2025/2026 HESI Med-Surg RN Custom Exam (for Med Surg II
Class) – Pics & Q&As Included (A+) (Verified Answers)
Multiple-Choice Questions
Question 1: A patient with heart failure presents with dyspnea and bilateral crackles. What is
the priority nursing intervention? A. Administer oxygen therapy
B. Place the patient in a supine position
C. Encourage fluid intake
D. Administer a beta-blocker
Correct Answer: A. Administer oxygen therapy
Rationale: Dyspnea and crackles indicate pulmonary edema in heart failure, requir-
ing immediate oxygen therapy to improve oxygenation. Supine positioning worsens
dyspnea, fluid intake exacerbates fluid overload, and beta-blockers are not acute
interventions.
bilateral infiltrates What condition is most likely indicated by this chest X-ray? A. Pneumothorax
B. Pulmonary edema
C. Pleural effusion
D. Chronic obstructive pulmonary disease
Correct Answer: B. Pulmonary edema
Rationale: Bilateral infiltrates on a chest X-ray suggest pulmonary edema, often due
to heart failure. Pneumothorax shows unilateral lucency, pleural effusion appears
as blunting of costophrenic angles, and COPD typically shows hyperinflation.
Question 2: A patient with type 2 diabetes has a blood glucose of 450 mg/dL and is lethargic.
What is the most likely diagnosis? A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin overdose
Correct Answer: C. Hyperosmolar hyperglycemic state
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia (>600 mg/dL), lethargy, and minimal ketosis, common in type 2
diabetes. DKA involves acidosis and ketones, hypoglycemia shows low glucose, and
insulin overdose causes hypoglycemia.
Question 3: Which electrolyte imbalance is most concerning in a patient with prolonged vom-
iting? A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Prolonged vomiting causes loss of potassium-rich gastric fluids, leading
to hypokalemia, which can cause arrhythmias. Hyperkalemia occurs with renal
failure, hypernatremia with dehydration, and hypermagnesemia is rare.
Question 4: A patient post-myocardial infarction develops chest pain and ST elevation. What
is the priority action? A. Administer aspirin
B. Notify the provider for catheterization
1
, C. Increase oxygen flow
D. Administer morphine
Correct Answer: B. Notify the provider for catheterization
Rationale: Recurrent chest pain and ST elevation post-MI suggest reinfarction,
requiring urgent percutaneous coronary intervention (PCI). Aspirin and morphine
are adjuncts, and oxygen is supportive but not the priority.
all, peaked T waves What electrolyte imbalance is indicated by this ECG? A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B. Hyperkalemia
Rationale: Tall, peaked T waves on ECG indicate hyperkalemia, which can lead to
lethal arrhythmias. Hypokalemia shows flattened T waves, hypocalcemia prolongs
QT, and hypermagnesemia is not typically associated with T-wave changes.
Question 5: A patient with cirrhosis develops confusion and asterixis. What is the most likely
cause? A. Hepatic encephalopathy
B. Hypoglycemia
C. Stroke
D. Uremia
Correct Answer: A. Hepatic encephalopathy
Rationale: Confusion and asterixis in cirrhosis suggest hepatic encephalopathy due
to ammonia accumulation. Hypoglycemia causes sweating and shakiness, stroke
presents with focal deficits, and uremia is related to renal failure.
Question 6: Which intervention is most appropriate for a patient with acute pancreatitis? A.
Encourage a high-fat diet
B. Administer IV fluids
C. Promote early ambulation
D. Administer oral pain medication
Correct Answer: B. Administer IV fluids
Rationale: Acute pancreatitis requires IV fluids to correct hypovolemia and prevent
complications. High-fat diets worsen symptoms, early ambulation is secondary, and
IV pain medication is preferred due to gastric irritation.
Question 7: A patient with COPD has a PaCO2 of 60 mmHg. What does this indicate? A.
Hypoxemia
B. Hypercapnia
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: B. Hypercapnia
Rationale: A PaCO2 of 60 mmHg indicates hypercapnia (CO2 retention), common
in COPD due to impaired ventilation. Hypoxemia is low PaO2, metabolic acidosis
involves bicarbonate, and respiratory alkalosis shows low PaCO2.
Question 8: A patient with a new colostomy reports redness around the stoma. What is the
first nursing action? A. Apply a warm compress
B. Assess the skin for irritation
C. Change the ostomy appliance
2
Class) – Pics & Q&As Included (A+) (Verified Answers)
Multiple-Choice Questions
Question 1: A patient with heart failure presents with dyspnea and bilateral crackles. What is
the priority nursing intervention? A. Administer oxygen therapy
B. Place the patient in a supine position
C. Encourage fluid intake
D. Administer a beta-blocker
Correct Answer: A. Administer oxygen therapy
Rationale: Dyspnea and crackles indicate pulmonary edema in heart failure, requir-
ing immediate oxygen therapy to improve oxygenation. Supine positioning worsens
dyspnea, fluid intake exacerbates fluid overload, and beta-blockers are not acute
interventions.
bilateral infiltrates What condition is most likely indicated by this chest X-ray? A. Pneumothorax
B. Pulmonary edema
C. Pleural effusion
D. Chronic obstructive pulmonary disease
Correct Answer: B. Pulmonary edema
Rationale: Bilateral infiltrates on a chest X-ray suggest pulmonary edema, often due
to heart failure. Pneumothorax shows unilateral lucency, pleural effusion appears
as blunting of costophrenic angles, and COPD typically shows hyperinflation.
Question 2: A patient with type 2 diabetes has a blood glucose of 450 mg/dL and is lethargic.
What is the most likely diagnosis? A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin overdose
Correct Answer: C. Hyperosmolar hyperglycemic state
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia (>600 mg/dL), lethargy, and minimal ketosis, common in type 2
diabetes. DKA involves acidosis and ketones, hypoglycemia shows low glucose, and
insulin overdose causes hypoglycemia.
Question 3: Which electrolyte imbalance is most concerning in a patient with prolonged vom-
iting? A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Correct Answer: B. Hypokalemia
Rationale: Prolonged vomiting causes loss of potassium-rich gastric fluids, leading
to hypokalemia, which can cause arrhythmias. Hyperkalemia occurs with renal
failure, hypernatremia with dehydration, and hypermagnesemia is rare.
Question 4: A patient post-myocardial infarction develops chest pain and ST elevation. What
is the priority action? A. Administer aspirin
B. Notify the provider for catheterization
1
, C. Increase oxygen flow
D. Administer morphine
Correct Answer: B. Notify the provider for catheterization
Rationale: Recurrent chest pain and ST elevation post-MI suggest reinfarction,
requiring urgent percutaneous coronary intervention (PCI). Aspirin and morphine
are adjuncts, and oxygen is supportive but not the priority.
all, peaked T waves What electrolyte imbalance is indicated by this ECG? A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer: B. Hyperkalemia
Rationale: Tall, peaked T waves on ECG indicate hyperkalemia, which can lead to
lethal arrhythmias. Hypokalemia shows flattened T waves, hypocalcemia prolongs
QT, and hypermagnesemia is not typically associated with T-wave changes.
Question 5: A patient with cirrhosis develops confusion and asterixis. What is the most likely
cause? A. Hepatic encephalopathy
B. Hypoglycemia
C. Stroke
D. Uremia
Correct Answer: A. Hepatic encephalopathy
Rationale: Confusion and asterixis in cirrhosis suggest hepatic encephalopathy due
to ammonia accumulation. Hypoglycemia causes sweating and shakiness, stroke
presents with focal deficits, and uremia is related to renal failure.
Question 6: Which intervention is most appropriate for a patient with acute pancreatitis? A.
Encourage a high-fat diet
B. Administer IV fluids
C. Promote early ambulation
D. Administer oral pain medication
Correct Answer: B. Administer IV fluids
Rationale: Acute pancreatitis requires IV fluids to correct hypovolemia and prevent
complications. High-fat diets worsen symptoms, early ambulation is secondary, and
IV pain medication is preferred due to gastric irritation.
Question 7: A patient with COPD has a PaCO2 of 60 mmHg. What does this indicate? A.
Hypoxemia
B. Hypercapnia
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: B. Hypercapnia
Rationale: A PaCO2 of 60 mmHg indicates hypercapnia (CO2 retention), common
in COPD due to impaired ventilation. Hypoxemia is low PaO2, metabolic acidosis
involves bicarbonate, and respiratory alkalosis shows low PaCO2.
Question 8: A patient with a new colostomy reports redness around the stoma. What is the
first nursing action? A. Apply a warm compress
B. Assess the skin for irritation
C. Change the ostomy appliance
2
