HESI MED SURG RN EXAM QUESTIONS AND
ANSWERS (2021/ 2022 UPDATE)
SECTION I: PERIOPERATIVE NURSING
1. A patient is scheduled for surgery in 2 hours. The nurse reviews the preoperative checklist.
Which finding requires immediate intervention?
A. The patient's hemoglobin is 11.2 g/dL
B. The patient ate a light breakfast 3 hours ago
C. The patient's potassium is 3.2 mEq/L
D. The patient took metformin this morning
Correct Answer: B
Rationale: Eating within 6–8 hours of surgery increases the risk of aspiration during
anesthesia. The nurse must notify the surgeon and anesthesia provider immediately; surgery
may be delayed or cancelled. Hemoglobin of 11.2 g/dL is slightly low but not immediately
dangerous. Potassium of 3.2 mEq/L is low but not the priority over aspiration risk. Metformin is
typically held before surgery, but the immediate threat is the full stomach.
2. The nurse is teaching a patient about postoperative deep vein thrombosis (DVT)
prevention. Which statements indicate understanding? (SATA)
A. "I will perform ankle pumps every hour while awake."
B. "I should massage my legs daily to improve circulation."
C. "I will use the incentive spirometer 10 times every hour."
D. "I should drink plenty of fluids unless otherwise restricted."
E. "I will cross my legs when sitting to reduce swelling."
Correct Answers: A, C, D
Rationale: Ankle pumps promote venous return and prevent stasis. Incentive spirometry
prevents respiratory complications but also encourages mobility and circulation. Adequate
hydration prevents dehydration and hypercoagulability. Massaging the legs is contraindicated
because it can dislodge a clot. Crossing the legs impedes venous return and increases DVT risk.
,3. A patient is 24 hours postoperative following abdominal surgery. The nurse notes the
patient's wound edges are approximated with staples, and there is serosanguineous drainage
on the dressing. Which action is most appropriate?
A. Change the dressing every 2 hours
B. Reinforce the dressing and document the finding
C. Apply warm compresses to the wound
D. Notify the surgeon immediately
Correct Answer: B
Rationale: Serosanguineous drainage is normal in the first 24–48 hours after surgery.
Reinforcing the dressing and documenting is appropriate. Changing the dressing every 2 hours is
unnecessary and may increase infection risk. Warm compresses are not indicated. Notifying the
surgeon is not urgent for expected drainage.
4. The nurse is caring for a patient recovering from general anesthesia. Which assessment
finding is the priority?
A. Blood pressure 110/70 mm Hg
B. Respiratory rate 8 breaths/min and shallow
C. Temperature 99.1°F (37.3°C)
D. Pain level 4/10 at the surgical site
Correct Answer: B
Rationale: A respiratory rate of 8 breaths/min with shallow breathing indicates respiratory
depression, a life-threatening complication of anesthesia. Airway and breathing take priority.
Blood pressure of 110/70 is acceptable. Low-grade temperature is common postoperatively.
Pain is important but not the immediate priority.
5. A patient scheduled for colon surgery asks why they must take neomycin and erythromycin
preoperatively. What is the nurse's best response?
A. "These medications prevent blood clots during surgery."
B. "These antibiotics reduce the bacteria in your bowel to prevent infection."
C. "These medications help you relax before surgery."
D. "These antibiotics treat an infection you already have."
Correct Answer: B
Rationale: Neomycin and erythromycin are nonabsorbable antibiotics used for bowel
,preparation to reduce intestinal flora and prevent surgical site infection during colorectal
surgery. They do not prevent clots, provide sedation, or treat existing infections.
6. The nurse is performing a preoperative assessment. Which finding places the patient at
highest risk for surgical complications?
A. History of asthma controlled with an inhaler
B. Body mass index (BMI) of 42
C. Allergy to penicillin
D. Occasional alcohol use
Correct Answer: B
Rationale: A BMI of 42 indicates severe obesity, which increases risks including poor wound
healing, DVT, respiratory complications, and anesthesia difficulties. Controlled asthma, penicillin
allergy, and occasional alcohol use are manageable risks but not the highest priority.
7. A patient is in the PACU following surgery. The patient's Aldrete score is 8. What is the
nurse's priority action?
A. Prepare the patient for discharge from PACU
B. Continue monitoring and reassess in 30 minutes
C. Administer oxygen at 2 L/min
D. Notify the surgeon of the score
Correct Answer: B
Rationale: An Aldrete score of 8 indicates the patient is not yet ready for discharge (score of
9–10 is typically required). The nurse should continue monitoring and reassess. Oxygen may or
may not be indicated. Notifying the surgeon is not necessary for this score.
8. The nurse is teaching a patient about using an incentive spirometer postoperatively. Which
instruction is correct?
A. "Inhale quickly and forcefully through the mouthpiece."
B. "Exhale slowly and deeply into the mouthpiece."
C. "Inhale slowly and deeply, holding your breath for 3 seconds."
D. "Use the spirometer only when you feel short of breath."
, Correct Answer: C
Rationale: The incentive spirometer is used with slow, deep inhalation, holding the breath
for approximately 3 seconds to promote alveolar expansion. Quick forceful inhalation does not
achieve optimal lung expansion. Exhaling into the device is incorrect. The spirometer should be
used routinely, not just when short of breath.
9. A patient is 3 days postoperative and reports calf pain, warmth, and swelling in the left leg.
Which action should the nurse take first?
A. Apply a heating pad to the affected calf
B. Massage the affected leg to relieve pain
C. Notify the provider and keep the leg elevated
D. Ambulate the patient to improve circulation
Correct Answer: C
Rationale: These signs suggest DVT. The nurse should notify the provider immediately and
keep the leg elevated to reduce swelling. Heat, massage, and ambulation are contraindicated
because they may dislodge the clot, causing pulmonary embolism.
10. The nurse is reviewing discharge instructions with a patient who had a laparoscopic
cholecystectomy. Which statement indicates a need for further teaching?
A. "I should avoid heavy lifting for 2 weeks."
B. "I can expect some shoulder pain from the gas."
C. "I will take my prescribed opioid every 4 hours even if I have no pain."
D. "I should call my doctor if I develop a fever over 101°F."
Correct Answer: C
Rationale: Opioid pain medication should be taken as needed for pain, not on a fixed
schedule when pain is absent. Taking opioids unnecessarily increases the risk of constipation,
respiratory depression, and dependency. The other statements are correct.
11. A patient is being prepared for surgery and asks the nurse to explain "informed consent."
Which statement by the nurse is most accurate?
A. "The surgeon will explain the procedure and you will sign the form."
B. "The nurse will explain the risks and you will sign the form."
ANSWERS (2021/ 2022 UPDATE)
SECTION I: PERIOPERATIVE NURSING
1. A patient is scheduled for surgery in 2 hours. The nurse reviews the preoperative checklist.
Which finding requires immediate intervention?
A. The patient's hemoglobin is 11.2 g/dL
B. The patient ate a light breakfast 3 hours ago
C. The patient's potassium is 3.2 mEq/L
D. The patient took metformin this morning
Correct Answer: B
Rationale: Eating within 6–8 hours of surgery increases the risk of aspiration during
anesthesia. The nurse must notify the surgeon and anesthesia provider immediately; surgery
may be delayed or cancelled. Hemoglobin of 11.2 g/dL is slightly low but not immediately
dangerous. Potassium of 3.2 mEq/L is low but not the priority over aspiration risk. Metformin is
typically held before surgery, but the immediate threat is the full stomach.
2. The nurse is teaching a patient about postoperative deep vein thrombosis (DVT)
prevention. Which statements indicate understanding? (SATA)
A. "I will perform ankle pumps every hour while awake."
B. "I should massage my legs daily to improve circulation."
C. "I will use the incentive spirometer 10 times every hour."
D. "I should drink plenty of fluids unless otherwise restricted."
E. "I will cross my legs when sitting to reduce swelling."
Correct Answers: A, C, D
Rationale: Ankle pumps promote venous return and prevent stasis. Incentive spirometry
prevents respiratory complications but also encourages mobility and circulation. Adequate
hydration prevents dehydration and hypercoagulability. Massaging the legs is contraindicated
because it can dislodge a clot. Crossing the legs impedes venous return and increases DVT risk.
,3. A patient is 24 hours postoperative following abdominal surgery. The nurse notes the
patient's wound edges are approximated with staples, and there is serosanguineous drainage
on the dressing. Which action is most appropriate?
A. Change the dressing every 2 hours
B. Reinforce the dressing and document the finding
C. Apply warm compresses to the wound
D. Notify the surgeon immediately
Correct Answer: B
Rationale: Serosanguineous drainage is normal in the first 24–48 hours after surgery.
Reinforcing the dressing and documenting is appropriate. Changing the dressing every 2 hours is
unnecessary and may increase infection risk. Warm compresses are not indicated. Notifying the
surgeon is not urgent for expected drainage.
4. The nurse is caring for a patient recovering from general anesthesia. Which assessment
finding is the priority?
A. Blood pressure 110/70 mm Hg
B. Respiratory rate 8 breaths/min and shallow
C. Temperature 99.1°F (37.3°C)
D. Pain level 4/10 at the surgical site
Correct Answer: B
Rationale: A respiratory rate of 8 breaths/min with shallow breathing indicates respiratory
depression, a life-threatening complication of anesthesia. Airway and breathing take priority.
Blood pressure of 110/70 is acceptable. Low-grade temperature is common postoperatively.
Pain is important but not the immediate priority.
5. A patient scheduled for colon surgery asks why they must take neomycin and erythromycin
preoperatively. What is the nurse's best response?
A. "These medications prevent blood clots during surgery."
B. "These antibiotics reduce the bacteria in your bowel to prevent infection."
C. "These medications help you relax before surgery."
D. "These antibiotics treat an infection you already have."
Correct Answer: B
Rationale: Neomycin and erythromycin are nonabsorbable antibiotics used for bowel
,preparation to reduce intestinal flora and prevent surgical site infection during colorectal
surgery. They do not prevent clots, provide sedation, or treat existing infections.
6. The nurse is performing a preoperative assessment. Which finding places the patient at
highest risk for surgical complications?
A. History of asthma controlled with an inhaler
B. Body mass index (BMI) of 42
C. Allergy to penicillin
D. Occasional alcohol use
Correct Answer: B
Rationale: A BMI of 42 indicates severe obesity, which increases risks including poor wound
healing, DVT, respiratory complications, and anesthesia difficulties. Controlled asthma, penicillin
allergy, and occasional alcohol use are manageable risks but not the highest priority.
7. A patient is in the PACU following surgery. The patient's Aldrete score is 8. What is the
nurse's priority action?
A. Prepare the patient for discharge from PACU
B. Continue monitoring and reassess in 30 minutes
C. Administer oxygen at 2 L/min
D. Notify the surgeon of the score
Correct Answer: B
Rationale: An Aldrete score of 8 indicates the patient is not yet ready for discharge (score of
9–10 is typically required). The nurse should continue monitoring and reassess. Oxygen may or
may not be indicated. Notifying the surgeon is not necessary for this score.
8. The nurse is teaching a patient about using an incentive spirometer postoperatively. Which
instruction is correct?
A. "Inhale quickly and forcefully through the mouthpiece."
B. "Exhale slowly and deeply into the mouthpiece."
C. "Inhale slowly and deeply, holding your breath for 3 seconds."
D. "Use the spirometer only when you feel short of breath."
, Correct Answer: C
Rationale: The incentive spirometer is used with slow, deep inhalation, holding the breath
for approximately 3 seconds to promote alveolar expansion. Quick forceful inhalation does not
achieve optimal lung expansion. Exhaling into the device is incorrect. The spirometer should be
used routinely, not just when short of breath.
9. A patient is 3 days postoperative and reports calf pain, warmth, and swelling in the left leg.
Which action should the nurse take first?
A. Apply a heating pad to the affected calf
B. Massage the affected leg to relieve pain
C. Notify the provider and keep the leg elevated
D. Ambulate the patient to improve circulation
Correct Answer: C
Rationale: These signs suggest DVT. The nurse should notify the provider immediately and
keep the leg elevated to reduce swelling. Heat, massage, and ambulation are contraindicated
because they may dislodge the clot, causing pulmonary embolism.
10. The nurse is reviewing discharge instructions with a patient who had a laparoscopic
cholecystectomy. Which statement indicates a need for further teaching?
A. "I should avoid heavy lifting for 2 weeks."
B. "I can expect some shoulder pain from the gas."
C. "I will take my prescribed opioid every 4 hours even if I have no pain."
D. "I should call my doctor if I develop a fever over 101°F."
Correct Answer: C
Rationale: Opioid pain medication should be taken as needed for pain, not on a fixed
schedule when pain is absent. Taking opioids unnecessarily increases the risk of constipation,
respiratory depression, and dependency. The other statements are correct.
11. A patient is being prepared for surgery and asks the nurse to explain "informed consent."
Which statement by the nurse is most accurate?
A. "The surgeon will explain the procedure and you will sign the form."
B. "The nurse will explain the risks and you will sign the form."
