HESI PN MEDICAL SURGICAL NGN 2025
REAL ACTUAL EXAM QUESTIONS WITH
VERIFIED ANSWERS AND RATIONALE
GRADED A+
Question 1:
A patient with chronic obstructive pulmonary disease (COPD) is experiencing shortness of
breath and has an oxygen saturation level of 88% on room air. What is the nurse’s priority
intervention?
A. Administer a prescribed bronchodilator.
B. Encourage the patient to use pursed-lip breathing.
C. Increase the patient’s oxygen flow rate to 4 liters per minute.
D. Position the patient in a supine position.
Answer:
B. Encourage the patient to use pursed-lip breathing.
Rationale:
Pursed-lip breathing helps improve oxygenation and reduces air trapping in patients with COPD.
While administering a bronchodilator (option A) might be part of the treatment plan, it is not an
immediate intervention. Increasing the oxygen flow rate above 2-3 liters per minute (option C)
can suppress the respiratory drive in patients with COPD. Positioning the patient supine (option
D) may worsen dyspnea; an upright position is preferred.
Question 2:
A patient is admitted with diabetic ketoacidosis (DKA). The nurse notes a blood glucose level of
450 mg/dL, deep rapid respirations, and a fruity odor to the breath. What is the priority nursing
action?
A. Administer insulin as prescribed.
B. Encourage the patient to drink fluids.
C. Monitor for signs of infection.
D. Place the patient on seizure precautions.
Answer:
A. Administer insulin as prescribed.
Rationale:
DKA results from a lack of insulin, leading to hyperglycemia and ketone accumulation.
Administering insulin is essential to reduce blood glucose levels and stop ketone production.
Encouraging fluids (option B) may help with dehydration but is not the priority. Monitoring for
,infection (option C) and seizure precautions (option D) are important but secondary to insulin
administration.
Question 3:
A patient with a history of hypertension presents with a severe headache, blurred vision, and a
blood pressure of 200/120 mmHg. What is the most appropriate nursing intervention?
A. Administer a prescribed antihypertensive medication.
B. Place the patient in a Trendelenburg position.
C. Restrict fluid intake.
D. Assess for peripheral edema.
Answer:
A. Administer a prescribed antihypertensive medication.
Rationale:
This patient is experiencing a hypertensive crisis, which requires immediate intervention to
lower blood pressure safely. Administering antihypertensive medication is the priority. Placing
the patient in a Trendelenburg position (option B) is contraindicated as it can worsen the
condition. Restricting fluids (option C) is not appropriate unless fluid overload is present.
Assessing for peripheral edema (option D) is part of the assessment but not the immediate
intervention.
Question 4:
A post-operative patient who underwent abdominal surgery is complaining of sudden severe pain
in the abdomen and has a rigid, board-like abdomen. What is the nurse’s priority action?
A. Administer prescribed analgesics.
B. Notify the healthcare provider immediately.
C. Assess bowel sounds for hyperactivity.
D. Encourage the patient to ambulate.
Answer:
B. Notify the healthcare provider immediately.
Rationale:
A rigid, board-like abdomen and severe pain suggest possible peritonitis or bowel perforation,
which are surgical emergencies. The healthcare provider must be notified immediately.
Administering analgesics (option A) may mask symptoms. Assessing bowel sounds (option C) is
important but does not take precedence over reporting the findings. Ambulation (option D) is
contraindicated in this situation.
,Question 5:
A patient with a history of heart failure presents with shortness of breath, crackles in the lungs,
and jugular vein distension. What is the most appropriate nursing intervention?
A. Encourage fluid intake.
B. Administer a prescribed diuretic.
C. Place the patient in a flat position.
D. Provide a high-sodium diet.
Answer:
B. Administer a prescribed diuretic.
Rationale:
The symptoms indicate fluid overload related to heart failure. Administering a diuretic will help
reduce excess fluid and alleviate symptoms. Encouraging fluid intake (option A) and a high-
sodium diet (option D) would exacerbate the condition. Placing the patient in a flat position
(option C) can worsen dyspnea; a high Fowler’s position is more appropriate.
Question 6:
A patient is receiving a blood transfusion and begins to experience chills, fever, and back pain.
What is the nurse’s priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
C. Administer acetaminophen as prescribed.
D. Notify the healthcare provider.
Answer:
B. Stop the transfusion immediately.
Rationale:
The patient is showing signs of a possible transfusion reaction, which is a medical emergency.
The transfusion must be stopped immediately to prevent further complications. While notifying
the provider (option D) is important, it is secondary to stopping the transfusion. Slowing the rate
(option A) does not address the reaction. Administering acetaminophen (option C) may treat
symptoms but does not address the cause.
Question 7:
A patient with a history of peptic ulcer disease reports sudden, sharp abdominal pain and
vomiting. On examination, the abdomen is rigid, and the patient appears pale and diaphoretic.
What should the nurse do first?
A. Administer an antacid as prescribed.
B. Insert a nasogastric tube for decompression.
, C. Notify the healthcare provider immediately.
D. Assess for the presence of melena or hematemesis.
Answer:
C. Notify the healthcare provider immediately.
Rationale:
The symptoms suggest a perforated ulcer, which is a surgical emergency. Immediate notification
of the healthcare provider is essential to initiate treatment. Administering an antacid (option A) is
not appropriate in this scenario. Inserting an NG tube (option B) may be required later but only
with the provider’s order. Assessing for melena or hematemesis (option D) is part of the overall
assessment but not the immediate priority.
Question 8:
A patient with acute kidney injury has a serum potassium level of 6.5 mEq/L. Which
intervention should the nurse implement first?
A. Administer a prescribed potassium-binding resin.
B. Prepare the patient for hemodialysis.
C. Administer a prescribed dose of IV insulin and dextrose.
D. Place the patient on a cardiac monitor.
Answer:
D. Place the patient on a cardiac monitor.
Rationale:
A serum potassium level of 6.5 mEq/L indicates hyperkalemia, which can lead to life-threatening
arrhythmias. The first action is to monitor the patient’s cardiac rhythm. Administering insulin
and dextrose (option C) and potassium-binding resins (option A) are important but follow after
cardiac monitoring. Preparing for hemodialysis (option B) may be necessary if other measures
fail, but it is not the initial step.
Question 9:
A patient with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse notes that
the patient’s activated partial thromboplastin time (aPTT) is 90 seconds (normal range: 25-35
seconds). What is the nurse’s priority action?
A. Continue the heparin infusion as prescribed.
B. Notify the healthcare provider immediately.
C. Reduce the heparin infusion rate.
D. Assess the patient for signs of bleeding.
Answer:
D. Assess the patient for signs of bleeding.
REAL ACTUAL EXAM QUESTIONS WITH
VERIFIED ANSWERS AND RATIONALE
GRADED A+
Question 1:
A patient with chronic obstructive pulmonary disease (COPD) is experiencing shortness of
breath and has an oxygen saturation level of 88% on room air. What is the nurse’s priority
intervention?
A. Administer a prescribed bronchodilator.
B. Encourage the patient to use pursed-lip breathing.
C. Increase the patient’s oxygen flow rate to 4 liters per minute.
D. Position the patient in a supine position.
Answer:
B. Encourage the patient to use pursed-lip breathing.
Rationale:
Pursed-lip breathing helps improve oxygenation and reduces air trapping in patients with COPD.
While administering a bronchodilator (option A) might be part of the treatment plan, it is not an
immediate intervention. Increasing the oxygen flow rate above 2-3 liters per minute (option C)
can suppress the respiratory drive in patients with COPD. Positioning the patient supine (option
D) may worsen dyspnea; an upright position is preferred.
Question 2:
A patient is admitted with diabetic ketoacidosis (DKA). The nurse notes a blood glucose level of
450 mg/dL, deep rapid respirations, and a fruity odor to the breath. What is the priority nursing
action?
A. Administer insulin as prescribed.
B. Encourage the patient to drink fluids.
C. Monitor for signs of infection.
D. Place the patient on seizure precautions.
Answer:
A. Administer insulin as prescribed.
Rationale:
DKA results from a lack of insulin, leading to hyperglycemia and ketone accumulation.
Administering insulin is essential to reduce blood glucose levels and stop ketone production.
Encouraging fluids (option B) may help with dehydration but is not the priority. Monitoring for
,infection (option C) and seizure precautions (option D) are important but secondary to insulin
administration.
Question 3:
A patient with a history of hypertension presents with a severe headache, blurred vision, and a
blood pressure of 200/120 mmHg. What is the most appropriate nursing intervention?
A. Administer a prescribed antihypertensive medication.
B. Place the patient in a Trendelenburg position.
C. Restrict fluid intake.
D. Assess for peripheral edema.
Answer:
A. Administer a prescribed antihypertensive medication.
Rationale:
This patient is experiencing a hypertensive crisis, which requires immediate intervention to
lower blood pressure safely. Administering antihypertensive medication is the priority. Placing
the patient in a Trendelenburg position (option B) is contraindicated as it can worsen the
condition. Restricting fluids (option C) is not appropriate unless fluid overload is present.
Assessing for peripheral edema (option D) is part of the assessment but not the immediate
intervention.
Question 4:
A post-operative patient who underwent abdominal surgery is complaining of sudden severe pain
in the abdomen and has a rigid, board-like abdomen. What is the nurse’s priority action?
A. Administer prescribed analgesics.
B. Notify the healthcare provider immediately.
C. Assess bowel sounds for hyperactivity.
D. Encourage the patient to ambulate.
Answer:
B. Notify the healthcare provider immediately.
Rationale:
A rigid, board-like abdomen and severe pain suggest possible peritonitis or bowel perforation,
which are surgical emergencies. The healthcare provider must be notified immediately.
Administering analgesics (option A) may mask symptoms. Assessing bowel sounds (option C) is
important but does not take precedence over reporting the findings. Ambulation (option D) is
contraindicated in this situation.
,Question 5:
A patient with a history of heart failure presents with shortness of breath, crackles in the lungs,
and jugular vein distension. What is the most appropriate nursing intervention?
A. Encourage fluid intake.
B. Administer a prescribed diuretic.
C. Place the patient in a flat position.
D. Provide a high-sodium diet.
Answer:
B. Administer a prescribed diuretic.
Rationale:
The symptoms indicate fluid overload related to heart failure. Administering a diuretic will help
reduce excess fluid and alleviate symptoms. Encouraging fluid intake (option A) and a high-
sodium diet (option D) would exacerbate the condition. Placing the patient in a flat position
(option C) can worsen dyspnea; a high Fowler’s position is more appropriate.
Question 6:
A patient is receiving a blood transfusion and begins to experience chills, fever, and back pain.
What is the nurse’s priority action?
A. Slow the transfusion rate.
B. Stop the transfusion immediately.
C. Administer acetaminophen as prescribed.
D. Notify the healthcare provider.
Answer:
B. Stop the transfusion immediately.
Rationale:
The patient is showing signs of a possible transfusion reaction, which is a medical emergency.
The transfusion must be stopped immediately to prevent further complications. While notifying
the provider (option D) is important, it is secondary to stopping the transfusion. Slowing the rate
(option A) does not address the reaction. Administering acetaminophen (option C) may treat
symptoms but does not address the cause.
Question 7:
A patient with a history of peptic ulcer disease reports sudden, sharp abdominal pain and
vomiting. On examination, the abdomen is rigid, and the patient appears pale and diaphoretic.
What should the nurse do first?
A. Administer an antacid as prescribed.
B. Insert a nasogastric tube for decompression.
, C. Notify the healthcare provider immediately.
D. Assess for the presence of melena or hematemesis.
Answer:
C. Notify the healthcare provider immediately.
Rationale:
The symptoms suggest a perforated ulcer, which is a surgical emergency. Immediate notification
of the healthcare provider is essential to initiate treatment. Administering an antacid (option A) is
not appropriate in this scenario. Inserting an NG tube (option B) may be required later but only
with the provider’s order. Assessing for melena or hematemesis (option D) is part of the overall
assessment but not the immediate priority.
Question 8:
A patient with acute kidney injury has a serum potassium level of 6.5 mEq/L. Which
intervention should the nurse implement first?
A. Administer a prescribed potassium-binding resin.
B. Prepare the patient for hemodialysis.
C. Administer a prescribed dose of IV insulin and dextrose.
D. Place the patient on a cardiac monitor.
Answer:
D. Place the patient on a cardiac monitor.
Rationale:
A serum potassium level of 6.5 mEq/L indicates hyperkalemia, which can lead to life-threatening
arrhythmias. The first action is to monitor the patient’s cardiac rhythm. Administering insulin
and dextrose (option C) and potassium-binding resins (option A) are important but follow after
cardiac monitoring. Preparing for hemodialysis (option B) may be necessary if other measures
fail, but it is not the initial step.
Question 9:
A patient with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse notes that
the patient’s activated partial thromboplastin time (aPTT) is 90 seconds (normal range: 25-35
seconds). What is the nurse’s priority action?
A. Continue the heparin infusion as prescribed.
B. Notify the healthcare provider immediately.
C. Reduce the heparin infusion rate.
D. Assess the patient for signs of bleeding.
Answer:
D. Assess the patient for signs of bleeding.
