HESI Medical-Surgical Nursing Exam Practice Newest 2026/2027
Questions and Correct Detailed Answers with Rationales Already
Graded A+
1. A patient is scheduled for an elective cholecystectomy in 4 hours. The nurse
notes the patient ate a light breakfast 2 hours ago. What is the nurse's priority
action?
A) Proceed with surgery as scheduled since it was only a light meal
B) Notify the surgeon and anesthesiologist immediately
C) Administer metoclopramide to promote gastric emptying
D) Reschedule the surgery for the following day without consulting the surgeon
Answer: B) Notify the surgeon and anesthesiologist immediately
Rationale: The standard NPO (nothing by mouth) guideline for elective surgery is
typically 6-8 hours for solid foods to reduce aspiration risk. Eating 2 hours before
surgery significantly increases the risk of aspiration during anesthesia induction.
The nurse must immediately notify the surgeon and anesthesiologist to
determine if the procedure should be delayed or cancelled. This is a patient safety
,issue that requires provider notification, not independent nursing decision or
masking the problem .
2. A postoperative patient develops wound dehiscence with evisceration 5 days
after abdominal surgery. What is the nurse's immediate action?
A) Apply sterile saline-soaked dressings and cover with sterile towel
B) Push the protruding organs back into the abdominal cavity
C) Remove the sutures to allow for better drainage
D) Place the patient in high Fowler's position
Answer: A) Apply sterile saline-soaked dressings and cover with sterile towel
Rationale: Wound dehiscence (separation of wound edges) with evisceration
(protrusion of organs) is a surgical emergency. The nurse must: (1) call for help
and notify surgeon immediately, (2) place patient in low Fowler's position with
knees flexed to reduce abdominal tension, (3) cover exposed organs with sterile
saline-soaked dressings to prevent desiccation, and (4) never attempt to reinsert
organs (risk of infection, trauma). Soaked dressings keep tissues moist; dry
dressings adhere and cause damage .
,3. A patient has a serum potassium level of 6.2 mEq/L. Which ECG change should
the nurse anticipate?
A) Peaked T waves, widened QRS complex, and absent P waves
B) ST segment elevation and pathological Q waves
C) Prolonged QT interval and flattened T waves
D) Sinus tachycardia with normal PR interval
Answer: A) Peaked T waves, widened QRS complex, and absent P waves
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) produces characteristic ECG changes
that progress with severity: peaked T waves (earliest sign), PR prolongation, P
wave flattening/absence, widened QRS (bundle branch block pattern), sine wave
pattern, and ventricular fibrillation/asystole. Option B describes MI changes.
Option C describes hypokalemia or hypocalcemia. Progression to remember:
Peaked T waves → PR prolongation → P waves disappear → QRS widens → sine
wave → cardiac arrest .
4. A patient is receiving IV therapy through a peripheral catheter. The nurse notes
the insertion site is cool, pale, and edematous with sluggish flow. The patient
complains of tightness and discomfort. What complication is occurring?
, A) Phlebitis
B) Infiltration
C) Air embolism
D) Septicemia
Answer: B) Infiltration
Rationale: Infiltration occurs when IV fluid leaks into interstitial tissue due to
catheter dislodgement or vein perforation. Signs include: coolness, pallor, edema,
sluggish or stopped flow, tightness, and discomfort at site. Phlebitis presents with
warmth, erythema, and tenderness along the vein. Air embolism causes sudden
dyspnea, chest pain, and cardiovascular collapse .
5. A patient with heart failure is experiencing sudden onset of shortness of breath
and a "wet" cough. Which electrolyte imbalance is the nurse most concerned
about when initiating high-dose furosemide?
A) Hypercalcemia
B) Hypokalemia
C) Hypernatremia
Questions and Correct Detailed Answers with Rationales Already
Graded A+
1. A patient is scheduled for an elective cholecystectomy in 4 hours. The nurse
notes the patient ate a light breakfast 2 hours ago. What is the nurse's priority
action?
A) Proceed with surgery as scheduled since it was only a light meal
B) Notify the surgeon and anesthesiologist immediately
C) Administer metoclopramide to promote gastric emptying
D) Reschedule the surgery for the following day without consulting the surgeon
Answer: B) Notify the surgeon and anesthesiologist immediately
Rationale: The standard NPO (nothing by mouth) guideline for elective surgery is
typically 6-8 hours for solid foods to reduce aspiration risk. Eating 2 hours before
surgery significantly increases the risk of aspiration during anesthesia induction.
The nurse must immediately notify the surgeon and anesthesiologist to
determine if the procedure should be delayed or cancelled. This is a patient safety
,issue that requires provider notification, not independent nursing decision or
masking the problem .
2. A postoperative patient develops wound dehiscence with evisceration 5 days
after abdominal surgery. What is the nurse's immediate action?
A) Apply sterile saline-soaked dressings and cover with sterile towel
B) Push the protruding organs back into the abdominal cavity
C) Remove the sutures to allow for better drainage
D) Place the patient in high Fowler's position
Answer: A) Apply sterile saline-soaked dressings and cover with sterile towel
Rationale: Wound dehiscence (separation of wound edges) with evisceration
(protrusion of organs) is a surgical emergency. The nurse must: (1) call for help
and notify surgeon immediately, (2) place patient in low Fowler's position with
knees flexed to reduce abdominal tension, (3) cover exposed organs with sterile
saline-soaked dressings to prevent desiccation, and (4) never attempt to reinsert
organs (risk of infection, trauma). Soaked dressings keep tissues moist; dry
dressings adhere and cause damage .
,3. A patient has a serum potassium level of 6.2 mEq/L. Which ECG change should
the nurse anticipate?
A) Peaked T waves, widened QRS complex, and absent P waves
B) ST segment elevation and pathological Q waves
C) Prolonged QT interval and flattened T waves
D) Sinus tachycardia with normal PR interval
Answer: A) Peaked T waves, widened QRS complex, and absent P waves
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) produces characteristic ECG changes
that progress with severity: peaked T waves (earliest sign), PR prolongation, P
wave flattening/absence, widened QRS (bundle branch block pattern), sine wave
pattern, and ventricular fibrillation/asystole. Option B describes MI changes.
Option C describes hypokalemia or hypocalcemia. Progression to remember:
Peaked T waves → PR prolongation → P waves disappear → QRS widens → sine
wave → cardiac arrest .
4. A patient is receiving IV therapy through a peripheral catheter. The nurse notes
the insertion site is cool, pale, and edematous with sluggish flow. The patient
complains of tightness and discomfort. What complication is occurring?
, A) Phlebitis
B) Infiltration
C) Air embolism
D) Septicemia
Answer: B) Infiltration
Rationale: Infiltration occurs when IV fluid leaks into interstitial tissue due to
catheter dislodgement or vein perforation. Signs include: coolness, pallor, edema,
sluggish or stopped flow, tightness, and discomfort at site. Phlebitis presents with
warmth, erythema, and tenderness along the vein. Air embolism causes sudden
dyspnea, chest pain, and cardiovascular collapse .
5. A patient with heart failure is experiencing sudden onset of shortness of breath
and a "wet" cough. Which electrolyte imbalance is the nurse most concerned
about when initiating high-dose furosemide?
A) Hypercalcemia
B) Hypokalemia
C) Hypernatremia
