1
NSG 233 Medical-Surgical Nursing II HESI Final
Exam Herzing University Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Safe & Effective Care Environment | Q1 – Q10
Section 2 | Health Promotion & Maintenance | Q11 – Q20
Section 3 | Psychosocial Integrity | Q21 – Q30
Section 4 | Physiological Integrity (Basic Care, Comfort, Pharmacology, Parenteral
Therapies) | Q31 – Q40
Section 5 | Physiological Integrity (Physiological Adaptation & NGN Clinical
Judgment) | Q41 – Q50
Instructions: Choose the single best answer. Pass: 75% in 90 minutes.
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client with heart failure reports new-onset dyspnea and has an
oxygen saturation of 89% on room air. The unlicensed assistive personnel offers to
obtain the vital signs while the nurse prepares to administer oxygen. What action
should the nurse take first?
,2
A. Assess the client's respiratory status and apply oxygen immediately ✓
CORRECT
B. Ask the UAP to apply the oxygen while the nurse obtains vital signs
C. Instruct the UAP to obtain the vital signs while the nurse applies oxygen
D. Perform a complete head-to-toe assessment before any interventions
Correct Answer: A
Rationale: An unstable client with dyspnea and hypoxia requires immediate RN
assessment and intervention, which cannot be delegated to UAP. Asking the UAP
to apply oxygen is inappropriate because UAP cannot manage unstable patients or
administer oxygen without direct RN supervision. On the HESI exam, always
prioritize ABCs and remember that RNs must directly manage unstable clients.
Question 2 of 50
A 45-year-old client is admitted with severe diarrhea and a Clostridium difficile
infection. The client is in a double-occupancy room. What is the priority nursing
action to prevent transmission?
A. Move the client to a negative pressure isolation room
B. Don a gown and gloves before entering the client's room ✓ CORRECT
C. Place a surgical mask on the client during transport
D. Assign the client to a room with another client who has C. difficile
Correct Answer: B
Rationale: C. difficile requires contact precautions, which mandate the use of a
gown and gloves to prevent transmission via direct contact with the patient or
contaminated environment. Negative pressure rooms are reserved for airborne
,3
pathogens like tuberculosis, not C. difficile. Alcohol-based hand rubs are
ineffective against C. difficile spores, so hand hygiene must be performed with
soap and water.
Question 3 of 50
A nurse is caring for four clients on a medical-surgical unit. The client in Room
201 is post-operative day one from an appendectomy requesting pain medication;
the client in Room 202 is an 80-year-old with an acute asthma exacerbation with
wheezing; the client in Room 203 is a 55-year-old with new-onset chest pain and
diaphoresis; the client in Room 204 is a diabetic with a blood glucose of 140
mg/dL. Which client should the nurse assess first?
A. The post-operative client requesting pain medication
B. The client with an acute asthma exacerbation
C. The client with new-onset chest pain and diaphoresis ✓ CORRECT
D. The diabetic client with a blood glucose of 140 mg/dL
Correct Answer: C
Rationale: New-onset chest pain and diaphoresis indicate a potential acute
myocardial infarction, which is an immediate life threat requiring rapid assessment
and intervention to preserve myocardial tissue. While the asthma exacerbation is a
respiratory issue, it is ongoing, whereas the chest pain represents a new, potentially
lethal acute event. Use the ABCs and Maslow's hierarchy to prioritize acute life
threats over chronic conditions or comfort issues.
Question 4 of 50
, 4
A hospital unit is responding to a mass casualty incident. A 35-year-old client
arrives with a penetrating chest wound, severe respiratory distress, and absent
breath sounds on the left side. Using the START triage system, what tag should the
nurse assign to this client?
A. Green tag indicating minimal injuries
B. Yellow tag indicating delayed care
C. Black tag indicating expectant care
D. Red tag indicating immediate care ✓ CORRECT
Correct Answer: D
Rationale: A penetrating chest wound with severe respiratory distress and absent
breath sounds is a life-threatening injury requiring immediate intervention,
categorizing the client as a red tag. A yellow tag is for serious but non-life-
threatening injuries, while a black tag is for injuries that are fatal or where the
client is deceased. In disaster triage, focus on doing the greatest good for the
greatest number by rapidly identifying those who need immediate life-saving care.
Question 5 of 50
A 78-year-old client with dementia is admitted to the medical-surgical unit after a
fall at home. The client keeps attempting to climb out of bed despite repeated
instructions to stay in bed. What is the most appropriate initial nursing
intervention?
A. Place the client in a low bed with a nonskid floor mat ✓ CORRECT
B. Apply a vest restraint to prevent the client from falling
C. Administer a prescribed sedative to calm the client
D. Raise all four side rails to keep the client in bed
NSG 233 Medical-Surgical Nursing II HESI Final
Exam Herzing University Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Safe & Effective Care Environment | Q1 – Q10
Section 2 | Health Promotion & Maintenance | Q11 – Q20
Section 3 | Psychosocial Integrity | Q21 – Q30
Section 4 | Physiological Integrity (Basic Care, Comfort, Pharmacology, Parenteral
Therapies) | Q31 – Q40
Section 5 | Physiological Integrity (Physiological Adaptation & NGN Clinical
Judgment) | Q41 – Q50
Instructions: Choose the single best answer. Pass: 75% in 90 minutes.
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client with heart failure reports new-onset dyspnea and has an
oxygen saturation of 89% on room air. The unlicensed assistive personnel offers to
obtain the vital signs while the nurse prepares to administer oxygen. What action
should the nurse take first?
,2
A. Assess the client's respiratory status and apply oxygen immediately ✓
CORRECT
B. Ask the UAP to apply the oxygen while the nurse obtains vital signs
C. Instruct the UAP to obtain the vital signs while the nurse applies oxygen
D. Perform a complete head-to-toe assessment before any interventions
Correct Answer: A
Rationale: An unstable client with dyspnea and hypoxia requires immediate RN
assessment and intervention, which cannot be delegated to UAP. Asking the UAP
to apply oxygen is inappropriate because UAP cannot manage unstable patients or
administer oxygen without direct RN supervision. On the HESI exam, always
prioritize ABCs and remember that RNs must directly manage unstable clients.
Question 2 of 50
A 45-year-old client is admitted with severe diarrhea and a Clostridium difficile
infection. The client is in a double-occupancy room. What is the priority nursing
action to prevent transmission?
A. Move the client to a negative pressure isolation room
B. Don a gown and gloves before entering the client's room ✓ CORRECT
C. Place a surgical mask on the client during transport
D. Assign the client to a room with another client who has C. difficile
Correct Answer: B
Rationale: C. difficile requires contact precautions, which mandate the use of a
gown and gloves to prevent transmission via direct contact with the patient or
contaminated environment. Negative pressure rooms are reserved for airborne
,3
pathogens like tuberculosis, not C. difficile. Alcohol-based hand rubs are
ineffective against C. difficile spores, so hand hygiene must be performed with
soap and water.
Question 3 of 50
A nurse is caring for four clients on a medical-surgical unit. The client in Room
201 is post-operative day one from an appendectomy requesting pain medication;
the client in Room 202 is an 80-year-old with an acute asthma exacerbation with
wheezing; the client in Room 203 is a 55-year-old with new-onset chest pain and
diaphoresis; the client in Room 204 is a diabetic with a blood glucose of 140
mg/dL. Which client should the nurse assess first?
A. The post-operative client requesting pain medication
B. The client with an acute asthma exacerbation
C. The client with new-onset chest pain and diaphoresis ✓ CORRECT
D. The diabetic client with a blood glucose of 140 mg/dL
Correct Answer: C
Rationale: New-onset chest pain and diaphoresis indicate a potential acute
myocardial infarction, which is an immediate life threat requiring rapid assessment
and intervention to preserve myocardial tissue. While the asthma exacerbation is a
respiratory issue, it is ongoing, whereas the chest pain represents a new, potentially
lethal acute event. Use the ABCs and Maslow's hierarchy to prioritize acute life
threats over chronic conditions or comfort issues.
Question 4 of 50
, 4
A hospital unit is responding to a mass casualty incident. A 35-year-old client
arrives with a penetrating chest wound, severe respiratory distress, and absent
breath sounds on the left side. Using the START triage system, what tag should the
nurse assign to this client?
A. Green tag indicating minimal injuries
B. Yellow tag indicating delayed care
C. Black tag indicating expectant care
D. Red tag indicating immediate care ✓ CORRECT
Correct Answer: D
Rationale: A penetrating chest wound with severe respiratory distress and absent
breath sounds is a life-threatening injury requiring immediate intervention,
categorizing the client as a red tag. A yellow tag is for serious but non-life-
threatening injuries, while a black tag is for injuries that are fatal or where the
client is deceased. In disaster triage, focus on doing the greatest good for the
greatest number by rapidly identifying those who need immediate life-saving care.
Question 5 of 50
A 78-year-old client with dementia is admitted to the medical-surgical unit after a
fall at home. The client keeps attempting to climb out of bed despite repeated
instructions to stay in bed. What is the most appropriate initial nursing
intervention?
A. Place the client in a low bed with a nonskid floor mat ✓ CORRECT
B. Apply a vest restraint to prevent the client from falling
C. Administer a prescribed sedative to calm the client
D. Raise all four side rails to keep the client in bed
