Spring Semester 2026 | HESI Medical-Surgical
Exam – Complete NCLEX-Style Nursing Review,
Medical-Surgical Disorders, Pharmacology, Clinical
Judgment, Prioritization, Delegation, Patient
Safety, NCLEX-Style Practice Questions & High-
Yield Predictor Preparation
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
experiencing acute shortness of breath. Which intervention should the nurse
implement first?
• A) Administer a bronchodilator.
• B) Position the patient in a high-Fowler's position.
• C) Offer supplemental oxygen.
• D) Assess the patient's vital signs.
Correct Option: B) Position the patient in a high-Fowler's position.
Rationale: Positioning the patient in a high-Fowler’s position facilitates maximal lung
expansion and promotes better oxygenation. While administering a bronchodilator and
offering supplemental oxygen are important, establishing optimal positioning can
provide immediate relief by reducing diaphragmatic compression and enhancing
ventilation.
Question 2: A nurse is planning care for a patient with a new diagnosis of heart failure.
What is the most important teaching point for the nurse to include?
• A) Limit fluid intake to prevent overload.
• B) Monitor weight daily to assess fluid status.
• C) Participate in regular aerobic exercise.
• D) Increase sodium intake for energy.
Correct Option: B) Monitor weight daily to assess fluid status.
Rationale: Daily weight monitoring is crucial for patients with heart failure as it allows
for early detection of fluid retention. A sudden increase in weight may indicate
worsening heart failure, prompting timely intervention. The other options are relevant
but secondary to the importance of monitoring weight for immediate assessment of the
patient’s condition.
Question 3: A nurse is caring for a patient post-hip replacement surgery. Which nursing
intervention is most essential to prevent complications?
, • A) Encourage the use of an incentive spirometer.
• B) Maintain the patient's leg in an immobilizer.
• C) Administer anticoagulants as prescribed.
• D) Assess neurovascular status every shift.
Correct Option: C) Administer anticoagulants as prescribed.
Rationale: Administering anticoagulants as prescribed is critical in preventing
thromboembolic complications, such as deep vein thrombosis (DVT) and pulmonary
embolism, which are common risks following hip replacement surgery. While other
interventions like using an incentive spirometer and assessing neurovascular status are
also important, they do not directly address the prevention of thrombotic events.
Question 4: A patient diagnosed with diabetes mellitus is being discharged with a
prescription for metformin. What critical instruction should the nurse provide?
• A) "You can take this medication with or without food."
• B) "You should avoid all carbohydrates in your diet."
• C) "Monitor your blood glucose daily before meals."
• D) "Watch for signs of gastrointestinal discomfort and report them."
Correct Option: D) "Watch for signs of gastrointestinal discomfort and report
them."
Rationale: Patients taking metformin may experience gastrointestinal side effects,
including nausea, diarrhea, and abdominal pain. It’s essential that the patient
understands to monitor for these symptoms and contact their healthcare provider if
they occur, as they may lead to dehydration and affect compliance with therapy. While
the other options provide useful information, they do not address potential adverse
effects specific to metformin.
Question 5: A patient undergoing chemotherapy is experiencing mucositis. What
should be the nurse's primary intervention?
• A) Encourage the use of mouthwashes with alcohol.
• B) Recommend a diet high in spicy foods.
• C) Suggest soft, bland foods and adequate hydration.
• D) Advise the patient to avoid all oral intake.
Correct Option: C) Suggest soft, bland foods and adequate hydration.
Rationale: Soft, bland foods and adequate hydration help minimize discomfort and
prevent further irritation of the oral mucosa in patients with mucositis due to
,chemotherapy. The other options can exacerbate mucositis and lead to further
complications.
Question 6: A patient with liver cirrhosis is presenting with ascites. What is the priority
nursing intervention?
• A) Administer diuretics as prescribed.
• B) Monitor abdominal girth daily.
• C) Provide a low-sodium diet.
• D) Assess for signs of infection.
Correct Option: A) Administer diuretics as prescribed.
Rationale: Administering diuretics helps manage fluid retention in ascites and is a
primary intervention to alleviate this complication. While monitoring abdominal girth
and providing dietary modifications are important, they serve as supportive measures.
Question 7: A patient is diagnosed with pneumonia and started on antibiotics. What is
the most important assessment for the nurse to make?
• A) Respiratory rate and effort.
• B) Temperature every four hours.
• C) Skin turgor and hydration status.
• D) Electrolyte levels.
Correct Option: A) Respiratory rate and effort.
Rationale: Monitoring respiratory rate and effort is crucial to assess the effectiveness of
treatment and the patient’s respiratory status. Early detection of worsening pneumonia
or respiratory distress can guide timely interventions.
Question 8: A nurse is caring for a patient with chronic kidney disease (CKD). Which lab
value is most indicative of worsening renal function?
• A) Serum sodium level.
• B) Serum creatinine level.
• C) Serum potassium level.
• D) Blood urea nitrogen (BUN).
Correct Option: B) Serum creatinine level.
, Rationale: Serum creatinine is a direct indicator of renal function. An increase in
creatinine levels signifies a decline in renal function and is critical in managing patients
with CKD. While BUN and potassium are also relevant, creatinine is the most specific
marker.
Question 9: A nurse is monitoring a patient after an angioplasty. Which assessment
finding would require immediate intervention?
• A) Mild pain at the insertion site.
• B) Diminished pulse in the affected limb.
• C) Slight fever within normal limits.
• D) Mild edema in the affected leg.
Correct Option: B) Diminished pulse in the affected limb.
Rationale: A diminished pulse in the affected limb indicates potential complications
such as impaired perfusion or occlusion, which requires immediate intervention to
prevent ischemia. Other findings may be expected post-procedure and do not indicate
an immediate threat.
Question 10: A patient diagnosed with hypertension is prescribed a thiazide diuretic.
What electrolyte imbalance should the nurse monitor for?
• A) Hyperkalemia.
• B) Hyponatremia.
• C) Hypercalcemia.
• D) Hypokalemia.
Correct Option: D) Hypokalemia.
Rationale: Thiazide diuretics commonly lead to hypokalemia due to increased renal
excretion of potassium. Monitoring potassium levels is essential to prevent
complications associated with low potassium, such as cardiac arrhythmias.
Question 11: A postoperative patient is exhibiting signs of delirium. What is the priority
nursing action?
• A) Reassure the patient and provide a calm environment.
• B) Encourage the family to stay with the patient.
• C) Assess the patient for pain and discomfort.
Exam – Complete NCLEX-Style Nursing Review,
Medical-Surgical Disorders, Pharmacology, Clinical
Judgment, Prioritization, Delegation, Patient
Safety, NCLEX-Style Practice Questions & High-
Yield Predictor Preparation
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
experiencing acute shortness of breath. Which intervention should the nurse
implement first?
• A) Administer a bronchodilator.
• B) Position the patient in a high-Fowler's position.
• C) Offer supplemental oxygen.
• D) Assess the patient's vital signs.
Correct Option: B) Position the patient in a high-Fowler's position.
Rationale: Positioning the patient in a high-Fowler’s position facilitates maximal lung
expansion and promotes better oxygenation. While administering a bronchodilator and
offering supplemental oxygen are important, establishing optimal positioning can
provide immediate relief by reducing diaphragmatic compression and enhancing
ventilation.
Question 2: A nurse is planning care for a patient with a new diagnosis of heart failure.
What is the most important teaching point for the nurse to include?
• A) Limit fluid intake to prevent overload.
• B) Monitor weight daily to assess fluid status.
• C) Participate in regular aerobic exercise.
• D) Increase sodium intake for energy.
Correct Option: B) Monitor weight daily to assess fluid status.
Rationale: Daily weight monitoring is crucial for patients with heart failure as it allows
for early detection of fluid retention. A sudden increase in weight may indicate
worsening heart failure, prompting timely intervention. The other options are relevant
but secondary to the importance of monitoring weight for immediate assessment of the
patient’s condition.
Question 3: A nurse is caring for a patient post-hip replacement surgery. Which nursing
intervention is most essential to prevent complications?
, • A) Encourage the use of an incentive spirometer.
• B) Maintain the patient's leg in an immobilizer.
• C) Administer anticoagulants as prescribed.
• D) Assess neurovascular status every shift.
Correct Option: C) Administer anticoagulants as prescribed.
Rationale: Administering anticoagulants as prescribed is critical in preventing
thromboembolic complications, such as deep vein thrombosis (DVT) and pulmonary
embolism, which are common risks following hip replacement surgery. While other
interventions like using an incentive spirometer and assessing neurovascular status are
also important, they do not directly address the prevention of thrombotic events.
Question 4: A patient diagnosed with diabetes mellitus is being discharged with a
prescription for metformin. What critical instruction should the nurse provide?
• A) "You can take this medication with or without food."
• B) "You should avoid all carbohydrates in your diet."
• C) "Monitor your blood glucose daily before meals."
• D) "Watch for signs of gastrointestinal discomfort and report them."
Correct Option: D) "Watch for signs of gastrointestinal discomfort and report
them."
Rationale: Patients taking metformin may experience gastrointestinal side effects,
including nausea, diarrhea, and abdominal pain. It’s essential that the patient
understands to monitor for these symptoms and contact their healthcare provider if
they occur, as they may lead to dehydration and affect compliance with therapy. While
the other options provide useful information, they do not address potential adverse
effects specific to metformin.
Question 5: A patient undergoing chemotherapy is experiencing mucositis. What
should be the nurse's primary intervention?
• A) Encourage the use of mouthwashes with alcohol.
• B) Recommend a diet high in spicy foods.
• C) Suggest soft, bland foods and adequate hydration.
• D) Advise the patient to avoid all oral intake.
Correct Option: C) Suggest soft, bland foods and adequate hydration.
Rationale: Soft, bland foods and adequate hydration help minimize discomfort and
prevent further irritation of the oral mucosa in patients with mucositis due to
,chemotherapy. The other options can exacerbate mucositis and lead to further
complications.
Question 6: A patient with liver cirrhosis is presenting with ascites. What is the priority
nursing intervention?
• A) Administer diuretics as prescribed.
• B) Monitor abdominal girth daily.
• C) Provide a low-sodium diet.
• D) Assess for signs of infection.
Correct Option: A) Administer diuretics as prescribed.
Rationale: Administering diuretics helps manage fluid retention in ascites and is a
primary intervention to alleviate this complication. While monitoring abdominal girth
and providing dietary modifications are important, they serve as supportive measures.
Question 7: A patient is diagnosed with pneumonia and started on antibiotics. What is
the most important assessment for the nurse to make?
• A) Respiratory rate and effort.
• B) Temperature every four hours.
• C) Skin turgor and hydration status.
• D) Electrolyte levels.
Correct Option: A) Respiratory rate and effort.
Rationale: Monitoring respiratory rate and effort is crucial to assess the effectiveness of
treatment and the patient’s respiratory status. Early detection of worsening pneumonia
or respiratory distress can guide timely interventions.
Question 8: A nurse is caring for a patient with chronic kidney disease (CKD). Which lab
value is most indicative of worsening renal function?
• A) Serum sodium level.
• B) Serum creatinine level.
• C) Serum potassium level.
• D) Blood urea nitrogen (BUN).
Correct Option: B) Serum creatinine level.
, Rationale: Serum creatinine is a direct indicator of renal function. An increase in
creatinine levels signifies a decline in renal function and is critical in managing patients
with CKD. While BUN and potassium are also relevant, creatinine is the most specific
marker.
Question 9: A nurse is monitoring a patient after an angioplasty. Which assessment
finding would require immediate intervention?
• A) Mild pain at the insertion site.
• B) Diminished pulse in the affected limb.
• C) Slight fever within normal limits.
• D) Mild edema in the affected leg.
Correct Option: B) Diminished pulse in the affected limb.
Rationale: A diminished pulse in the affected limb indicates potential complications
such as impaired perfusion or occlusion, which requires immediate intervention to
prevent ischemia. Other findings may be expected post-procedure and do not indicate
an immediate threat.
Question 10: A patient diagnosed with hypertension is prescribed a thiazide diuretic.
What electrolyte imbalance should the nurse monitor for?
• A) Hyperkalemia.
• B) Hyponatremia.
• C) Hypercalcemia.
• D) Hypokalemia.
Correct Option: D) Hypokalemia.
Rationale: Thiazide diuretics commonly lead to hypokalemia due to increased renal
excretion of potassium. Monitoring potassium levels is essential to prevent
complications associated with low potassium, such as cardiac arrhythmias.
Question 11: A postoperative patient is exhibiting signs of delirium. What is the priority
nursing action?
• A) Reassure the patient and provide a calm environment.
• B) Encourage the family to stay with the patient.
• C) Assess the patient for pain and discomfort.
