HESI RN MEDICAL-SURGICAL SET 3 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
A 60-year-old adult has been identified as having thyroid storm. The patient has just
arrived, so the nurse must translate the findings into an immediate nursing decision.
Which nursing action should be implemented first to address the condition safely?
A. support ventilation and circulation and administer prescribed thyroid hormone and
stress-dose steroid while treating triggers
B. provide aggressive supportive care and administer prescribed beta blockade,
antithyroid therapy, iodine at the correct sequence, and corticosteroid therapy
C. give rapid glucose if the patient can safely swallow or emergency glucagon/IV dextrose
when they cannot
D. begin isotonic fluid resuscitation, then administer insulin and replace electrolytes
according to protocol while treating the trigger
Correct Answer: B. provide aggressive supportive care and administer
prescribed beta blockade, antithyroid therapy, iodine at the correct sequence,
and corticosteroid therapy
Explanation: The priority is to provide aggressive supportive care and administer
prescribed beta blockade, antithyroid therapy, iodine at the correct sequence, and
corticosteroid therapy. That response addresses the immediate physiologic threat or
moves the patient directly toward time-sensitive definitive care. Several alternatives may
be reasonable in a different condition or later in the sequence, but delaying this step can
increase risk. After the initial action, the nurse should reassess the patient and continue
cause-specific management.
Question 2.
After initial stabilization of a 63-year-old adult with peripheral arterial disease, which
assessment should the nurse prioritize during ongoing care?
A. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. access-site bleeding or hematoma, distal pulse, skin color and temperature, vital signs,
and urine output
D. distal pulses, color, temperature, capillary refill, skin integrity, and walking tolerance
Correct Answer: D. distal pulses, color, temperature, capillary refill, skin
integrity, and walking tolerance
Explanation: Ongoing evaluation should focus on distal pulses, color, temperature,
capillary refill, skin integrity, and walking tolerance. These data show whether the patient
is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
,Question 3.
A 77-year-old man has been identified as having severe thrombocytopenia. Several
findings are present, and the nurse must distinguish the most urgent problem from
plausible but lower-priority concerns. Which nursing action should be implemented first to
address the condition safely?
A. stop the vesicant infusion but leave the access device in place for aspiration and
agent-specific management
B. treat fever as an emergency, obtain cultures as ordered, and start prompt empiric
antimicrobial therapy for febrile neutropenia
C. use bleeding precautions and avoid unnecessary invasive procedures or medications
that worsen platelet function
D. rapidly assess for acute chest syndrome or stroke, provide prescribed analgesia,
hydration as appropriate, and oxygen for hypoxemia
Correct Answer: C. use bleeding precautions and avoid unnecessary invasive
procedures or medications that worsen platelet function
Explanation: The priority is to use bleeding precautions and avoid unnecessary invasive
procedures or medications that worsen platelet function. That response addresses the
immediate physiologic threat or moves the patient directly toward time-sensitive definitive
care. Several alternatives may be reasonable in a different condition or later in the
sequence, but delaying this step can increase risk. After the initial action, the nurse should
reassess the patient and continue cause-specific management.
Question 4.
Which statement by a patient or caregiver after teaching about post-cardiac
catheterization care best shows correct understanding?
A. follow lifting and activity restrictions and report increasing swelling, bleeding,
numbness, or coolness of the limb
B. report increasing dyspnea, dizziness, or chest pressure rather than assuming all pain is
expected
C. keep follow-up imaging appointments and control blood pressure and smoking risk
D. call emergency services for persistent chest pressure rather than driving to the hospital
Correct Answer: A. follow lifting and activity restrictions and report increasing
swelling, bleeding, numbness, or coolness of the limb
Explanation: Effective teaching for post-cardiac catheterization care includes the
instruction to follow lifting and activity restrictions and report increasing swelling,
bleeding, numbness, or coolness of the limb. This guidance targets recurrence prevention,
early recognition of deterioration, or safe self-management. The other statements may
apply to different disorders and should not replace condition-specific teaching. Teach-back
should be used so the nurse can confirm that the patient or caregiver can apply the plan
correctly.
,Question 5.
The nurse is reassessing a 49-year-old woman with severe thrombocytopenia. Several
findings are present, and the nurse must distinguish the most urgent problem from
plausible but lower-priority concerns. Which finding requires the most immediate
escalation?
A. hypotension, respiratory distress, chest or back pain, hemoglobinuria, or rapidly
worsening symptoms
B. new severe headache, neurologic change, uncontrolled bleeding, hematemesis, or
melena
C. new chest pain, fever, hypoxemia, neurologic deficit, priapism, or splenic enlargement
in a child
D. blistering, tissue necrosis, rapidly increasing pain, or neurovascular compromise of the
limb
Correct Answer: B. new severe headache, neurologic change, uncontrolled
bleeding, hematemesis, or melena
Explanation: The most urgent finding is new severe headache, neurologic change,
uncontrolled bleeding, hematemesis, or melena. It suggests a time-sensitive complication
or loss of physiologic reserve rather than an expected or lower-priority feature. The nurse
should respond using ABCs, safety principles, and the condition-specific emergency
pathway. Delay could allow rapid progression to organ dysfunction, respiratory failure,
shock, or irreversible injury.
Question 6.
After initial stabilization of a 54-year-old adult with acute decompensated heart failure,
which assessment should the nurse prioritize during ongoing care?
A. serial ECG changes, cardiac biomarkers, pain, rhythm, and hemodynamic status
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. daily weight, intake and output, lung sounds, oxygenation, renal function, and
electrolytes
D. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
Correct Answer: C. daily weight, intake and output, lung sounds, oxygenation,
renal function, and electrolytes
Explanation: Ongoing evaluation should focus on daily weight, intake and output, lung
sounds, oxygenation, renal function, and electrolytes. These data show whether the
patient is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
, Question 7.
The nurse is reassessing a 67-year-old woman with acute pulmonary edema. Initial
supportive care has begun, but the patient is changing; the nurse must integrate the
original cues, response to treatment, and the next safety-critical decision. Which finding
requires the most immediate escalation?
A. refractory hypoxemia, extreme fatigue, hypotension, new dysrhythmia, or declining
consciousness
B. persistent hypotension, rising lactate, oliguria, worsening hypoxemia, or altered mental
status
C. hoarseness, stridor, facial burns with smoke exposure, circumferential limb ischemia, or
shock
D. worsening hypotension, chest pain, oliguria, altered consciousness, or uncontrolled
hemorrhage
Correct Answer: A. refractory hypoxemia, extreme fatigue, hypotension, new
dysrhythmia, or declining consciousness
Explanation: The most urgent finding is refractory hypoxemia, extreme fatigue,
hypotension, new dysrhythmia, or declining consciousness. It suggests a time-sensitive
complication or loss of physiologic reserve rather than an expected or lower-priority
feature. The nurse should respond using ABCs, safety principles, and the condition-specific
emergency pathway. Delay could allow rapid progression to organ dysfunction, respiratory
failure, shock, or irreversible injury.
Question 8.
After initial stabilization of a 59-year-old man with severe neutropenia, which assessment
should the nurse prioritize during ongoing care?
A. site appearance, pain, swelling, skin integrity, and progression after antidote or local
measures
B. pain, oxygenation, respiratory findings, neurologic status, temperature, hydration, and
hemoglobin
C. platelet count, visible or occult bleeding, neurologic status, and hemoglobin
D. temperature, ANC, cultures, hemodynamics, infection signs, and antimicrobial response
Correct Answer: D. temperature, ANC, cultures, hemodynamics, infection signs,
and antimicrobial response
Explanation: Ongoing evaluation should focus on temperature, ANC, cultures,
hemodynamics, infection signs, and antimicrobial response. These data show whether the
patient is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
A 60-year-old adult has been identified as having thyroid storm. The patient has just
arrived, so the nurse must translate the findings into an immediate nursing decision.
Which nursing action should be implemented first to address the condition safely?
A. support ventilation and circulation and administer prescribed thyroid hormone and
stress-dose steroid while treating triggers
B. provide aggressive supportive care and administer prescribed beta blockade,
antithyroid therapy, iodine at the correct sequence, and corticosteroid therapy
C. give rapid glucose if the patient can safely swallow or emergency glucagon/IV dextrose
when they cannot
D. begin isotonic fluid resuscitation, then administer insulin and replace electrolytes
according to protocol while treating the trigger
Correct Answer: B. provide aggressive supportive care and administer
prescribed beta blockade, antithyroid therapy, iodine at the correct sequence,
and corticosteroid therapy
Explanation: The priority is to provide aggressive supportive care and administer
prescribed beta blockade, antithyroid therapy, iodine at the correct sequence, and
corticosteroid therapy. That response addresses the immediate physiologic threat or
moves the patient directly toward time-sensitive definitive care. Several alternatives may
be reasonable in a different condition or later in the sequence, but delaying this step can
increase risk. After the initial action, the nurse should reassess the patient and continue
cause-specific management.
Question 2.
After initial stabilization of a 63-year-old adult with peripheral arterial disease, which
assessment should the nurse prioritize during ongoing care?
A. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. access-site bleeding or hematoma, distal pulse, skin color and temperature, vital signs,
and urine output
D. distal pulses, color, temperature, capillary refill, skin integrity, and walking tolerance
Correct Answer: D. distal pulses, color, temperature, capillary refill, skin
integrity, and walking tolerance
Explanation: Ongoing evaluation should focus on distal pulses, color, temperature,
capillary refill, skin integrity, and walking tolerance. These data show whether the patient
is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
,Question 3.
A 77-year-old man has been identified as having severe thrombocytopenia. Several
findings are present, and the nurse must distinguish the most urgent problem from
plausible but lower-priority concerns. Which nursing action should be implemented first to
address the condition safely?
A. stop the vesicant infusion but leave the access device in place for aspiration and
agent-specific management
B. treat fever as an emergency, obtain cultures as ordered, and start prompt empiric
antimicrobial therapy for febrile neutropenia
C. use bleeding precautions and avoid unnecessary invasive procedures or medications
that worsen platelet function
D. rapidly assess for acute chest syndrome or stroke, provide prescribed analgesia,
hydration as appropriate, and oxygen for hypoxemia
Correct Answer: C. use bleeding precautions and avoid unnecessary invasive
procedures or medications that worsen platelet function
Explanation: The priority is to use bleeding precautions and avoid unnecessary invasive
procedures or medications that worsen platelet function. That response addresses the
immediate physiologic threat or moves the patient directly toward time-sensitive definitive
care. Several alternatives may be reasonable in a different condition or later in the
sequence, but delaying this step can increase risk. After the initial action, the nurse should
reassess the patient and continue cause-specific management.
Question 4.
Which statement by a patient or caregiver after teaching about post-cardiac
catheterization care best shows correct understanding?
A. follow lifting and activity restrictions and report increasing swelling, bleeding,
numbness, or coolness of the limb
B. report increasing dyspnea, dizziness, or chest pressure rather than assuming all pain is
expected
C. keep follow-up imaging appointments and control blood pressure and smoking risk
D. call emergency services for persistent chest pressure rather than driving to the hospital
Correct Answer: A. follow lifting and activity restrictions and report increasing
swelling, bleeding, numbness, or coolness of the limb
Explanation: Effective teaching for post-cardiac catheterization care includes the
instruction to follow lifting and activity restrictions and report increasing swelling,
bleeding, numbness, or coolness of the limb. This guidance targets recurrence prevention,
early recognition of deterioration, or safe self-management. The other statements may
apply to different disorders and should not replace condition-specific teaching. Teach-back
should be used so the nurse can confirm that the patient or caregiver can apply the plan
correctly.
,Question 5.
The nurse is reassessing a 49-year-old woman with severe thrombocytopenia. Several
findings are present, and the nurse must distinguish the most urgent problem from
plausible but lower-priority concerns. Which finding requires the most immediate
escalation?
A. hypotension, respiratory distress, chest or back pain, hemoglobinuria, or rapidly
worsening symptoms
B. new severe headache, neurologic change, uncontrolled bleeding, hematemesis, or
melena
C. new chest pain, fever, hypoxemia, neurologic deficit, priapism, or splenic enlargement
in a child
D. blistering, tissue necrosis, rapidly increasing pain, or neurovascular compromise of the
limb
Correct Answer: B. new severe headache, neurologic change, uncontrolled
bleeding, hematemesis, or melena
Explanation: The most urgent finding is new severe headache, neurologic change,
uncontrolled bleeding, hematemesis, or melena. It suggests a time-sensitive complication
or loss of physiologic reserve rather than an expected or lower-priority feature. The nurse
should respond using ABCs, safety principles, and the condition-specific emergency
pathway. Delay could allow rapid progression to organ dysfunction, respiratory failure,
shock, or irreversible injury.
Question 6.
After initial stabilization of a 54-year-old adult with acute decompensated heart failure,
which assessment should the nurse prioritize during ongoing care?
A. serial ECG changes, cardiac biomarkers, pain, rhythm, and hemodynamic status
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. daily weight, intake and output, lung sounds, oxygenation, renal function, and
electrolytes
D. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
Correct Answer: C. daily weight, intake and output, lung sounds, oxygenation,
renal function, and electrolytes
Explanation: Ongoing evaluation should focus on daily weight, intake and output, lung
sounds, oxygenation, renal function, and electrolytes. These data show whether the
patient is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
, Question 7.
The nurse is reassessing a 67-year-old woman with acute pulmonary edema. Initial
supportive care has begun, but the patient is changing; the nurse must integrate the
original cues, response to treatment, and the next safety-critical decision. Which finding
requires the most immediate escalation?
A. refractory hypoxemia, extreme fatigue, hypotension, new dysrhythmia, or declining
consciousness
B. persistent hypotension, rising lactate, oliguria, worsening hypoxemia, or altered mental
status
C. hoarseness, stridor, facial burns with smoke exposure, circumferential limb ischemia, or
shock
D. worsening hypotension, chest pain, oliguria, altered consciousness, or uncontrolled
hemorrhage
Correct Answer: A. refractory hypoxemia, extreme fatigue, hypotension, new
dysrhythmia, or declining consciousness
Explanation: The most urgent finding is refractory hypoxemia, extreme fatigue,
hypotension, new dysrhythmia, or declining consciousness. It suggests a time-sensitive
complication or loss of physiologic reserve rather than an expected or lower-priority
feature. The nurse should respond using ABCs, safety principles, and the condition-specific
emergency pathway. Delay could allow rapid progression to organ dysfunction, respiratory
failure, shock, or irreversible injury.
Question 8.
After initial stabilization of a 59-year-old man with severe neutropenia, which assessment
should the nurse prioritize during ongoing care?
A. site appearance, pain, swelling, skin integrity, and progression after antidote or local
measures
B. pain, oxygenation, respiratory findings, neurologic status, temperature, hydration, and
hemoglobin
C. platelet count, visible or occult bleeding, neurologic status, and hemoglobin
D. temperature, ANC, cultures, hemodynamics, infection signs, and antimicrobial response
Correct Answer: D. temperature, ANC, cultures, hemodynamics, infection signs,
and antimicrobial response
Explanation: Ongoing evaluation should focus on temperature, ANC, cultures,
hemodynamics, infection signs, and antimicrobial response. These data show whether the
patient is stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
