HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 72-year-old client with a history of anterior-wall myocardial infarction is
admitted with acute decompensated heart failure. Vital signs: BP 82/48 mm Hg,
HR 118 beats/min, and urine output 15 mL/h for the past 3 hours.
Pulmonary-artery catheter readings show CI 1.8 L/min/m² and PCWP 24 mm Hg.
Which ordered intervention should the nurse implement first?
A. Start dobutamine 5 mcg/kg/min
B. Infuse 500 mL 0.9% saline over 30 min
C. Administer furosemide 40 mg IV push
D. Titrate nitroglycerin 10 mcg/min per protocol
Correct Answer: A
Rationale: The low cardiac index (CI < 2.2) and high PCWP (> 18) with hypotension
indicate cardiogenic shock; positive inotropy with dobutamine is priority to restore
perfusion. Volume loading (B) would worsen pulmonary congestion, while IV
furosemide (C) is reserved once perfusion improves. Nitroglycerin (D) reduces preload
and can further drop BP.
2. A client with a subarachnoid hemorrhage (day 2) develops sudden onset of
left-sided weakness and decreased level of consciousness. Which complication
should the nurse suspect?
A. Re-bleed
B. Cerebral vasospasm
C. Hydrocephalus
D. Seizure
Correct Answer: B
,Rationale: New focal deficits and decreased LOC between days 2-7 point to vasospasm
reducing cerebral perfusion. Re-bleed (A) usually occurs within 24 h; hydrocephalus (C)
presents with headache and upward gaze; seizure (D) would show tonic-clonic activity.
3. The nurse is caring for a client with ARDS who is on volume-controlled
ventilation (FiO₂ 0.8, PEEP 14 cm H₂O). Recent ABG: pH 7.48, PaCO₂ 30 mm
Hg, PaO₂ 58 mm Hg, HCO₃⁻ 22 mEq/L. Which change should the nurse
anticipate?
A. Increase PEEP to 18 cm H₂O
B. Decrease tidal volume
C. Reduce FiO₂ to 0.6
D. Add dead-space tubing
Correct Answer: A
Rationale: PaO₂ < 60 mm Hg despite high FiO₂ suggests recruitable alveoli; PEEP is
increased per ARDS-Net protocol while plateau pressure < 30 cm H₂O. Tidal volume (B)
is already low (6 mL/kg). Decreasing FiO₂ (C) would worsen hypoxemia, and adding
dead space (D) increases PaCO₂ but does not improve oxygenation.
4. A client with DKA has serum K⁺ 2.9 mEq/L on admission. An insulin infusion is
started. Which action is most appropriate?
A. Begin potassium chloride 20 mEq/h IV central line
B. Hold insulin until K⁺ ≥ 3.3 mEq/L
C. Give oral potassium 40 mEq
D. Monitor K⁺ q2h without replacement
Correct Answer: B
Rationale: Insulin drives potassium intracellularly, risking severe hypokalemia and
arrhythmia; replacement precedes insulin when K⁺ < 3.3. IV potassium (A) requires
,adequate urine output and central access verification. Oral K (C) is inadequate in ileus,
and monitoring alone (D) is unsafe.
5. A client with acute pancreatitis develops tetany and a positive Chvostek sign.
Which laboratory value should the nurse check first?
A. Serum calcium
B. Serum amylase
C. Serum glucose
D. Serum lactate
Correct Answer: A
Rationale: Hypocalcemia is common in severe pancreatitis due to saponification; tetany
and Chvostek reflect neuromuscular irritability. Amylase (B) confirms diagnosis but not
complication, while glucose (C) and lactate (D) assess severity, not acute tetany.
6. A client with a C-5 spinal cord injury 24 h ago has a heart rate of 48 bpm and BP
80/50 mm Hg. Which intervention is priority?
A. Administer atropine 0.5 mg IV
B. Infuse 1 L normal saline rapidly
C. Apply compression stockings
D. Increase room temperature
Correct Answer: A
Rationale: Neurogenic shock causes loss of sympathetic tone and bradycardia; atropine
increases HR and cardiac output. Volume (B) is second-line, and stockings (C) or
warming (D) are adjunctive.
7. A client with sepsis has a central venous O₂ saturation (ScvO₂) of 65% on
norepinephrine. Which intervention is indicated?
A. Add vasopressin 0.03 units/min
, B. Transfuse 1 unit PRBC if Hgb < 7 g/dL
C. Start dobutamine 5 mcg/kg/min
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: ScvO₂ < 70% with adequate MAP suggests inadequate oxygen delivery;
dobutamine improves cardiac output. Vasopressin (A) raises MAP but not flow.
Transfusion (B) is indicated for Hgb < 7 g/dL but does not address contractility.
Increasing FiO₂ (D) may already be maximal.
8. A client with Addisonian crisis is receiving hydrocortisone 100 mg IV q8h. Which
assessment finding indicates therapeutic effectiveness?
A. Blood pressure 110/70 mm Hg
B. Serum sodium 128 mEq/L
C. Serum potassium 5.2 mEq/L
D. Weight gain 1 kg in 24 h
Correct Answer: A
Rationale: Improved BP reflects restoration of vascular tone and sodium retention.
Persistent hyponatremia (B) and hyperkalemia (C) normalize more slowly, while weight
gain (D) may reflect fluid overload rather than adrenal recovery.
9. A client with a serum sodium of 118 mEq/L is receiving 3% saline at 30 mL/h.
Which assessment finding requires immediate intervention?
A. Urine output 45 mL/h
B. Restlessness and new slurred speech
C. Deep tendon reflexes 2+
D. Serum osmolality 268 mOsm/kg
Correct Answer: B
Advanced Medical-Surgical Nursing Questions with
Correct Answers & Detailed Rationales
1. A 72-year-old client with a history of anterior-wall myocardial infarction is
admitted with acute decompensated heart failure. Vital signs: BP 82/48 mm Hg,
HR 118 beats/min, and urine output 15 mL/h for the past 3 hours.
Pulmonary-artery catheter readings show CI 1.8 L/min/m² and PCWP 24 mm Hg.
Which ordered intervention should the nurse implement first?
A. Start dobutamine 5 mcg/kg/min
B. Infuse 500 mL 0.9% saline over 30 min
C. Administer furosemide 40 mg IV push
D. Titrate nitroglycerin 10 mcg/min per protocol
Correct Answer: A
Rationale: The low cardiac index (CI < 2.2) and high PCWP (> 18) with hypotension
indicate cardiogenic shock; positive inotropy with dobutamine is priority to restore
perfusion. Volume loading (B) would worsen pulmonary congestion, while IV
furosemide (C) is reserved once perfusion improves. Nitroglycerin (D) reduces preload
and can further drop BP.
2. A client with a subarachnoid hemorrhage (day 2) develops sudden onset of
left-sided weakness and decreased level of consciousness. Which complication
should the nurse suspect?
A. Re-bleed
B. Cerebral vasospasm
C. Hydrocephalus
D. Seizure
Correct Answer: B
,Rationale: New focal deficits and decreased LOC between days 2-7 point to vasospasm
reducing cerebral perfusion. Re-bleed (A) usually occurs within 24 h; hydrocephalus (C)
presents with headache and upward gaze; seizure (D) would show tonic-clonic activity.
3. The nurse is caring for a client with ARDS who is on volume-controlled
ventilation (FiO₂ 0.8, PEEP 14 cm H₂O). Recent ABG: pH 7.48, PaCO₂ 30 mm
Hg, PaO₂ 58 mm Hg, HCO₃⁻ 22 mEq/L. Which change should the nurse
anticipate?
A. Increase PEEP to 18 cm H₂O
B. Decrease tidal volume
C. Reduce FiO₂ to 0.6
D. Add dead-space tubing
Correct Answer: A
Rationale: PaO₂ < 60 mm Hg despite high FiO₂ suggests recruitable alveoli; PEEP is
increased per ARDS-Net protocol while plateau pressure < 30 cm H₂O. Tidal volume (B)
is already low (6 mL/kg). Decreasing FiO₂ (C) would worsen hypoxemia, and adding
dead space (D) increases PaCO₂ but does not improve oxygenation.
4. A client with DKA has serum K⁺ 2.9 mEq/L on admission. An insulin infusion is
started. Which action is most appropriate?
A. Begin potassium chloride 20 mEq/h IV central line
B. Hold insulin until K⁺ ≥ 3.3 mEq/L
C. Give oral potassium 40 mEq
D. Monitor K⁺ q2h without replacement
Correct Answer: B
Rationale: Insulin drives potassium intracellularly, risking severe hypokalemia and
arrhythmia; replacement precedes insulin when K⁺ < 3.3. IV potassium (A) requires
,adequate urine output and central access verification. Oral K (C) is inadequate in ileus,
and monitoring alone (D) is unsafe.
5. A client with acute pancreatitis develops tetany and a positive Chvostek sign.
Which laboratory value should the nurse check first?
A. Serum calcium
B. Serum amylase
C. Serum glucose
D. Serum lactate
Correct Answer: A
Rationale: Hypocalcemia is common in severe pancreatitis due to saponification; tetany
and Chvostek reflect neuromuscular irritability. Amylase (B) confirms diagnosis but not
complication, while glucose (C) and lactate (D) assess severity, not acute tetany.
6. A client with a C-5 spinal cord injury 24 h ago has a heart rate of 48 bpm and BP
80/50 mm Hg. Which intervention is priority?
A. Administer atropine 0.5 mg IV
B. Infuse 1 L normal saline rapidly
C. Apply compression stockings
D. Increase room temperature
Correct Answer: A
Rationale: Neurogenic shock causes loss of sympathetic tone and bradycardia; atropine
increases HR and cardiac output. Volume (B) is second-line, and stockings (C) or
warming (D) are adjunctive.
7. A client with sepsis has a central venous O₂ saturation (ScvO₂) of 65% on
norepinephrine. Which intervention is indicated?
A. Add vasopressin 0.03 units/min
, B. Transfuse 1 unit PRBC if Hgb < 7 g/dL
C. Start dobutamine 5 mcg/kg/min
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: ScvO₂ < 70% with adequate MAP suggests inadequate oxygen delivery;
dobutamine improves cardiac output. Vasopressin (A) raises MAP but not flow.
Transfusion (B) is indicated for Hgb < 7 g/dL but does not address contractility.
Increasing FiO₂ (D) may already be maximal.
8. A client with Addisonian crisis is receiving hydrocortisone 100 mg IV q8h. Which
assessment finding indicates therapeutic effectiveness?
A. Blood pressure 110/70 mm Hg
B. Serum sodium 128 mEq/L
C. Serum potassium 5.2 mEq/L
D. Weight gain 1 kg in 24 h
Correct Answer: A
Rationale: Improved BP reflects restoration of vascular tone and sodium retention.
Persistent hyponatremia (B) and hyperkalemia (C) normalize more slowly, while weight
gain (D) may reflect fluid overload rather than adrenal recovery.
9. A client with a serum sodium of 118 mEq/L is receiving 3% saline at 30 mL/h.
Which assessment finding requires immediate intervention?
A. Urine output 45 mL/h
B. Restlessness and new slurred speech
C. Deep tendon reflexes 2+
D. Serum osmolality 268 mOsm/kg
Correct Answer: B
