HESI Med Surg Exam Study Guide 2025/2026: Ace Your
Test First Try with Key Notes from Harding & Kwong's
Lewis's Medical-Surgical Nursing, 12th Edition
An 85-year-old male client comes to the clinic for his annual physical exam and renewal of
antihypertensive medication prescriptions. The client's radial pulse rate is 104 beats/minute. Which
additional assessment should the nurse complete?
A: Palpate the pedal pulse volume.
B: Count the brachial pulse rate.
C: Measure the blood pressure.
D: Assess for a carotid bruit.
C: Measure the blood pressure.
Elderly clients who take antihypertensive medications often experience side effects, such as
hypotension, which causes tachycardia, a compensatory mechanism to maintain adequate cardiac
output, so the client's blood pressure should be measured.
The nurse is completing the health assessment of a 79-year-old client who denies any significant
health problems. Which finding requires the most immediate follow-up assessment?
A: Kyphosis with a reduction in height.
B: Dilated superficial veins on both legs.
C: External hemorrhoids with itching.
D: Yellowish discoloration of the sclerae.
D: Yellowish discoloration of the sclerae.
In a geriatric client, a yellowish discoloration (jaundice) of the sclerae is not a normal finding and may
indicate liver damage and requires further assessment.
The nurse is assessing a client with a chest tube that is attached to suction and a closed drainage
system. Which finding is most important for the nurse to further assess?
Page 1 of 45
,A: Upper chest subcutaneous emphysema.
B: Tidaling (fluctuation) of fluid in the water-seal chamber.
C: Constant air bubbling in the suction-control chamber.
D: Pain rated "8" (0-10) at the insertion site.
A: Upper chest subcutaneous emphysema.
Subcutaneous emphysema is a complication and indicates air is leaking beneath the skin surrounding
the chest tube.
A client asks the nurse about the purpose of beginning chemotherapy (CT) because the tumor is still
very small. Which information supports the explanation that the nurse should provide?
A: Side effects are less likely if therapy is started early.
B: Collateral circulation increases as the tumor grows.
C: Sensitivity of cancer cells to CT is based on cell cycle rate.
D: The cell count of the tumor reduces by half with each dose.
D: The cell count of the tumor reduces by half with each dose.
Initiating chemotherapy while the tumor is small provides a better chance of eradicating all cancer cells
because 50% of cancer cells or tumor cells are killed with each dose.
A client is admitted to the hospital with a traumatic brain injury after his head violently struck a brick
wall during a gang fight. Which finding is most important for the nurse to assess further?
A: A scalp laceration oozing blood.
B: Serosanguineous nasal drainage.
C: Headache rated "10" on a 0-10 scale.
D: Dizziness, nausea and transient confusion.
B: Serosanguineous nasal drainage.
Any nasal discharge following a head injury should be evaluated to determine the presence of cerebral
spinal fluid which would indicate a tear in the dura making the client susceptible to meningitis.
The nurse is teaching a client about precautions for a new prescription for lovastatin. Which symptom
should the nurse instruct the client to report to the healthcare provider immediately?
A: Terrible nightmares.
B: Increased nocturia.
C: Severe muscle pain.
D: Visual disturbances.
Page 2 of 45
,C: Severe muscle pain.
A potential, serious side effect of statin therapy that is used to lower both LDL-C and triglyceride levels is
rhabdomyolysis, which is manifested by severe muscle pain and aching.
The nurse is caring for a client who is two days postoperative. Which observation should alert the
nurse to call the Rapid Response Team (RRT)?
A: Fresh bleeding noted on abdominal surgical wound dressing.
B: Pulse change from 85 to160 beats/minute lasting more than 10 minutes.
C: Temperature of 103.1 F (39.5 C) and white blood cell (WBC) count of 16,000 mm3.
D: Weakness, diaphoresis, reports of feeling faint. BP 100/56 mmHg.
B: Pulse change from 85 to160 beats/minute lasting more than 10 minutes.
The RRT should be called to intervene for a postoperative client with an acute life-threatening change,
such as a pulse change resulting in tachycardia for a prolonged time period.
A client is admitted after blunt abdominal injury. Which assessment finding requires immediate action
by the nurse?
A: Radiating abdominal pain with left lower quadrant palpation.
B: Grimacing after palpation of the right hypochondriac region.
C: Rebound tenderness with abdominal palpation.
D: Bluish periumbilical skin discoloration.
D: Bluish periumbilical skin discoloration.
Immediate action is indicated for intraperitoneal hemorrhage which causes periumbilical discoloration
and indicates the presence of a splenic rupture, a life-threatening complication of blunt abdominal
injury.
Based on an analysis of the client's rhythm, atrial fibrillation, the nurse should prepare the client for
which treatment protocol?
A: Diuretic therapy.
B: Pacemaker implantation.
C: Anticoagulation therapy.
D: Cardiac catheterization.
C: Anticoagulation therapy.
The client is experiencing atrial fibrillation, and the nurse should prepare the client for anticoagulation
Page 3 of 45
, therapy which should be prescribed before rhythm control therapies to prevent cardioembolic events
which result from blood pooling in the fibrillating atria.
The nurse is preparing a client for orthopedic surgery on the left leg and completing a safety checklist
before transport to the operating room. Which items should the nurse remove from the client? (Select
all that apply.)
-Nail polish.
-Hearing aid.
-Wedding band.
-Left leg brace.
-Contact lenses.
-Partial dentures.
-Nail Polish
-Hearing Aid
-Contact Lenses
-Partial Dentures
The removal of nail polish provides a more accurate pulse oximetry readings and evaluation of capillary
refill. Hearing aids, contact lenses, and partial dentures are removed to prevent damage, loss or
misplacement, or injury during surgery. Ideally, give the client's significant other the contact lenses if
they are not the disposable ones, hearing aids and partial dentures once placed in an appropriate
labeled container to hold for safe keeping. If no significant other is not able to hold onto the items, then
secured them in an appropriate and safe place.
The nurse obtains a client's history that includes right mastectomy and radiation therapy for breast
cancer 10 years ago. Which current health problem should the nurse consider is a consequence of the
radiation therapy?
A: Asthma.
B: Myocardial infarction.
C: Chronic esophagitis with gastroesophageal reflux.
D: Pathologic fracture of two ribs on the right chest.
D: Pathologic fracture of two ribs on the right chest.
The ribs lie in the radiation pathway and lose density over time, becoming thin and brittle, so the
occurrence of two right-sided ribs with pathological fractures resulting without evidence of trauma is
related to radiation damage.
The nurse is preparing a teaching plan for a client with newly diagnosed glacoma and a history of
allergic rhinitis. Which information is most important for the nurse to provide the client about using
Page 4 of 45
Test First Try with Key Notes from Harding & Kwong's
Lewis's Medical-Surgical Nursing, 12th Edition
An 85-year-old male client comes to the clinic for his annual physical exam and renewal of
antihypertensive medication prescriptions. The client's radial pulse rate is 104 beats/minute. Which
additional assessment should the nurse complete?
A: Palpate the pedal pulse volume.
B: Count the brachial pulse rate.
C: Measure the blood pressure.
D: Assess for a carotid bruit.
C: Measure the blood pressure.
Elderly clients who take antihypertensive medications often experience side effects, such as
hypotension, which causes tachycardia, a compensatory mechanism to maintain adequate cardiac
output, so the client's blood pressure should be measured.
The nurse is completing the health assessment of a 79-year-old client who denies any significant
health problems. Which finding requires the most immediate follow-up assessment?
A: Kyphosis with a reduction in height.
B: Dilated superficial veins on both legs.
C: External hemorrhoids with itching.
D: Yellowish discoloration of the sclerae.
D: Yellowish discoloration of the sclerae.
In a geriatric client, a yellowish discoloration (jaundice) of the sclerae is not a normal finding and may
indicate liver damage and requires further assessment.
The nurse is assessing a client with a chest tube that is attached to suction and a closed drainage
system. Which finding is most important for the nurse to further assess?
Page 1 of 45
,A: Upper chest subcutaneous emphysema.
B: Tidaling (fluctuation) of fluid in the water-seal chamber.
C: Constant air bubbling in the suction-control chamber.
D: Pain rated "8" (0-10) at the insertion site.
A: Upper chest subcutaneous emphysema.
Subcutaneous emphysema is a complication and indicates air is leaking beneath the skin surrounding
the chest tube.
A client asks the nurse about the purpose of beginning chemotherapy (CT) because the tumor is still
very small. Which information supports the explanation that the nurse should provide?
A: Side effects are less likely if therapy is started early.
B: Collateral circulation increases as the tumor grows.
C: Sensitivity of cancer cells to CT is based on cell cycle rate.
D: The cell count of the tumor reduces by half with each dose.
D: The cell count of the tumor reduces by half with each dose.
Initiating chemotherapy while the tumor is small provides a better chance of eradicating all cancer cells
because 50% of cancer cells or tumor cells are killed with each dose.
A client is admitted to the hospital with a traumatic brain injury after his head violently struck a brick
wall during a gang fight. Which finding is most important for the nurse to assess further?
A: A scalp laceration oozing blood.
B: Serosanguineous nasal drainage.
C: Headache rated "10" on a 0-10 scale.
D: Dizziness, nausea and transient confusion.
B: Serosanguineous nasal drainage.
Any nasal discharge following a head injury should be evaluated to determine the presence of cerebral
spinal fluid which would indicate a tear in the dura making the client susceptible to meningitis.
The nurse is teaching a client about precautions for a new prescription for lovastatin. Which symptom
should the nurse instruct the client to report to the healthcare provider immediately?
A: Terrible nightmares.
B: Increased nocturia.
C: Severe muscle pain.
D: Visual disturbances.
Page 2 of 45
,C: Severe muscle pain.
A potential, serious side effect of statin therapy that is used to lower both LDL-C and triglyceride levels is
rhabdomyolysis, which is manifested by severe muscle pain and aching.
The nurse is caring for a client who is two days postoperative. Which observation should alert the
nurse to call the Rapid Response Team (RRT)?
A: Fresh bleeding noted on abdominal surgical wound dressing.
B: Pulse change from 85 to160 beats/minute lasting more than 10 minutes.
C: Temperature of 103.1 F (39.5 C) and white blood cell (WBC) count of 16,000 mm3.
D: Weakness, diaphoresis, reports of feeling faint. BP 100/56 mmHg.
B: Pulse change from 85 to160 beats/minute lasting more than 10 minutes.
The RRT should be called to intervene for a postoperative client with an acute life-threatening change,
such as a pulse change resulting in tachycardia for a prolonged time period.
A client is admitted after blunt abdominal injury. Which assessment finding requires immediate action
by the nurse?
A: Radiating abdominal pain with left lower quadrant palpation.
B: Grimacing after palpation of the right hypochondriac region.
C: Rebound tenderness with abdominal palpation.
D: Bluish periumbilical skin discoloration.
D: Bluish periumbilical skin discoloration.
Immediate action is indicated for intraperitoneal hemorrhage which causes periumbilical discoloration
and indicates the presence of a splenic rupture, a life-threatening complication of blunt abdominal
injury.
Based on an analysis of the client's rhythm, atrial fibrillation, the nurse should prepare the client for
which treatment protocol?
A: Diuretic therapy.
B: Pacemaker implantation.
C: Anticoagulation therapy.
D: Cardiac catheterization.
C: Anticoagulation therapy.
The client is experiencing atrial fibrillation, and the nurse should prepare the client for anticoagulation
Page 3 of 45
, therapy which should be prescribed before rhythm control therapies to prevent cardioembolic events
which result from blood pooling in the fibrillating atria.
The nurse is preparing a client for orthopedic surgery on the left leg and completing a safety checklist
before transport to the operating room. Which items should the nurse remove from the client? (Select
all that apply.)
-Nail polish.
-Hearing aid.
-Wedding band.
-Left leg brace.
-Contact lenses.
-Partial dentures.
-Nail Polish
-Hearing Aid
-Contact Lenses
-Partial Dentures
The removal of nail polish provides a more accurate pulse oximetry readings and evaluation of capillary
refill. Hearing aids, contact lenses, and partial dentures are removed to prevent damage, loss or
misplacement, or injury during surgery. Ideally, give the client's significant other the contact lenses if
they are not the disposable ones, hearing aids and partial dentures once placed in an appropriate
labeled container to hold for safe keeping. If no significant other is not able to hold onto the items, then
secured them in an appropriate and safe place.
The nurse obtains a client's history that includes right mastectomy and radiation therapy for breast
cancer 10 years ago. Which current health problem should the nurse consider is a consequence of the
radiation therapy?
A: Asthma.
B: Myocardial infarction.
C: Chronic esophagitis with gastroesophageal reflux.
D: Pathologic fracture of two ribs on the right chest.
D: Pathologic fracture of two ribs on the right chest.
The ribs lie in the radiation pathway and lose density over time, becoming thin and brittle, so the
occurrence of two right-sided ribs with pathological fractures resulting without evidence of trauma is
related to radiation damage.
The nurse is preparing a teaching plan for a client with newly diagnosed glacoma and a history of
allergic rhinitis. Which information is most important for the nurse to provide the client about using
Page 4 of 45
