, HESI Med-Surg Comprehensive Practice Exam
150 Questions and correct answers with rationales
1. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic
encephalopathy. Which finding would the nurse consider an indication of progressive
hepatic encephalopathy?
A) An increase in abdominal girth.
B) Hypertension and a bounding pulse.
C) Decreased bowel sounds.
D) Difficulty in handwriting. (Correct Answer)
✔️ Rationale: Hepatic encephalopathy is a progressive neuropsychiatric complication of
advanced liver disease caused by the accumulation of toxic substances, primarily
ammonia, in the central nervous system. Early signs include subtle neurocognitive and
neuromuscular changes, such as asterixis (flapping tremors of the hands) and difficulty
with fine motor coordination, which manifests visibly as changes or difficulties in
handwriting (apraxia).
2. A nurse is caring for a client who is 24 hours postoperative following a subtotal
thyroidectomy. Which clinical finding should the nurse prioritize as an immediate
indication of a life-threatening complication?
A) Laryngeal stridor and a harsh, high-pitched respiratory sound (Correct
Answer)
B) Serosanguineous drainage on the posterior neck dressing
C) Mild pain at the incision site when swallowing
D) A slight reduction in the client's vocal volume
✔️ Rationale: Laryngeal stridor indicates airway obstruction, which can occur after a
thyroidectomy due to severe laryngeal edema, bilateral recurrent laryngeal nerve injury,
or hypocalcemic tetany leading to laryngospasm. Airway maintenance takes absolute
precedence over local surgical pain or normal serosanguineous wound seepage.
3. A client with chronic kidney disease (CKD) presents with an elevated serum potassium
level of 6.8 mEq/L. Which immediate collaborative intervention is the highest priority to
protect the client from lethal cardiac arrhythmias?
A) Administration of oral sodium polystyrene sulfonate
B) Intravenous administration of 10% calcium gluconate (Correct Answer)
C) Initiating a continuous subcutaneous insulin infusion pump
D) Scheduling the client for an urgent diagnostic renal ultrasound
✔️ Rationale: While therapies like sodium polystyrene sulfonate or insulin work to lower
the actual serum potassium concentration, they take time to act. Intravenous calcium
gluconate is the highest immediate priority because it directly stabilizes the myocardial
150 Questions and correct answers with rationales
1. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic
encephalopathy. Which finding would the nurse consider an indication of progressive
hepatic encephalopathy?
A) An increase in abdominal girth.
B) Hypertension and a bounding pulse.
C) Decreased bowel sounds.
D) Difficulty in handwriting. (Correct Answer)
✔️ Rationale: Hepatic encephalopathy is a progressive neuropsychiatric complication of
advanced liver disease caused by the accumulation of toxic substances, primarily
ammonia, in the central nervous system. Early signs include subtle neurocognitive and
neuromuscular changes, such as asterixis (flapping tremors of the hands) and difficulty
with fine motor coordination, which manifests visibly as changes or difficulties in
handwriting (apraxia).
2. A nurse is caring for a client who is 24 hours postoperative following a subtotal
thyroidectomy. Which clinical finding should the nurse prioritize as an immediate
indication of a life-threatening complication?
A) Laryngeal stridor and a harsh, high-pitched respiratory sound (Correct
Answer)
B) Serosanguineous drainage on the posterior neck dressing
C) Mild pain at the incision site when swallowing
D) A slight reduction in the client's vocal volume
✔️ Rationale: Laryngeal stridor indicates airway obstruction, which can occur after a
thyroidectomy due to severe laryngeal edema, bilateral recurrent laryngeal nerve injury,
or hypocalcemic tetany leading to laryngospasm. Airway maintenance takes absolute
precedence over local surgical pain or normal serosanguineous wound seepage.
3. A client with chronic kidney disease (CKD) presents with an elevated serum potassium
level of 6.8 mEq/L. Which immediate collaborative intervention is the highest priority to
protect the client from lethal cardiac arrhythmias?
A) Administration of oral sodium polystyrene sulfonate
B) Intravenous administration of 10% calcium gluconate (Correct Answer)
C) Initiating a continuous subcutaneous insulin infusion pump
D) Scheduling the client for an urgent diagnostic renal ultrasound
✔️ Rationale: While therapies like sodium polystyrene sulfonate or insulin work to lower
the actual serum potassium concentration, they take time to act. Intravenous calcium
gluconate is the highest immediate priority because it directly stabilizes the myocardial
