HESI MILESTONE 2 ACTUAL EXAM 3 LATEST VERSIONS
(V1, V2 AND V3) EACH VERSION CONTAINS QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+ 2026
🏥 HESI Milestone 2 – Version 1 (2024)
Questions 1–25 – Verified Answers with Explanations
1. A patient with dehydration has concentrated urine and low blood pressure. The nurse’s first
action is:
A. Administer IV fluids as ordered
B. Encourage oral intake only
C. Monitor urine output
D. Restrict fluids
Answer: A – Priority is to restore circulating volume.
2. NGN Case: A postoperative patient develops sudden shortness of breath and chest pain.
Nursing action:
A. Call rapid response, administer oxygen, monitor vitals
B. Encourage ambulation
C. Apply a heating pad
D. Document only
Answer: A – Signs indicate possible pulmonary embolism; immediate intervention is required.
3. A patient on heparin therapy has aPTT above therapeutic range. Nursing action:
A. Hold the dose and notify provider
B. Administer the full dose
C. Encourage fluids only
D. Monitor vitals without action
Answer: A – Risk of bleeding; holding dose and notifying provider is essential.
,4. The nurse teaches a patient prescribed metoprolol to:
A. Monitor heart rate and blood pressure daily
B. Avoid all activity
C. Take only with meals
D. Restrict fluids
Answer: A – Beta-blockers can cause bradycardia and hypotension; monitoring is key.
5. NGN Case: Patient reports tingling in fingers after IV calcium infusion. Nursing action:
A. Stop infusion and notify provider
B. Continue infusion
C. Apply ice
D. Encourage ambulation
Answer: A – Tingling may indicate hypercalcemia or infiltration; intervention is required.
6. Patient receiving insulin lispro should:
A. Administer 15 minutes before meals
B. Take only when hypoglycemic
C. Avoid monitoring
D. Restrict fluids
Answer: A – Rapid-acting insulin works quickly; timing with meals prevents hypoglycemia.
7. A patient with COPD is prescribed oxygen at 2 L/min. Nursing teaching:
A. Monitor oxygen saturation and respiratory rate
B. Increase to 6 L/min immediately
C. Restrict fluids
D. Avoid monitoring
Answer: A – Safety priority is preventing hypoxia and CO2 retention.
8. NGN Case: A patient with heart failure develops crackles in lungs and edema. Priority nursing
action:
A. Assess oxygenation, administer prescribed diuretics
B. Restrict fluids only
C. Encourage ambulation
D. Document findings only
Answer: A – Pulmonary edema is life-threatening; oxygen and diuretics are priority.
, 9. Patient prescribed warfarin should be taught to:
A. Monitor INR, avoid vitamin K-rich foods, report bleeding
B. Take NSAIDs freely
C. Increase vitamin K intake
D. Avoid protein
Answer: A – Ensures therapeutic anticoagulation and reduces bleeding risk.
10. NGN Case: Patient receiving vancomycin develops flushing and hypotension. Nursing
action:
A. Slow infusion, monitor vitals, notify provider
B. Stop infusion permanently
C. Ignore reaction
D. Restrict fluids
Answer: A – Red Man Syndrome; slowing infusion and monitoring is key.
11. A patient with asthma prescribed albuterol should:
A. Use a spacer and rinse mouth after use
B. Take only with meals
C. Avoid inhalation technique
D. Restrict fluids
Answer: A – Reduces oral thrush and ensures proper drug delivery.
12. NGN Case: Pediatric patient on chemotherapy is neutropenic. Nursing action:
A. Implement strict infection precautions, monitor temperature
B. Encourage group activities
C. Restrict fluids only
D. Observe only
Answer: A – Neutropenia increases risk of infection; precautions are essential.
13. Patient prescribed ACE inhibitor develops persistent cough. Nursing action:
A. Notify provider; substitution may be required
B. Ignore cough
C. Increase dose
D. Restrict fluids
Answer: A – Persistent cough is a common adverse effect; provider intervention needed.
(V1, V2 AND V3) EACH VERSION CONTAINS QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+ 2026
🏥 HESI Milestone 2 – Version 1 (2024)
Questions 1–25 – Verified Answers with Explanations
1. A patient with dehydration has concentrated urine and low blood pressure. The nurse’s first
action is:
A. Administer IV fluids as ordered
B. Encourage oral intake only
C. Monitor urine output
D. Restrict fluids
Answer: A – Priority is to restore circulating volume.
2. NGN Case: A postoperative patient develops sudden shortness of breath and chest pain.
Nursing action:
A. Call rapid response, administer oxygen, monitor vitals
B. Encourage ambulation
C. Apply a heating pad
D. Document only
Answer: A – Signs indicate possible pulmonary embolism; immediate intervention is required.
3. A patient on heparin therapy has aPTT above therapeutic range. Nursing action:
A. Hold the dose and notify provider
B. Administer the full dose
C. Encourage fluids only
D. Monitor vitals without action
Answer: A – Risk of bleeding; holding dose and notifying provider is essential.
,4. The nurse teaches a patient prescribed metoprolol to:
A. Monitor heart rate and blood pressure daily
B. Avoid all activity
C. Take only with meals
D. Restrict fluids
Answer: A – Beta-blockers can cause bradycardia and hypotension; monitoring is key.
5. NGN Case: Patient reports tingling in fingers after IV calcium infusion. Nursing action:
A. Stop infusion and notify provider
B. Continue infusion
C. Apply ice
D. Encourage ambulation
Answer: A – Tingling may indicate hypercalcemia or infiltration; intervention is required.
6. Patient receiving insulin lispro should:
A. Administer 15 minutes before meals
B. Take only when hypoglycemic
C. Avoid monitoring
D. Restrict fluids
Answer: A – Rapid-acting insulin works quickly; timing with meals prevents hypoglycemia.
7. A patient with COPD is prescribed oxygen at 2 L/min. Nursing teaching:
A. Monitor oxygen saturation and respiratory rate
B. Increase to 6 L/min immediately
C. Restrict fluids
D. Avoid monitoring
Answer: A – Safety priority is preventing hypoxia and CO2 retention.
8. NGN Case: A patient with heart failure develops crackles in lungs and edema. Priority nursing
action:
A. Assess oxygenation, administer prescribed diuretics
B. Restrict fluids only
C. Encourage ambulation
D. Document findings only
Answer: A – Pulmonary edema is life-threatening; oxygen and diuretics are priority.
, 9. Patient prescribed warfarin should be taught to:
A. Monitor INR, avoid vitamin K-rich foods, report bleeding
B. Take NSAIDs freely
C. Increase vitamin K intake
D. Avoid protein
Answer: A – Ensures therapeutic anticoagulation and reduces bleeding risk.
10. NGN Case: Patient receiving vancomycin develops flushing and hypotension. Nursing
action:
A. Slow infusion, monitor vitals, notify provider
B. Stop infusion permanently
C. Ignore reaction
D. Restrict fluids
Answer: A – Red Man Syndrome; slowing infusion and monitoring is key.
11. A patient with asthma prescribed albuterol should:
A. Use a spacer and rinse mouth after use
B. Take only with meals
C. Avoid inhalation technique
D. Restrict fluids
Answer: A – Reduces oral thrush and ensures proper drug delivery.
12. NGN Case: Pediatric patient on chemotherapy is neutropenic. Nursing action:
A. Implement strict infection precautions, monitor temperature
B. Encourage group activities
C. Restrict fluids only
D. Observe only
Answer: A – Neutropenia increases risk of infection; precautions are essential.
13. Patient prescribed ACE inhibitor develops persistent cough. Nursing action:
A. Notify provider; substitution may be required
B. Ignore cough
C. Increase dose
D. Restrict fluids
Answer: A – Persistent cough is a common adverse effect; provider intervention needed.
