NSG 223 MEDICAL-SURGICAL NURSING
HESI FINAL EXAM COMPREHENSIVE
REVIEW
1. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via nasal cannula at 2L/min. Which finding requires immediate intervention by the
nurse?
A. Oxygen saturation of 90%
B. Respiratory rate of 10 breaths per minute
C. Presence of barrel chest
D. Productive cough with clear sputum
Answer: B
Conceptual Explanation: In patients with COPD, a low respiratory rate (bradypnea) can
indicate CO2 narcosis or respiratory failure, as their drive to breathe is often triggered by
low oxygen levels rather than high CO2. An SpO2 of 90% is often acceptable for COPD
patients.
2. A client is admitted with suspected Diabetic Ketoacidosis (DKA). Which laboratory result
most confirms this diagnosis?
A. Serum bicarbonate 24 mEq/L
,B. Blood glucose 650 mg/dL and absent ketones
C. Blood glucose 250 mg/dL and arterial pH 7.25
D. Negative urine ketones
Answer: C
Conceptual Explanation: DKA is characterized by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH <7.30), and ketosis. Choice B describes Hyperosmolar
Hyperglycemic State (HHS).
3. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingers and around the mouth. Which action should the nurse take first?
A. Check the patient’s potassium level
B. Encourage deep breathing exercises
C. Administer a dose of levothyroxine
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Tingling (paresthesia) after a thyroidectomy suggests
hypocalcemia due to accidental parathyroid gland removal. Assessing for Chvostek’s sign
or Trousseau’s sign helps confirm tetany.
, 4. A patient with Acute Renal Failure has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Regular insulin and D50W
D. Calcium gluconate
Answer: D
Conceptual Explanation: While insulin and sodium polystyrene sulfonate help lower
potassium, calcium gluconate is administered first to stabilize the myocardial cell
membrane and prevent life-threatening arrhythmias.
5. Which assessment finding in a patient with a tension pneumothorax is a late, life-
threatening sign?
A. Diminished breath sounds on the affected side
B. Tachycardia and tachypnea
C. Sharp chest pain on inspiration
D. Tracheal deviation to the unaffected side
Answer: D
Conceptual Explanation: Tracheal deviation is a late sign of tension pneumothorax
indicating significant mediastinal shift, which compromises cardiac output.
HESI FINAL EXAM COMPREHENSIVE
REVIEW
1. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via nasal cannula at 2L/min. Which finding requires immediate intervention by the
nurse?
A. Oxygen saturation of 90%
B. Respiratory rate of 10 breaths per minute
C. Presence of barrel chest
D. Productive cough with clear sputum
Answer: B
Conceptual Explanation: In patients with COPD, a low respiratory rate (bradypnea) can
indicate CO2 narcosis or respiratory failure, as their drive to breathe is often triggered by
low oxygen levels rather than high CO2. An SpO2 of 90% is often acceptable for COPD
patients.
2. A client is admitted with suspected Diabetic Ketoacidosis (DKA). Which laboratory result
most confirms this diagnosis?
A. Serum bicarbonate 24 mEq/L
,B. Blood glucose 650 mg/dL and absent ketones
C. Blood glucose 250 mg/dL and arterial pH 7.25
D. Negative urine ketones
Answer: C
Conceptual Explanation: DKA is characterized by hyperglycemia (usually >250 mg/dL),
metabolic acidosis (pH <7.30), and ketosis. Choice B describes Hyperosmolar
Hyperglycemic State (HHS).
3. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingers and around the mouth. Which action should the nurse take first?
A. Check the patient’s potassium level
B. Encourage deep breathing exercises
C. Administer a dose of levothyroxine
D. Assess for Chvostek’s sign
Answer: D
Conceptual Explanation: Tingling (paresthesia) after a thyroidectomy suggests
hypocalcemia due to accidental parathyroid gland removal. Assessing for Chvostek’s sign
or Trousseau’s sign helps confirm tetany.
, 4. A patient with Acute Renal Failure has a serum potassium level of 6.8 mEq/L. Which
medication should the nurse anticipate administering to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Regular insulin and D50W
D. Calcium gluconate
Answer: D
Conceptual Explanation: While insulin and sodium polystyrene sulfonate help lower
potassium, calcium gluconate is administered first to stabilize the myocardial cell
membrane and prevent life-threatening arrhythmias.
5. Which assessment finding in a patient with a tension pneumothorax is a late, life-
threatening sign?
A. Diminished breath sounds on the affected side
B. Tachycardia and tachypnea
C. Sharp chest pain on inspiration
D. Tracheal deviation to the unaffected side
Answer: D
Conceptual Explanation: Tracheal deviation is a late sign of tension pneumothorax
indicating significant mediastinal shift, which compromises cardiac output.
