1
HESI ComprEHEnSIvE Exam mEd Surg
[2026/2027] updatEd vErSIon |
vErIfIEd QuEStIonS & dEtaIlEd
ratIonalES
1. A nurse on the evening shift notes that a prescribed medication dose is higher than the
normal dose. The primary healthcare provider is off for the night. What should the nurse do
next?
• A. Call the nursing supervisor.
• B. Ask the answering service to contact the on-call primary healthcare provider.
• C. Withhold the medication until the morning.
• D. Administer the medication and consult the provider in the morning.
Answer: B. Ask the answering service to contact the on-call primary healthcare provider.
Rationale: The nurse has a duty to protect the client from harm and must clarify an unclear or
unsafe prescription before administering it. The nurse should not administer the medication or
wait until the next morning. Contacting the nursing supervisor is premature if an on-call
provider is available .
2. An emergency department nurse notes the sudden onset of non-perfusing premature
ventricular contractions (PVCs) on a client with a suspected acute myocardial infarction (MI).
What is the most appropriate action?
• A. Document the findings.
• B. Continue to monitor the client's cardiac status.
• C. Ask the ED primary healthcare provider to check the client.
• D. Inform the client that PVCs are expected after an MI.
Answer: C. Ask the ED primary healthcare provider to check the client.
Rationale: Non-perfusing PVCs in the context of an acute MI are considered warning
1
, 2
dysrhythmias that can herald ventricular tachycardia or ventricular fibrillation. The nurse must
promptly notify the healthcare provider for immediate evaluation and potential intervention .
3. Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse
perform as a priority before administering the medication?
• A. Checking the client's blood pressure.
• B. Checking the client's peripheral pulses.
• C. Checking the most recent potassium level.
• D. Checking the client's intake-and-output record for the last 24 hours.
Answer: A. Checking the client's blood pressure.
Rationale: Enalapril maleate is an ACE inhibitor used to treat hypertension. One common side
effect is postural hypotension. Therefore, the nurse would check the client's blood pressure
immediately before administering each dose .
4. A client is scheduled to undergo an upper gastrointestinal (GI) series. Which statement by
the client indicates a need for further instruction?
• A. "The test will take about 30 minutes."
• B. "I need to fast for 8 hours before the test."
• C. "I need to drink citrate of magnesia the night before the test and give myself a Fleet
enema on the morning of the test."
• D. "I need to take a laxative after the test is completed, because the liquid that I'll have
to drink for the test can be constipating."
Answer: C. "I need to drink citrate of magnesia the night before the test and give myself a
Fleet enema on the morning of the test."
Rationale: No special preparation (like a bowel prep) is necessary before an upper GI series,
except for maintaining NPO status for 8 hours before the test. A bowel prep is required for a
lower GI series .
5. A nurse provides home care instructions to a client with coronary artery disease (CAD).
Which statement by the client indicates a need for further instruction?
• A. "I need to carry my nitroglycerin with me at all times."
• B. "I need to check my pulse before, during, and after exercise."
• C. "I need to avoid foods with saturated fats and foods high in cholesterol."
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, 3
• D. "I need to participate in aerobic and weightlifting exercise three times a week."
Answer: D. "I need to participate in aerobic and weightlifting exercise three times a week."
Rationale: Clients with CAD should avoid activities that involve straining, including weightlifting.
They should participate in a simple exercise program on a regular basis, such as a walking
program .
6. A client who has undergone knee-replacement surgery will be self-administering
enoxaparin sodium at home. What does the nurse tell the client?
• A. Store the medication in the refrigerator.
• B. Lie down to administer the subcutaneous injection.
• C. Inject the medication in the upper outer aspect of the arm.
• D. Discard the medication if the solution appears pale yellow.
Answer: B. Lie down to administer the subcutaneous injection.
Rationale: Enoxaparin is an anticoagulant. The client is instructed to lie down to administer the
injection and to introduce the entire length of the needle into a skin fold held between the
thumb and forefinger .
7. A nurse is preparing to administer digoxin to a client. Which finding should lead the nurse
to withhold the medication?
• A. Respiratory rate of 16 breaths per minute.
• B. Blood pressure of 110/70 mmHg.
• C. Apical pulse of 52 beats per minute.
• D. Serum potassium level of 4.5 mEq/L.
Answer: C. Apical pulse of 52 beats per minute.
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia. The nurse should
withhold the medication and notify the healthcare provider if the apical pulse is below 60 beats
per minute .
8. Which assessment finding should the nurse report immediately for a client who underwent
a total hip arthroplasty 6 hours ago?
• A. Pain level of 4 on a 10-point scale.
• B. Small amount of serosanguinous drainage on the dressing.
• C. Inability to dorsiflex the foot on the affected side.
3
, 4
• D. Complaint of thirst.
Answer: C. Inability to dorsiflex the foot on the affected side.
Rationale: The inability to dorsiflex the foot can indicate peroneal nerve damage or be a sign of
compartment syndrome. This requires immediate intervention to prevent permanent disability .
9. A nurse administers nitroglycerin sublingually to a client diagnosed with angina pectoris
who reports chest pain. The medication is ineffective, so the nurse prepares to administer a
second dose. Before administering the nitroglycerin, which action does the nurse make a
priority?
• A. Checking the client's blood pressure.
• B. Obtaining blood levels of cardiac enzymes.
• C. Asking the client if experiencing headache.
• D. Obtaining a 12-lead electrocardiogram (ECG).
Answer: A. Checking the client's blood pressure.
Rationale: Nitroglycerin is a nitrate that dilates the coronary arteries. One adverse effect of the
medication is hypotension, and the nurse would assess the blood pressure and apical pulse
before administration .
10. Ciprofloxacin hydrochloride is prescribed to a client with a urinary tract infection. The
nurse provides instruction about the medication. What does the nurse tell the client about
how best to take the medication?
• A. With milk.
• B. With an antacid.
• C. 2 hours after meals.
• D. With aluminum hydroxide.
Answer: C. 2 hours after meals.
Rationale: Ciprofloxacin is a fluoroquinolone antibiotic. It may be taken without regard to
meals, but the best dosing time is 2 hours after a meal. Milk and antacids may affect
absorption .
11. A rape victim being treated in the emergency department says to the nurse, "I'm really
worried that I've got HIV now." What is the most appropriate response by the nurse?
• A. "HIV is rarely an issue in rape victims."
4
HESI ComprEHEnSIvE Exam mEd Surg
[2026/2027] updatEd vErSIon |
vErIfIEd QuEStIonS & dEtaIlEd
ratIonalES
1. A nurse on the evening shift notes that a prescribed medication dose is higher than the
normal dose. The primary healthcare provider is off for the night. What should the nurse do
next?
• A. Call the nursing supervisor.
• B. Ask the answering service to contact the on-call primary healthcare provider.
• C. Withhold the medication until the morning.
• D. Administer the medication and consult the provider in the morning.
Answer: B. Ask the answering service to contact the on-call primary healthcare provider.
Rationale: The nurse has a duty to protect the client from harm and must clarify an unclear or
unsafe prescription before administering it. The nurse should not administer the medication or
wait until the next morning. Contacting the nursing supervisor is premature if an on-call
provider is available .
2. An emergency department nurse notes the sudden onset of non-perfusing premature
ventricular contractions (PVCs) on a client with a suspected acute myocardial infarction (MI).
What is the most appropriate action?
• A. Document the findings.
• B. Continue to monitor the client's cardiac status.
• C. Ask the ED primary healthcare provider to check the client.
• D. Inform the client that PVCs are expected after an MI.
Answer: C. Ask the ED primary healthcare provider to check the client.
Rationale: Non-perfusing PVCs in the context of an acute MI are considered warning
1
, 2
dysrhythmias that can herald ventricular tachycardia or ventricular fibrillation. The nurse must
promptly notify the healthcare provider for immediate evaluation and potential intervention .
3. Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse
perform as a priority before administering the medication?
• A. Checking the client's blood pressure.
• B. Checking the client's peripheral pulses.
• C. Checking the most recent potassium level.
• D. Checking the client's intake-and-output record for the last 24 hours.
Answer: A. Checking the client's blood pressure.
Rationale: Enalapril maleate is an ACE inhibitor used to treat hypertension. One common side
effect is postural hypotension. Therefore, the nurse would check the client's blood pressure
immediately before administering each dose .
4. A client is scheduled to undergo an upper gastrointestinal (GI) series. Which statement by
the client indicates a need for further instruction?
• A. "The test will take about 30 minutes."
• B. "I need to fast for 8 hours before the test."
• C. "I need to drink citrate of magnesia the night before the test and give myself a Fleet
enema on the morning of the test."
• D. "I need to take a laxative after the test is completed, because the liquid that I'll have
to drink for the test can be constipating."
Answer: C. "I need to drink citrate of magnesia the night before the test and give myself a
Fleet enema on the morning of the test."
Rationale: No special preparation (like a bowel prep) is necessary before an upper GI series,
except for maintaining NPO status for 8 hours before the test. A bowel prep is required for a
lower GI series .
5. A nurse provides home care instructions to a client with coronary artery disease (CAD).
Which statement by the client indicates a need for further instruction?
• A. "I need to carry my nitroglycerin with me at all times."
• B. "I need to check my pulse before, during, and after exercise."
• C. "I need to avoid foods with saturated fats and foods high in cholesterol."
2
, 3
• D. "I need to participate in aerobic and weightlifting exercise three times a week."
Answer: D. "I need to participate in aerobic and weightlifting exercise three times a week."
Rationale: Clients with CAD should avoid activities that involve straining, including weightlifting.
They should participate in a simple exercise program on a regular basis, such as a walking
program .
6. A client who has undergone knee-replacement surgery will be self-administering
enoxaparin sodium at home. What does the nurse tell the client?
• A. Store the medication in the refrigerator.
• B. Lie down to administer the subcutaneous injection.
• C. Inject the medication in the upper outer aspect of the arm.
• D. Discard the medication if the solution appears pale yellow.
Answer: B. Lie down to administer the subcutaneous injection.
Rationale: Enoxaparin is an anticoagulant. The client is instructed to lie down to administer the
injection and to introduce the entire length of the needle into a skin fold held between the
thumb and forefinger .
7. A nurse is preparing to administer digoxin to a client. Which finding should lead the nurse
to withhold the medication?
• A. Respiratory rate of 16 breaths per minute.
• B. Blood pressure of 110/70 mmHg.
• C. Apical pulse of 52 beats per minute.
• D. Serum potassium level of 4.5 mEq/L.
Answer: C. Apical pulse of 52 beats per minute.
Rationale: Digoxin has a narrow therapeutic index and can cause bradycardia. The nurse should
withhold the medication and notify the healthcare provider if the apical pulse is below 60 beats
per minute .
8. Which assessment finding should the nurse report immediately for a client who underwent
a total hip arthroplasty 6 hours ago?
• A. Pain level of 4 on a 10-point scale.
• B. Small amount of serosanguinous drainage on the dressing.
• C. Inability to dorsiflex the foot on the affected side.
3
, 4
• D. Complaint of thirst.
Answer: C. Inability to dorsiflex the foot on the affected side.
Rationale: The inability to dorsiflex the foot can indicate peroneal nerve damage or be a sign of
compartment syndrome. This requires immediate intervention to prevent permanent disability .
9. A nurse administers nitroglycerin sublingually to a client diagnosed with angina pectoris
who reports chest pain. The medication is ineffective, so the nurse prepares to administer a
second dose. Before administering the nitroglycerin, which action does the nurse make a
priority?
• A. Checking the client's blood pressure.
• B. Obtaining blood levels of cardiac enzymes.
• C. Asking the client if experiencing headache.
• D. Obtaining a 12-lead electrocardiogram (ECG).
Answer: A. Checking the client's blood pressure.
Rationale: Nitroglycerin is a nitrate that dilates the coronary arteries. One adverse effect of the
medication is hypotension, and the nurse would assess the blood pressure and apical pulse
before administration .
10. Ciprofloxacin hydrochloride is prescribed to a client with a urinary tract infection. The
nurse provides instruction about the medication. What does the nurse tell the client about
how best to take the medication?
• A. With milk.
• B. With an antacid.
• C. 2 hours after meals.
• D. With aluminum hydroxide.
Answer: C. 2 hours after meals.
Rationale: Ciprofloxacin is a fluoroquinolone antibiotic. It may be taken without regard to
meals, but the best dosing time is 2 hours after a meal. Milk and antacids may affect
absorption .
11. A rape victim being treated in the emergency department says to the nurse, "I'm really
worried that I've got HIV now." What is the most appropriate response by the nurse?
• A. "HIV is rarely an issue in rape victims."
4
