MEDICAL SURGERY HESI EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
*Core Domains*
*Perioperative Nursing Care*
*Fluid and Electrolyte Management*
*Cardiovascular System Disorders*
*Respiratory Pathophysiology*
*Endocrine and Metabolic Stability*
*Gastrointestinal and Nutritional Support*
*Neurological Assessment and Intervention*
*Integumentary and Wound Management*
*Introduction*
*This examination serves to evaluate the clinical proficiency and theoretical knowledge of
nursing students within the medical-surgical specialty. It assesses mastery across diverse
physiological systems, prioritizing patient safety, evidence-based practice, and critical
decision-making. The structure utilizes both foundational theory and complex, scenario-
based questions to mirror the realities of acute care environments. Candidates are tested on
their ability to synthesize clinical data, implement appropriate interventions, and adhere to
legal and ethical professional standards. Successful completion demonstrates the requisite
competence for professional nursing practice, emphasizing clinical judgment, effective
nursing process application, and the delivery of high-quality, patient-centered healthcare
interventions.*
SECTION ONE: QUESTIONS 1–100
1. A patient arrives in the post-anesthesia care unit following an abdominal surgery.
Which assessment finding requires the most immediate intervention? A. Respiratory
rate of 10 breaths per minute B. Oxygen saturation of 92% C. Patient reporting pain
level of 7 out of 10 D. Absent bowel sounds in all four quadrants A. Respiratory
rate of 10 breaths per minute Explanation: A respiratory rate of 10 is indicative of
potential respiratory depression, often a side effect of anesthesia or opioid
, analgesics, which requires immediate nursing intervention to ensure airway patency
and ventilation.
2. A patient with hyperkalemia is prescribed sodium polystyrene sulfonate. What is the
priority nursing action when administering this medication? A. Monitor for signs of
fluid overload B. Assess bowel sounds before and after administration C. Document
the patient’s intake and output D. Monitor blood pressure for hypotension B.
Assess bowel sounds before and after administration Explanation: Sodium
polystyrene sulfonate works by exchanging sodium for potassium in the bowel. It is
contraindicated if bowel sounds are absent, as this increases the risk of intestinal
necrosis.
3. Which dietary modification should the nurse recommend for a patient diagnosed
with chronic gastritis to reduce irritation? A. Increase intake of acidic citrus fruits B.
Consume small, frequent meals throughout the day C. Eat large meals to increase
gastric emptying D. Eliminate all dairy products permanently B. Consume small,
frequent meals throughout the day Explanation: Small, frequent meals help to
neutralize gastric acid and reduce the stress placed on the stomach lining, which is
essential for managing gastritis symptoms.
4. When caring for a patient with a suspected deep vein thrombosis (DVT), which action
should the nurse avoid? A. Elevating the affected extremity B. Applying warm
compresses to the area C. Massaging the affected leg D. Administering
anticoagulants as ordered C. Massaging the affected leg Explanation:
Massaging an area with a suspected DVT can dislodge the thrombus, potentially
causing a pulmonary embolism, which is a life-threatening complication.
5. A patient with type 1 diabetes mellitus is found confused, diaphoretic, and
tremulous. What is the nurse's priority action? A. Administer regular insulin B. Check
the patient's blood glucose level C. Provide a high-protein snack D. Document the
neurologic assessment B. Check the patient's blood glucose level
Explanation: The patient is exhibiting classic signs of hypoglycemia. Checking the
blood glucose level provides the definitive diagnostic data required to initiate the
appropriate protocol for glycemic correction.
6. Which assessment finding in a patient with a chest tube indicates that the system is
functioning correctly? A. Continuous bubbling in the water seal chamber B. Absence
of fluctuations in the water seal chamber C. Intermittent bubbling in the water seal
chamber during expiration D. Tidaling in the water seal chamber D. Tidaling in
the water seal chamber Explanation: Tidaling is the expected fluctuation of fluid
in the water seal chamber that corresponds with the patient’s respiratory cycle,
indicating the chest tube is patent and correctly positioned.
,7. A patient is scheduled for a cholecystectomy. Which statement by the patient
indicates an understanding of the procedure? A. I will need to take medication to
digest fats for the rest of my life. B. My gallbladder will be removed through small
incisions in my abdomen. C. This surgery will cure my chronic constipation. D. I will
have a large open incision that will require daily packing. B. My gallbladder will
be removed through small incisions in my abdomen. Explanation: A laparoscopic
cholecystectomy is the standard approach, involving minimal incisions, which allows
for faster recovery compared to an open procedure.
8. When developing a plan of care for a patient with pressure injuries, which
intervention is most effective for prevention? A. Repositioning the patient every 4
hours B. Using donut-shaped cushions for pressure relief C. Maintaining a dry,
wrinkle-free bed linen surface D. Applying heat lamps to the sacral area C.
Maintaining a dry, wrinkle-free bed linen surface Explanation: Preventing
moisture and friction by keeping bed linens dry and wrinkle-free is essential in
reducing the risk of skin breakdown and pressure injury development.
9. A patient with heart failure is receiving furosemide. Which lab value should the nurse
monitor most closely? A. Serum sodium B. Serum potassium C. Blood urea nitrogen
D. Serum calcium B. Serum potassium Explanation: Furosemide is a loop
diuretic that promotes the excretion of potassium in the urine. Hypokalemia is a
common and dangerous side effect that requires consistent monitoring.
10. A patient reports severe pain in the right lower quadrant with rebound tenderness.
Which condition should the nurse suspect? A. Cholecystitis B. Appendicitis C.
Diverticulitis D. Pancreatitis B. Appendicitis Explanation: Pain in the right
lower quadrant, specifically at McBurney's point, accompanied by rebound
tenderness, is a hallmark clinical presentation of acute appendicitis.
11. What is the primary purpose of incentive spirometry postoperatively? A. To increase
total lung capacity B. To prevent atelectasis and pneumonia C. To decrease the
patient’s pain level D. To facilitate the clearance of carbon dioxide B. To prevent
atelectasis and pneumonia Explanation: Incentive spirometry encourages deep
breathing, which helps expand the alveoli and clear secretions, effectively preventing
postoperative pulmonary complications like atelectasis.
12. A patient with cirrhosis exhibits ascites. Which nursing intervention is most
appropriate? A. Encourage a high-protein diet B. Monitor abdominal girth daily C.
Administer diuretics as needed to eliminate all fluid D. Restrict all fluid intake B.
Monitor abdominal girth daily Explanation: Daily measurement of abdominal
girth allows the nurse to quantify the accumulation of fluid in the peritoneal cavity,
which is crucial for tracking the progression of ascites.
, 13. A patient is diagnosed with a pneumothorax. What is the expected priority outcome
of care? A. Return of lung expansion B. Decrease in pain intensity C. Stabilization of
cardiac rhythm D. Improved dietary intake A. Return of lung expansion
Explanation: A pneumothorax occurs when air enters the pleural space, causing lung
collapse. The primary goal of intervention, such as chest tube insertion, is to re-
establish negative pressure and expand the lung.
14. Which symptom is most indicative of a pulmonary embolism? A. Sudden onset of
dyspnea and chest pain B. Gradual development of a productive cough C. Peripheral
edema in both ankles D. Bradycardia A. Sudden onset of dyspnea and chest pain
Explanation: A pulmonary embolism typically presents with sudden respiratory
distress, pleuritic chest pain, and tachycardia, requiring emergency medical
intervention.
15. When administering blood products, what is the nurse's first action if a transfusion
reaction is suspected? A. Notify the physician B. Slow the infusion rate C. Stop the
infusion D. Obtain a blood sample C. Stop the infusion Explanation: Stopping
the transfusion immediately is the most critical intervention to prevent further
introduction of the antigen and minimize the severity of the reaction.
16. A patient with chronic obstructive pulmonary disease (COPD) is using pursed-lip
breathing. What is the primary benefit of this technique? A. It increases oxygen
concentration in the blood B. It promotes carbon dioxide elimination by prolonging
exhalation C. It reduces the work of the diaphragm D. It prevents the patient from
coughing B. It promotes carbon dioxide elimination by prolonging exhalation
Explanation: Pursed-lip breathing creates backpressure that keeps airways open
longer, allowing for more complete exhalation of trapped air and carbon dioxide.
17. A patient post-thyroidectomy complains of tingling around the mouth and fingers.
Which action should the nurse take? A. Administer a sedative B. Assess for Chvostek's
sign C. Encourage deep breathing exercises D. Apply a cold compress to the neck
B. Assess for Chvostek's sign Explanation: Tingling around the mouth and
extremities following a thyroidectomy suggests hypocalcemia, which can occur due
to accidental damage to the parathyroid glands. Chvostek's sign is an assessment for
this electrolyte imbalance.
18. What is the priority nursing diagnosis for a patient with a severe burn injury during
the emergent phase? A. Impaired physical mobility B. Deficient fluid volume C. Risk
for infection D. Disturbed body image B. Deficient fluid volume Explanation:
During the emergent phase of a burn, fluid shift from the intravascular space to the
interstitial space occurs rapidly, leading to hypovolemia, making fluid volume deficit
the primary concern.
DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
*Core Domains*
*Perioperative Nursing Care*
*Fluid and Electrolyte Management*
*Cardiovascular System Disorders*
*Respiratory Pathophysiology*
*Endocrine and Metabolic Stability*
*Gastrointestinal and Nutritional Support*
*Neurological Assessment and Intervention*
*Integumentary and Wound Management*
*Introduction*
*This examination serves to evaluate the clinical proficiency and theoretical knowledge of
nursing students within the medical-surgical specialty. It assesses mastery across diverse
physiological systems, prioritizing patient safety, evidence-based practice, and critical
decision-making. The structure utilizes both foundational theory and complex, scenario-
based questions to mirror the realities of acute care environments. Candidates are tested on
their ability to synthesize clinical data, implement appropriate interventions, and adhere to
legal and ethical professional standards. Successful completion demonstrates the requisite
competence for professional nursing practice, emphasizing clinical judgment, effective
nursing process application, and the delivery of high-quality, patient-centered healthcare
interventions.*
SECTION ONE: QUESTIONS 1–100
1. A patient arrives in the post-anesthesia care unit following an abdominal surgery.
Which assessment finding requires the most immediate intervention? A. Respiratory
rate of 10 breaths per minute B. Oxygen saturation of 92% C. Patient reporting pain
level of 7 out of 10 D. Absent bowel sounds in all four quadrants A. Respiratory
rate of 10 breaths per minute Explanation: A respiratory rate of 10 is indicative of
potential respiratory depression, often a side effect of anesthesia or opioid
, analgesics, which requires immediate nursing intervention to ensure airway patency
and ventilation.
2. A patient with hyperkalemia is prescribed sodium polystyrene sulfonate. What is the
priority nursing action when administering this medication? A. Monitor for signs of
fluid overload B. Assess bowel sounds before and after administration C. Document
the patient’s intake and output D. Monitor blood pressure for hypotension B.
Assess bowel sounds before and after administration Explanation: Sodium
polystyrene sulfonate works by exchanging sodium for potassium in the bowel. It is
contraindicated if bowel sounds are absent, as this increases the risk of intestinal
necrosis.
3. Which dietary modification should the nurse recommend for a patient diagnosed
with chronic gastritis to reduce irritation? A. Increase intake of acidic citrus fruits B.
Consume small, frequent meals throughout the day C. Eat large meals to increase
gastric emptying D. Eliminate all dairy products permanently B. Consume small,
frequent meals throughout the day Explanation: Small, frequent meals help to
neutralize gastric acid and reduce the stress placed on the stomach lining, which is
essential for managing gastritis symptoms.
4. When caring for a patient with a suspected deep vein thrombosis (DVT), which action
should the nurse avoid? A. Elevating the affected extremity B. Applying warm
compresses to the area C. Massaging the affected leg D. Administering
anticoagulants as ordered C. Massaging the affected leg Explanation:
Massaging an area with a suspected DVT can dislodge the thrombus, potentially
causing a pulmonary embolism, which is a life-threatening complication.
5. A patient with type 1 diabetes mellitus is found confused, diaphoretic, and
tremulous. What is the nurse's priority action? A. Administer regular insulin B. Check
the patient's blood glucose level C. Provide a high-protein snack D. Document the
neurologic assessment B. Check the patient's blood glucose level
Explanation: The patient is exhibiting classic signs of hypoglycemia. Checking the
blood glucose level provides the definitive diagnostic data required to initiate the
appropriate protocol for glycemic correction.
6. Which assessment finding in a patient with a chest tube indicates that the system is
functioning correctly? A. Continuous bubbling in the water seal chamber B. Absence
of fluctuations in the water seal chamber C. Intermittent bubbling in the water seal
chamber during expiration D. Tidaling in the water seal chamber D. Tidaling in
the water seal chamber Explanation: Tidaling is the expected fluctuation of fluid
in the water seal chamber that corresponds with the patient’s respiratory cycle,
indicating the chest tube is patent and correctly positioned.
,7. A patient is scheduled for a cholecystectomy. Which statement by the patient
indicates an understanding of the procedure? A. I will need to take medication to
digest fats for the rest of my life. B. My gallbladder will be removed through small
incisions in my abdomen. C. This surgery will cure my chronic constipation. D. I will
have a large open incision that will require daily packing. B. My gallbladder will
be removed through small incisions in my abdomen. Explanation: A laparoscopic
cholecystectomy is the standard approach, involving minimal incisions, which allows
for faster recovery compared to an open procedure.
8. When developing a plan of care for a patient with pressure injuries, which
intervention is most effective for prevention? A. Repositioning the patient every 4
hours B. Using donut-shaped cushions for pressure relief C. Maintaining a dry,
wrinkle-free bed linen surface D. Applying heat lamps to the sacral area C.
Maintaining a dry, wrinkle-free bed linen surface Explanation: Preventing
moisture and friction by keeping bed linens dry and wrinkle-free is essential in
reducing the risk of skin breakdown and pressure injury development.
9. A patient with heart failure is receiving furosemide. Which lab value should the nurse
monitor most closely? A. Serum sodium B. Serum potassium C. Blood urea nitrogen
D. Serum calcium B. Serum potassium Explanation: Furosemide is a loop
diuretic that promotes the excretion of potassium in the urine. Hypokalemia is a
common and dangerous side effect that requires consistent monitoring.
10. A patient reports severe pain in the right lower quadrant with rebound tenderness.
Which condition should the nurse suspect? A. Cholecystitis B. Appendicitis C.
Diverticulitis D. Pancreatitis B. Appendicitis Explanation: Pain in the right
lower quadrant, specifically at McBurney's point, accompanied by rebound
tenderness, is a hallmark clinical presentation of acute appendicitis.
11. What is the primary purpose of incentive spirometry postoperatively? A. To increase
total lung capacity B. To prevent atelectasis and pneumonia C. To decrease the
patient’s pain level D. To facilitate the clearance of carbon dioxide B. To prevent
atelectasis and pneumonia Explanation: Incentive spirometry encourages deep
breathing, which helps expand the alveoli and clear secretions, effectively preventing
postoperative pulmonary complications like atelectasis.
12. A patient with cirrhosis exhibits ascites. Which nursing intervention is most
appropriate? A. Encourage a high-protein diet B. Monitor abdominal girth daily C.
Administer diuretics as needed to eliminate all fluid D. Restrict all fluid intake B.
Monitor abdominal girth daily Explanation: Daily measurement of abdominal
girth allows the nurse to quantify the accumulation of fluid in the peritoneal cavity,
which is crucial for tracking the progression of ascites.
, 13. A patient is diagnosed with a pneumothorax. What is the expected priority outcome
of care? A. Return of lung expansion B. Decrease in pain intensity C. Stabilization of
cardiac rhythm D. Improved dietary intake A. Return of lung expansion
Explanation: A pneumothorax occurs when air enters the pleural space, causing lung
collapse. The primary goal of intervention, such as chest tube insertion, is to re-
establish negative pressure and expand the lung.
14. Which symptom is most indicative of a pulmonary embolism? A. Sudden onset of
dyspnea and chest pain B. Gradual development of a productive cough C. Peripheral
edema in both ankles D. Bradycardia A. Sudden onset of dyspnea and chest pain
Explanation: A pulmonary embolism typically presents with sudden respiratory
distress, pleuritic chest pain, and tachycardia, requiring emergency medical
intervention.
15. When administering blood products, what is the nurse's first action if a transfusion
reaction is suspected? A. Notify the physician B. Slow the infusion rate C. Stop the
infusion D. Obtain a blood sample C. Stop the infusion Explanation: Stopping
the transfusion immediately is the most critical intervention to prevent further
introduction of the antigen and minimize the severity of the reaction.
16. A patient with chronic obstructive pulmonary disease (COPD) is using pursed-lip
breathing. What is the primary benefit of this technique? A. It increases oxygen
concentration in the blood B. It promotes carbon dioxide elimination by prolonging
exhalation C. It reduces the work of the diaphragm D. It prevents the patient from
coughing B. It promotes carbon dioxide elimination by prolonging exhalation
Explanation: Pursed-lip breathing creates backpressure that keeps airways open
longer, allowing for more complete exhalation of trapped air and carbon dioxide.
17. A patient post-thyroidectomy complains of tingling around the mouth and fingers.
Which action should the nurse take? A. Administer a sedative B. Assess for Chvostek's
sign C. Encourage deep breathing exercises D. Apply a cold compress to the neck
B. Assess for Chvostek's sign Explanation: Tingling around the mouth and
extremities following a thyroidectomy suggests hypocalcemia, which can occur due
to accidental damage to the parathyroid glands. Chvostek's sign is an assessment for
this electrolyte imbalance.
18. What is the priority nursing diagnosis for a patient with a severe burn injury during
the emergent phase? A. Impaired physical mobility B. Deficient fluid volume C. Risk
for infection D. Disturbed body image B. Deficient fluid volume Explanation:
During the emergent phase of a burn, fluid shift from the intravascular space to the
interstitial space occurs rapidly, leading to hypovolemia, making fluid volume deficit
the primary concern.
