HESI Med-Surg II Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 69-year-old client is 8 hours post-CABG and has a cardiac output (CO) of
3.2 L/min (normal 4–8) and pulmonary artery wedge pressure (PAWP) of 18
mm Hg (normal 6–12). Which intervention should the nurse anticipate first?
A. Administer IV furosemide 40 mg
B. Increase dobutamine from 5 to 7 μg/kg/min
C. Restrict fluids to 500 mL per day
D. Apply compression stockings
Correct Answer: B
Rationale: Elevated PAWP indicates fluid overload and poor LV compliance, yet
low CO suggests the heart needs inotropic support to eject the excess fluid.
Increasing dobutamine enhances contractility and promotes diuresis. Furosemide
alone (A) would drop preload but not improve pump function. Fluid restriction (C)
is slow; stockings (D) do not address pump failure.
2. A client with aortic stenosis develops syncope on exertion. Which
pathophysiologic mechanism best explains the syncope?
A. Acute cerebral hemorrhage
B. Left-ventricular outflow obstruction limits cerebral perfusion
,C. Excessive parasympathetic response
D. Pulmonary embolism
Correct Answer: B
Rationale: Critical AS creates a fixed outflow obstruction; during exertion cardiac
output cannot increase, causing a sudden drop in cerebral perfusion. This is not
related to hemorrhage (A), vasovagal overdrive (C), or PE (D).
3. The nurse is monitoring a client with acute decompensated HF who is
receiving nesiritide. Which finding requires immediate intervention?
A. BP 84/48 mm Hg
B. HR 92 beats/min
C. Urine output 40 mL/hr
D. Oxygen saturation 93 %
Correct Answer: A
Rationale: Nesiritide is a vasodilator; systolic BP <90 mm Hg can precipitate renal
hypoperfusion and shock. The drug should be reduced or discontinued. Other
values are acceptable.
4. A client in DKA has serum K⁺ 5.8 mEq/L on admission. Insulin infusion is
started. Which change should the nurse expect?
A. K⁺ will rise further due to insulin
B. K⁺ will fall as insulin drives K⁺ intracellularly
,C. No change until fluids are given
D. K⁺ will rise because of concurrent acidosis
Correct Answer: B
Rationale: Insulin promotes Na⁺/K⁺-ATPase, shifting potassium into cells and
lowering serum levels. Although acidosis raises K⁺, insulin’s effect dominates;
levels often drop to <3.5 within 2–4 hours, mandating replacement.
5. A client with a thyroid storm has temp 40.1 °C. Which cooling measure is
contraindicated?
A. Acetaminophen 650 mg PO
B. Ice packs to axilla and groin
C. Cooling blanket
D. Aspirin 650 mg PR
Correct Answer: D
Rationale: Aspirin increases free T₄ by displacing thyroid hormone from binding
proteins and blocks peripheral conversion of T₄ to rT₃, potentially worsening storm.
Acetaminophen (A) is safe; external cooling (B, C) is standard.
6. A ventilated client with ARDS has plateau pressure 30 cm H₂O on Vt 6
mL/kg, PEEP 12, FiO₂ 0.8. Which change is most appropriate?
A. Increase Vt to 8 mL/kg
B. Decrease PEEP to 8
, C. Reduce Vt to 4 mL/kg
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: ARDSNet lung-protective strategy targets plateau ≤30 cm H₂O; if
exceeded on 6 mL/kg, reduce Vt further to 4 mL/kg and accept hypercapnia.
Raising Vt (A) would risk barotrauma; lowering PEEP (B) would collapse alveoli.
7. A client with a PE receives heparin 18 units/kg/hr. aPTT is 42 s (goal
46–70). Which adjustment is correct per protocol?
A. 80 units/kg bolus & increase 4 units/kg/hr
B. 40 units/kg bolus & increase 2 units/kg/hr
C. No bolus; increase 1 unit/kg/hr
D. Stop infusion 1 h then restart lower
Correct Answer: A
Rationale: Subtherapeutic aPTT (<1.2 × control) warrants an 80 units/kg bolus and
hourly rate increase of 4 units/kg to reach target quickly and prevent clot extension.
Smaller adjustments (B, C) are insufficient; holding (D) delays therapy.
8. A client with a T-spine complete lesion at T6 reports severe headache and
nasal stuffiness. BP 210/110 mm Hg. Which action is priority?
A. Sit upright and loosen clothing
B. Administer sublingual nifedipine
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 69-year-old client is 8 hours post-CABG and has a cardiac output (CO) of
3.2 L/min (normal 4–8) and pulmonary artery wedge pressure (PAWP) of 18
mm Hg (normal 6–12). Which intervention should the nurse anticipate first?
A. Administer IV furosemide 40 mg
B. Increase dobutamine from 5 to 7 μg/kg/min
C. Restrict fluids to 500 mL per day
D. Apply compression stockings
Correct Answer: B
Rationale: Elevated PAWP indicates fluid overload and poor LV compliance, yet
low CO suggests the heart needs inotropic support to eject the excess fluid.
Increasing dobutamine enhances contractility and promotes diuresis. Furosemide
alone (A) would drop preload but not improve pump function. Fluid restriction (C)
is slow; stockings (D) do not address pump failure.
2. A client with aortic stenosis develops syncope on exertion. Which
pathophysiologic mechanism best explains the syncope?
A. Acute cerebral hemorrhage
B. Left-ventricular outflow obstruction limits cerebral perfusion
,C. Excessive parasympathetic response
D. Pulmonary embolism
Correct Answer: B
Rationale: Critical AS creates a fixed outflow obstruction; during exertion cardiac
output cannot increase, causing a sudden drop in cerebral perfusion. This is not
related to hemorrhage (A), vasovagal overdrive (C), or PE (D).
3. The nurse is monitoring a client with acute decompensated HF who is
receiving nesiritide. Which finding requires immediate intervention?
A. BP 84/48 mm Hg
B. HR 92 beats/min
C. Urine output 40 mL/hr
D. Oxygen saturation 93 %
Correct Answer: A
Rationale: Nesiritide is a vasodilator; systolic BP <90 mm Hg can precipitate renal
hypoperfusion and shock. The drug should be reduced or discontinued. Other
values are acceptable.
4. A client in DKA has serum K⁺ 5.8 mEq/L on admission. Insulin infusion is
started. Which change should the nurse expect?
A. K⁺ will rise further due to insulin
B. K⁺ will fall as insulin drives K⁺ intracellularly
,C. No change until fluids are given
D. K⁺ will rise because of concurrent acidosis
Correct Answer: B
Rationale: Insulin promotes Na⁺/K⁺-ATPase, shifting potassium into cells and
lowering serum levels. Although acidosis raises K⁺, insulin’s effect dominates;
levels often drop to <3.5 within 2–4 hours, mandating replacement.
5. A client with a thyroid storm has temp 40.1 °C. Which cooling measure is
contraindicated?
A. Acetaminophen 650 mg PO
B. Ice packs to axilla and groin
C. Cooling blanket
D. Aspirin 650 mg PR
Correct Answer: D
Rationale: Aspirin increases free T₄ by displacing thyroid hormone from binding
proteins and blocks peripheral conversion of T₄ to rT₃, potentially worsening storm.
Acetaminophen (A) is safe; external cooling (B, C) is standard.
6. A ventilated client with ARDS has plateau pressure 30 cm H₂O on Vt 6
mL/kg, PEEP 12, FiO₂ 0.8. Which change is most appropriate?
A. Increase Vt to 8 mL/kg
B. Decrease PEEP to 8
, C. Reduce Vt to 4 mL/kg
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: ARDSNet lung-protective strategy targets plateau ≤30 cm H₂O; if
exceeded on 6 mL/kg, reduce Vt further to 4 mL/kg and accept hypercapnia.
Raising Vt (A) would risk barotrauma; lowering PEEP (B) would collapse alveoli.
7. A client with a PE receives heparin 18 units/kg/hr. aPTT is 42 s (goal
46–70). Which adjustment is correct per protocol?
A. 80 units/kg bolus & increase 4 units/kg/hr
B. 40 units/kg bolus & increase 2 units/kg/hr
C. No bolus; increase 1 unit/kg/hr
D. Stop infusion 1 h then restart lower
Correct Answer: A
Rationale: Subtherapeutic aPTT (<1.2 × control) warrants an 80 units/kg bolus and
hourly rate increase of 4 units/kg to reach target quickly and prevent clot extension.
Smaller adjustments (B, C) are insufficient; holding (D) delays therapy.
8. A client with a T-spine complete lesion at T6 reports severe headache and
nasal stuffiness. BP 210/110 mm Hg. Which action is priority?
A. Sit upright and loosen clothing
B. Administer sublingual nifedipine
