HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with Correct
Answers & Detailed Rationales
1. A 68-year-old post-CABG client has a cardiac output (CO) of 3.2 L/min
(normal 4–8 L/min) and a pulmonary artery wedge pressure (PAWP) of 18
mmHg. Which intervention should the nurse anticipate?
A. Administer IV furosemide
B. Infuse 500 mL normal saline bolus
C. Increase dobutamine drip
D. Decrease PEEP on ventilator
Correct Answer: C
Rationale: A low CO with elevated PAWP indicates LV dysfunction and fluid
overload; inotropic support (dobutamine) improves contractility and CO.
Furosemide would reduce preload but not address pump failure. A fluid bolus
would worsen congestion. PEEP changes do not directly improve cardiac
performance.
2. The nurse is caring for a ventilated ARDS client whose PaO₂ drops from 88
to 52 mmHg after suctioning. Which action is most appropriate?
A. Increase FiO₂ to 1.0 and re-check ABG in 30 min
B. Administer vecuronium for paralysis
,C. Suction again to clear residual secretions
D. Decrease tidal volume to 4 mL/kg
Correct Answer: A
Rationale: Acute desaturation post-suctioning suggests derecruitment; temporarily
increasing FiO₂ restores oxygenation quickly. Paralysis is used for vent
dyssynchrony, not hypoxemia alone. Re-suctioning would worsen derecruitment.
Low tidal volume is already ordered and would not correct immediate hypoxia.
3. A client with DKA has a serum K⁺ of 2.9 mEq/L after several hours of
insulin infusion. Which provider order should the nurse question?
A. Add 20 mEq KCl to each liter of IVF
B. Continue insulin at 0.1 unit/kg/h
C. Give 40 mEq KCl IV over 1 hour centrally
D. Hold insulin until K⁺ ≥ 3.5 mEq/L
Correct Answer: C
Rationale: Peripheral administration of 40 mEq/h carries phlebitis and cardiac
arrest risk; central administration should not exceed 10–20 mEq/h. Replacing 20
mEq/L in fluids is standard. Holding insulin until K⁺ ≥ 3.5 prevents fatal
hypokalemia.
4. A client with a C6 spinal cord injury develops a throbbing headache, BP
210/110, and bradycardia 48 bpm. Which action is priority?
,A. Administer sublingual nifedipine
B. Sit patient upright and loosen clothing
C. Check bladder for distention
D. Both B and C
Correct Answer: D
Rationale: These are classic signs of autonomic dysreflexia triggered by noxious
stimuli below the lesion—most commonly bladder distention. Sitting upright
lowers ICP while the trigger is sought and removed. Antihypertensives are
second-line after stimulus removal.
5. A client with a thyroid storm has a temp of 40.1 °C. Which cooling measure
is most effective?
A. Ice packs to axillae and groin
B. Cooling blanket set to 36 °C
C. Ice-water immersion
D. Propofol infusion for shivering
Correct Answer: B
Rationale: A servo-controlled blanket provides sustained, measurable cooling
without the risks of immersion (arrhythmias, skin necrosis) and can be titrated. Ice
packs are adjunctive. Propofol treats shivering but does not cool.
, 6. A client with a Glasgow Coma Scale of 6 receives mannitol 1 g/kg IV.
Which parameter best reflects therapeutic effect?
A. Decrease in ICP waveform amplitude
B. Urine output > 200 mL/h
C. Serum osmolality 310 mOsm/kg
D. Systolic BP 150 mmHg
Correct Answer: A
Rationale: Mannitol reduces cerebral edema, reflected by lower ICP waveform
amplitude on monitoring. Diuresis and serum osmolality are expected side effects,
not therapeutic endpoints. Blood pressure is not a direct measure of ICP reduction.
7. A client with Addisonian crisis has BP 78/50 and Na 128 mEq/L. Which IV
fluid is most appropriate initially?
A. 0.9% saline with hydrocortisone 100 mg
B. D5W with hydrocortisone
C. 0.45% saline with potassium chloride
D. D5½NS with insulin
Correct Answer: A
Rationale: Isotonic saline restores volume and sodium; hydrocortisone provides
glucocorticoid and mineralocorticoid effect. D5W is hypotonic and risks
Advanced Medical-Surgical Nursing Questions with Correct
Answers & Detailed Rationales
1. A 68-year-old post-CABG client has a cardiac output (CO) of 3.2 L/min
(normal 4–8 L/min) and a pulmonary artery wedge pressure (PAWP) of 18
mmHg. Which intervention should the nurse anticipate?
A. Administer IV furosemide
B. Infuse 500 mL normal saline bolus
C. Increase dobutamine drip
D. Decrease PEEP on ventilator
Correct Answer: C
Rationale: A low CO with elevated PAWP indicates LV dysfunction and fluid
overload; inotropic support (dobutamine) improves contractility and CO.
Furosemide would reduce preload but not address pump failure. A fluid bolus
would worsen congestion. PEEP changes do not directly improve cardiac
performance.
2. The nurse is caring for a ventilated ARDS client whose PaO₂ drops from 88
to 52 mmHg after suctioning. Which action is most appropriate?
A. Increase FiO₂ to 1.0 and re-check ABG in 30 min
B. Administer vecuronium for paralysis
,C. Suction again to clear residual secretions
D. Decrease tidal volume to 4 mL/kg
Correct Answer: A
Rationale: Acute desaturation post-suctioning suggests derecruitment; temporarily
increasing FiO₂ restores oxygenation quickly. Paralysis is used for vent
dyssynchrony, not hypoxemia alone. Re-suctioning would worsen derecruitment.
Low tidal volume is already ordered and would not correct immediate hypoxia.
3. A client with DKA has a serum K⁺ of 2.9 mEq/L after several hours of
insulin infusion. Which provider order should the nurse question?
A. Add 20 mEq KCl to each liter of IVF
B. Continue insulin at 0.1 unit/kg/h
C. Give 40 mEq KCl IV over 1 hour centrally
D. Hold insulin until K⁺ ≥ 3.5 mEq/L
Correct Answer: C
Rationale: Peripheral administration of 40 mEq/h carries phlebitis and cardiac
arrest risk; central administration should not exceed 10–20 mEq/h. Replacing 20
mEq/L in fluids is standard. Holding insulin until K⁺ ≥ 3.5 prevents fatal
hypokalemia.
4. A client with a C6 spinal cord injury develops a throbbing headache, BP
210/110, and bradycardia 48 bpm. Which action is priority?
,A. Administer sublingual nifedipine
B. Sit patient upright and loosen clothing
C. Check bladder for distention
D. Both B and C
Correct Answer: D
Rationale: These are classic signs of autonomic dysreflexia triggered by noxious
stimuli below the lesion—most commonly bladder distention. Sitting upright
lowers ICP while the trigger is sought and removed. Antihypertensives are
second-line after stimulus removal.
5. A client with a thyroid storm has a temp of 40.1 °C. Which cooling measure
is most effective?
A. Ice packs to axillae and groin
B. Cooling blanket set to 36 °C
C. Ice-water immersion
D. Propofol infusion for shivering
Correct Answer: B
Rationale: A servo-controlled blanket provides sustained, measurable cooling
without the risks of immersion (arrhythmias, skin necrosis) and can be titrated. Ice
packs are adjunctive. Propofol treats shivering but does not cool.
, 6. A client with a Glasgow Coma Scale of 6 receives mannitol 1 g/kg IV.
Which parameter best reflects therapeutic effect?
A. Decrease in ICP waveform amplitude
B. Urine output > 200 mL/h
C. Serum osmolality 310 mOsm/kg
D. Systolic BP 150 mmHg
Correct Answer: A
Rationale: Mannitol reduces cerebral edema, reflected by lower ICP waveform
amplitude on monitoring. Diuresis and serum osmolality are expected side effects,
not therapeutic endpoints. Blood pressure is not a direct measure of ICP reduction.
7. A client with Addisonian crisis has BP 78/50 and Na 128 mEq/L. Which IV
fluid is most appropriate initially?
A. 0.9% saline with hydrocortisone 100 mg
B. D5W with hydrocortisone
C. 0.45% saline with potassium chloride
D. D5½NS with insulin
Correct Answer: A
Rationale: Isotonic saline restores volume and sodium; hydrocortisone provides
glucocorticoid and mineralocorticoid effect. D5W is hypotonic and risks
