HESI Med-Surg RN Custom Exam
2025/2026 – Verified Questions,
Answers, and Images (Med Surg II Class)
Question 1
A client with chest pain presents to the ER. The ECG strip shows ST elevation in leads II, III, and
aVF. What is the nurse’s priority action?
A. Administer aspirin 325 mg orally
B. Prepare for thrombolytic therapy
C. Obtain a 12-lead ECG
D. Administer oxygen at 2 L/min via nasal cannula
Correct Answer: D. Administer oxygen at 2 L/min via nasal cannula
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction
(MI), likely due to right coronary artery occlusion. The priority is to improve myocardial
oxygenation by administering oxygen to prevent further ischemia. Aspirin is given after initial
stabilization, thrombolytics require physician orders, and a 12-lead ECG is likely already
obtained.
Question 2
A client with COPD experiences acute dyspnea. The pulse oximetry reading is 88%. What is the
nurse’s first action?
A. Administer albuterol via nebulizer
B. Increase oxygen to 4 L/min
C. Position the client in high Fowler’s
D. Notify the healthcare provider
Correct Answer: C. Position the client in high Fowler’s
,Rationale: Positioning in high Fowler’s optimizes lung expansion and eases breathing in COPD
exacerbation. Oxygen saturation of 88% is low but acceptable for COPD (target 88–92%), so
increasing oxygen is not the first action. Albuterol and notifying the provider are secondary steps.
Question 3
A client with type 1 diabetes presents with blood glucose of 600 mg/dL, Kussmaul respirations,
and fruity breath. What is the nurse’s priority?
A. Administer regular insulin IV
B. Start an IV of normal saline
C. Obtain an arterial blood gas (ABG)
D. Administer sodium bicarbonate
Correct Answer: B. Start an IV of normal saline
Rationale: The symptoms indicate diabetic ketoacidosis (DKA). Fluid replacement with normal
saline is the priority to correct dehydration and improve perfusion, which drives ketone
production. Insulin is given after fluids, ABGs confirm acidosis, and bicarbonate is rarely used.
Question 4
A client post-thyroidectomy reports tingling around the mouth and muscle twitching. What is the
nurse’s first action?
A. Administer calcium gluconate IV
B. Check serum calcium levels
C. Assess for Chvostek’s sign
D. Notify the healthcare provider
Correct Answer: C. Assess for Chvostek’s sign
Rationale: Tingling and twitching suggest hypocalcemia, common post-thyroidectomy due to
parathyroid damage. Assessing for Chvostek’s sign (facial twitching on tapping) confirms
hypocalcemia. Calcium administration and lab checks follow, and notifying the provider is not the
first step.
Question 5
A client with heart failure has crackles in the lungs and +2 pitting edema. Which medication is
most likely prescribed?
A. Furosemide
B. Metoprolol
,C. Digoxin
D. Spironolactone
Correct Answer: A. Furosemide
Rationale: Furosemide, a loop diuretic, reduces fluid overload in heart failure, alleviating
crackles and edema. Metoprolol and digoxin address heart rate and contractility, while
spironolactone is used long-term but not primarily for acute fluid overload.
Question 6
A client with a new colostomy reports leakage around the stoma. What is the nurse’s first
action?
A. Change the ostomy appliance
B. Assess the stoma and skin
C. Irrigate the colostomy
D. Notify the wound care team
Correct Answer: B. Assess the stoma and skin
Rationale: Leakage may indicate improper fit or skin breakdown. Assessing the stoma and
peristomal skin determines the cause (e.g., poor seal, irritation). Changing the appliance,
irrigation, or notification are secondary steps.
Question 7
A client with a suspected stroke has unequal pupils and a Glasgow Coma Scale (GCS) score of
8. What is the priority intervention?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Prepare for CT scan
D. Initiate seizure precautions
Correct Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Unequal pupils and a GCS of 8 suggest increased intracranial pressure (ICP) from a
stroke. Elevating the head to 30 degrees reduces ICP by promoting venous drainage. Mannitol
requires an order, CT scan follows initial stabilization, and seizure precautions are secondary.
Question 8
, A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. What is the
nurse’s first action?
A. Administer kayexalate
B. Restrict dietary potassium
C. Obtain an ECG
D. Administer insulin and D50
Correct Answer: C. Obtain an ECG
Rationale: Hyperkalemia (potassium >5.5 mEq/L) can cause cardiac arrhythmias. Obtaining an
ECG assesses for changes (e.g., peaked T waves) to prioritize treatment. Kayexalate,
insulin/D50, and dietary restrictions are subsequent interventions.
Question 9
A client with pancreatitis has severe abdominal pain. Which position should the nurse
recommend?
A. Supine with legs elevated
B. Side-lying with knees flexed
C. Prone with head turned
D. High Fowler’s with legs straight
Correct Answer: B. Side-lying with knees flexed
Rationale: Side-lying with knees flexed reduces tension on the abdominal muscles, alleviating
pain in pancreatitis. Supine, prone, or high Fowler’s positions may worsen discomfort.
Question 10
A client with a pulmonary embolism (PE) is on heparin. Which finding requires immediate
action?
A. Oxygen saturation of 92%
B. Heart rate of 100 bpm
C. Blood in the urine
D. Respiratory rate of 20/min
Correct Answer: C. Blood in the urine
Rationale: Hematuria indicates a potential heparin overdose, risking hemorrhage. Oxygen
saturation of 92%, heart rate of 100 bpm, and respiratory rate of 20/min are expected in PE but
not immediately life-threatening.
2025/2026 – Verified Questions,
Answers, and Images (Med Surg II Class)
Question 1
A client with chest pain presents to the ER. The ECG strip shows ST elevation in leads II, III, and
aVF. What is the nurse’s priority action?
A. Administer aspirin 325 mg orally
B. Prepare for thrombolytic therapy
C. Obtain a 12-lead ECG
D. Administer oxygen at 2 L/min via nasal cannula
Correct Answer: D. Administer oxygen at 2 L/min via nasal cannula
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction
(MI), likely due to right coronary artery occlusion. The priority is to improve myocardial
oxygenation by administering oxygen to prevent further ischemia. Aspirin is given after initial
stabilization, thrombolytics require physician orders, and a 12-lead ECG is likely already
obtained.
Question 2
A client with COPD experiences acute dyspnea. The pulse oximetry reading is 88%. What is the
nurse’s first action?
A. Administer albuterol via nebulizer
B. Increase oxygen to 4 L/min
C. Position the client in high Fowler’s
D. Notify the healthcare provider
Correct Answer: C. Position the client in high Fowler’s
,Rationale: Positioning in high Fowler’s optimizes lung expansion and eases breathing in COPD
exacerbation. Oxygen saturation of 88% is low but acceptable for COPD (target 88–92%), so
increasing oxygen is not the first action. Albuterol and notifying the provider are secondary steps.
Question 3
A client with type 1 diabetes presents with blood glucose of 600 mg/dL, Kussmaul respirations,
and fruity breath. What is the nurse’s priority?
A. Administer regular insulin IV
B. Start an IV of normal saline
C. Obtain an arterial blood gas (ABG)
D. Administer sodium bicarbonate
Correct Answer: B. Start an IV of normal saline
Rationale: The symptoms indicate diabetic ketoacidosis (DKA). Fluid replacement with normal
saline is the priority to correct dehydration and improve perfusion, which drives ketone
production. Insulin is given after fluids, ABGs confirm acidosis, and bicarbonate is rarely used.
Question 4
A client post-thyroidectomy reports tingling around the mouth and muscle twitching. What is the
nurse’s first action?
A. Administer calcium gluconate IV
B. Check serum calcium levels
C. Assess for Chvostek’s sign
D. Notify the healthcare provider
Correct Answer: C. Assess for Chvostek’s sign
Rationale: Tingling and twitching suggest hypocalcemia, common post-thyroidectomy due to
parathyroid damage. Assessing for Chvostek’s sign (facial twitching on tapping) confirms
hypocalcemia. Calcium administration and lab checks follow, and notifying the provider is not the
first step.
Question 5
A client with heart failure has crackles in the lungs and +2 pitting edema. Which medication is
most likely prescribed?
A. Furosemide
B. Metoprolol
,C. Digoxin
D. Spironolactone
Correct Answer: A. Furosemide
Rationale: Furosemide, a loop diuretic, reduces fluid overload in heart failure, alleviating
crackles and edema. Metoprolol and digoxin address heart rate and contractility, while
spironolactone is used long-term but not primarily for acute fluid overload.
Question 6
A client with a new colostomy reports leakage around the stoma. What is the nurse’s first
action?
A. Change the ostomy appliance
B. Assess the stoma and skin
C. Irrigate the colostomy
D. Notify the wound care team
Correct Answer: B. Assess the stoma and skin
Rationale: Leakage may indicate improper fit or skin breakdown. Assessing the stoma and
peristomal skin determines the cause (e.g., poor seal, irritation). Changing the appliance,
irrigation, or notification are secondary steps.
Question 7
A client with a suspected stroke has unequal pupils and a Glasgow Coma Scale (GCS) score of
8. What is the priority intervention?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Prepare for CT scan
D. Initiate seizure precautions
Correct Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Unequal pupils and a GCS of 8 suggest increased intracranial pressure (ICP) from a
stroke. Elevating the head to 30 degrees reduces ICP by promoting venous drainage. Mannitol
requires an order, CT scan follows initial stabilization, and seizure precautions are secondary.
Question 8
, A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. What is the
nurse’s first action?
A. Administer kayexalate
B. Restrict dietary potassium
C. Obtain an ECG
D. Administer insulin and D50
Correct Answer: C. Obtain an ECG
Rationale: Hyperkalemia (potassium >5.5 mEq/L) can cause cardiac arrhythmias. Obtaining an
ECG assesses for changes (e.g., peaked T waves) to prioritize treatment. Kayexalate,
insulin/D50, and dietary restrictions are subsequent interventions.
Question 9
A client with pancreatitis has severe abdominal pain. Which position should the nurse
recommend?
A. Supine with legs elevated
B. Side-lying with knees flexed
C. Prone with head turned
D. High Fowler’s with legs straight
Correct Answer: B. Side-lying with knees flexed
Rationale: Side-lying with knees flexed reduces tension on the abdominal muscles, alleviating
pain in pancreatitis. Supine, prone, or high Fowler’s positions may worsen discomfort.
Question 10
A client with a pulmonary embolism (PE) is on heparin. Which finding requires immediate
action?
A. Oxygen saturation of 92%
B. Heart rate of 100 bpm
C. Blood in the urine
D. Respiratory rate of 20/min
Correct Answer: C. Blood in the urine
Rationale: Hematuria indicates a potential heparin overdose, risking hemorrhage. Oxygen
saturation of 92%, heart rate of 100 bpm, and respiratory rate of 20/min are expected in PE but
not immediately life-threatening.
