HESI MEDICAL-SURGICAL NCLEX-RN EXAMINATION
PREPARATION BY HESI
SECTION I: PERIOPERATIVE NURSING CARE (Questions 1–15)
1. A client is scheduled for surgery in 2 hours. The nurse reviews the preoperative checklist.
Which finding requires immediate notification of the surgeon?
A. Blood pressure 138/86 mmHg
B. Serum potassium 3.1 mEq/L
C. Hemoglobin 13.2 g/dL
D. Temperature 37.1°C (98.8°F)
Correct Answer: B
Rationale: A serum potassium of 3.1 mEq/L indicates hypokalemia, which increases the risk
of cardiac dysrhythmias during anesthesia and surgery. Normal potassium is 3.5–5.0 mEq/L. This
must be reported to the surgeon before proceeding. The other values are within normal limits
and do not require immediate intervention.
2. The nurse is teaching a client about postoperative leg exercises. Which statement by the
client indicates correct understanding?
A. "I should point my toes and hold them for 10 seconds."
B. "I will flex and extend my ankles and knees every hour while awake."
C. "I should cross my legs to improve circulation."
D. "I will only do these exercises if I feel pain."
Correct Answer: B
Rationale: Ankle and knee flexion/extension exercises promote venous return and prevent
deep vein thrombosis (DVT). Pointing toes (A) is not the correct technique—dorsiflexion and
plantarflexion are used. Crossing legs (C) impedes circulation. Exercises should be performed
regularly, not only when pain occurs (D).
3. A client who underwent abdominal surgery 24 hours ago reports sudden shortness of breath
and chest pain. The nurse notes a heart rate of 118 bpm and oxygen saturation of 89% on room
air. Which action should the nurse take first?
,A. Administer prescribed pain medication
B. Apply supplemental oxygen and raise the head of the bed
C. Encourage the client to cough and deep breathe
D. Obtain a chest x-ray
Correct Answer: B
Rationale: The client is demonstrating signs of a pulmonary embolism (PE)—sudden
dyspnea, chest pain, tachycardia, and hypoxemia following surgery. The priority is to apply
oxygen and position the client upright to improve oxygenation. Pain medication (A) may mask
symptoms. Coughing (C) is not helpful for PE. Chest x-ray (D) is diagnostic but not the first
action.
4. The nurse is preparing a client for surgery. Which statement by the client requires further
teaching?
A. "I will remove my wedding ring before surgery."
B. "I can drink a small amount of water the morning of surgery."
C. "I should inform the surgeon about my herbal supplements."
D. "I will need to sign a consent form before surgery."
Correct Answer: B
Rationale: Clients are typically NPO (nothing by mouth) after midnight or at least 6–8 hours
before surgery to prevent aspiration during anesthesia. Drinking water (B) is incorrect.
Removing jewelry (A), reporting herbal supplements (C), and signing consent (D) are all correct.
5. A postoperative client has a drain in place. The nurse notes 150 mL of sanguineous drainage
in the first hour. Which action is most appropriate?
A. Document the finding and continue to monitor
B. Notify the surgeon immediately
C. Clamp the drain
D. Irrigate the drain with sterile saline
Correct Answer: B
Rationale: Drainage exceeding 100 mL/hour or sudden large amounts of sanguineous
drainage may indicate hemorrhage. The surgeon must be notified immediately. Clamping (C) or
,irrigating (D) without a prescription is inappropriate. Simply documenting (A) delays necessary
intervention.
6. Which client is at highest risk for malignant hyperthermia during surgery?
A. A client with a history of asthma
B. A client with a family history of malignant hyperthermia
C. A client with diabetes mellitus
D. A client with hypertension
Correct Answer: B
Rationale: Malignant hyperthermia is an autosomal dominant genetic disorder triggered by
certain anesthetic agents (e.g., halothane, succinylcholine). A family history is the strongest risk
factor. The other conditions do not predispose to malignant hyperthermia.
7. The nurse is caring for a client in the PACU. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 12 breaths/min
B. Oxygen saturation of 92%
C. Urine output of 30 mL/hr
D. Blood pressure of 88/50 mmHg with a heart rate of 122 bpm
Correct Answer: D
Rationale: Hypotension with tachycardia indicates hypovolemia or shock, possibly from
hemorrhage. This requires immediate intervention. Respiratory rate of 12 (A), SpO₂ of 92% (B),
and urine output of 30 mL/hr (C) are acceptable in the immediate postoperative period, though
SpO₂ should be monitored.
8. A client is 6 hours postoperative following a total hip arthroplasty. Which intervention is
priority?
A. Encourage the client to sit in a chair
B. Apply antiembolism stockings
C. Maintain hip abduction with a pillow between the legs
D. Perform range-of-motion exercises on the affected hip
, Correct Answer: C
Rationale: Maintaining hip abduction prevents dislocation of the new hip prosthesis. Sitting
in a chair (A) may be allowed but is not the priority. Antiembolism stockings (B) are important
but secondary. ROM exercises (D) on the affected hip are contraindicated initially.
9. The nurse is teaching a client about the purpose of incentive spirometry. Which statement is
most accurate?
A. "It helps prevent blood clots in your legs."
B. "It helps keep your lungs expanded and prevents pneumonia."
C. "It helps improve your kidney function."
D. "It helps prevent wound infection."
Correct Answer: B
Rationale: Incentive spirometry encourages deep breathing, which helps prevent atelectasis
and pneumonia. It does not prevent DVT (A), improve kidney function (C), or prevent wound
infection (D).
10. A client is scheduled for emergency surgery. The client is confused and unable to sign the
consent form. The client's spouse is present. Which action should the nurse take?
A. Have the spouse sign the consent form
B. Proceed with surgery without consent
C. Contact the hospital ethics committee
D. Document the client's confusion and proceed
Correct Answer: A
Rationale: In an emergency, if the client is unable to consent, the spouse or next of kin may
sign. Proceeding without consent (B) is illegal. The ethics committee (C) is not needed in an
emergency. Documenting confusion (D) alone does not address the consent issue.
11. Which finding in a preoperative client should the nurse report to the surgeon?
A. Blood glucose 110 mg/dL
B. White blood cell count 12,000/mm³
PREPARATION BY HESI
SECTION I: PERIOPERATIVE NURSING CARE (Questions 1–15)
1. A client is scheduled for surgery in 2 hours. The nurse reviews the preoperative checklist.
Which finding requires immediate notification of the surgeon?
A. Blood pressure 138/86 mmHg
B. Serum potassium 3.1 mEq/L
C. Hemoglobin 13.2 g/dL
D. Temperature 37.1°C (98.8°F)
Correct Answer: B
Rationale: A serum potassium of 3.1 mEq/L indicates hypokalemia, which increases the risk
of cardiac dysrhythmias during anesthesia and surgery. Normal potassium is 3.5–5.0 mEq/L. This
must be reported to the surgeon before proceeding. The other values are within normal limits
and do not require immediate intervention.
2. The nurse is teaching a client about postoperative leg exercises. Which statement by the
client indicates correct understanding?
A. "I should point my toes and hold them for 10 seconds."
B. "I will flex and extend my ankles and knees every hour while awake."
C. "I should cross my legs to improve circulation."
D. "I will only do these exercises if I feel pain."
Correct Answer: B
Rationale: Ankle and knee flexion/extension exercises promote venous return and prevent
deep vein thrombosis (DVT). Pointing toes (A) is not the correct technique—dorsiflexion and
plantarflexion are used. Crossing legs (C) impedes circulation. Exercises should be performed
regularly, not only when pain occurs (D).
3. A client who underwent abdominal surgery 24 hours ago reports sudden shortness of breath
and chest pain. The nurse notes a heart rate of 118 bpm and oxygen saturation of 89% on room
air. Which action should the nurse take first?
,A. Administer prescribed pain medication
B. Apply supplemental oxygen and raise the head of the bed
C. Encourage the client to cough and deep breathe
D. Obtain a chest x-ray
Correct Answer: B
Rationale: The client is demonstrating signs of a pulmonary embolism (PE)—sudden
dyspnea, chest pain, tachycardia, and hypoxemia following surgery. The priority is to apply
oxygen and position the client upright to improve oxygenation. Pain medication (A) may mask
symptoms. Coughing (C) is not helpful for PE. Chest x-ray (D) is diagnostic but not the first
action.
4. The nurse is preparing a client for surgery. Which statement by the client requires further
teaching?
A. "I will remove my wedding ring before surgery."
B. "I can drink a small amount of water the morning of surgery."
C. "I should inform the surgeon about my herbal supplements."
D. "I will need to sign a consent form before surgery."
Correct Answer: B
Rationale: Clients are typically NPO (nothing by mouth) after midnight or at least 6–8 hours
before surgery to prevent aspiration during anesthesia. Drinking water (B) is incorrect.
Removing jewelry (A), reporting herbal supplements (C), and signing consent (D) are all correct.
5. A postoperative client has a drain in place. The nurse notes 150 mL of sanguineous drainage
in the first hour. Which action is most appropriate?
A. Document the finding and continue to monitor
B. Notify the surgeon immediately
C. Clamp the drain
D. Irrigate the drain with sterile saline
Correct Answer: B
Rationale: Drainage exceeding 100 mL/hour or sudden large amounts of sanguineous
drainage may indicate hemorrhage. The surgeon must be notified immediately. Clamping (C) or
,irrigating (D) without a prescription is inappropriate. Simply documenting (A) delays necessary
intervention.
6. Which client is at highest risk for malignant hyperthermia during surgery?
A. A client with a history of asthma
B. A client with a family history of malignant hyperthermia
C. A client with diabetes mellitus
D. A client with hypertension
Correct Answer: B
Rationale: Malignant hyperthermia is an autosomal dominant genetic disorder triggered by
certain anesthetic agents (e.g., halothane, succinylcholine). A family history is the strongest risk
factor. The other conditions do not predispose to malignant hyperthermia.
7. The nurse is caring for a client in the PACU. Which assessment finding requires immediate
intervention?
A. Respiratory rate of 12 breaths/min
B. Oxygen saturation of 92%
C. Urine output of 30 mL/hr
D. Blood pressure of 88/50 mmHg with a heart rate of 122 bpm
Correct Answer: D
Rationale: Hypotension with tachycardia indicates hypovolemia or shock, possibly from
hemorrhage. This requires immediate intervention. Respiratory rate of 12 (A), SpO₂ of 92% (B),
and urine output of 30 mL/hr (C) are acceptable in the immediate postoperative period, though
SpO₂ should be monitored.
8. A client is 6 hours postoperative following a total hip arthroplasty. Which intervention is
priority?
A. Encourage the client to sit in a chair
B. Apply antiembolism stockings
C. Maintain hip abduction with a pillow between the legs
D. Perform range-of-motion exercises on the affected hip
, Correct Answer: C
Rationale: Maintaining hip abduction prevents dislocation of the new hip prosthesis. Sitting
in a chair (A) may be allowed but is not the priority. Antiembolism stockings (B) are important
but secondary. ROM exercises (D) on the affected hip are contraindicated initially.
9. The nurse is teaching a client about the purpose of incentive spirometry. Which statement is
most accurate?
A. "It helps prevent blood clots in your legs."
B. "It helps keep your lungs expanded and prevents pneumonia."
C. "It helps improve your kidney function."
D. "It helps prevent wound infection."
Correct Answer: B
Rationale: Incentive spirometry encourages deep breathing, which helps prevent atelectasis
and pneumonia. It does not prevent DVT (A), improve kidney function (C), or prevent wound
infection (D).
10. A client is scheduled for emergency surgery. The client is confused and unable to sign the
consent form. The client's spouse is present. Which action should the nurse take?
A. Have the spouse sign the consent form
B. Proceed with surgery without consent
C. Contact the hospital ethics committee
D. Document the client's confusion and proceed
Correct Answer: A
Rationale: In an emergency, if the client is unable to consent, the spouse or next of kin may
sign. Proceeding without consent (B) is illegal. The ethics committee (C) is not needed in an
emergency. Documenting confusion (D) alone does not address the consent issue.
11. Which finding in a preoperative client should the nurse report to the surgeon?
A. Blood glucose 110 mg/dL
B. White blood cell count 12,000/mm³
