[2022 HESI MED SURG EXIT EXAM (V1 VERSION 1)] QUESTIONS AND ANSWERS ALREADY GRADED A+| 100%
VERIFIED SOLUTIONS………...
Core Domains:
Cardiovascular and Respiratory Disorders
Gastrointestinal and Endocrine Disorders
Neurological and Musculoskeletal Disorders
Renal, Genitourinary, and Reproductive Health
Hematological, Immunological, and Integumentary Disorders
Perioperative, Emergency, and Critical Care Nursing
Fluid, Electrolyte, and Acid-Base Balance
Pharmacology and Safe Medication Administration
Nursing Ethics, Legal Standards, and Prioritization
Introduction
This comprehensive examination is designed to rigorously assess the graduating nursing student's mastery of
medical-surgical nursing principles and their readiness for clinical practice. It evaluates the integration of
foundational nursing theory with evidence-based practice, emphasizing clinical judgment, patient safety, and
prioritization of care. The exam utilizes a multiple-choice and scenario-based format to test the student's ability to
analyze complex patient data, identify nursing diagnoses, plan appropriate interventions, and evaluate patient
outcomes. Questions are structured to reflect real-world clinical situations, requiring the student to apply critical
thinking, make sound clinical decisions, and understand the legal and ethical frameworks guiding nursing practice.
,Mastery of these competencies is essential for successful transition to professional nursing practice and the delivery
of safe, high-quality patient care.
SECTION ONE: QUESTIONS 1–100
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The patient becomes lethargic and confused. The arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of
68 mmHg, and PaO2 of 55 mmHg. What is the most appropriate nursing action?
A. Increase the oxygen flow rate to 4 L/min.
B. Decrease the oxygen flow rate to 1 L/min.
C. Prepare for mechanical ventilation.
D. Administer a dose of naloxone.
🟢C
🔴 RATIONALE: The patient is exhibiting signs of acute respiratory failure with respiratory acidosis (elevated
PaCO2 and low pH). Lethargy and confusion are signs of hypercapnia. In a COPD patient with known CO2
retention, this level of respiratory acidosis indicates that the patient is likely failing to maintain adequate
ventilation and may require mechanical ventilation. Decreasing oxygen (B) would worsen hypoxemia. Increasing
oxygen (A) could suppress the respiratory drive further. Naloxone (D) is for opioid overdose, which is not the
primary issue here.
2. A patient who is post-operative day 1 from a total hip replacement is experiencing sudden onset of shortness
of breath, pleuritic chest pain, and hemoptysis. The patient is tachycardic and tachypneic. What is the most
,likely diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Myocardial infarction
🟢B
🔴 RATIONALE: The classic triad of sudden onset shortness of breath, pleuritic chest pain, and hemoptysis in a
post-surgical patient is highly suggestive of a pulmonary embolism (PE). Post-operative patients are at
increased risk for venous thromboembolism due to immobility and hypercoagulability. Atelectasis (A) would
present with crackles and decreased breath sounds, not typically pleuritic pain and hemoptysis. Pneumonia (C)
usually has a more gradual onset with fever and productive cough. Myocardial infarction (D) presents with chest
pressure, often radiating to the jaw or arm, and is not typically associated with hemoptysis.
3. A patient with heart failure is prescribed furosemide. Which of the following laboratory values should the
nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
🟢B
🔴 RATIONALE: Furosemide is a loop diuretic that acts on the ascending loop of Henle to inhibit sodium and
chloride reabsorption, leading to increased excretion of water and electrolytes. It causes significant potassium
, wasting, making hypokalemia a major adverse effect that can lead to cardiac arrhythmias. Monitoring serum
potassium is essential. While sodium (A), calcium (C), and magnesium (D) can also be affected, potassium is the
most critical and frequently monitored electrolyte.
4. A patient is receiving a continuous heparin infusion for a pulmonary embolism. The nurse notes that the
patient's aPTT level is 110 seconds. The baseline aPTT is 30 seconds. What is the most appropriate nursing
action?
A. Continue the infusion at the current rate.
B. Increase the infusion rate to achieve a higher aPTT.
C. Decrease the infusion rate and notify the healthcare provider.
D. Discontinue the infusion and administer protamine sulfate.
🟢C
🔴 RATIONALE: The therapeutic goal for heparin therapy is an aPTT level that is 1.5 to 2.5 times the normal
control value (baseline). With a baseline of 30 seconds, the target range is 45-75 seconds. An aPTT of 110
seconds is significantly above the therapeutic range, indicating a high risk for bleeding. The infusion rate should
be decreased, and the healthcare provider should be notified. Continuing (A) or increasing (B) the rate would
increase the bleeding risk. Protamine sulfate (D) is the antidote for heparin but is used for severe bleeding, not
just an elevated aPTT.
5. The nurse is preparing to administer a blood transfusion to a patient with anemia. Which of the following is a
priority nursing action before starting the transfusion?
A. Ensure the patient has a signed consent form.
B. Verify the patient's identity and blood product compatibility with another nurse.
VERIFIED SOLUTIONS………...
Core Domains:
Cardiovascular and Respiratory Disorders
Gastrointestinal and Endocrine Disorders
Neurological and Musculoskeletal Disorders
Renal, Genitourinary, and Reproductive Health
Hematological, Immunological, and Integumentary Disorders
Perioperative, Emergency, and Critical Care Nursing
Fluid, Electrolyte, and Acid-Base Balance
Pharmacology and Safe Medication Administration
Nursing Ethics, Legal Standards, and Prioritization
Introduction
This comprehensive examination is designed to rigorously assess the graduating nursing student's mastery of
medical-surgical nursing principles and their readiness for clinical practice. It evaluates the integration of
foundational nursing theory with evidence-based practice, emphasizing clinical judgment, patient safety, and
prioritization of care. The exam utilizes a multiple-choice and scenario-based format to test the student's ability to
analyze complex patient data, identify nursing diagnoses, plan appropriate interventions, and evaluate patient
outcomes. Questions are structured to reflect real-world clinical situations, requiring the student to apply critical
thinking, make sound clinical decisions, and understand the legal and ethical frameworks guiding nursing practice.
,Mastery of these competencies is essential for successful transition to professional nursing practice and the delivery
of safe, high-quality patient care.
SECTION ONE: QUESTIONS 1–100
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The patient becomes lethargic and confused. The arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of
68 mmHg, and PaO2 of 55 mmHg. What is the most appropriate nursing action?
A. Increase the oxygen flow rate to 4 L/min.
B. Decrease the oxygen flow rate to 1 L/min.
C. Prepare for mechanical ventilation.
D. Administer a dose of naloxone.
🟢C
🔴 RATIONALE: The patient is exhibiting signs of acute respiratory failure with respiratory acidosis (elevated
PaCO2 and low pH). Lethargy and confusion are signs of hypercapnia. In a COPD patient with known CO2
retention, this level of respiratory acidosis indicates that the patient is likely failing to maintain adequate
ventilation and may require mechanical ventilation. Decreasing oxygen (B) would worsen hypoxemia. Increasing
oxygen (A) could suppress the respiratory drive further. Naloxone (D) is for opioid overdose, which is not the
primary issue here.
2. A patient who is post-operative day 1 from a total hip replacement is experiencing sudden onset of shortness
of breath, pleuritic chest pain, and hemoptysis. The patient is tachycardic and tachypneic. What is the most
,likely diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Myocardial infarction
🟢B
🔴 RATIONALE: The classic triad of sudden onset shortness of breath, pleuritic chest pain, and hemoptysis in a
post-surgical patient is highly suggestive of a pulmonary embolism (PE). Post-operative patients are at
increased risk for venous thromboembolism due to immobility and hypercoagulability. Atelectasis (A) would
present with crackles and decreased breath sounds, not typically pleuritic pain and hemoptysis. Pneumonia (C)
usually has a more gradual onset with fever and productive cough. Myocardial infarction (D) presents with chest
pressure, often radiating to the jaw or arm, and is not typically associated with hemoptysis.
3. A patient with heart failure is prescribed furosemide. Which of the following laboratory values should the
nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
🟢B
🔴 RATIONALE: Furosemide is a loop diuretic that acts on the ascending loop of Henle to inhibit sodium and
chloride reabsorption, leading to increased excretion of water and electrolytes. It causes significant potassium
, wasting, making hypokalemia a major adverse effect that can lead to cardiac arrhythmias. Monitoring serum
potassium is essential. While sodium (A), calcium (C), and magnesium (D) can also be affected, potassium is the
most critical and frequently monitored electrolyte.
4. A patient is receiving a continuous heparin infusion for a pulmonary embolism. The nurse notes that the
patient's aPTT level is 110 seconds. The baseline aPTT is 30 seconds. What is the most appropriate nursing
action?
A. Continue the infusion at the current rate.
B. Increase the infusion rate to achieve a higher aPTT.
C. Decrease the infusion rate and notify the healthcare provider.
D. Discontinue the infusion and administer protamine sulfate.
🟢C
🔴 RATIONALE: The therapeutic goal for heparin therapy is an aPTT level that is 1.5 to 2.5 times the normal
control value (baseline). With a baseline of 30 seconds, the target range is 45-75 seconds. An aPTT of 110
seconds is significantly above the therapeutic range, indicating a high risk for bleeding. The infusion rate should
be decreased, and the healthcare provider should be notified. Continuing (A) or increasing (B) the rate would
increase the bleeding risk. Protamine sulfate (D) is the antidote for heparin but is used for severe bleeding, not
just an elevated aPTT.
5. The nurse is preparing to administer a blood transfusion to a patient with anemia. Which of the following is a
priority nursing action before starting the transfusion?
A. Ensure the patient has a signed consent form.
B. Verify the patient's identity and blood product compatibility with another nurse.
