratory compensation (low
PaCO2).
