HESI Med-Surg II Practice Exam (2025/2026) — 130
Advanced Medical-Surgical Nursing Questions with Correct
Answers & Detailed Rationales
A 68-year-old post-CABG patient has a Swan-Ganz catheter in place. The nurse notes the
pulmonary artery wedge pressure (PAWP) has increased from 10 mmHg to 18 mmHg
over 2 hours. Which assessment finding should the nurse expect?
1. A. Bilateral wheezing
B. Jugular venous distension
C. Bradycardia
D. Hypertension
Correct Answer: B
Rationale: Elevated PAWP reflects increased left ventricular end-diastolic pressure and
fluid overload, manifesting as JVD, crackles, or pulmonary edema. Wheezing is not
typical of cardiogenic overload; bradycardia and hypertension are not consistent
responses. Elevated PAWP is an early indicator of left-sided heart failure or fluid volume
excess.
A client with ARDS is on mechanical ventilation with PEEP 14 cm H₂O and FiO₂ 0.8.
The PaO₂ is 58 mmHg. Which ventilator adjustment is most appropriate?
2. A. Increase PEEP to 18 cm H₂O
B. Increase FiO₂ to 1.0
C. Decrease tidal volume to 4 mL/kg
D. Initiate prone positioning
Correct Answer: D
,Rationale: Prone positioning recruits dependent lung zones, improves V/Q matching, and
can raise PaO₂ without barotrauma. Further increases in PEEP or FiO₂ risk
volutrauma/oxygen toxicity. Very low tidal volumes are already used (6 mL/kg) but do
not improve oxygenation directly.
A client with DKA is receiving an insulin infusion. K⁺ is 3.2 mEq/L and the monitor
shows peaked T waves. Which action is most urgent?
3. A. Give 20 mEq KCl IV over 1 hour
B. Administer 1 g calcium gluconate IV
C. Start magnesium sulfate 2 g IV
D. Stop the insulin drip
Correct Answer: B
Rationale: Peaked T waves signal hyperkalemic cardiotoxicity; however, insulin shifts K⁺
intracellularly and total-body K⁺ is low. Calcium stabilizes cardiac membranes
immediately while potassium is replaced cautiously. Stopping insulin would worsen
acidosis and ketosis.
A client with a cervical spinal cord injury at C4 develops bradycardia 42 beats/min and
BP 82/50 mmHg. Which intervention is priority?
4. A. Administer atropine 0.5 mg IV
B. Apply compression stockings
C. Increase IV fluids to 200 mL/h
D. Elevate head of bed 45°
Correct Answer: A
,Rationale: Neurogenic shock causes loss of sympathetic tone below T1-T4, leading to
vagal bradycardia and hypotension. Atropine blocks vagal input and increases heart rate.
Fluids alone are insufficient because the primary problem is vasomotor tone; compression
garments help but are adjunctive.
A client with acute pancreatitis develops cyanosis and PaO₂ 52 mmHg despite FiO₂ 0.6.
Which complication is most likely?
5. A. Acute respiratory distress syndrome (ARDS)
B. Pneumothorax
C. Pulmonary embolism
D. Pleural effusion
Correct Answer: A
Rationale: Severe pancreatitis releases inflammatory cytokines causing capillary leak and
ARDS. Rapid hypoxemia refractory to oxygen is characteristic. PE and effusion are
possible but usually present later and with different gas-exchange patterns.
A client with cirrhosis has massive hematemesis. Which pharmacologic agent should the
nurse anticipate first?
6. A. Octreotide 50 mcg IV bolus
B. Pantoprazole 80 mg IV
C. Vitamin K 10 mg IV
D. Propranolol 20 mg PO
Correct Answer: A
, Rationale: Octreotide lowers portal pressure by splanchnic vasoconstriction and is
first-line for variceal bleeding. PPIs treat ulcer bleeding, not varices. Vitamin K corrects
coagulopathy but takes hours. Propranolol is used for prevention, not acute hemorrhage.
A client with septic shock has a central venous oxygen saturation (ScvO₂) of 55 % on
norepinephrine. Which intervention is most appropriate?
7. A. Increase FiO₂ to achieve SpO₂ > 98 %
B. Start dobutamine 5 mcg/kg/min
C. Administer 1 L crystalloid bolus
D. Transfuse 1 unit PRBC
Correct Answer: B
Rationale: ScvO₂ < 65 % indicates inadequate oxygen delivery relative to demand. If
MAP is adequate and Hgb ≥ 7 g/dL, adding an inotrope (dobutamine) improves cardiac
output and tissue perfusion. Excess FiO₂ or more fluids may not help and can harm.
A burn client weighing 70 kg has 45 % TBSA second- and third-degree burns. Using the
Parkland formula, what is the 24-hour fluid requirement?
8. A. 6,300 mL
B. 8,100 mL
C. 9,450 mL
D. 12,600 mL
Correct Answer: B
Rationale: Parkland = 4 mL × kg × %TBSA = 4 × 70 × 45 = 12,600 mL total, but half is
given in first 8 hours and remainder over 16 hours. The question asks for 24-hour
Advanced Medical-Surgical Nursing Questions with Correct
Answers & Detailed Rationales
A 68-year-old post-CABG patient has a Swan-Ganz catheter in place. The nurse notes the
pulmonary artery wedge pressure (PAWP) has increased from 10 mmHg to 18 mmHg
over 2 hours. Which assessment finding should the nurse expect?
1. A. Bilateral wheezing
B. Jugular venous distension
C. Bradycardia
D. Hypertension
Correct Answer: B
Rationale: Elevated PAWP reflects increased left ventricular end-diastolic pressure and
fluid overload, manifesting as JVD, crackles, or pulmonary edema. Wheezing is not
typical of cardiogenic overload; bradycardia and hypertension are not consistent
responses. Elevated PAWP is an early indicator of left-sided heart failure or fluid volume
excess.
A client with ARDS is on mechanical ventilation with PEEP 14 cm H₂O and FiO₂ 0.8.
The PaO₂ is 58 mmHg. Which ventilator adjustment is most appropriate?
2. A. Increase PEEP to 18 cm H₂O
B. Increase FiO₂ to 1.0
C. Decrease tidal volume to 4 mL/kg
D. Initiate prone positioning
Correct Answer: D
,Rationale: Prone positioning recruits dependent lung zones, improves V/Q matching, and
can raise PaO₂ without barotrauma. Further increases in PEEP or FiO₂ risk
volutrauma/oxygen toxicity. Very low tidal volumes are already used (6 mL/kg) but do
not improve oxygenation directly.
A client with DKA is receiving an insulin infusion. K⁺ is 3.2 mEq/L and the monitor
shows peaked T waves. Which action is most urgent?
3. A. Give 20 mEq KCl IV over 1 hour
B. Administer 1 g calcium gluconate IV
C. Start magnesium sulfate 2 g IV
D. Stop the insulin drip
Correct Answer: B
Rationale: Peaked T waves signal hyperkalemic cardiotoxicity; however, insulin shifts K⁺
intracellularly and total-body K⁺ is low. Calcium stabilizes cardiac membranes
immediately while potassium is replaced cautiously. Stopping insulin would worsen
acidosis and ketosis.
A client with a cervical spinal cord injury at C4 develops bradycardia 42 beats/min and
BP 82/50 mmHg. Which intervention is priority?
4. A. Administer atropine 0.5 mg IV
B. Apply compression stockings
C. Increase IV fluids to 200 mL/h
D. Elevate head of bed 45°
Correct Answer: A
,Rationale: Neurogenic shock causes loss of sympathetic tone below T1-T4, leading to
vagal bradycardia and hypotension. Atropine blocks vagal input and increases heart rate.
Fluids alone are insufficient because the primary problem is vasomotor tone; compression
garments help but are adjunctive.
A client with acute pancreatitis develops cyanosis and PaO₂ 52 mmHg despite FiO₂ 0.6.
Which complication is most likely?
5. A. Acute respiratory distress syndrome (ARDS)
B. Pneumothorax
C. Pulmonary embolism
D. Pleural effusion
Correct Answer: A
Rationale: Severe pancreatitis releases inflammatory cytokines causing capillary leak and
ARDS. Rapid hypoxemia refractory to oxygen is characteristic. PE and effusion are
possible but usually present later and with different gas-exchange patterns.
A client with cirrhosis has massive hematemesis. Which pharmacologic agent should the
nurse anticipate first?
6. A. Octreotide 50 mcg IV bolus
B. Pantoprazole 80 mg IV
C. Vitamin K 10 mg IV
D. Propranolol 20 mg PO
Correct Answer: A
, Rationale: Octreotide lowers portal pressure by splanchnic vasoconstriction and is
first-line for variceal bleeding. PPIs treat ulcer bleeding, not varices. Vitamin K corrects
coagulopathy but takes hours. Propranolol is used for prevention, not acute hemorrhage.
A client with septic shock has a central venous oxygen saturation (ScvO₂) of 55 % on
norepinephrine. Which intervention is most appropriate?
7. A. Increase FiO₂ to achieve SpO₂ > 98 %
B. Start dobutamine 5 mcg/kg/min
C. Administer 1 L crystalloid bolus
D. Transfuse 1 unit PRBC
Correct Answer: B
Rationale: ScvO₂ < 65 % indicates inadequate oxygen delivery relative to demand. If
MAP is adequate and Hgb ≥ 7 g/dL, adding an inotrope (dobutamine) improves cardiac
output and tissue perfusion. Excess FiO₂ or more fluids may not help and can harm.
A burn client weighing 70 kg has 45 % TBSA second- and third-degree burns. Using the
Parkland formula, what is the 24-hour fluid requirement?
8. A. 6,300 mL
B. 8,100 mL
C. 9,450 mL
D. 12,600 mL
Correct Answer: B
Rationale: Parkland = 4 mL × kg × %TBSA = 4 × 70 × 45 = 12,600 mL total, but half is
given in first 8 hours and remainder over 16 hours. The question asks for 24-hour
