HESI MED-SURG 3 FINAL EXAM–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A nurse is caring for a client admitted with acute decompensated heart failure who
presents with severe dyspnea, orthopnea, and pink, frothy sputum. Which of the following
collaborative interventions should the nurse anticipate implementing first?
A. Administering sublingual nitroglycerin as prescribed
B. Initiating continuous positive airway pressure (CPAP) therapy
C. Administering intravenous furosemide as prescribed
D. Drawing blood for serial troponin and brain natriuretic peptide levels
Answer: C
The administration of high-ceiling loop diuretics, such as intravenous furosemide, is the
priority immediate intervention for a client experiencing acute pulmonary edema to reduce
preload and alleviate pulmonary congestion. While oxygen support, vasodilators, and
diagnostic labs are critical components of care, rapid fluid removal via diuresis is the
cornerstone of emergency management for acute decompensated heart failure with severe
fluid overload.
2. A nurse is assessing a client who has a diagnosis of chronic obstructive pulmonary
disease (COPD) and is receiving a continuous oxygen titration via nasal cannula. Which of
the following clinical findings indicates that the client is experiencing acute carbon dioxide
retention?
A. Intermittent restlessness and increasing confusion
B. Decreased respiratory rate accompanied by bradypnea
C. Persistent productive cough with tenacious green sputum
D. Elevated blood pressure and bounding peripheral pulses
Answer: A
Central nervous system changes, particularly increasing confusion, lethargy, or restlessness,
are hallmark early indicators of acute hypercapnia and carbon dioxide narcosis in clients with
COPD. While respiratory rate changes can occur, mental status alterations provide the most
,sensitive and immediate clinical cue regarding cerebral oxygenation and carbon dioxide
accumulation.
3. A nurse is monitoring a client who has undergone a total thyroidectomy 4 hours ago.
Which of the following assessments requires immediate notification of the primary
healthcare provider?
A. The client reports mild discomfort at the surgical incision site during swallowing.
B. The client exhibits involuntary muscle twitching around the mouth and fingers.
C. The client's blood pressure is 132/84 mm Hg and heart rate is 88 beats per minute.
D. The client speaks in a hoarse voice when answering routine assessment questions.
Answer: B
Involuntary muscle twitching, numbness, and tingling around the mouth and fingers are
classic signs of hypocalcemia resulting from inadvertent trauma or removal of the parathyroid
glands during a thyroidectomy. This finding places the client at immediate risk for tetany,
laryngeal spasm, and airway compromise, requiring urgent intervention with intravenous
calcium gluconate.
4. A nurse is caring for a client who is admitted with diabetic ketoacidosis (DKA). The
client's arterial blood gas results show pH 7.28, PaCO2 32 mm Hg, and HCO3 16 mEq/L.
Which of the following pathophysiological mechanisms explains these laboratory findings?
A. Inadequate renal excretion of hydrogen ions due to acute tubular necrosis
B. Excessive loss of bicarbonate ions secondary to prolonged profuse diarrhea
C. Accumulation of circulating ketone bodies from unutilized cellular glucose
D. Alveolar hypoventilation leading to primary carbon dioxide retention
Answer: C
Diabetic ketoacidosis results from severe insulin deficiency, forcing the body to metabolize
free fatty acids for energy, which produces acidic ketone bodies and leads to metabolic
acidosis. The kidneys and lungs attempt to compensate, but the primary driver of the acid-base
imbalance is ketoacid accumulation.
5. A nurse is planning care for a client who has sustained a severe burn injury covering
40% of their total body surface area. During the emergent phase of burn management,
which of the following interventions should take highest priority?
,A. Initiating aggressive fluid resuscitation using a weight-based formula
B. Administering scheduled intravenous opioid analgesics for pain control
C. Applying prescribed silver sulfadiazine cream to open burn wounds
D. Inserting an indwelling urinary catheter to monitor hourly urine output
Answer: A
Fluid resuscitation is the primary physiological priority during the emergent phase of burn
care to prevent hypovolemic burn shock and maintain adequate organ perfusion secondary to
massive capillary leak. While pain management and wound care are vital, restoring
circulating blood volume is lifesaving in the immediate post-injury window.
6. A nurse is caring for a client with a newly placed mechanical heart valve who is receiving
long-term warfarin therapy. Which of the following laboratory values indicates that the
therapeutic goal for this client has been achieved?
A. International Normalized Ratio (INR) of 0.9
B. Prothrombin Time (PT) of 12 seconds
C. International Normalized Ratio (INR) of 2.8
D. Activated Partial Thromboplastin Time (aPTT) of 75 seconds
Answer: C
The therapeutic target range for a client with a mechanical heart valve receiving warfarin is
typically an INR between 2.5 and 3.5. An INR of 2.8 falls squarely within this protective
therapeutic window, preventing thromboembolic events while minimizing bleeding risks.
7. A nurse is assessing a client who has cirrhosis and portal hypertension. Which of the
following physical examination findings is directly related to elevated pressure within the
portal venous system?
A. Bilateral lower extremity pitting edema and dull flank pain
B. Prominent, tortuous superficial veins visible across the abdominal wall
C. Generalized cutaneous jaundice and scleral icterus
D. Diffuse muscle wasting and prominent temporal muscle depression
Answer: B
, Prominent abdominal wall veins, known as caput medusae, are a direct clinical manifestation
of portal hypertension, which forces blood to bypass the liver through collateral venous
channels. While jaundice and muscle wasting are common in cirrhosis, caput medusae
specifically indicates altered portal hemodynamics.
8. A nurse is providing discharge instructions to a client who has a new prescription for
digoxin and furosemide. Which of the following client statements indicates an accurate
understanding of the medication regimen?
A. "I will restrict my intake of bananas, oranges, and green leafy vegetables while taking these
drugs."
B. "I should immediately stop taking my digoxin if my pulse drops below 80 beats per minute."
C. "I will notify my provider if I experience persistent nausea, visual halos, or extreme fatigue."
D. "I can take both medications together with a large glass of grapefruit juice every morning."
Answer: C
Persistent nausea, vomiting, visual disturbances such as yellow-green halos, and fatigue are
classic signs of digitalis toxicity, which must be reported immediately. Hypokalemia induced
by furosemide significantly potentiates the risk of digoxin toxicity, making symptom
recognition essential.
9. A nurse is admitting a client with suspected acute appendicitis. Which of the following
assessment findings should the nurse expect to elicit during the physical examination?
A. Right lower quadrant rebound tenderness located at McBurney's point
B. Left lower quadrant cramping pain that worsens after a fatty meal
C. Right upper quadrant sharp pain radiating directly to the right scapula
D. Periumbilical pain that radiates to the bilateral flanks and groin
Answer: A
Classic clinical manifestations of acute appendicitis include localized tenderness at
McBurney's point in the right lower quadrant, often accompanied by rebound tenderness and
guarding. Pain typically originates periumumbilically before localizing to the right lower
quadrant as inflammation progresses.
10. A nurse is caring for a client who is experiencing an acute ischemic stroke. Which of the
following interventions must be verified before the administration of intravenous
recombinant tissue plasminogen activator (rt-PA)?
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A nurse is caring for a client admitted with acute decompensated heart failure who
presents with severe dyspnea, orthopnea, and pink, frothy sputum. Which of the following
collaborative interventions should the nurse anticipate implementing first?
A. Administering sublingual nitroglycerin as prescribed
B. Initiating continuous positive airway pressure (CPAP) therapy
C. Administering intravenous furosemide as prescribed
D. Drawing blood for serial troponin and brain natriuretic peptide levels
Answer: C
The administration of high-ceiling loop diuretics, such as intravenous furosemide, is the
priority immediate intervention for a client experiencing acute pulmonary edema to reduce
preload and alleviate pulmonary congestion. While oxygen support, vasodilators, and
diagnostic labs are critical components of care, rapid fluid removal via diuresis is the
cornerstone of emergency management for acute decompensated heart failure with severe
fluid overload.
2. A nurse is assessing a client who has a diagnosis of chronic obstructive pulmonary
disease (COPD) and is receiving a continuous oxygen titration via nasal cannula. Which of
the following clinical findings indicates that the client is experiencing acute carbon dioxide
retention?
A. Intermittent restlessness and increasing confusion
B. Decreased respiratory rate accompanied by bradypnea
C. Persistent productive cough with tenacious green sputum
D. Elevated blood pressure and bounding peripheral pulses
Answer: A
Central nervous system changes, particularly increasing confusion, lethargy, or restlessness,
are hallmark early indicators of acute hypercapnia and carbon dioxide narcosis in clients with
COPD. While respiratory rate changes can occur, mental status alterations provide the most
,sensitive and immediate clinical cue regarding cerebral oxygenation and carbon dioxide
accumulation.
3. A nurse is monitoring a client who has undergone a total thyroidectomy 4 hours ago.
Which of the following assessments requires immediate notification of the primary
healthcare provider?
A. The client reports mild discomfort at the surgical incision site during swallowing.
B. The client exhibits involuntary muscle twitching around the mouth and fingers.
C. The client's blood pressure is 132/84 mm Hg and heart rate is 88 beats per minute.
D. The client speaks in a hoarse voice when answering routine assessment questions.
Answer: B
Involuntary muscle twitching, numbness, and tingling around the mouth and fingers are
classic signs of hypocalcemia resulting from inadvertent trauma or removal of the parathyroid
glands during a thyroidectomy. This finding places the client at immediate risk for tetany,
laryngeal spasm, and airway compromise, requiring urgent intervention with intravenous
calcium gluconate.
4. A nurse is caring for a client who is admitted with diabetic ketoacidosis (DKA). The
client's arterial blood gas results show pH 7.28, PaCO2 32 mm Hg, and HCO3 16 mEq/L.
Which of the following pathophysiological mechanisms explains these laboratory findings?
A. Inadequate renal excretion of hydrogen ions due to acute tubular necrosis
B. Excessive loss of bicarbonate ions secondary to prolonged profuse diarrhea
C. Accumulation of circulating ketone bodies from unutilized cellular glucose
D. Alveolar hypoventilation leading to primary carbon dioxide retention
Answer: C
Diabetic ketoacidosis results from severe insulin deficiency, forcing the body to metabolize
free fatty acids for energy, which produces acidic ketone bodies and leads to metabolic
acidosis. The kidneys and lungs attempt to compensate, but the primary driver of the acid-base
imbalance is ketoacid accumulation.
5. A nurse is planning care for a client who has sustained a severe burn injury covering
40% of their total body surface area. During the emergent phase of burn management,
which of the following interventions should take highest priority?
,A. Initiating aggressive fluid resuscitation using a weight-based formula
B. Administering scheduled intravenous opioid analgesics for pain control
C. Applying prescribed silver sulfadiazine cream to open burn wounds
D. Inserting an indwelling urinary catheter to monitor hourly urine output
Answer: A
Fluid resuscitation is the primary physiological priority during the emergent phase of burn
care to prevent hypovolemic burn shock and maintain adequate organ perfusion secondary to
massive capillary leak. While pain management and wound care are vital, restoring
circulating blood volume is lifesaving in the immediate post-injury window.
6. A nurse is caring for a client with a newly placed mechanical heart valve who is receiving
long-term warfarin therapy. Which of the following laboratory values indicates that the
therapeutic goal for this client has been achieved?
A. International Normalized Ratio (INR) of 0.9
B. Prothrombin Time (PT) of 12 seconds
C. International Normalized Ratio (INR) of 2.8
D. Activated Partial Thromboplastin Time (aPTT) of 75 seconds
Answer: C
The therapeutic target range for a client with a mechanical heart valve receiving warfarin is
typically an INR between 2.5 and 3.5. An INR of 2.8 falls squarely within this protective
therapeutic window, preventing thromboembolic events while minimizing bleeding risks.
7. A nurse is assessing a client who has cirrhosis and portal hypertension. Which of the
following physical examination findings is directly related to elevated pressure within the
portal venous system?
A. Bilateral lower extremity pitting edema and dull flank pain
B. Prominent, tortuous superficial veins visible across the abdominal wall
C. Generalized cutaneous jaundice and scleral icterus
D. Diffuse muscle wasting and prominent temporal muscle depression
Answer: B
, Prominent abdominal wall veins, known as caput medusae, are a direct clinical manifestation
of portal hypertension, which forces blood to bypass the liver through collateral venous
channels. While jaundice and muscle wasting are common in cirrhosis, caput medusae
specifically indicates altered portal hemodynamics.
8. A nurse is providing discharge instructions to a client who has a new prescription for
digoxin and furosemide. Which of the following client statements indicates an accurate
understanding of the medication regimen?
A. "I will restrict my intake of bananas, oranges, and green leafy vegetables while taking these
drugs."
B. "I should immediately stop taking my digoxin if my pulse drops below 80 beats per minute."
C. "I will notify my provider if I experience persistent nausea, visual halos, or extreme fatigue."
D. "I can take both medications together with a large glass of grapefruit juice every morning."
Answer: C
Persistent nausea, vomiting, visual disturbances such as yellow-green halos, and fatigue are
classic signs of digitalis toxicity, which must be reported immediately. Hypokalemia induced
by furosemide significantly potentiates the risk of digoxin toxicity, making symptom
recognition essential.
9. A nurse is admitting a client with suspected acute appendicitis. Which of the following
assessment findings should the nurse expect to elicit during the physical examination?
A. Right lower quadrant rebound tenderness located at McBurney's point
B. Left lower quadrant cramping pain that worsens after a fatty meal
C. Right upper quadrant sharp pain radiating directly to the right scapula
D. Periumbilical pain that radiates to the bilateral flanks and groin
Answer: A
Classic clinical manifestations of acute appendicitis include localized tenderness at
McBurney's point in the right lower quadrant, often accompanied by rebound tenderness and
guarding. Pain typically originates periumumbilically before localizing to the right lower
quadrant as inflammation progresses.
10. A nurse is caring for a client who is experiencing an acute ischemic stroke. Which of the
following interventions must be verified before the administration of intravenous
recombinant tissue plasminogen activator (rt-PA)?
