NSG 223 HESI MED SERG II FINAL REVIEW
| QUESTIONS AND ANSWERS | 2026
UPDATED | 100% CORRECT - HERZING
180 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NSG 223 HESI MED SERG II FINAL REVIEW | QUESTIONS AND ANSWERS | 2026 UPDATED | 100%
CORRECT - HERZING. It contains 180 carefully selected questions that reflect the most current exam content
and testing strategies. Each question is accompanied by a correct answer and a detailed rationale that explains
the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 180 Questions
Foundations - Application - NSG 223 HESI MED SERG II Review AND 2026 Updated 100 Correct Herzing
Medical-surgical Nursing II Undergraduate YEAR 3
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-30 Finding, Acute, Fluid, Shock, Indicates
Safety AND Infection Control 31-60 Acute, Finding, Injury, Immediate, Laboratory
Health Promotion AND 61-90 Acute, Appropriate, Intervention, Finding, Serum
Maintenance
Psychosocial Integrity 91-120 Finding, Acute, Indicates, Intervention, Immediate
Basic CARE AND Comfort 121-150 Finding, Acute, Intervention, Indicates, Kidney
Pharmacological Therapies 151-180 Acute, Intervention, Finding, Appropriate, Medication
TOTAL 180 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
In a patient with septic shock unresponsive to fluid resuscitation, which hemodynamic
profile indicates the need for adding a vasopressor rather than further fluid boluses?
A. Cardiac index 4.2 L/min/m², systemic B. Cardiac index 2.1 L/min/m², systemic
vascular resistance 900 dyn-s/cm, central vascular resistance 1400 dyn-s/cm, central
venous pressure 12 mmHg venous pressure 4 mmHg
C. Cardiac index 2.8 L/min/m², systemic D. Cardiac index 3.5 L/min/m², systemic
vascular resistance 1200 dyn-s/cm, central vascular resistance 600 dyn-s/cm, central
venous pressure 8 mmHg venous pressure 10 mmHg
Correct: D - Cardiac index 3.5 L/min/m², systemic vascular resistance 600 dyn-s/cm,
central venous pressure 10 mmHg
Rationale:Septic shock typically presents with high cardiac output and low systemic vascular
resistance (warm shock). When fluid resuscitation is insufficient, vasopressors are indicated
to raise SVR. Option D shows a low SVR (600) with adequate CI, indicating vasoplegia.
Options A and C show SVR within normal range; B shows high SVR with low CI, suggesting
cardiogenic or hypovolemic pattern, not septic.
Q2.
A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation. Which ventilator adjustment directly addresses the primary
pathophysiological mechanism of refractory hypoxemia?
A. Increase positive end-expiratory pressure B. Increase fraction of inspired oxygen
(PEEP) to recruit collapsed alveoli (FiO2) to 100%
C. Decrease tidal volume to 6 mL/kg of D. Increase respiratory rate to maintain
predicted body weight minute ventilation
Correct: A - Increase positive end-expiratory pressure (PEEP) to recruit collapsed alveoli
Rationale:Refractory hypoxemia in ARDS results from alveolar collapse and
ventilation-perfusion mismatch. PEEP recruits collapsed alveoli, improving functional residual
capacity and oxygenation. Increasing FiO2 alone may not correct hypoxemia if shunt is large.
Low tidal volume protects lungs but does not directly improve oxygenation. Increasing
respiratory rate addresses ventilation, not oxygenation.
Q3.
In a patient with hyperkalemic ECG changes (peaked T waves, widened QRS), which
treatment sequence reflects the current guideline-based priority order?
Page 3
, Section A - Management OF CARE
A. IV calcium gluconate, then insulin with B. IV insulin with glucose, then IV calcium
glucose, then albuterol, then sodium gluconate, then albuterol, then sodium
bicarbonate bicarbonate
C. IV albuterol, then IV calcium gluconate, D. IV sodium bicarbonate, then IV calcium
then insulin with glucose, then sodium gluconate, then insulin with glucose, then
bicarbonate albuterol
Correct: A - IV calcium gluconate, then insulin with glucose, then albuterol, then sodium
bicarbonate
Rationale:Calcium stabilizes the cardiac membrane immediately, protecting against
arrhythmias, and is therefore given first in hyperkalemia with ECG changes. Insulin with
glucose shifts potassium into cells, followed by albuterol (also shifts K+). Sodium bicarbonate
is reserved for metabolic acidosis and is not first-line. Thus, option A is correct.
Q4.
Which assessment finding in a patient with diabetic ketoacidosis (DKA) indicates that the
treatment is leading to a potentially fatal complication?
A. Serum potassium level of 3.0 mEq/L with B. Serum glucose level of 200 mg/dL after 4
decreasing urine output hours of insulin infusion
C. Bicarbonate level of 18 mEq/L with a pH D. Anion gap of 12 mEq/L with resolution of
of 7.32 Kussmaul respirations
Correct: A - Serum potassium level of 3.0 mEq/L with decreasing urine output
Rationale:Hypokalemia in DKA is a dangerous complication because insulin drives
potassium into cells, and if potassium is not replaced, it can cause life-threatening
arrhythmias. Decreasing urine output further suggests inadequate renal excretion, worsening
hyperkalemia risk. The other options reflect expected improvements in DKA (glucose falling,
acidosis resolving).
Q5.
A patient with cirrhosis and ascites develops acute kidney injury. Which laboratory finding
most strongly supports hepatorenal syndrome (HRS) rather than acute tubular necrosis
(ATN)?
A. Urine sodium less than 10 mEq/L and B. Urine sodium greater than 40 mEq/L and
fractional excretion of sodium less than 1% fractional excretion of sodium greater than
2%
C. Urine osmolality less than 350 mOsm/kg D. Presence of granular casts and muddy
and specific gravity 1.010 brown casts in urinalysis
Correct: A - Urine sodium less than 10 mEq/L and fractional excretion of sodium less than
1%
Page 4
| QUESTIONS AND ANSWERS | 2026
UPDATED | 100% CORRECT - HERZING
180 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NSG 223 HESI MED SERG II FINAL REVIEW | QUESTIONS AND ANSWERS | 2026 UPDATED | 100%
CORRECT - HERZING. It contains 180 carefully selected questions that reflect the most current exam content
and testing strategies. Each question is accompanied by a correct answer and a detailed rationale that explains
the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 180 Questions
Foundations - Application - NSG 223 HESI MED SERG II Review AND 2026 Updated 100 Correct Herzing
Medical-surgical Nursing II Undergraduate YEAR 3
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-30 Finding, Acute, Fluid, Shock, Indicates
Safety AND Infection Control 31-60 Acute, Finding, Injury, Immediate, Laboratory
Health Promotion AND 61-90 Acute, Appropriate, Intervention, Finding, Serum
Maintenance
Psychosocial Integrity 91-120 Finding, Acute, Indicates, Intervention, Immediate
Basic CARE AND Comfort 121-150 Finding, Acute, Intervention, Indicates, Kidney
Pharmacological Therapies 151-180 Acute, Intervention, Finding, Appropriate, Medication
TOTAL 180 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
In a patient with septic shock unresponsive to fluid resuscitation, which hemodynamic
profile indicates the need for adding a vasopressor rather than further fluid boluses?
A. Cardiac index 4.2 L/min/m², systemic B. Cardiac index 2.1 L/min/m², systemic
vascular resistance 900 dyn-s/cm, central vascular resistance 1400 dyn-s/cm, central
venous pressure 12 mmHg venous pressure 4 mmHg
C. Cardiac index 2.8 L/min/m², systemic D. Cardiac index 3.5 L/min/m², systemic
vascular resistance 1200 dyn-s/cm, central vascular resistance 600 dyn-s/cm, central
venous pressure 8 mmHg venous pressure 10 mmHg
Correct: D - Cardiac index 3.5 L/min/m², systemic vascular resistance 600 dyn-s/cm,
central venous pressure 10 mmHg
Rationale:Septic shock typically presents with high cardiac output and low systemic vascular
resistance (warm shock). When fluid resuscitation is insufficient, vasopressors are indicated
to raise SVR. Option D shows a low SVR (600) with adequate CI, indicating vasoplegia.
Options A and C show SVR within normal range; B shows high SVR with low CI, suggesting
cardiogenic or hypovolemic pattern, not septic.
Q2.
A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation. Which ventilator adjustment directly addresses the primary
pathophysiological mechanism of refractory hypoxemia?
A. Increase positive end-expiratory pressure B. Increase fraction of inspired oxygen
(PEEP) to recruit collapsed alveoli (FiO2) to 100%
C. Decrease tidal volume to 6 mL/kg of D. Increase respiratory rate to maintain
predicted body weight minute ventilation
Correct: A - Increase positive end-expiratory pressure (PEEP) to recruit collapsed alveoli
Rationale:Refractory hypoxemia in ARDS results from alveolar collapse and
ventilation-perfusion mismatch. PEEP recruits collapsed alveoli, improving functional residual
capacity and oxygenation. Increasing FiO2 alone may not correct hypoxemia if shunt is large.
Low tidal volume protects lungs but does not directly improve oxygenation. Increasing
respiratory rate addresses ventilation, not oxygenation.
Q3.
In a patient with hyperkalemic ECG changes (peaked T waves, widened QRS), which
treatment sequence reflects the current guideline-based priority order?
Page 3
, Section A - Management OF CARE
A. IV calcium gluconate, then insulin with B. IV insulin with glucose, then IV calcium
glucose, then albuterol, then sodium gluconate, then albuterol, then sodium
bicarbonate bicarbonate
C. IV albuterol, then IV calcium gluconate, D. IV sodium bicarbonate, then IV calcium
then insulin with glucose, then sodium gluconate, then insulin with glucose, then
bicarbonate albuterol
Correct: A - IV calcium gluconate, then insulin with glucose, then albuterol, then sodium
bicarbonate
Rationale:Calcium stabilizes the cardiac membrane immediately, protecting against
arrhythmias, and is therefore given first in hyperkalemia with ECG changes. Insulin with
glucose shifts potassium into cells, followed by albuterol (also shifts K+). Sodium bicarbonate
is reserved for metabolic acidosis and is not first-line. Thus, option A is correct.
Q4.
Which assessment finding in a patient with diabetic ketoacidosis (DKA) indicates that the
treatment is leading to a potentially fatal complication?
A. Serum potassium level of 3.0 mEq/L with B. Serum glucose level of 200 mg/dL after 4
decreasing urine output hours of insulin infusion
C. Bicarbonate level of 18 mEq/L with a pH D. Anion gap of 12 mEq/L with resolution of
of 7.32 Kussmaul respirations
Correct: A - Serum potassium level of 3.0 mEq/L with decreasing urine output
Rationale:Hypokalemia in DKA is a dangerous complication because insulin drives
potassium into cells, and if potassium is not replaced, it can cause life-threatening
arrhythmias. Decreasing urine output further suggests inadequate renal excretion, worsening
hyperkalemia risk. The other options reflect expected improvements in DKA (glucose falling,
acidosis resolving).
Q5.
A patient with cirrhosis and ascites develops acute kidney injury. Which laboratory finding
most strongly supports hepatorenal syndrome (HRS) rather than acute tubular necrosis
(ATN)?
A. Urine sodium less than 10 mEq/L and B. Urine sodium greater than 40 mEq/L and
fractional excretion of sodium less than 1% fractional excretion of sodium greater than
2%
C. Urine osmolality less than 350 mOsm/kg D. Presence of granular casts and muddy
and specific gravity 1.010 brown casts in urinalysis
Correct: A - Urine sodium less than 10 mEq/L and fractional excretion of sodium less than
1%
Page 4
