LATEST MED SURGE HESI REAL EXAM 1 & 2 2026/2027 EXAM VERIFIED WITH
CORRECT ANSWERS PLUS RATIONALES
1. A patient with diabetic ketoacidosis (DKA) is being treated with IV fluids and insulin.
Which finding indicates that treatment is effective?
A. Urine output increasing to 40 mL/hr
B. Serum potassium decreasing
C. Blood glucose decreasing
D. Respiratory rate increasing
Answer: C
Rationale: In DKA, treatment goals include decreasing blood glucose, correcting dehydration,
and reversing acidosis. A decreasing blood glucose level indicates insulin therapy is effective. As
blood glucose decreases, the anion gap closes .
2. The nurse is assessing a patient with suspected pulmonary embolism. Which finding is
most characteristic?
A. Bradycardia and hypertension
B. Productive cough with green sputum
C. Sudden onset of pleuritic chest pain and dyspnea
D. Wheezing on expiration
Answer: C
Rationale: Pulmonary embolism typically presents with sudden onset of pleuritic chest pain and
dyspnea. Other signs include tachypnea, tachycardia, hypoxemia, and hemoptysis .
3. A patient with cirrhosis is prescribed lactulose. Which finding indicates the medication is
working?
A. Increased serum ammonia levels
B. Decreased serum bilirubin
C. Decreased serum ammonia levels
D. Increased urine output
Answer: C
,Rationale: Lactulose reduces serum ammonia levels, treating hepatic encephalopathy. It
acidifies the colon, trapping ammonia as ammonium ions, promoting excretion. A decrease in
serum ammonia indicates effective treatment .
4. A patient with chronic kidney disease has hyperkalemia. Which dietary instruction
should the nurse provide?
A. Increase intake of bananas and oranges
B. Increase intake of lean meats
C. Limit intake of bananas and oranges
D. Limit intake of apples and grapes
Answer: C
Rationale: Patients with CKD and hyperkalemia should limit high-potassium foods, including
bananas, oranges, tomatoes, potatoes, and avocados. Apples and grapes are low-potassium
fruits .
5. The nurse is caring for a patient with acute pancreatitis. Which finding requires
immediate intervention?
A. Blood glucose of 180 mg/dL
B. Serum amylase of 300 U/L
C. Serum calcium of 7.0 mg/dL
D. White blood cell count of 12,000/mm³
Answer: C
Rationale: In acute pancreatitis, serum calcium may drop due to saponification. A serum
calcium of 7.0 mg/dL is critically low (normal 8.5-10.5 mg/dL) and can lead to tetany, cardiac
arrhythmias, and seizures .
6. A patient prescribed digoxin for heart failure reports nausea and visual changes. Which
finding indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Yellow-green halos around lights
C. Blood pressure of 130/80 mmHg
D. Decreased urine output
,Answer: B
Rationale: Digoxin toxicity causes visual disturbances, including yellow-green halos around
lights (xanthopsia). Other signs include nausea, vomiting, bradycardia, and cardiac
arrhythmias .
7. The nurse is preparing to administer a blood transfusion. Which action should the nurse
take first?
A. Check the patient's vital signs
B. Start the transfusion slowly
C. Verify the blood product with another RN
D. Obtain baseline laboratory values
Answer: C
Rationale: Verification of the blood product with another registered nurse is the priority action
to ensure patient safety and prevent transfusion reactions. This includes checking patient
identification, blood type, and expiration date .
8. The nurse is teaching pursed-lip breathing to a patient with COPD. What is the primary
purpose of this technique?
A. Increase oxygen intake
B. Strengthen respiratory muscles
C. Keep airways open and prevent collapse
D. Decrease air trapping
Answer: C
Rationale: Pursed-lip breathing creates positive pressure at the end of expiration, keeping small
airways open and preventing airway collapse. This improves ventilation and gas exchange .
9. The nurse is caring for a patient with acute renal failure. Which finding requires
immediate action?
A. Serum potassium of 5.2 mEq/L
B. Urine output of 20 mL/hr
C. Serum creatinine of 2.8 mg/dL
D. Blood pressure of 150/90 mmHg
, Answer: B
Rationale: Urine output of less than 30 mL/hr over 2 hours indicates oliguria and acute kidney
injury requiring immediate evaluation. Fluid and electrolyte imbalances are likely developing .
10. A patient is receiving warfarin for atrial fibrillation. Which INR indicates the patient is
within therapeutic range?
A. 2.5
B. 1.5
C. 4.0
D. 5.0
Answer: A
Rationale: The therapeutic INR range for warfarin in atrial fibrillation is 2.0-3.0. An INR of 2.5
is within this target range .
11. A nurse is assessing a client with preeclampsia who is receiving magnesium sulfate. The
nurse determines that deep tendon reflexes are 1+, respiratory rate is 12 breaths/minute,
urinary output is 90 mL in 4 hours, and magnesium sulfate level is 9 mg/dL. Based on these
findings, what intervention should the nurse implement?
A. Continue the magnesium sulfate infusion
B. Decrease the magnesium sulfate infusion rate
C. Discontinue the magnesium sulfate infusion
D. Administer calcium gluconate immediately
Answer: C
Rationale: Magnesium toxicity is indicated by loss of deep tendon reflexes (1+), respiratory
depression (RR <12), and oliguria (urine output <30 mL/hr). With a magnesium level of 9 mg/dL
(therapeutic range 4-7 mg/dL), the infusion should be discontinued and calcium gluconate
should be readily available as the antidote .
12. A patient with a history of hypertension is prescribed lisinopril. Which side effect
should the nurse monitor for?
A. Dry cough
B. Peripheral edema
CORRECT ANSWERS PLUS RATIONALES
1. A patient with diabetic ketoacidosis (DKA) is being treated with IV fluids and insulin.
Which finding indicates that treatment is effective?
A. Urine output increasing to 40 mL/hr
B. Serum potassium decreasing
C. Blood glucose decreasing
D. Respiratory rate increasing
Answer: C
Rationale: In DKA, treatment goals include decreasing blood glucose, correcting dehydration,
and reversing acidosis. A decreasing blood glucose level indicates insulin therapy is effective. As
blood glucose decreases, the anion gap closes .
2. The nurse is assessing a patient with suspected pulmonary embolism. Which finding is
most characteristic?
A. Bradycardia and hypertension
B. Productive cough with green sputum
C. Sudden onset of pleuritic chest pain and dyspnea
D. Wheezing on expiration
Answer: C
Rationale: Pulmonary embolism typically presents with sudden onset of pleuritic chest pain and
dyspnea. Other signs include tachypnea, tachycardia, hypoxemia, and hemoptysis .
3. A patient with cirrhosis is prescribed lactulose. Which finding indicates the medication is
working?
A. Increased serum ammonia levels
B. Decreased serum bilirubin
C. Decreased serum ammonia levels
D. Increased urine output
Answer: C
,Rationale: Lactulose reduces serum ammonia levels, treating hepatic encephalopathy. It
acidifies the colon, trapping ammonia as ammonium ions, promoting excretion. A decrease in
serum ammonia indicates effective treatment .
4. A patient with chronic kidney disease has hyperkalemia. Which dietary instruction
should the nurse provide?
A. Increase intake of bananas and oranges
B. Increase intake of lean meats
C. Limit intake of bananas and oranges
D. Limit intake of apples and grapes
Answer: C
Rationale: Patients with CKD and hyperkalemia should limit high-potassium foods, including
bananas, oranges, tomatoes, potatoes, and avocados. Apples and grapes are low-potassium
fruits .
5. The nurse is caring for a patient with acute pancreatitis. Which finding requires
immediate intervention?
A. Blood glucose of 180 mg/dL
B. Serum amylase of 300 U/L
C. Serum calcium of 7.0 mg/dL
D. White blood cell count of 12,000/mm³
Answer: C
Rationale: In acute pancreatitis, serum calcium may drop due to saponification. A serum
calcium of 7.0 mg/dL is critically low (normal 8.5-10.5 mg/dL) and can lead to tetany, cardiac
arrhythmias, and seizures .
6. A patient prescribed digoxin for heart failure reports nausea and visual changes. Which
finding indicates digoxin toxicity?
A. Heart rate of 72 bpm
B. Yellow-green halos around lights
C. Blood pressure of 130/80 mmHg
D. Decreased urine output
,Answer: B
Rationale: Digoxin toxicity causes visual disturbances, including yellow-green halos around
lights (xanthopsia). Other signs include nausea, vomiting, bradycardia, and cardiac
arrhythmias .
7. The nurse is preparing to administer a blood transfusion. Which action should the nurse
take first?
A. Check the patient's vital signs
B. Start the transfusion slowly
C. Verify the blood product with another RN
D. Obtain baseline laboratory values
Answer: C
Rationale: Verification of the blood product with another registered nurse is the priority action
to ensure patient safety and prevent transfusion reactions. This includes checking patient
identification, blood type, and expiration date .
8. The nurse is teaching pursed-lip breathing to a patient with COPD. What is the primary
purpose of this technique?
A. Increase oxygen intake
B. Strengthen respiratory muscles
C. Keep airways open and prevent collapse
D. Decrease air trapping
Answer: C
Rationale: Pursed-lip breathing creates positive pressure at the end of expiration, keeping small
airways open and preventing airway collapse. This improves ventilation and gas exchange .
9. The nurse is caring for a patient with acute renal failure. Which finding requires
immediate action?
A. Serum potassium of 5.2 mEq/L
B. Urine output of 20 mL/hr
C. Serum creatinine of 2.8 mg/dL
D. Blood pressure of 150/90 mmHg
, Answer: B
Rationale: Urine output of less than 30 mL/hr over 2 hours indicates oliguria and acute kidney
injury requiring immediate evaluation. Fluid and electrolyte imbalances are likely developing .
10. A patient is receiving warfarin for atrial fibrillation. Which INR indicates the patient is
within therapeutic range?
A. 2.5
B. 1.5
C. 4.0
D. 5.0
Answer: A
Rationale: The therapeutic INR range for warfarin in atrial fibrillation is 2.0-3.0. An INR of 2.5
is within this target range .
11. A nurse is assessing a client with preeclampsia who is receiving magnesium sulfate. The
nurse determines that deep tendon reflexes are 1+, respiratory rate is 12 breaths/minute,
urinary output is 90 mL in 4 hours, and magnesium sulfate level is 9 mg/dL. Based on these
findings, what intervention should the nurse implement?
A. Continue the magnesium sulfate infusion
B. Decrease the magnesium sulfate infusion rate
C. Discontinue the magnesium sulfate infusion
D. Administer calcium gluconate immediately
Answer: C
Rationale: Magnesium toxicity is indicated by loss of deep tendon reflexes (1+), respiratory
depression (RR <12), and oliguria (urine output <30 mL/hr). With a magnesium level of 9 mg/dL
(therapeutic range 4-7 mg/dL), the infusion should be discontinued and calcium gluconate
should be readily available as the antidote .
12. A patient with a history of hypertension is prescribed lisinopril. Which side effect
should the nurse monitor for?
A. Dry cough
B. Peripheral edema
