ID: A
ANS:
2026-2027 LATEST HESI Med Surg Exit Exam (V1
Version 1) Brand New Q&As RATED A+ GRADE |
ALREADY GRADED A+ | LATEST VERSIONS
(JUST RELEASED)
Guaranteed A+
GRADE
A healthcare provider prescribes streptomycin 15 mg/kg for an infant weighing 4 pounds. The medication
is diluted in 25 mL of D5W and is to be administered over 8 hours. What total dose of streptomycin should
the infant receive?
a. 9 mg
b. 18 mg
c. 27 mg
d. 36 mg
✔️ Correct Answer: C
Rationale:
To calculate the correct dosage, the nurse must first convert the infant's weight from pounds to kilograms.
Using the conversion factor of 2.2 pounds per kilogram, 4 pounds divided by 2.2 equals approximately
1
, ID: A
ANS:
1.818 kilograms. The prescribed dose is 15 mg per kilogram of body weight, so the nurse multiplies 15 mg
by 1.818 kg, yielding 27.27 mg. Rounding to the nearest whole milligram gives 27 mg. The volume of
diluent (25 mL of D5W) and the infusion duration (8 hours) are extraneous information for this specific
calculation, as the question asks only for the total dose to be administered. Option A (9 mg) represents an
incorrect calculation, possibly from using the wrong conversion factor. Option B (18 mg) is also incorrect
and does not reflect proper weight-based dosing. Option D (36 mg) would result from multiplying 15 mg
by 2.4 kg, which does not correspond to the infant's actual weight. Accurate weight-based dosing is critical
in pediatric populations to prevent underdosing or toxicity.
A nurse is assessing a client with diabetes mellitus and notes an absence of hair growth on the client's
legs. Which additional assessment should the nurse perform to gather further data related to this finding?
a. Palpate for the presence of femoral pulses bilaterally
b. Assess for the presence of a positive Homan's sign
c. Observe the appearance of the skin on the client's legs
d. Watch the client's posture and balance during ambulation
✔️ Correct Answer: A
Rationale:
Absence of hair growth on the lower extremities is a classic manifestation of peripheral artery disease
(PAD), which commonly occurs in clients with diabetes mellitus due to atherosclerotic changes. This
finding indicates reduced arterial blood flow to the extremities. The most appropriate additional
assessment to support this finding is palpation of femoral pulses bilaterally. Diminished or absent pulses
would provide further evidence of compromised arterial circulation consistent with PAD. Homan's sign
(Option B) is associated with deep vein thrombosis and is no longer considered a reliable assessment
technique due to the risk of dislodging a thrombus. Observing the skin (Option C) may reveal additional
signs of PAD such as pallor, shiny appearance, or dependent rubor, but pulse assessment is more directly
related to the vascular insufficiency suggested by hair loss. Posture and balance assessment (Option D)
relates to neurological function and falls risk, which is not the primary concern associated with this finding.
Comprehensive vascular assessment including pulses, skin temperature, color, and capillary refill time is
essential for clients with diabetes.
2
, ID: A
ANS:
A client with preeclampsia is receiving a magnesium sulfate infusion. The nurse's assessment reveals deep
tendon reflexes of 1+, respiratory rate of 12 breaths per minute, urinary output of 90 mL over 4 hours, and
a serum magnesium level of 9 mg/dL. Which intervention should the nurse implement?
a. Continue the magnesium sulfate infusion as prescribed
b. Decrease the magnesium sulfate infusion by one-half
c. Stop the magnesium sulfate infusion immediately
d. Administer calcium gluconate immediately
✔️ Correct Answer: C
Rationale:
The assessment findings indicate magnesium toxicity, a potentially life-threatening complication of
magnesium sulfate therapy. Therapeutic magnesium levels range from 4 to 7 mg/dL; a level of 9 mg/dL is
significantly elevated. Deep tendon reflexes of 1+ (normal is 2+) indicate neuromuscular depression, while
a respiratory rate of 12 breaths per minute approaches the threshold for concern (less than 12 breaths per
minute is an indication for the antidote). Urinary output of 90 mL over 4 hours averages only 22.5 mL per
hour, which is below the minimum acceptable output of 30 mL per hour, indicating impaired renal
clearance of magnesium. The nurse should immediately stop the magnesium sulfate infusion to prevent
further toxicity. Option A is contraindicated as continuing the infusion would worsen toxicity. Option B
would not adequately address the severity of the findings. Option D (calcium gluconate) is the antidote for
magnesium toxicity and should be administered if respiratory depression occurs (less than 12 breaths per
minute) or cardiac arrest is imminent, but stopping the infusion is the priority intervention.
A client on a mechanical ventilator is receiving tubocurarine chloride (Tubarine), a neuromuscular blocking
agent. Which finding indicates that the medication is achieving its intended therapeutic effect?
a. The client's extremities are paralyzed
b. The peripheral nerve stimulator causes twitching
3
, ID: A
ANS:
c. The client clenches fist upon command
d. The client's Glasgow Coma Scale score is 14
✔️ Correct Answer: A
Rationale:
Tubocurarine chloride is a nondepolarizing neuromuscular blocking agent used to induce skeletal muscle
paralysis in mechanically ventilated clients. This paralysis facilitates mechanical ventilation by eliminating
spontaneous respirations that could interfere with ventilator synchrony and by reducing oxygen
consumption. The desired therapeutic effect is complete paralysis of voluntary muscles, which is indicated
by the client's extremities being paralyzed and an inability to move in response to command. Option B
indicates inadequate paralysis, as the peripheral nerve stimulator should not elicit twitching when the
medication is effective. Option C demonstrates that the client retains voluntary muscle control, indicating
the medication has not achieved its intended effect. Option D refers to the Glasgow Coma Scale, which
assesses neurological status and level of consciousness, not muscle paralysis; a score of 14 indicates the
client is alert and oriented but does not evaluate neuromuscular blockade effectiveness. The nurse should
also monitor for signs of awakening and use train-of-four monitoring to assess the degree of
neuromuscular blockade.
An elderly female client visits the clinic for a routine check-up and reports that she has been taking
increased doses of acetaminophen (Tylenol) daily for the past month to manage joint pain. Which previous
laboratory value should the nurse compare with today's results to evaluate for potential complications?
a. Hemoglobin and hematocrit from last quarter, expecting an increase today due to dehydration
b. Lactate dehydrogenase (LDH) from the previous visit to assess for possible liver damage
c. Activated partial thromboplastin time (APTT) from last quarter due to bleeding risk
d. Serum potassium from the previous visit to evaluate for renal compromise
✔️ Correct Answer: B
Rationale:
Acetaminophen is primarily metabolized in the liver through conjugation pathways. When taken in
excessive doses, these pathways become saturated, and the drug is instead metabolized through the
cytochrome P450 system, producing a toxic metabolite (N-acetyl-p-benzoquinone imine, or NAPQI) that
4
ANS:
2026-2027 LATEST HESI Med Surg Exit Exam (V1
Version 1) Brand New Q&As RATED A+ GRADE |
ALREADY GRADED A+ | LATEST VERSIONS
(JUST RELEASED)
Guaranteed A+
GRADE
A healthcare provider prescribes streptomycin 15 mg/kg for an infant weighing 4 pounds. The medication
is diluted in 25 mL of D5W and is to be administered over 8 hours. What total dose of streptomycin should
the infant receive?
a. 9 mg
b. 18 mg
c. 27 mg
d. 36 mg
✔️ Correct Answer: C
Rationale:
To calculate the correct dosage, the nurse must first convert the infant's weight from pounds to kilograms.
Using the conversion factor of 2.2 pounds per kilogram, 4 pounds divided by 2.2 equals approximately
1
, ID: A
ANS:
1.818 kilograms. The prescribed dose is 15 mg per kilogram of body weight, so the nurse multiplies 15 mg
by 1.818 kg, yielding 27.27 mg. Rounding to the nearest whole milligram gives 27 mg. The volume of
diluent (25 mL of D5W) and the infusion duration (8 hours) are extraneous information for this specific
calculation, as the question asks only for the total dose to be administered. Option A (9 mg) represents an
incorrect calculation, possibly from using the wrong conversion factor. Option B (18 mg) is also incorrect
and does not reflect proper weight-based dosing. Option D (36 mg) would result from multiplying 15 mg
by 2.4 kg, which does not correspond to the infant's actual weight. Accurate weight-based dosing is critical
in pediatric populations to prevent underdosing or toxicity.
A nurse is assessing a client with diabetes mellitus and notes an absence of hair growth on the client's
legs. Which additional assessment should the nurse perform to gather further data related to this finding?
a. Palpate for the presence of femoral pulses bilaterally
b. Assess for the presence of a positive Homan's sign
c. Observe the appearance of the skin on the client's legs
d. Watch the client's posture and balance during ambulation
✔️ Correct Answer: A
Rationale:
Absence of hair growth on the lower extremities is a classic manifestation of peripheral artery disease
(PAD), which commonly occurs in clients with diabetes mellitus due to atherosclerotic changes. This
finding indicates reduced arterial blood flow to the extremities. The most appropriate additional
assessment to support this finding is palpation of femoral pulses bilaterally. Diminished or absent pulses
would provide further evidence of compromised arterial circulation consistent with PAD. Homan's sign
(Option B) is associated with deep vein thrombosis and is no longer considered a reliable assessment
technique due to the risk of dislodging a thrombus. Observing the skin (Option C) may reveal additional
signs of PAD such as pallor, shiny appearance, or dependent rubor, but pulse assessment is more directly
related to the vascular insufficiency suggested by hair loss. Posture and balance assessment (Option D)
relates to neurological function and falls risk, which is not the primary concern associated with this finding.
Comprehensive vascular assessment including pulses, skin temperature, color, and capillary refill time is
essential for clients with diabetes.
2
, ID: A
ANS:
A client with preeclampsia is receiving a magnesium sulfate infusion. The nurse's assessment reveals deep
tendon reflexes of 1+, respiratory rate of 12 breaths per minute, urinary output of 90 mL over 4 hours, and
a serum magnesium level of 9 mg/dL. Which intervention should the nurse implement?
a. Continue the magnesium sulfate infusion as prescribed
b. Decrease the magnesium sulfate infusion by one-half
c. Stop the magnesium sulfate infusion immediately
d. Administer calcium gluconate immediately
✔️ Correct Answer: C
Rationale:
The assessment findings indicate magnesium toxicity, a potentially life-threatening complication of
magnesium sulfate therapy. Therapeutic magnesium levels range from 4 to 7 mg/dL; a level of 9 mg/dL is
significantly elevated. Deep tendon reflexes of 1+ (normal is 2+) indicate neuromuscular depression, while
a respiratory rate of 12 breaths per minute approaches the threshold for concern (less than 12 breaths per
minute is an indication for the antidote). Urinary output of 90 mL over 4 hours averages only 22.5 mL per
hour, which is below the minimum acceptable output of 30 mL per hour, indicating impaired renal
clearance of magnesium. The nurse should immediately stop the magnesium sulfate infusion to prevent
further toxicity. Option A is contraindicated as continuing the infusion would worsen toxicity. Option B
would not adequately address the severity of the findings. Option D (calcium gluconate) is the antidote for
magnesium toxicity and should be administered if respiratory depression occurs (less than 12 breaths per
minute) or cardiac arrest is imminent, but stopping the infusion is the priority intervention.
A client on a mechanical ventilator is receiving tubocurarine chloride (Tubarine), a neuromuscular blocking
agent. Which finding indicates that the medication is achieving its intended therapeutic effect?
a. The client's extremities are paralyzed
b. The peripheral nerve stimulator causes twitching
3
, ID: A
ANS:
c. The client clenches fist upon command
d. The client's Glasgow Coma Scale score is 14
✔️ Correct Answer: A
Rationale:
Tubocurarine chloride is a nondepolarizing neuromuscular blocking agent used to induce skeletal muscle
paralysis in mechanically ventilated clients. This paralysis facilitates mechanical ventilation by eliminating
spontaneous respirations that could interfere with ventilator synchrony and by reducing oxygen
consumption. The desired therapeutic effect is complete paralysis of voluntary muscles, which is indicated
by the client's extremities being paralyzed and an inability to move in response to command. Option B
indicates inadequate paralysis, as the peripheral nerve stimulator should not elicit twitching when the
medication is effective. Option C demonstrates that the client retains voluntary muscle control, indicating
the medication has not achieved its intended effect. Option D refers to the Glasgow Coma Scale, which
assesses neurological status and level of consciousness, not muscle paralysis; a score of 14 indicates the
client is alert and oriented but does not evaluate neuromuscular blockade effectiveness. The nurse should
also monitor for signs of awakening and use train-of-four monitoring to assess the degree of
neuromuscular blockade.
An elderly female client visits the clinic for a routine check-up and reports that she has been taking
increased doses of acetaminophen (Tylenol) daily for the past month to manage joint pain. Which previous
laboratory value should the nurse compare with today's results to evaluate for potential complications?
a. Hemoglobin and hematocrit from last quarter, expecting an increase today due to dehydration
b. Lactate dehydrogenase (LDH) from the previous visit to assess for possible liver damage
c. Activated partial thromboplastin time (APTT) from last quarter due to bleeding risk
d. Serum potassium from the previous visit to evaluate for renal compromise
✔️ Correct Answer: B
Rationale:
Acetaminophen is primarily metabolized in the liver through conjugation pathways. When taken in
excessive doses, these pathways become saturated, and the drug is instead metabolized through the
cytochrome P450 system, producing a toxic metabolite (N-acetyl-p-benzoquinone imine, or NAPQI) that
4
