PART 1 of 5
HESI Medical-Surgical Specialty
Exam
TABLE OF CONTENTS
Chapter 1: Pharmacological and Parenteral Therapies — Questions 1–17
Chapter 2: Reduction of Risk Potential — Questions 18–33
Chapter 3: Physiological Adaptation — Questions 34–50
Q1. A practical nurse is preparing to administer furosemide to a client. Which laboratory value should
the nurse monitor?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: Serum potassium ✅
Rationale: The correct answer is option A. Furosemide is a loop diuretic that acts on the
ascending loop of Henle to inhibit sodium and chloride reabsorption, which also increases potassium
excretion and can cause hypokalemia. The nurse should monitor serum potassium levels closely
because hypokalemia can lead to cardiac dysrhythmias, muscle weakness, and increased digitalis
toxicity in clients taking digoxin. Option B is incorrect because while serum sodium can be affected by
diuretic therapy, potassium is the primary electrolyte of concern with loop diuretics. Option C is
incorrect because serum calcium is not the primary electrolyte affected by furosemide, although
long-term use can increase calcium excretion. Option D is incorrect because serum magnesium can
be affected but is not the primary concern in routine monitoring. The concept tested is the
laboratory monitoring required during furosemide therapy.
,Q2. A practical nurse is preparing to administer spironolactone to a client. Which laboratory value
should the nurse monitor?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: Serum potassium ✅
Rationale: The correct answer is option A. Spironolactone is a potassium-sparing diuretic
that acts as an aldosterone antagonist in the distal tubule, promoting sodium excretion while
retaining potassium. Because it retains potassium, the nurse should monitor serum potassium levels
for hyperkalemia, which can cause cardiac dysrhythmias, muscle weakness, and peaked T waves on
ECG. Option B is incorrect because while sodium is affected, potassium is the primary concern.
Option C is incorrect because serum calcium is not primarily affected by spironolactone. Option D is
incorrect because serum magnesium is not the primary concern with spironolactone therapy. The
concept tested is the laboratory monitoring required during spironolactone therapy.
Q3. A practical nurse is preparing to administer enoxaparin to a client. Which laboratory value should
the nurse monitor?
A. International normalized ratio
B. Activated partial thromboplastin time
C. Platelet count
D. Bleeding time
Correct Answer: Platelet count ✅
Rationale: The correct answer is option C. Enoxaparin is a low molecular weight heparin that
can cause heparin-induced thrombocytopenia, a serious immune-mediated reaction that leads to a
paradoxical decrease in platelet count and increased risk of thrombosis. The nurse should monitor
platelet counts before and during therapy. Option A is incorrect because the international normalized
ratio is used to monitor warfarin, not enoxaparin. Option B is incorrect because the activated partial
thromboplastin time is used to monitor unfractionated heparin, not low molecular weight heparin.
,Option D is incorrect because bleeding time is used to assess platelet function, not to monitor
enoxaparin therapy. The concept tested is the laboratory monitoring required during enoxaparin
therapy.
Q4. A practical nurse is preparing to administer warfarin to a client. Which laboratory value should
the nurse monitor?
A. International normalized ratio
B. Activated partial thromboplastin time
C. Platelet count
D. Bleeding time
Correct Answer: International normalized ratio ✅
Rationale: The correct answer is option A. Warfarin is an oral anticoagulant that inhibits the
synthesis of vitamin K-dependent clotting factors, and it is monitored using the international
normalized ratio, with a therapeutic range typically between 2.0 and 3.0 for most indications. Option
B is incorrect because the activated partial thromboplastin time is used to monitor unfractionated
heparin. Option C is incorrect because platelet count is monitored for heparin-induced
thrombocytopenia. Option D is incorrect because bleeding time is used to assess platelet function.
The concept tested is the laboratory monitoring of warfarin therapy.
Q5. A practical nurse is preparing to administer insulin to a client. Which action should the nurse take
to ensure client safety?
A. Verify the insulin dose with another nurse
B. Administer the insulin without a meal
C. Use the same injection site each time
D. Store the insulin in the freezer
Correct Answer: Verify the insulin dose with another nurse ✅
Rationale: The correct answer is option A. Insulin is a high-alert medication, and having a
second nurse verify the dose, type of insulin, and client identity helps prevent medication errors.
, Option B is incorrect because insulin should be administered in relation to meals to prevent
hypoglycemia. Option C is incorrect because rotating injection sites prevents lipohypertrophy and
ensures consistent absorption. Option D is incorrect because insulin should be stored in the
refrigerator, not the freezer, as freezing can damage the insulin. The concept tested is the safe
administration of high-alert medications.
Q6. A practical nurse is preparing to administer a blood transfusion to a client. Which action should
the nurse take first?
A. Verify the client's identity and blood product with another nurse
B. Obtain the client's vital signs
C. Start the transfusion slowly
D. Administer the transfusion through a filter
Correct Answer: Verify the client's identity and blood product with another nurse ✅
Rationale: The correct answer is option A. The nurse must first verify the client's identity and
the blood product with another nurse to prevent transfusion reactions due to ABO incompatibility.
Option B is incorrect because vital signs are obtained after verification. Option C is incorrect because
starting the transfusion occurs after verification and vital signs. Option D is incorrect because
administering through a filter occurs after verification. The concept tested is the safe administration
of blood transfusions.
Q7. A practical nurse is preparing to administer a blood transfusion to a client. Which finding
indicates a transfusion reaction?
A. Blood pressure of 120/80 millimeters of mercury
B. Heart rate of 72 beats per minute
C. Fever and chills
D. Urine output of 50 milliliters per hour
Correct Answer: Fever and chills ✅
HESI Medical-Surgical Specialty
Exam
TABLE OF CONTENTS
Chapter 1: Pharmacological and Parenteral Therapies — Questions 1–17
Chapter 2: Reduction of Risk Potential — Questions 18–33
Chapter 3: Physiological Adaptation — Questions 34–50
Q1. A practical nurse is preparing to administer furosemide to a client. Which laboratory value should
the nurse monitor?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: Serum potassium ✅
Rationale: The correct answer is option A. Furosemide is a loop diuretic that acts on the
ascending loop of Henle to inhibit sodium and chloride reabsorption, which also increases potassium
excretion and can cause hypokalemia. The nurse should monitor serum potassium levels closely
because hypokalemia can lead to cardiac dysrhythmias, muscle weakness, and increased digitalis
toxicity in clients taking digoxin. Option B is incorrect because while serum sodium can be affected by
diuretic therapy, potassium is the primary electrolyte of concern with loop diuretics. Option C is
incorrect because serum calcium is not the primary electrolyte affected by furosemide, although
long-term use can increase calcium excretion. Option D is incorrect because serum magnesium can
be affected but is not the primary concern in routine monitoring. The concept tested is the
laboratory monitoring required during furosemide therapy.
,Q2. A practical nurse is preparing to administer spironolactone to a client. Which laboratory value
should the nurse monitor?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: Serum potassium ✅
Rationale: The correct answer is option A. Spironolactone is a potassium-sparing diuretic
that acts as an aldosterone antagonist in the distal tubule, promoting sodium excretion while
retaining potassium. Because it retains potassium, the nurse should monitor serum potassium levels
for hyperkalemia, which can cause cardiac dysrhythmias, muscle weakness, and peaked T waves on
ECG. Option B is incorrect because while sodium is affected, potassium is the primary concern.
Option C is incorrect because serum calcium is not primarily affected by spironolactone. Option D is
incorrect because serum magnesium is not the primary concern with spironolactone therapy. The
concept tested is the laboratory monitoring required during spironolactone therapy.
Q3. A practical nurse is preparing to administer enoxaparin to a client. Which laboratory value should
the nurse monitor?
A. International normalized ratio
B. Activated partial thromboplastin time
C. Platelet count
D. Bleeding time
Correct Answer: Platelet count ✅
Rationale: The correct answer is option C. Enoxaparin is a low molecular weight heparin that
can cause heparin-induced thrombocytopenia, a serious immune-mediated reaction that leads to a
paradoxical decrease in platelet count and increased risk of thrombosis. The nurse should monitor
platelet counts before and during therapy. Option A is incorrect because the international normalized
ratio is used to monitor warfarin, not enoxaparin. Option B is incorrect because the activated partial
thromboplastin time is used to monitor unfractionated heparin, not low molecular weight heparin.
,Option D is incorrect because bleeding time is used to assess platelet function, not to monitor
enoxaparin therapy. The concept tested is the laboratory monitoring required during enoxaparin
therapy.
Q4. A practical nurse is preparing to administer warfarin to a client. Which laboratory value should
the nurse monitor?
A. International normalized ratio
B. Activated partial thromboplastin time
C. Platelet count
D. Bleeding time
Correct Answer: International normalized ratio ✅
Rationale: The correct answer is option A. Warfarin is an oral anticoagulant that inhibits the
synthesis of vitamin K-dependent clotting factors, and it is monitored using the international
normalized ratio, with a therapeutic range typically between 2.0 and 3.0 for most indications. Option
B is incorrect because the activated partial thromboplastin time is used to monitor unfractionated
heparin. Option C is incorrect because platelet count is monitored for heparin-induced
thrombocytopenia. Option D is incorrect because bleeding time is used to assess platelet function.
The concept tested is the laboratory monitoring of warfarin therapy.
Q5. A practical nurse is preparing to administer insulin to a client. Which action should the nurse take
to ensure client safety?
A. Verify the insulin dose with another nurse
B. Administer the insulin without a meal
C. Use the same injection site each time
D. Store the insulin in the freezer
Correct Answer: Verify the insulin dose with another nurse ✅
Rationale: The correct answer is option A. Insulin is a high-alert medication, and having a
second nurse verify the dose, type of insulin, and client identity helps prevent medication errors.
, Option B is incorrect because insulin should be administered in relation to meals to prevent
hypoglycemia. Option C is incorrect because rotating injection sites prevents lipohypertrophy and
ensures consistent absorption. Option D is incorrect because insulin should be stored in the
refrigerator, not the freezer, as freezing can damage the insulin. The concept tested is the safe
administration of high-alert medications.
Q6. A practical nurse is preparing to administer a blood transfusion to a client. Which action should
the nurse take first?
A. Verify the client's identity and blood product with another nurse
B. Obtain the client's vital signs
C. Start the transfusion slowly
D. Administer the transfusion through a filter
Correct Answer: Verify the client's identity and blood product with another nurse ✅
Rationale: The correct answer is option A. The nurse must first verify the client's identity and
the blood product with another nurse to prevent transfusion reactions due to ABO incompatibility.
Option B is incorrect because vital signs are obtained after verification. Option C is incorrect because
starting the transfusion occurs after verification and vital signs. Option D is incorrect because
administering through a filter occurs after verification. The concept tested is the safe administration
of blood transfusions.
Q7. A practical nurse is preparing to administer a blood transfusion to a client. Which finding
indicates a transfusion reaction?
A. Blood pressure of 120/80 millimeters of mercury
B. Heart rate of 72 beats per minute
C. Fever and chills
D. Urine output of 50 milliliters per hour
Correct Answer: Fever and chills ✅
