HESI Med Surg Practice Mode Naxlex
(Latest 2025/2026 Update) Complete
Q&A with Verified Answers and
Detailed Rationales Proctored Exam
HESI Med Surg Practice Mode Naxlex (Latest | Comprehensive
Examination
HESI Med Surg Practice Mode Naxlex (Latest 2025/2026
Update) Complete Q&A with Verified Answers and Detailed
Rationales Proctored Exam Preparation for RN Medical
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Practice Mode Naxlex (Latest
2025/2026 Update) Complete Q&A with Verified Answers and
Detailed Rationales Proctored Exam Preparation for RN
Medical Surgical Nursing A+ Graded. Every item uses a
focused exam stem, four response options, a keyed response,
and a clear rationale, making it easier to understand the
subject, spot distractors, and build real exam confidence.
Page 1
, Question 1
A client with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, if newly noted, most urgently indicates a need to
hold the medication and notify the provider?
A. Serum potassium of 3.1 mEq/L with new-onset U waves on ECG
B. Urine output of 150 mL over the past 4 hours
C. Blood pressure of 106/68 mm Hg with mild dizziness on standing
D. Serum sodium of 134 mEq/L and complaints of thirst
Correct Answer: A - Serum potassium of 3.1 mEq/L with
new-onset U waves on ECG
RATIONALE
Loop diuretics cause significant potassium loss; hypokalemia with
ECG changes (U waves) predisposes to lethal dysrhythmias and
requires holding the dose and provider notification. Mild hypotension,
reduced but present urine output, and borderline sodium are expected
or less immediately dangerous.
Question 2
A client with COPD has an oxygen saturation of 88% on room air. Which
oxygen delivery approach is most appropriate based on current evidence?
A. High-flow nasal cannula at 100% FiO2 to rapidly correct hypoxemia
B. Non-rebreather mask at 15 L/min to achieve SpO2 >95%
C. Venturi mask titrated to maintain SpO2 between 88% and 92%
D. Simple face mask at 10 L/min targeting SpO2 of 94%-98%
Correct Answer: C - Venturi mask titrated to maintain SpO2
between 88% and 92%
Page 2
, RATIONALE
Current guidelines recommend controlled oxygen therapy targeting
SpO2 88%-92% in COPD to avoid hyperoxia-induced hypercapnia
while correcting hypoxemia. High-flow or non-rebreather oxygen
risks worsening CO2 retention, and targeting >94% is not
recommended for this population.
Question 3
A client with chronic kidney disease (CKD) stage 5 has a serum potassium of
6.8 mEq/L and peaked T waves. Which prescription should the nurse
implement first?
A. Administer sodium polystyrene sulfonate 15 g PO
B. Initiate continuous cardiac monitoring and administer IV calcium
gluconate
C. Give insulin 10 units regular IV with 25 g dextrose
D. Prepare for emergency hemodialysis
Correct Answer: B - Initiate continuous cardiac monitoring and
administer IV calcium gluconate
RATIONALE
IV calcium gluconate is the immediate cardioprotective measure for
hyperkalemia with ECG changes, stabilizing the myocardium while
other therapies take effect. Insulin/dextrose and polystyrene shift or
eliminate potassium but do not provide immediate cardiac protection;
dialysis is definitive but not the first emergency action.
Question 4
A client with type 1 diabetes is admitted with DKA. After initial fluid
resuscitation and insulin infusion, which finding best indicates the treatment is
effective?
A. Serum glucose has decreased from 520 to 310 mg/dL
B. Serum bicarbonate has increased from 10 to 16 mEq/L
Page 3
, C. Urine ketones remain large
D. Serum potassium has decreased from 5.4 to 4.0 mEq/L
Correct Answer: B - Serum bicarbonate has increased from 10 to
16 mEq/L
RATIONALE
Resolution of metabolic acidosis, reflected by rising bicarbonate and
closure of the anion gap, is the key indicator that DKA is resolving.
Glucose reduction alone can occur with fluid dilution, persistent
ketones indicate ongoing ketogenesis, and potassium changes reflect
insulin effects but not overall DKA resolution.
Question 5
A client is admitted with suspected increased intracranial pressure (ICP).
Which nursing action is contraindicated?
A. Elevating the head of the bed to 30 degrees
B. Performing frequent oral suctioning with a Yankauer catheter
C. Maintaining normothermia with a cooling blanket
D. Administering prescribed mannitol IV
Correct Answer: B - Performing frequent oral suctioning with a
Yankauer catheter
RATIONALE
Suctioning increases intrathoracic pressure, impairs cerebral venous
return, and can precipitously raise ICP; it should be limited to
essential airway clearance with preoxygenation. Head elevation,
normothermia, and mannitol are standard ICP-reducing measures.
Question 6
A client is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
Page 4
(Latest 2025/2026 Update) Complete
Q&A with Verified Answers and
Detailed Rationales Proctored Exam
HESI Med Surg Practice Mode Naxlex (Latest | Comprehensive
Examination
HESI Med Surg Practice Mode Naxlex (Latest 2025/2026
Update) Complete Q&A with Verified Answers and Detailed
Rationales Proctored Exam Preparation for RN Medical
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Practice Mode Naxlex (Latest
2025/2026 Update) Complete Q&A with Verified Answers and
Detailed Rationales Proctored Exam Preparation for RN
Medical Surgical Nursing A+ Graded. Every item uses a
focused exam stem, four response options, a keyed response,
and a clear rationale, making it easier to understand the
subject, spot distractors, and build real exam confidence.
Page 1
, Question 1
A client with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, if newly noted, most urgently indicates a need to
hold the medication and notify the provider?
A. Serum potassium of 3.1 mEq/L with new-onset U waves on ECG
B. Urine output of 150 mL over the past 4 hours
C. Blood pressure of 106/68 mm Hg with mild dizziness on standing
D. Serum sodium of 134 mEq/L and complaints of thirst
Correct Answer: A - Serum potassium of 3.1 mEq/L with
new-onset U waves on ECG
RATIONALE
Loop diuretics cause significant potassium loss; hypokalemia with
ECG changes (U waves) predisposes to lethal dysrhythmias and
requires holding the dose and provider notification. Mild hypotension,
reduced but present urine output, and borderline sodium are expected
or less immediately dangerous.
Question 2
A client with COPD has an oxygen saturation of 88% on room air. Which
oxygen delivery approach is most appropriate based on current evidence?
A. High-flow nasal cannula at 100% FiO2 to rapidly correct hypoxemia
B. Non-rebreather mask at 15 L/min to achieve SpO2 >95%
C. Venturi mask titrated to maintain SpO2 between 88% and 92%
D. Simple face mask at 10 L/min targeting SpO2 of 94%-98%
Correct Answer: C - Venturi mask titrated to maintain SpO2
between 88% and 92%
Page 2
, RATIONALE
Current guidelines recommend controlled oxygen therapy targeting
SpO2 88%-92% in COPD to avoid hyperoxia-induced hypercapnia
while correcting hypoxemia. High-flow or non-rebreather oxygen
risks worsening CO2 retention, and targeting >94% is not
recommended for this population.
Question 3
A client with chronic kidney disease (CKD) stage 5 has a serum potassium of
6.8 mEq/L and peaked T waves. Which prescription should the nurse
implement first?
A. Administer sodium polystyrene sulfonate 15 g PO
B. Initiate continuous cardiac monitoring and administer IV calcium
gluconate
C. Give insulin 10 units regular IV with 25 g dextrose
D. Prepare for emergency hemodialysis
Correct Answer: B - Initiate continuous cardiac monitoring and
administer IV calcium gluconate
RATIONALE
IV calcium gluconate is the immediate cardioprotective measure for
hyperkalemia with ECG changes, stabilizing the myocardium while
other therapies take effect. Insulin/dextrose and polystyrene shift or
eliminate potassium but do not provide immediate cardiac protection;
dialysis is definitive but not the first emergency action.
Question 4
A client with type 1 diabetes is admitted with DKA. After initial fluid
resuscitation and insulin infusion, which finding best indicates the treatment is
effective?
A. Serum glucose has decreased from 520 to 310 mg/dL
B. Serum bicarbonate has increased from 10 to 16 mEq/L
Page 3
, C. Urine ketones remain large
D. Serum potassium has decreased from 5.4 to 4.0 mEq/L
Correct Answer: B - Serum bicarbonate has increased from 10 to
16 mEq/L
RATIONALE
Resolution of metabolic acidosis, reflected by rising bicarbonate and
closure of the anion gap, is the key indicator that DKA is resolving.
Glucose reduction alone can occur with fluid dilution, persistent
ketones indicate ongoing ketogenesis, and potassium changes reflect
insulin effects but not overall DKA resolution.
Question 5
A client is admitted with suspected increased intracranial pressure (ICP).
Which nursing action is contraindicated?
A. Elevating the head of the bed to 30 degrees
B. Performing frequent oral suctioning with a Yankauer catheter
C. Maintaining normothermia with a cooling blanket
D. Administering prescribed mannitol IV
Correct Answer: B - Performing frequent oral suctioning with a
Yankauer catheter
RATIONALE
Suctioning increases intrathoracic pressure, impairs cerebral venous
return, and can precipitously raise ICP; it should be limited to
essential airway clearance with preoxygenation. Head elevation,
normothermia, and mannitol are standard ICP-reducing measures.
Question 6
A client is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
Page 4
