HESI ExIt Exam mEd Surg
[2026/2027] updatEd VErSIon |
VErIfIEd QuEStIonS & dEtaIlEd
ratIonalES
Section 1: Safe & Effective Care Environment (Management of Care, Safety & Infection
Control) - Questions 1-20
1. A charge nurse is making client assignments on a medical-surgical unit. Which client should
be assigned to the most experienced registered nurse (RN)?
A) A client who is 1-day post-operative following a cholecystectomy and is ready for discharge
teaching.
B) A client with a new diagnosis of diabetes mellitus requiring initial insulin administration and
education.
C) A client who is 12-hours post-operative following a laryngectomy with a new tracheostomy.
D) A client who requires a blood transfusion for a hemoglobin of 7.8 g/dL.
Answer: C. A client with a new tracheostomy is potentially unstable and requires close
assessment of the airway. The most experienced RN should be assigned to this complex and
high-risk client .
2. A nurse is caring for a client who is confused and attempting to pull out his IV line. Which
action should the nurse take FIRST?
A) Apply wrist restraints to prevent the client from pulling the IV.
B) Request a prescription for a sedative from the provider.
C) Assign a staff member to sit with the client and provide redirection.
D) Dim the lights and reduce stimuli in the client's room.
Answer: C. The priority is to use the least restrictive intervention. Assigning a staff member to
stay with the client allows for constant observation and de-escalation, which is a safer first step
than restraints or sedation .
1
, 3. A nurse is preparing to administer a blood transfusion to a client. Which of the following
actions is MOST important to prevent a transfusion error?
A) Verify the provider's prescription for the blood transfusion.
B) Check the client's vital signs 15 minutes after the transfusion begins.
C) Assess the client's IV site for patency and redness.
D) Verify the client's identity using two unique identifiers (e.g., name and date of birth).
Answer: D. Verifying the client's identity using two identifiers is the priority action to prevent a
fatal transfusion reaction. This is a critical safety step .
4. A nurse observes a colleague taking a photograph of a client without consent. Which action
should the nurse take FIRST?
A) Report the colleague to the nursing supervisor.
B) Notify the hospital's privacy officer.
C) Speak to the colleague privately to address the concern.
D) Ignore the behavior to avoid conflict.
Answer: C. The nurse should first address the concern directly with the colleague in private. If
the behavior continues, it should then be reported to a supervisor or privacy officer .
5. A nurse is caring for a client who is refusing a prescribed blood transfusion. The client's
family insists that the transfusion be given. Which action should the nurse take?
A) Respect the client's decision and document the refusal.
B) Proceed with the transfusion after obtaining consent from the family.
C) Notify the healthcare provider to obtain a court order.
D) Explain the risks to the family and proceed with the transfusion.
Answer: A. A competent adult client has the right to refuse treatment. The nurse must respect
the client's autonomy and document the refusal .
6. A client is scheduled for surgery and has a living will that states "do not resuscitate" (DNR).
The client's family requests that resuscitation be attempted if needed. What should the nurse
do?
A) Follow the family's request and initiate resuscitation.
B) Notify the provider to discuss the matter with the client's family.
C) Consult the hospital ethics committee.
D) Follow the client's living will and honor the DNR order.
Answer: D. The client's living will is a legally binding document. The nurse must honor the
client's documented wishes. The provider should be consulted to discuss the family's concerns,
but the DNR order remains in effect .
2
, 7. A nurse is preparing to give a handoff report to the oncoming shift. Which communication
tool is most effective for ensuring continuity of care and patient safety?
A) SBAR (Situation, Background, Assessment, Recommendation)
B) Providing a written report only
C) Giving a verbal report without any documentation
D) A brief summary of the client's current status
Answer: A. SBAR is a standardized, structured communication method that ensures critical
information is communicated clearly and concisely, improving patient safety and continuity of
care .
8. A nurse is caring for a client with a new tracheostomy. The nurse notes thick secretions.
What action should the nurse take FIRST?
A) Suction the tracheostomy.
B) Increase the client's fluid intake.
C) Change the tracheostomy ties.
D) Administer an antibiotic.
Answer: A. Thick secretions can block the airway, which is a life-threatening emergency.
Suctioning the tracheostomy is the priority action to clear the airway .
9. A client is on contact precautions for a wound infection. Which of the following is a correct
action by the nurse?
A) Wear an N95 respirator when entering the room.
B) Place the client in a negative pressure room.
C) Wear gloves and a gown when providing direct care.
D) Keep the door closed at all times.
Answer: C. Contact precautions require the use of a gown and gloves. Airborne precautions
(N95, negative pressure) are used for tuberculosis, measles, and varicella .
10. A client is being discharged with a new colostomy. Which action should the nurse take to
ensure the client understands how to care for the stoma and appliance?
A) Provide verbal instructions only.
B) Provide written instructions and use the teach-back method.
C) Refer the client to a support group.
D) Ask a family member to perform the care.
Answer: B. Using the teach-back method confirms the client's understanding by having them
demonstrate or explain the care. This is the most effective way to ensure learning and safety .
3
[2026/2027] updatEd VErSIon |
VErIfIEd QuEStIonS & dEtaIlEd
ratIonalES
Section 1: Safe & Effective Care Environment (Management of Care, Safety & Infection
Control) - Questions 1-20
1. A charge nurse is making client assignments on a medical-surgical unit. Which client should
be assigned to the most experienced registered nurse (RN)?
A) A client who is 1-day post-operative following a cholecystectomy and is ready for discharge
teaching.
B) A client with a new diagnosis of diabetes mellitus requiring initial insulin administration and
education.
C) A client who is 12-hours post-operative following a laryngectomy with a new tracheostomy.
D) A client who requires a blood transfusion for a hemoglobin of 7.8 g/dL.
Answer: C. A client with a new tracheostomy is potentially unstable and requires close
assessment of the airway. The most experienced RN should be assigned to this complex and
high-risk client .
2. A nurse is caring for a client who is confused and attempting to pull out his IV line. Which
action should the nurse take FIRST?
A) Apply wrist restraints to prevent the client from pulling the IV.
B) Request a prescription for a sedative from the provider.
C) Assign a staff member to sit with the client and provide redirection.
D) Dim the lights and reduce stimuli in the client's room.
Answer: C. The priority is to use the least restrictive intervention. Assigning a staff member to
stay with the client allows for constant observation and de-escalation, which is a safer first step
than restraints or sedation .
1
, 3. A nurse is preparing to administer a blood transfusion to a client. Which of the following
actions is MOST important to prevent a transfusion error?
A) Verify the provider's prescription for the blood transfusion.
B) Check the client's vital signs 15 minutes after the transfusion begins.
C) Assess the client's IV site for patency and redness.
D) Verify the client's identity using two unique identifiers (e.g., name and date of birth).
Answer: D. Verifying the client's identity using two identifiers is the priority action to prevent a
fatal transfusion reaction. This is a critical safety step .
4. A nurse observes a colleague taking a photograph of a client without consent. Which action
should the nurse take FIRST?
A) Report the colleague to the nursing supervisor.
B) Notify the hospital's privacy officer.
C) Speak to the colleague privately to address the concern.
D) Ignore the behavior to avoid conflict.
Answer: C. The nurse should first address the concern directly with the colleague in private. If
the behavior continues, it should then be reported to a supervisor or privacy officer .
5. A nurse is caring for a client who is refusing a prescribed blood transfusion. The client's
family insists that the transfusion be given. Which action should the nurse take?
A) Respect the client's decision and document the refusal.
B) Proceed with the transfusion after obtaining consent from the family.
C) Notify the healthcare provider to obtain a court order.
D) Explain the risks to the family and proceed with the transfusion.
Answer: A. A competent adult client has the right to refuse treatment. The nurse must respect
the client's autonomy and document the refusal .
6. A client is scheduled for surgery and has a living will that states "do not resuscitate" (DNR).
The client's family requests that resuscitation be attempted if needed. What should the nurse
do?
A) Follow the family's request and initiate resuscitation.
B) Notify the provider to discuss the matter with the client's family.
C) Consult the hospital ethics committee.
D) Follow the client's living will and honor the DNR order.
Answer: D. The client's living will is a legally binding document. The nurse must honor the
client's documented wishes. The provider should be consulted to discuss the family's concerns,
but the DNR order remains in effect .
2
, 7. A nurse is preparing to give a handoff report to the oncoming shift. Which communication
tool is most effective for ensuring continuity of care and patient safety?
A) SBAR (Situation, Background, Assessment, Recommendation)
B) Providing a written report only
C) Giving a verbal report without any documentation
D) A brief summary of the client's current status
Answer: A. SBAR is a standardized, structured communication method that ensures critical
information is communicated clearly and concisely, improving patient safety and continuity of
care .
8. A nurse is caring for a client with a new tracheostomy. The nurse notes thick secretions.
What action should the nurse take FIRST?
A) Suction the tracheostomy.
B) Increase the client's fluid intake.
C) Change the tracheostomy ties.
D) Administer an antibiotic.
Answer: A. Thick secretions can block the airway, which is a life-threatening emergency.
Suctioning the tracheostomy is the priority action to clear the airway .
9. A client is on contact precautions for a wound infection. Which of the following is a correct
action by the nurse?
A) Wear an N95 respirator when entering the room.
B) Place the client in a negative pressure room.
C) Wear gloves and a gown when providing direct care.
D) Keep the door closed at all times.
Answer: C. Contact precautions require the use of a gown and gloves. Airborne precautions
(N95, negative pressure) are used for tuberculosis, measles, and varicella .
10. A client is being discharged with a new colostomy. Which action should the nurse take to
ensure the client understands how to care for the stoma and appliance?
A) Provide verbal instructions only.
B) Provide written instructions and use the teach-back method.
C) Refer the client to a support group.
D) Ask a family member to perform the care.
Answer: B. Using the teach-back method confirms the client's understanding by having them
demonstrate or explain the care. This is the most effective way to ensure learning and safety .
3
