Medical-Surgical Nursing: Assessment and
Management of Clinical Problems, 12th Edition –
HESI Concepts 2025/2026 Exam Prep by
Mariann M. Harding, Jeffrey Kwong, Dottie
Roberts, Debra Hagler, and Courtney Reinisch.
*
*1. A 68-year-old male with heart failure with reduced ejection fraction
(HFrEF) is admitted with dyspnea, crackles, and JVD. His meds include
lisinopril, furosemide, and carvedilol. Which finding indicates the
furosemide is effective?**
A. Blood pressure 100/70 mmHg
B. Daily weight decreased by 2 kg in 24 hours
C. Serum potassium 4.0 mEq/L
D. Heart rate 88 bpm
**Answer:** B
**Rationale:** Furosemide is a loop diuretic used to reduce fluid
overload. Daily weight is the most accurate indicator of fluid status; a
loss of 1-2 kg/day suggests effective diuresis. BP and HR are important
to monitor but do not directly measure diuresis effectiveness .
**2. A client with COPD has an SpO2 of 88% on room air. The nurse
initiates oxygen at 2 L/min. Which finding requires immediate
action?**
,A. Respiratory rate decreases from 22 to 10 breaths/min
B. The client reports feeling less short of breath
C. Heart rate decreases from 100 to 88 bpm
D. The client requests a blanket for chills
**Answer:** A
**Rationale:** Some COPD clients are chronic CO2 retainers who rely
on a hypoxic drive to breathe. Oxygen-induced hypoventilation
(decreased RR) leads to hypercapnia and respiratory acidosis, which can
be life-threatening .
**3. A patient with pneumonia is on IV levofloxacin. Which finding
should the nurse report immediately?**
A. Mild nausea
B. Tendon pain in the right ankle
C. Elevated blood glucose
D. Headache
**Answer:** B
**Rationale:** Fluoroquinolones (levofloxacin) increase the risk of
tendonitis and tendon rupture, particularly in older adults and those on
corticosteroids. Tendon pain warrants immediate discontinuation and
provider notification .
,**4. A 55-year-old post-op day 1 from knee arthroplasty reports
sudden sharp chest pain and dyspnea. SpO2 is 88% on RA. What should
the nurse do first?**
A. Administer oxygen via nasal cannula
B. Obtain a stat ECG and troponin
C. Apply sequential compression devices
D. Prepare for chest tube insertion
**Answer:** A
**Rationale:** The ABCs (Airway, Breathing, Circulation) always come
first. This client is hypoxic (SpO2 88%), so the priority is administering
oxygen to correct hypoxemia before pursuing diagnostic tests for
possible PE .
**5. A 72-year-old female with CKD stage 4 has a potassium of 6.8
mEq/L and ECG shows peaked T waves. What is the priority
intervention?**
A. Administer calcium gluconate IV
B. Give sodium polystyrene sulfonate (Kayexalate)
C. Start insulin with dextrose IV
D. Prepare for emergent hemodialysis
**Answer:** A
, **Rationale:** In severe hyperkalemia with ECG changes, the priority is
to stabilize the cardiac membrane to prevent dysrhythmias. Calcium
gluconate works within minutes. Insulin/dextrose and Kayexalate lower
potassium but take longer .
**6. A client with heart failure is receiving IV furosemide. Which lab
value should the nurse monitor most closely?**
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum glucose
**Answer:** B
**Rationale:** Loop diuretics cause potassium wasting in the distal
tubule, leading to hypokalemia. Hypokalemia increases the risk of
digoxin toxicity and life-threatening arrhythmias, especially in heart
failure patients .
**7. A client with acute pancreatitis has an NG tube to low intermittent
suction. Which lab finding would the nurse expect?**
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated serum glucose
D. Decreased serum magnesium
Management of Clinical Problems, 12th Edition –
HESI Concepts 2025/2026 Exam Prep by
Mariann M. Harding, Jeffrey Kwong, Dottie
Roberts, Debra Hagler, and Courtney Reinisch.
*
*1. A 68-year-old male with heart failure with reduced ejection fraction
(HFrEF) is admitted with dyspnea, crackles, and JVD. His meds include
lisinopril, furosemide, and carvedilol. Which finding indicates the
furosemide is effective?**
A. Blood pressure 100/70 mmHg
B. Daily weight decreased by 2 kg in 24 hours
C. Serum potassium 4.0 mEq/L
D. Heart rate 88 bpm
**Answer:** B
**Rationale:** Furosemide is a loop diuretic used to reduce fluid
overload. Daily weight is the most accurate indicator of fluid status; a
loss of 1-2 kg/day suggests effective diuresis. BP and HR are important
to monitor but do not directly measure diuresis effectiveness .
**2. A client with COPD has an SpO2 of 88% on room air. The nurse
initiates oxygen at 2 L/min. Which finding requires immediate
action?**
,A. Respiratory rate decreases from 22 to 10 breaths/min
B. The client reports feeling less short of breath
C. Heart rate decreases from 100 to 88 bpm
D. The client requests a blanket for chills
**Answer:** A
**Rationale:** Some COPD clients are chronic CO2 retainers who rely
on a hypoxic drive to breathe. Oxygen-induced hypoventilation
(decreased RR) leads to hypercapnia and respiratory acidosis, which can
be life-threatening .
**3. A patient with pneumonia is on IV levofloxacin. Which finding
should the nurse report immediately?**
A. Mild nausea
B. Tendon pain in the right ankle
C. Elevated blood glucose
D. Headache
**Answer:** B
**Rationale:** Fluoroquinolones (levofloxacin) increase the risk of
tendonitis and tendon rupture, particularly in older adults and those on
corticosteroids. Tendon pain warrants immediate discontinuation and
provider notification .
,**4. A 55-year-old post-op day 1 from knee arthroplasty reports
sudden sharp chest pain and dyspnea. SpO2 is 88% on RA. What should
the nurse do first?**
A. Administer oxygen via nasal cannula
B. Obtain a stat ECG and troponin
C. Apply sequential compression devices
D. Prepare for chest tube insertion
**Answer:** A
**Rationale:** The ABCs (Airway, Breathing, Circulation) always come
first. This client is hypoxic (SpO2 88%), so the priority is administering
oxygen to correct hypoxemia before pursuing diagnostic tests for
possible PE .
**5. A 72-year-old female with CKD stage 4 has a potassium of 6.8
mEq/L and ECG shows peaked T waves. What is the priority
intervention?**
A. Administer calcium gluconate IV
B. Give sodium polystyrene sulfonate (Kayexalate)
C. Start insulin with dextrose IV
D. Prepare for emergent hemodialysis
**Answer:** A
, **Rationale:** In severe hyperkalemia with ECG changes, the priority is
to stabilize the cardiac membrane to prevent dysrhythmias. Calcium
gluconate works within minutes. Insulin/dextrose and Kayexalate lower
potassium but take longer .
**6. A client with heart failure is receiving IV furosemide. Which lab
value should the nurse monitor most closely?**
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum glucose
**Answer:** B
**Rationale:** Loop diuretics cause potassium wasting in the distal
tubule, leading to hypokalemia. Hypokalemia increases the risk of
digoxin toxicity and life-threatening arrhythmias, especially in heart
failure patients .
**7. A client with acute pancreatitis has an NG tube to low intermittent
suction. Which lab finding would the nurse expect?**
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated serum glucose
D. Decreased serum magnesium
