HESI Specialty Exams: Medical-Surgical Nursing 2025
– WGU D120 OBJECTIVE ASSESSMENT ACTUAL
EXAM STUDY GUIDE 2025/2026 COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES || 100% GUARANTEED PASS
<LATEST VERSION>
HESI Medical-Surgical Nursing 100-Question Study Guide
Cardiovascular Disorders
1. A client with congestive heart failure is prescribed Furosemide (Lasix) 40 mg IV twice daily.
The nurse should prioritize assessing for which potential adverse effect?
A) Tachycardia
B) Hyperkalemia
C) Ototoxicity ✓
D) Constipation
Rationale: While monitoring for hypokalemia is crucial, Furosemide is a loop diuretic that can
be ototoxic, especially with rapid IV administration and in patients with renal impairment. This
is a high-priority assessment to prevent permanent hearing damage.
2. The nurse is caring for a client 2 hours post-Myocardial Infarction (MI). The client becomes
diaphoretic, anxious, and reports severe chest pain. What is the nurse's priority action?
A) Administer Morphine Sulfate IV as ordered.
B) Notify the healthcare provider immediately.
C) Obtain a 12-lead electrocardiogram (ECG). ✓
D) Assess the client's vital signs.
Rationale: The symptoms suggest a possible extension of the MI or ischemia. The priority is to
obtain an ECG to identify changes (like ST-elevation) that will guide immediate treatment (e.g.,
emergency reperfusion). While all actions are important, the ECG provides critical diagnostic
data fastest.
3. When teaching a client about a new prescription for Warfarin (Coumadin), which statement
by the client indicates a need for further teaching?
,A) "I will use a soft-bristled toothbrush to prevent bleeding."
B) "I will avoid eating large amounts of green, leafy vegetables."
C) "I will take Ibuprofen for my occasional headaches." ✓
D) "I will have my blood levels checked regularly."
Rationale: Ibuprofen is an NSAID that can increase the risk of gastrointestinal bleeding and
potentiate the effects of Warfarin, creating a dangerous situation. This client requires
immediate education to avoid NSAIDs and use alternatives like Acetaminophen (if no liver
issues).
4. A client with an automatic implantable cardioverter-defibrillator (AICD) is being discharged.
Which client statement indicates effective teaching?
A) "I should avoid standing near a running microwave oven."
B) "I will not be able to use a cellular phone anymore."
C) "I may feel a dizzy sensation just before the device discharges."
D) "My family should call 911 if I get shocked and feel dizzy." ✓
Rationale: A single shock in a stable person may not be an emergency, but multiple shocks or a
shock followed by symptoms like dizziness, chest pain, or unresponsiveness require immediate
medical attention. Modern AICDs are less affected by microwaves and cell phones if used
correctly (e.g., on the opposite ear).
5. The nurse is reviewing the telemetry strip of a client and notes a rhythm with no P waves,
an irregularly irregular ventricular rate, and fibrillatory waves. The nurse interprets this as:
A) Ventricular Tachycardia
B) Atrial Fibrillation ✓
C) Sinus Tachycardia
D) First-Degree AV Block
Rationale: The classic triad of Atrial Fibrillation is: 1) Absence of distinct P waves, 2) An
irregularly irregular R-R interval, and 3) The presence of fibrillatory waves (f-waves).
Respiratory Disorders
6. A client with chronic obstructive pulmonary disease (COPD) has a pH of 7.30, PaCO2 of 55
mmHg, and HCO3- of 28 mEq/L. The nurse interprets these results as:
A) Metabolic Acidosis
B) Metabolic Alkalosis
C) Respiratory Acidosis ✓
D) Respiratory Alkalosis
Rationale: The low pH indicates acidosis. The elevated PaCO2 (primary respiratory problem) is
the cause, and the elevated HCO3- indicates partial metabolic compensation. This is a common
finding in COPD exacerbations.
,7. A client is receiving Streptomycin for tuberculosis. The nurse should monitor for which
primary toxicities associated with this medication?
A) Red Man Syndrome and nephrotoxicity
B) Hepatotoxicity and orange discoloration of bodily fluids
C) Ototoxicity and nephrotoxicity ✓
D) Peripheral neuropathy and optic neuritis
Rationale: Streptomycin is an aminoglycoside antibiotic. Its primary dose-limiting toxicities are
damage to the 8th cranial nerve (ototoxicity - hearing and balance) and nephrotoxicity (kidney
damage).
8. The nurse is preparing to administer the first dose of Isoniazid (INH) to a client. It is most
important for the nurse to assess the client for a history of what?
A) Seizure disorders
B) Liver disease ✓
C) Diabetes Mellitus
D) Hypertension
Rationale: Isoniazid is a first-line treatment for tuberculosis but carries a significant risk of
hepatotoxicity. A baseline assessment of liver function and history is crucial before initiation.
9. A client with a chest tube attached to a water-seal drainage system is anxious and reports a
sudden, sharp chest pain. The nurse assesses there is no tidaling in the water-seal chamber
and no drainage for the past hour. What is the most likely cause?
A) The system is functioning correctly.
B) The chest tube is kinked or obstructed. ✓
C) The client has developed a pneumothorax.
D) The suction setting is too high.
Rationale: The absence of tidaling (which indicates air is moving in/out of the pleural space with
respiration) and a sudden cessation of drainage, especially with new-onset pain, suggests an
obstruction of the chest tube. This is an emergency as it can lead to a tension pneumothorax.
10. The nurse is teaching a client how to use an albuterol inhaler. The client asks the purpose
of this medication. The nurse's correct response is that albuterol is a:
A) Corticosteroid to reduce inflammation.
B) Bronchodilator to open narrowed airways. ✓
C) Mast cell stabilizer to prevent attacks.
D) Mucolytic to thin secretions.
Rationale: Albuterol is a short-acting beta2-agonist (SABA). Its primary action is to relax the
smooth muscles in the airways, causing rapid bronchodilation.
Neurological Disorders
, 11. A client is admitted with a suspected stroke. The nurse receives the order for Alteplase
(tPA). What is the most critical factor the nurse must confirm before administration?
A) The client's blood pressure is controlled.
B) The time of symptom onset is within the therapeutic window. ✓
C) The client has not taken Aspirin in the last 24 hours.
D) A brain MRI has been completed.
Rationale: The administration of tPA for ischemic stroke is strictly time-dependent, typically
within 3-4.5 hours of symptom onset. Administration outside this window dramatically
increases the risk of catastrophic hemorrhagic conversion.
12. The nurse is assessing a client with a head injury. The client's blood pressure is 170/90 mm
Hg, pulse is 55 beats/minute, and respirations are 8 breaths/minute and irregular. This set of
vital signs is known as:
A) Hemorrhagic Shock
B) Autonomic Dysreflexia
C) Cushing's Triad ✓
D) Neurogenic Shock
Rationale: Cushing's Triad is a classic, late sign of increased intracranial pressure (ICP). It
consists of hypertension (with a widening pulse pressure), bradycardia, and irregular
respirations.
13. A client with a T4 spinal cord injury complains of a severe headache and is diaphoretic
above the level of injury. The nurse notes a blood pressure of 210/108 mm Hg. The nurse's
priority action is to:
A) Administer a PRN antihypertensive.
B) Place the client in a sitting position. ✓
C) Check for a fecal impaction.
D) Notify the healthcare provider.
Rationale: This describes Autonomic Dysreflexia, a medical emergency. The first nursing action
is to sit the client up (to promote orthostatic hypotension) and then check for and remove the
noxious stimulus, most commonly a distended bladder or constipation.
14. When caring for a client with meningitis, which order should the nurse implement first?
A) Administer the prescribed antibiotic. ✓
B) Obtain blood cultures.
C) Initiate droplet isolation precautions.
D) Administer a PRN analgesic for headache.
Rationale: While all are important, initiating antibiotic therapy is the priority in suspected
– WGU D120 OBJECTIVE ASSESSMENT ACTUAL
EXAM STUDY GUIDE 2025/2026 COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES || 100% GUARANTEED PASS
<LATEST VERSION>
HESI Medical-Surgical Nursing 100-Question Study Guide
Cardiovascular Disorders
1. A client with congestive heart failure is prescribed Furosemide (Lasix) 40 mg IV twice daily.
The nurse should prioritize assessing for which potential adverse effect?
A) Tachycardia
B) Hyperkalemia
C) Ototoxicity ✓
D) Constipation
Rationale: While monitoring for hypokalemia is crucial, Furosemide is a loop diuretic that can
be ototoxic, especially with rapid IV administration and in patients with renal impairment. This
is a high-priority assessment to prevent permanent hearing damage.
2. The nurse is caring for a client 2 hours post-Myocardial Infarction (MI). The client becomes
diaphoretic, anxious, and reports severe chest pain. What is the nurse's priority action?
A) Administer Morphine Sulfate IV as ordered.
B) Notify the healthcare provider immediately.
C) Obtain a 12-lead electrocardiogram (ECG). ✓
D) Assess the client's vital signs.
Rationale: The symptoms suggest a possible extension of the MI or ischemia. The priority is to
obtain an ECG to identify changes (like ST-elevation) that will guide immediate treatment (e.g.,
emergency reperfusion). While all actions are important, the ECG provides critical diagnostic
data fastest.
3. When teaching a client about a new prescription for Warfarin (Coumadin), which statement
by the client indicates a need for further teaching?
,A) "I will use a soft-bristled toothbrush to prevent bleeding."
B) "I will avoid eating large amounts of green, leafy vegetables."
C) "I will take Ibuprofen for my occasional headaches." ✓
D) "I will have my blood levels checked regularly."
Rationale: Ibuprofen is an NSAID that can increase the risk of gastrointestinal bleeding and
potentiate the effects of Warfarin, creating a dangerous situation. This client requires
immediate education to avoid NSAIDs and use alternatives like Acetaminophen (if no liver
issues).
4. A client with an automatic implantable cardioverter-defibrillator (AICD) is being discharged.
Which client statement indicates effective teaching?
A) "I should avoid standing near a running microwave oven."
B) "I will not be able to use a cellular phone anymore."
C) "I may feel a dizzy sensation just before the device discharges."
D) "My family should call 911 if I get shocked and feel dizzy." ✓
Rationale: A single shock in a stable person may not be an emergency, but multiple shocks or a
shock followed by symptoms like dizziness, chest pain, or unresponsiveness require immediate
medical attention. Modern AICDs are less affected by microwaves and cell phones if used
correctly (e.g., on the opposite ear).
5. The nurse is reviewing the telemetry strip of a client and notes a rhythm with no P waves,
an irregularly irregular ventricular rate, and fibrillatory waves. The nurse interprets this as:
A) Ventricular Tachycardia
B) Atrial Fibrillation ✓
C) Sinus Tachycardia
D) First-Degree AV Block
Rationale: The classic triad of Atrial Fibrillation is: 1) Absence of distinct P waves, 2) An
irregularly irregular R-R interval, and 3) The presence of fibrillatory waves (f-waves).
Respiratory Disorders
6. A client with chronic obstructive pulmonary disease (COPD) has a pH of 7.30, PaCO2 of 55
mmHg, and HCO3- of 28 mEq/L. The nurse interprets these results as:
A) Metabolic Acidosis
B) Metabolic Alkalosis
C) Respiratory Acidosis ✓
D) Respiratory Alkalosis
Rationale: The low pH indicates acidosis. The elevated PaCO2 (primary respiratory problem) is
the cause, and the elevated HCO3- indicates partial metabolic compensation. This is a common
finding in COPD exacerbations.
,7. A client is receiving Streptomycin for tuberculosis. The nurse should monitor for which
primary toxicities associated with this medication?
A) Red Man Syndrome and nephrotoxicity
B) Hepatotoxicity and orange discoloration of bodily fluids
C) Ototoxicity and nephrotoxicity ✓
D) Peripheral neuropathy and optic neuritis
Rationale: Streptomycin is an aminoglycoside antibiotic. Its primary dose-limiting toxicities are
damage to the 8th cranial nerve (ototoxicity - hearing and balance) and nephrotoxicity (kidney
damage).
8. The nurse is preparing to administer the first dose of Isoniazid (INH) to a client. It is most
important for the nurse to assess the client for a history of what?
A) Seizure disorders
B) Liver disease ✓
C) Diabetes Mellitus
D) Hypertension
Rationale: Isoniazid is a first-line treatment for tuberculosis but carries a significant risk of
hepatotoxicity. A baseline assessment of liver function and history is crucial before initiation.
9. A client with a chest tube attached to a water-seal drainage system is anxious and reports a
sudden, sharp chest pain. The nurse assesses there is no tidaling in the water-seal chamber
and no drainage for the past hour. What is the most likely cause?
A) The system is functioning correctly.
B) The chest tube is kinked or obstructed. ✓
C) The client has developed a pneumothorax.
D) The suction setting is too high.
Rationale: The absence of tidaling (which indicates air is moving in/out of the pleural space with
respiration) and a sudden cessation of drainage, especially with new-onset pain, suggests an
obstruction of the chest tube. This is an emergency as it can lead to a tension pneumothorax.
10. The nurse is teaching a client how to use an albuterol inhaler. The client asks the purpose
of this medication. The nurse's correct response is that albuterol is a:
A) Corticosteroid to reduce inflammation.
B) Bronchodilator to open narrowed airways. ✓
C) Mast cell stabilizer to prevent attacks.
D) Mucolytic to thin secretions.
Rationale: Albuterol is a short-acting beta2-agonist (SABA). Its primary action is to relax the
smooth muscles in the airways, causing rapid bronchodilation.
Neurological Disorders
, 11. A client is admitted with a suspected stroke. The nurse receives the order for Alteplase
(tPA). What is the most critical factor the nurse must confirm before administration?
A) The client's blood pressure is controlled.
B) The time of symptom onset is within the therapeutic window. ✓
C) The client has not taken Aspirin in the last 24 hours.
D) A brain MRI has been completed.
Rationale: The administration of tPA for ischemic stroke is strictly time-dependent, typically
within 3-4.5 hours of symptom onset. Administration outside this window dramatically
increases the risk of catastrophic hemorrhagic conversion.
12. The nurse is assessing a client with a head injury. The client's blood pressure is 170/90 mm
Hg, pulse is 55 beats/minute, and respirations are 8 breaths/minute and irregular. This set of
vital signs is known as:
A) Hemorrhagic Shock
B) Autonomic Dysreflexia
C) Cushing's Triad ✓
D) Neurogenic Shock
Rationale: Cushing's Triad is a classic, late sign of increased intracranial pressure (ICP). It
consists of hypertension (with a widening pulse pressure), bradycardia, and irregular
respirations.
13. A client with a T4 spinal cord injury complains of a severe headache and is diaphoretic
above the level of injury. The nurse notes a blood pressure of 210/108 mm Hg. The nurse's
priority action is to:
A) Administer a PRN antihypertensive.
B) Place the client in a sitting position. ✓
C) Check for a fecal impaction.
D) Notify the healthcare provider.
Rationale: This describes Autonomic Dysreflexia, a medical emergency. The first nursing action
is to sit the client up (to promote orthostatic hypotension) and then check for and remove the
noxious stimulus, most commonly a distended bladder or constipation.
14. When caring for a client with meningitis, which order should the nurse implement first?
A) Administer the prescribed antibiotic. ✓
B) Obtain blood cultures.
C) Initiate droplet isolation precautions.
D) Administer a PRN analgesic for headache.
Rationale: While all are important, initiating antibiotic therapy is the priority in suspected
