HESI Medical-Surgical Nursing Assessment — Complete Practice Test Bank 2026
500 Exam-Style Questions with Verified Answers & Detailed Rationales
TABLE OF CONTENTS
| Domain | Topic | Questions |
|--------|-------|-----------|
| I | Management of Care | 40 |
| II | Safety and Infection Control | 40 |
| III | Basic Care and Comfort | 35 |
| IV | Pharmacological and Parenteral Therapies | 45 |
| V | Reduction of Risk Potential | 45 |
| VI | Physiological Adaptation | 50 |
| VII | Cardiovascular Disorders | 55 |
| VIII | Respiratory Disorders | 50 |
| IX | Gastrointestinal Disorders | 40 |
| X | Renal & Genitourinary Disorders | 35 |
| XI | Neurological Disorders | 30 |
| XII | Endocrine Disorders | 35 |
| | Total | 500 |
---
EXAM OVERVIEW
Exam Title: HESI Medical-Surgical Nursing Assessment
Format: Multiple-choice (4 options A–D) and Next Generation NCLEX (NGN)-style questions
Total Practice Questions: 500
,Recommended Time: 3 hours (2 minutes per question)
Passing Score: 70% (350/500 correct)
Core Domains: Management of Care; Safety and Infection Control; Basic Care and Comfort;
Pharmacological and Parenteral Therapies; Reduction of Risk Potential; Physiological
Adaptation; Cardiovascular; Respiratory; Gastrointestinal; Renal & Genitourinary;
Neurological; and Endocrine Disorders.
Reference: HESI Medical-Surgical Nursing Exam Blueprint (2026/2027); Elsevier Evolve HESI
Med Surg Exam Standards; NCSBN Clinical Judgment Measurement Model; NCLEX-RN Test
Plan.
---
SECTION I: MANAGEMENT OF CARE — 40 Questions
Q1. 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
Rationale: The LPN can perform routine vital signs monitoring and dressing changes for a
stable postoperative client. Assessment for hypocalcemia, IV push medications, and wound
debridement/evaluation require the RN's clinical judgment.
,Why Wrong: A — Assessment for hypocalcemia requires RN-level evaluation. B — IV push
furosemide requires RN administration. C — Wound debridement and healing evaluation
require RN assessment.
---
Q2. The nurse enters a client's room to administer oral medications and finds an unlicensed
assistive personnel (UAP) providing personal care to a client whose condition has obviously
deteriorated. The client is lying supine and is weak, pale, and diaphoretic. Which is the
priority nursing action?
A. Determine why the UAP did not notify the nurse of the change in the client's condition
B. Advise the UAP to stop providing care so the nurse can assess the client's condition
C. Explain to the UAP that changes in a client's condition should be reported immediately
D. Ask the UAP to position the client so the oral medications can be administered
Correct Answer: B
Rationale: The priority is to assess the client's deteriorating condition. The nurse must stop
the UAP from providing care so that a focused assessment can be performed immediately.
Why Wrong: A — Determining why the UAP did not notify is secondary to client assessment.
C — Education is important but not the priority. D — Administering medications is not
appropriate when the client's condition has deteriorated.
---
Q3. The nurse is preparing a teaching plan for a client who is newly diagnosed with Type 1
diabetes mellitus. Which signs and symptoms should the nurse describe when teaching the
client about hypoglycemia?
A. Polyuria, polydipsia, polyphagia
B. Sweating, trembling, tachycardia
, C. Nausea, vomiting, anorexia
D. Fruity breath, tachypnea, chest pain
Correct Answer: B
Rationale: Sweating, trembling, and tachycardia are classic adrenergic signs of hypoglycemia
caused by the release of epinephrine in response to falling blood glucose levels. These
symptoms occur when blood glucose drops below 70 mg/dL.
Why Wrong: A — Polyuria, polydipsia, and polyphagia are classic signs of hyperglycemia. C
— Nausea, vomiting, and anorexia are non-specific gastrointestinal symptoms. D — Fruity
breath, tachypnea, and chest pain are associated with diabetic ketoacidosis.
---
Q4. A client who had abdominal surgery two days ago has prescriptions for intravenous
morphine sulfate 4 mg every 2 hours and a clear liquid diet. The client complains of
incisional pain rated 8/10 on a scale of 0–10. Which action should the nurse take first?
A. Administer the prescribed morphine sulfate
B. Assess the client's bowel sounds
C. Reposition the client for comfort
D. Notify the healthcare provider
Correct Answer: A
Rationale: The client is experiencing severe incisional pain (8/10) and has a prescribed PRN
opioid analgesic. The nurse should administer the medication to relieve the pain.
Why Wrong: B — Bowel sounds assessment is important but not the priority over pain
management. C — Repositioning alone will not address severe pain. D — The nurse can
administer the prescribed medication without notifying the provider first.
---
500 Exam-Style Questions with Verified Answers & Detailed Rationales
TABLE OF CONTENTS
| Domain | Topic | Questions |
|--------|-------|-----------|
| I | Management of Care | 40 |
| II | Safety and Infection Control | 40 |
| III | Basic Care and Comfort | 35 |
| IV | Pharmacological and Parenteral Therapies | 45 |
| V | Reduction of Risk Potential | 45 |
| VI | Physiological Adaptation | 50 |
| VII | Cardiovascular Disorders | 55 |
| VIII | Respiratory Disorders | 50 |
| IX | Gastrointestinal Disorders | 40 |
| X | Renal & Genitourinary Disorders | 35 |
| XI | Neurological Disorders | 30 |
| XII | Endocrine Disorders | 35 |
| | Total | 500 |
---
EXAM OVERVIEW
Exam Title: HESI Medical-Surgical Nursing Assessment
Format: Multiple-choice (4 options A–D) and Next Generation NCLEX (NGN)-style questions
Total Practice Questions: 500
,Recommended Time: 3 hours (2 minutes per question)
Passing Score: 70% (350/500 correct)
Core Domains: Management of Care; Safety and Infection Control; Basic Care and Comfort;
Pharmacological and Parenteral Therapies; Reduction of Risk Potential; Physiological
Adaptation; Cardiovascular; Respiratory; Gastrointestinal; Renal & Genitourinary;
Neurological; and Endocrine Disorders.
Reference: HESI Medical-Surgical Nursing Exam Blueprint (2026/2027); Elsevier Evolve HESI
Med Surg Exam Standards; NCSBN Clinical Judgment Measurement Model; NCLEX-RN Test
Plan.
---
SECTION I: MANAGEMENT OF CARE — 40 Questions
Q1. 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
Rationale: The LPN can perform routine vital signs monitoring and dressing changes for a
stable postoperative client. Assessment for hypocalcemia, IV push medications, and wound
debridement/evaluation require the RN's clinical judgment.
,Why Wrong: A — Assessment for hypocalcemia requires RN-level evaluation. B — IV push
furosemide requires RN administration. C — Wound debridement and healing evaluation
require RN assessment.
---
Q2. The nurse enters a client's room to administer oral medications and finds an unlicensed
assistive personnel (UAP) providing personal care to a client whose condition has obviously
deteriorated. The client is lying supine and is weak, pale, and diaphoretic. Which is the
priority nursing action?
A. Determine why the UAP did not notify the nurse of the change in the client's condition
B. Advise the UAP to stop providing care so the nurse can assess the client's condition
C. Explain to the UAP that changes in a client's condition should be reported immediately
D. Ask the UAP to position the client so the oral medications can be administered
Correct Answer: B
Rationale: The priority is to assess the client's deteriorating condition. The nurse must stop
the UAP from providing care so that a focused assessment can be performed immediately.
Why Wrong: A — Determining why the UAP did not notify is secondary to client assessment.
C — Education is important but not the priority. D — Administering medications is not
appropriate when the client's condition has deteriorated.
---
Q3. The nurse is preparing a teaching plan for a client who is newly diagnosed with Type 1
diabetes mellitus. Which signs and symptoms should the nurse describe when teaching the
client about hypoglycemia?
A. Polyuria, polydipsia, polyphagia
B. Sweating, trembling, tachycardia
, C. Nausea, vomiting, anorexia
D. Fruity breath, tachypnea, chest pain
Correct Answer: B
Rationale: Sweating, trembling, and tachycardia are classic adrenergic signs of hypoglycemia
caused by the release of epinephrine in response to falling blood glucose levels. These
symptoms occur when blood glucose drops below 70 mg/dL.
Why Wrong: A — Polyuria, polydipsia, and polyphagia are classic signs of hyperglycemia. C
— Nausea, vomiting, and anorexia are non-specific gastrointestinal symptoms. D — Fruity
breath, tachypnea, and chest pain are associated with diabetic ketoacidosis.
---
Q4. A client who had abdominal surgery two days ago has prescriptions for intravenous
morphine sulfate 4 mg every 2 hours and a clear liquid diet. The client complains of
incisional pain rated 8/10 on a scale of 0–10. Which action should the nurse take first?
A. Administer the prescribed morphine sulfate
B. Assess the client's bowel sounds
C. Reposition the client for comfort
D. Notify the healthcare provider
Correct Answer: A
Rationale: The client is experiencing severe incisional pain (8/10) and has a prescribed PRN
opioid analgesic. The nurse should administer the medication to relieve the pain.
Why Wrong: B — Bowel sounds assessment is important but not the priority over pain
management. C — Repositioning alone will not address severe pain. D — The nurse can
administer the prescribed medication without notifying the provider first.
---
