HESI Med Surg Assessment — 500 Practice Questions with Verified Answers & Detailed
Rationales
Table of Contents
1. Exam Overview
2. Domain 1: Management of Care (Questions 1–50)
3. Domain 2: Safety and Infection Control (Questions 51–100)
4. Domain 3: Basic Care and Comfort (Questions 101–150)
5. Domain 4: Pharmacological and Parenteral Therapies (Questions 151–200)
6. Domain 5: Reduction of Risk Potential (Questions 201–250)
7. Domain 6: Physiological Adaptation (Questions 251–300)
8. Domain 7: Cardiovascular Disorders (Questions 301–350)
9. Domain 8: Respiratory Disorders (Questions 351–390)
10. Domain 9: Gastrointestinal & Hepatic Disorders (Questions 391–420)
11. Domain 10: Endocrine & Metabolic Disorders (Questions 421–445)
12. Domain 11: Neurological Disorders (Questions 446–470)
13. Domain 12: Renal & Urinary Disorders (Questions 471–485)
14. Domain 13: Musculoskeletal & Integumentary Disorders (Questions 486–500)
15. Answer Key Summary
Exam Overview
The HESI Medical-Surgical (Med Surg) specialty examination is a comprehensive assessment
designed to evaluate a nursing student's clinical competency and readiness for professional
practice. It is aligned with the NCLEX-RN test plan and Elsevier's Clinical Judgment
Measurement Model (CJMM) .
,Exam Format:
| Feature | Details |
|---------|---------|
| Total Questions | 55–200 (varies by version; includes trial questions that do not count) |
| Testing Time | Approximately 180 minutes |
| Question Style | 75% scenario-based, 25% direct recall |
| Format | Multiple choice (4 options, single best answer); some versions include NGN-style
case scenarios |
| Cognitive Mix | 30% Recall, 50% Application, 20% Analysis |
| Passing Score | 850 (HESI) / 75–80% |
Core Domains and Weightings (based on published HESI blueprints) :
| Domain | Approx. Questions | Weight |
|--------|-------------------|--------|
| Management of Care | 30 | 15% |
| Safety and Infection Control | 24 | 12% |
| Basic Care and Comfort | 24 | 12% |
| Pharmacological & Parenteral Therapies | 30 | 15% |
| Reduction of Risk Potential | 28 | 14% |
| Physiological Adaptation | 24 | 12% |
| Cardiovascular & Respiratory Disorders | 20 | 10% |
| GI, Endocrine, Neuro, Musculoskeletal | 20 | 10% |
Additional specialty domains covered include cardiovascular, respiratory, gastrointestinal,
endocrine, renal, neurological, musculoskeletal, hematologic/oncologic, and perioperative
nursing .
,DOMAIN 1: MANAGEMENT OF CARE
Questions 1–50
1. The charge nurse is making client assignments for the night shift. Which client should be
assigned to the licensed practical nurse (LPN) under the supervision of the registered nurse
(RN)?
A) A client who is 12 hours postoperative following a subtotal thyroidectomy and requires
assessment for signs of hypocalcemia
B) A client admitted with heart failure exacerbation who has crackles bilaterally and needs a
furosemide IV push
C) A client with a stage III pressure injury requiring wound irrigation, debridement, and
evaluation of healing progress
D) A client who is 2 days post-appendectomy with an abdominal incision that needs vital
signs monitoring and a dressing change
Correct Answer: D) A client who is 2 days post-appendectomy with an abdominal incision
that needs vital signs monitoring and a dressing change
Rationale: The RN is responsible for assessment, evaluation, and complex interventions. The
LPN can perform stable, routine tasks such as vital signs monitoring and dressing changes on
a stable postoperative client . Options A, B, and C require RN-level assessment or
intervention (e.g., IV push medication, wound evaluation, and assessment for
hypocalcemia).
---
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A client who is 1 day postoperative and reports pain at a level of 6/10
, B) A client with COPD who has an oxygen saturation of 88% on room air
C) A client who is scheduled for discharge and needs discharge instructions
D) A client with a urinary tract infection who is requesting to void
Correct Answer: B) A client with COPD who has an oxygen saturation of 88% on room air
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, oxygenation is
the highest priority. An SpO₂ of 88% indicates hypoxemia and impaired gas exchange, which
is life-threatening . Pain, discharge teaching, and voiding are important but not immediately
life-threatening.
---
3. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A) Administering oral pain medication to a stable client
B) Assessing a client's incision for signs of infection
C) Obtaining a client's vital signs and recording them
D) Teaching a client about a new medication regimen
Correct Answer: C) Obtaining a client's vital signs and recording them
Rationale: Obtaining routine vital signs is a task that can be delegated to UAP because it
does not require nursing judgment. Medication administration, assessment, and teaching all
require the education and scope of practice of a licensed nurse .
---
Rationales
Table of Contents
1. Exam Overview
2. Domain 1: Management of Care (Questions 1–50)
3. Domain 2: Safety and Infection Control (Questions 51–100)
4. Domain 3: Basic Care and Comfort (Questions 101–150)
5. Domain 4: Pharmacological and Parenteral Therapies (Questions 151–200)
6. Domain 5: Reduction of Risk Potential (Questions 201–250)
7. Domain 6: Physiological Adaptation (Questions 251–300)
8. Domain 7: Cardiovascular Disorders (Questions 301–350)
9. Domain 8: Respiratory Disorders (Questions 351–390)
10. Domain 9: Gastrointestinal & Hepatic Disorders (Questions 391–420)
11. Domain 10: Endocrine & Metabolic Disorders (Questions 421–445)
12. Domain 11: Neurological Disorders (Questions 446–470)
13. Domain 12: Renal & Urinary Disorders (Questions 471–485)
14. Domain 13: Musculoskeletal & Integumentary Disorders (Questions 486–500)
15. Answer Key Summary
Exam Overview
The HESI Medical-Surgical (Med Surg) specialty examination is a comprehensive assessment
designed to evaluate a nursing student's clinical competency and readiness for professional
practice. It is aligned with the NCLEX-RN test plan and Elsevier's Clinical Judgment
Measurement Model (CJMM) .
,Exam Format:
| Feature | Details |
|---------|---------|
| Total Questions | 55–200 (varies by version; includes trial questions that do not count) |
| Testing Time | Approximately 180 minutes |
| Question Style | 75% scenario-based, 25% direct recall |
| Format | Multiple choice (4 options, single best answer); some versions include NGN-style
case scenarios |
| Cognitive Mix | 30% Recall, 50% Application, 20% Analysis |
| Passing Score | 850 (HESI) / 75–80% |
Core Domains and Weightings (based on published HESI blueprints) :
| Domain | Approx. Questions | Weight |
|--------|-------------------|--------|
| Management of Care | 30 | 15% |
| Safety and Infection Control | 24 | 12% |
| Basic Care and Comfort | 24 | 12% |
| Pharmacological & Parenteral Therapies | 30 | 15% |
| Reduction of Risk Potential | 28 | 14% |
| Physiological Adaptation | 24 | 12% |
| Cardiovascular & Respiratory Disorders | 20 | 10% |
| GI, Endocrine, Neuro, Musculoskeletal | 20 | 10% |
Additional specialty domains covered include cardiovascular, respiratory, gastrointestinal,
endocrine, renal, neurological, musculoskeletal, hematologic/oncologic, and perioperative
nursing .
,DOMAIN 1: MANAGEMENT OF CARE
Questions 1–50
1. The charge nurse is making client assignments for the night shift. Which client should be
assigned to the licensed practical nurse (LPN) under the supervision of the registered nurse
(RN)?
A) A client who is 12 hours postoperative following a subtotal thyroidectomy and requires
assessment for signs of hypocalcemia
B) A client admitted with heart failure exacerbation who has crackles bilaterally and needs a
furosemide IV push
C) A client with a stage III pressure injury requiring wound irrigation, debridement, and
evaluation of healing progress
D) A client who is 2 days post-appendectomy with an abdominal incision that needs vital
signs monitoring and a dressing change
Correct Answer: D) A client who is 2 days post-appendectomy with an abdominal incision
that needs vital signs monitoring and a dressing change
Rationale: The RN is responsible for assessment, evaluation, and complex interventions. The
LPN can perform stable, routine tasks such as vital signs monitoring and dressing changes on
a stable postoperative client . Options A, B, and C require RN-level assessment or
intervention (e.g., IV push medication, wound evaluation, and assessment for
hypocalcemia).
---
2. A nurse is caring for four clients. Which client should the nurse assess FIRST?
A) A client who is 1 day postoperative and reports pain at a level of 6/10
, B) A client with COPD who has an oxygen saturation of 88% on room air
C) A client who is scheduled for discharge and needs discharge instructions
D) A client with a urinary tract infection who is requesting to void
Correct Answer: B) A client with COPD who has an oxygen saturation of 88% on room air
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, oxygenation is
the highest priority. An SpO₂ of 88% indicates hypoxemia and impaired gas exchange, which
is life-threatening . Pain, discharge teaching, and voiding are important but not immediately
life-threatening.
---
3. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate to delegate?
A) Administering oral pain medication to a stable client
B) Assessing a client's incision for signs of infection
C) Obtaining a client's vital signs and recording them
D) Teaching a client about a new medication regimen
Correct Answer: C) Obtaining a client's vital signs and recording them
Rationale: Obtaining routine vital signs is a task that can be delegated to UAP because it
does not require nursing judgment. Medication administration, assessment, and teaching all
require the education and scope of practice of a licensed nurse .
---
