Med-Surg HESI PN Exam Test Bank
2025/2026 | 200 Q&As with Verified
Answers & Detailed Rationales
(Rated A+)
Question 1
A licensed practical nurse (LPN) is monitoring a client who returned to the nursing
unit 4 hours ago following a subtotal thyroidectomy. Which finding is the most critical
and requires immediate intervention?
A. Complaints of mild pain at the incision site.
B. A blood pressure reading of 128/74 mmHg.
C. Mild hoarseness when speaking to the nurse.
D. Direct development of laryngeal stridor.
,VERIFIED ANSWER: D. Direct development of laryngeal stridor.
EXPLANATION: Laryngeal stridor is a harsh, high-pitched respiratory sound
that indicates acute upper airway obstruction. This occurs due to laryngeal
nerve injury or severe tetany caused by accidental removal or injury to the
parathyroid glands. It is a life-threatening airway emergency. Pain and mild
hoarseness are expected findings post-thyroidectomy. A blood pressure of
128/74 mmHg is stable.
Question 2
The practical nurse is caring for an older adult client diagnosed with Type 2 Diabetes
Mellitus who is prescribed metformin. Which laboratory value requires immediate
follow-up prior to administering the next dose?
A. Glycated hemoglobin (HbA1c) of 7.2%.
B. Serum creatinine level of 1.9 mg/dL.
C. Fasting blood glucose of 140 mg/dL.
D. Serum potassium level of 4.1 mEq/L.
VERIFIED ANSWER: B. Serum creatinine level of 1.9 mg/dL.
EXPLANATION: Metformin is contraindicated in clients with renal impairment
because it accumulates in the bloodstream, increasing the risk of lactic
acidosis. A serum creatinine level of 1.9 mg/dL indicates impaired renal
function (normal range is typically 0.6–1.2 mg/dL). An HbA1c of 7.2% and
blood glucose of 140 mg/dL are expected findings in a diabetic client, and
potassium is within normal limits.
Question 3
A client is admitted to the medical unit with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). Which oxygen delivery device and setting
should the practical nurse expect to utilize to deliver a precise, low concentration of
oxygen?
A. Non-rebreather mask at 12 L/min.
B. Simple face mask at 6 L/min.
C. Venturi mask set at 28% oxygen.
D. Nasal cannula flowing at 6 L/min.
VERIFIED ANSWER: C. Venturi mask set at 28% oxygen.
EXPLANATION: The Venturi mask is the most accurate device for delivering
precise, controlled, low concentrations of oxygen. This makes it ideal for
COPD clients who depend on a hypoxic drive to breathe. High oxygen
concentrations (such as via non-rebreather or high-flow nasal cannula) can
,suppress their respiratory drive. A simple face mask does not deliver a highly
precise fraction of inspired oxygen (FiO2).
Question 4
The practical nurse is assessing a client with a history of deep vein thrombosis
(DVT) who suddenly reports sharp chest pain and severe shortness of breath. Which
initial action should the nurse take?
A. Prepare to administer a dose of prescribed subcutaneous heparin.
B. Elevate the head of the bed immediately and administer oxygen.
C. Ask the client to ambulate around the room to check for leg pain.
D. Obtain a 12-lead electrocardiogram (ECG) at the bedside.
VERIFIED ANSWER: B. Elevate the head of the bed immediately and
administer oxygen.
EXPLANATION: Sudden chest pain and shortness of breath in a client with a
known DVT point heavily toward a pulmonary embolism (PE). This is a medical
emergency. The immediate priority is to support oxygenation and ventilation
by elevating the head of the bed and administering oxygen. Ambulation is
contraindicated as it could dislodge further clots. Heparin administration and
an ECG will follow, but airway and breathing come first.
Question 5
A client with liver cirrhosis is scheduled to undergo a therapeutic paracentesis.
Which action must the practical nurse implement immediately before the procedure
begins?
A. Instruct the client to empty their bladder completely.
B. Maintain the client in a strict prone position.
C. Keep the client strictly NPO for at least 8 hours.
D. Apply a warm compress directly to the abdomen.
VERIFIED ANSWER: A. Instruct the client to empty their bladder completely.
EXPLANATION: The client must empty their bladder immediately before a
paracentesis to prevent accidental puncture of the bladder by the needle
during fluid aspiration. The client is typically placed in a Fowler's position, not
prone. NPO status is not required for a bedside paracentesis, and a warm
compress is unnecessary.
, Question 6
While assessing a client with a chest tube attached to a water-seal drainage system,
the practical nurse notes continuous, vigorous bubbling in the water-seal chamber.
How should the nurse interpret this finding?
A. The chest tube system is functioning perfectly as expected.
B. There is a leak within the drainage system or pleural space.
C. The client's lung has fully re-expanded over the shift.
D. The suction control pressure needs to be increased immediately.
VERIFIED ANSWER: B. There is a leak within the drainage system or pleural
space.
EXPLANATION: Continuous bubbling in the water-seal chamber indicates an
air leak in either the patient's pleural space or within the tubing system itself.
Intermittent bubbling is normal during coughing or exhalation, but continuous
bubbling requires immediate assessment and trouble-shooting. Fully re-
expanded lungs show minimal or no bubbling. Suction control alterations do
not fix an air leak in the water seal.
Question 7
The practical nurse is reviewing laboratory results for a client diagnosed with acute
pancreatitis. Which finding should the nurse expect to see elevated?
A. Serum amylase and lipase.
B. Serum calcium level.
C. Red blood cell count.
D. Blood urea nitrogen.
VERIFIED ANSWER: A. Serum amylase and lipase.
EXPLANATION: Acute pancreatitis causes inflammation of the pancreas,
leading to the massive release of digestive enzymes into the bloodstream.
Therefore, serum amylase and lipase levels elevate significantly within 24
hours of onset. Hypocalcemia (low calcium) is expected, not hypercalcemia.
Elevated RBCs and BUN are not specific diagnostics for pancreatic tissue
injury.
Question 8
A client diagnosed with rheumatoid arthritis is taking prescribed high-dose long-term
prednisone therapy. Which adverse reaction should the practical nurse monitor for
during routine assessments?
A. Hypoglycemia and profound weight loss.
2025/2026 | 200 Q&As with Verified
Answers & Detailed Rationales
(Rated A+)
Question 1
A licensed practical nurse (LPN) is monitoring a client who returned to the nursing
unit 4 hours ago following a subtotal thyroidectomy. Which finding is the most critical
and requires immediate intervention?
A. Complaints of mild pain at the incision site.
B. A blood pressure reading of 128/74 mmHg.
C. Mild hoarseness when speaking to the nurse.
D. Direct development of laryngeal stridor.
,VERIFIED ANSWER: D. Direct development of laryngeal stridor.
EXPLANATION: Laryngeal stridor is a harsh, high-pitched respiratory sound
that indicates acute upper airway obstruction. This occurs due to laryngeal
nerve injury or severe tetany caused by accidental removal or injury to the
parathyroid glands. It is a life-threatening airway emergency. Pain and mild
hoarseness are expected findings post-thyroidectomy. A blood pressure of
128/74 mmHg is stable.
Question 2
The practical nurse is caring for an older adult client diagnosed with Type 2 Diabetes
Mellitus who is prescribed metformin. Which laboratory value requires immediate
follow-up prior to administering the next dose?
A. Glycated hemoglobin (HbA1c) of 7.2%.
B. Serum creatinine level of 1.9 mg/dL.
C. Fasting blood glucose of 140 mg/dL.
D. Serum potassium level of 4.1 mEq/L.
VERIFIED ANSWER: B. Serum creatinine level of 1.9 mg/dL.
EXPLANATION: Metformin is contraindicated in clients with renal impairment
because it accumulates in the bloodstream, increasing the risk of lactic
acidosis. A serum creatinine level of 1.9 mg/dL indicates impaired renal
function (normal range is typically 0.6–1.2 mg/dL). An HbA1c of 7.2% and
blood glucose of 140 mg/dL are expected findings in a diabetic client, and
potassium is within normal limits.
Question 3
A client is admitted to the medical unit with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). Which oxygen delivery device and setting
should the practical nurse expect to utilize to deliver a precise, low concentration of
oxygen?
A. Non-rebreather mask at 12 L/min.
B. Simple face mask at 6 L/min.
C. Venturi mask set at 28% oxygen.
D. Nasal cannula flowing at 6 L/min.
VERIFIED ANSWER: C. Venturi mask set at 28% oxygen.
EXPLANATION: The Venturi mask is the most accurate device for delivering
precise, controlled, low concentrations of oxygen. This makes it ideal for
COPD clients who depend on a hypoxic drive to breathe. High oxygen
concentrations (such as via non-rebreather or high-flow nasal cannula) can
,suppress their respiratory drive. A simple face mask does not deliver a highly
precise fraction of inspired oxygen (FiO2).
Question 4
The practical nurse is assessing a client with a history of deep vein thrombosis
(DVT) who suddenly reports sharp chest pain and severe shortness of breath. Which
initial action should the nurse take?
A. Prepare to administer a dose of prescribed subcutaneous heparin.
B. Elevate the head of the bed immediately and administer oxygen.
C. Ask the client to ambulate around the room to check for leg pain.
D. Obtain a 12-lead electrocardiogram (ECG) at the bedside.
VERIFIED ANSWER: B. Elevate the head of the bed immediately and
administer oxygen.
EXPLANATION: Sudden chest pain and shortness of breath in a client with a
known DVT point heavily toward a pulmonary embolism (PE). This is a medical
emergency. The immediate priority is to support oxygenation and ventilation
by elevating the head of the bed and administering oxygen. Ambulation is
contraindicated as it could dislodge further clots. Heparin administration and
an ECG will follow, but airway and breathing come first.
Question 5
A client with liver cirrhosis is scheduled to undergo a therapeutic paracentesis.
Which action must the practical nurse implement immediately before the procedure
begins?
A. Instruct the client to empty their bladder completely.
B. Maintain the client in a strict prone position.
C. Keep the client strictly NPO for at least 8 hours.
D. Apply a warm compress directly to the abdomen.
VERIFIED ANSWER: A. Instruct the client to empty their bladder completely.
EXPLANATION: The client must empty their bladder immediately before a
paracentesis to prevent accidental puncture of the bladder by the needle
during fluid aspiration. The client is typically placed in a Fowler's position, not
prone. NPO status is not required for a bedside paracentesis, and a warm
compress is unnecessary.
, Question 6
While assessing a client with a chest tube attached to a water-seal drainage system,
the practical nurse notes continuous, vigorous bubbling in the water-seal chamber.
How should the nurse interpret this finding?
A. The chest tube system is functioning perfectly as expected.
B. There is a leak within the drainage system or pleural space.
C. The client's lung has fully re-expanded over the shift.
D. The suction control pressure needs to be increased immediately.
VERIFIED ANSWER: B. There is a leak within the drainage system or pleural
space.
EXPLANATION: Continuous bubbling in the water-seal chamber indicates an
air leak in either the patient's pleural space or within the tubing system itself.
Intermittent bubbling is normal during coughing or exhalation, but continuous
bubbling requires immediate assessment and trouble-shooting. Fully re-
expanded lungs show minimal or no bubbling. Suction control alterations do
not fix an air leak in the water seal.
Question 7
The practical nurse is reviewing laboratory results for a client diagnosed with acute
pancreatitis. Which finding should the nurse expect to see elevated?
A. Serum amylase and lipase.
B. Serum calcium level.
C. Red blood cell count.
D. Blood urea nitrogen.
VERIFIED ANSWER: A. Serum amylase and lipase.
EXPLANATION: Acute pancreatitis causes inflammation of the pancreas,
leading to the massive release of digestive enzymes into the bloodstream.
Therefore, serum amylase and lipase levels elevate significantly within 24
hours of onset. Hypocalcemia (low calcium) is expected, not hypercalcemia.
Elevated RBCs and BUN are not specific diagnostics for pancreatic tissue
injury.
Question 8
A client diagnosed with rheumatoid arthritis is taking prescribed high-dose long-term
prednisone therapy. Which adverse reaction should the practical nurse monitor for
during routine assessments?
A. Hypoglycemia and profound weight loss.
