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Medical-Surgical Nursing Final Exam: 150 NCLEX &
HESI Questions with Detailed Verified Rationales –
2025 Guaranteed Pass Edition"
Q1. A 68-year-old man with COPD presents with increased shortness of breath and
purulent sputum. His RR is 28/min, SpO₂ is 88% on room air. Which initial
nursing action is most appropriate?
A. Encourage deep-breathing and coughing exercises and continue to monitor.
B. Administer prescribed low-flow oxygen via nasal cannula and reassess.
C. Place the patient in Trendelenburg position to improve ventilation.
D. Immediately prepare the patient for endotracheal intubation.
Correct Answer: B
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Rationale: In a COPD patient who is hypoxemic, the priority intervention is to
administer supplemental oxygen at a low flow rate, typically 1–2 L/min via nasal
cannula, to improve oxygen saturation while avoiding suppression of the hypoxic
drive to breathe. While coughing and deep-breathing exercises can help mobilize
secretions, they do not address the immediate problem of low oxygen levels.
Placing the patient in the Trendelenburg position would impair diaphragmatic
movement and reduce ventilation, worsening respiratory distress. Endotracheal
intubation is only indicated if oxygen therapy fails or the patient shows signs of
severe respiratory failure. Therefore, giving low-flow oxygen and reassessing is the
safest and most effective initial action.
Q2. A 55-year-old woman is admitted with acute chest pain. ECG shows ST-
elevation in leads II, III, and aVF. Which artery is most likely occluded?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex artery (LCx)
D. Posterior descending artery (PDA)
,3
Correct Answer: B
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA). The LAD typically causes anterior wall changes (V1–V4)
and the LCx produces lateral changes (I, aVL, V5–V6). The posterior descending
artery may be involved but in many patients it branches from the RCA; the classic
lead pattern for an inferior MI points to the RCA as the likely culprit.
Q3. A client with heart failure has peripheral edema, bibasilar crackles, jugular
venous distention, and is on furosemide. Which lab should the nurse monitor most
closely?
A. Platelet count
B. Serum potassium
C. Hemoglobin
D. Serum creatinine
Correct Answer: B
Rationale: Loop diuretics like furosemide commonly cause potassium loss, risking
hypokalemia which can precipitate arrhythmias and muscle weakness; therefore
serum potassium requires close monitoring. While serum creatinine is also
important because diuretics can affect renal function, potassium is typically the
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immediate priority to prevent life-threatening cardiac effects. Platelet count and
hemoglobin are less directly affected by furosemide.
Q4. A postoperative client reports sudden onset of chest pain, dyspnea, and anxiety
on postoperative day 2. Oxygen saturation falls to 86% and there is unilateral
pleuritic chest pain. What is the most likely diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Myocardial infarction
Correct Answer: B
Rationale: Sudden dyspnea, hypoxemia, pleuritic chest pain, anxiety, and timing
(postoperative period) strongly suggest pulmonary embolism due to
thromboembolism. Atelectasis typically causes low-grade hypoxia and gradual
symptoms, pneumonia develops more gradually with fever and productive cough,
and myocardial infarction usually presents with central chest pain and ECG
changes rather than acute isolated hypoxemia and pleuritic pain.
Medical-Surgical Nursing Final Exam: 150 NCLEX &
HESI Questions with Detailed Verified Rationales –
2025 Guaranteed Pass Edition"
Q1. A 68-year-old man with COPD presents with increased shortness of breath and
purulent sputum. His RR is 28/min, SpO₂ is 88% on room air. Which initial
nursing action is most appropriate?
A. Encourage deep-breathing and coughing exercises and continue to monitor.
B. Administer prescribed low-flow oxygen via nasal cannula and reassess.
C. Place the patient in Trendelenburg position to improve ventilation.
D. Immediately prepare the patient for endotracheal intubation.
Correct Answer: B
,2
Rationale: In a COPD patient who is hypoxemic, the priority intervention is to
administer supplemental oxygen at a low flow rate, typically 1–2 L/min via nasal
cannula, to improve oxygen saturation while avoiding suppression of the hypoxic
drive to breathe. While coughing and deep-breathing exercises can help mobilize
secretions, they do not address the immediate problem of low oxygen levels.
Placing the patient in the Trendelenburg position would impair diaphragmatic
movement and reduce ventilation, worsening respiratory distress. Endotracheal
intubation is only indicated if oxygen therapy fails or the patient shows signs of
severe respiratory failure. Therefore, giving low-flow oxygen and reassessing is the
safest and most effective initial action.
Q2. A 55-year-old woman is admitted with acute chest pain. ECG shows ST-
elevation in leads II, III, and aVF. Which artery is most likely occluded?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex artery (LCx)
D. Posterior descending artery (PDA)
,3
Correct Answer: B
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA). The LAD typically causes anterior wall changes (V1–V4)
and the LCx produces lateral changes (I, aVL, V5–V6). The posterior descending
artery may be involved but in many patients it branches from the RCA; the classic
lead pattern for an inferior MI points to the RCA as the likely culprit.
Q3. A client with heart failure has peripheral edema, bibasilar crackles, jugular
venous distention, and is on furosemide. Which lab should the nurse monitor most
closely?
A. Platelet count
B. Serum potassium
C. Hemoglobin
D. Serum creatinine
Correct Answer: B
Rationale: Loop diuretics like furosemide commonly cause potassium loss, risking
hypokalemia which can precipitate arrhythmias and muscle weakness; therefore
serum potassium requires close monitoring. While serum creatinine is also
important because diuretics can affect renal function, potassium is typically the
, 4
immediate priority to prevent life-threatening cardiac effects. Platelet count and
hemoglobin are less directly affected by furosemide.
Q4. A postoperative client reports sudden onset of chest pain, dyspnea, and anxiety
on postoperative day 2. Oxygen saturation falls to 86% and there is unilateral
pleuritic chest pain. What is the most likely diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Myocardial infarction
Correct Answer: B
Rationale: Sudden dyspnea, hypoxemia, pleuritic chest pain, anxiety, and timing
(postoperative period) strongly suggest pulmonary embolism due to
thromboembolism. Atelectasis typically causes low-grade hypoxia and gradual
symptoms, pneumonia develops more gradually with fever and productive cough,
and myocardial infarction usually presents with central chest pain and ECG
changes rather than acute isolated hypoxemia and pleuritic pain.
