ADVANCED MED-SURG HESI EXAM – COMPLETE
STUDY GUIDE & CLINICAL REVIEW (2025 PACKAGE
EDITION)
Advanced Med-Surg HESI Practice Questions
1. A client with a history of heart failure is admitted with acute shortness of breath. The nurse
auscultates crackles bilaterally and notes an S3 gallop. Which finding should the nurse
anticipate when assessing the client's blood pressure?
A. Hypertension due to anxiety
B. Hypotension due to decreased cardiac output
C. Widened pulse pressure
D. Paradoxical blood pressure
Answer: B. Hypotension due to decreased cardiac output ✓
2. A client with a permanent pacemaker is scheduled for discharge. Which client statement
indicates a need for further teaching?
A. "I will avoid leaning over a running microwave oven."
B. "I need to check my pulse every morning and report if it's below the set rate."
C. "I should avoid magnetic resonance imaging (MRI) scans."
D. "I can resume playing tennis and golf immediately."
Answer: D. "I can resume playing tennis and golf immediately." ✓
3. The nurse is caring for a client with a suspected pulmonary embolism. Which diagnostic
test is considered the gold standard for diagnosis?
A. D-dimer
B. Arterial Blood Gas (ABG)
C. Ventilation-Perfusion (V/Q) Scan
D. Pulmonary Angiography ✓
4. A client with Crohn's disease is receiving total parenteral nutrition (TPN). The nurse notices
that the client's blood glucose level is 250 mg/dL. What is the nurse's priority action?
A. Stop the TPN infusion immediately.
B. Administer sliding-scale insulin as prescribed. ✓
C. Increase the rate of the IV normal saline.
D. Notify the healthcare provider.
,5. Four hours after a total thyroidectomy, a client complains of tingling in their fingers and
around their mouth. The nurse's immediate action should be to:
A. Assess for Chvostek's sign. ✓
B. Administer prescribed pain medication.
C. Encourage deep breathing and coughing.
D. Check the surgical dressing for bleeding.
6. A client with Guillain-Barré syndrome is admitted to the ICU. The nurse's priority
assessment is:
A. Deep tendon reflexes
B. Sensory perception
C. Respiratory effort ✓
D. Cranial nerve function
7. The nurse is preparing to administer warfarin (Coumadin) to a client. Which laboratory
value is most critical to review before administration?
A. Prothrombin Time (PT) / International Normalized Ratio (INR) ✓
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Hemoglobin and Hematocrit
8. A client with Myasthenia Gravis is experiencing increased muscle weakness and difficulty
swallowing. The nurse should be prepared for which primary intervention?
A. Administer a dose of pyridostigmine.
B. Assist with intubation and mechanical ventilation. ✓
C. Perform nasotracheal suctioning.
D. Administer IV immunoglobulins.
9. When assessing a client with Cushing's syndrome, the nurse would expect to find:
A. Hypotension and weight loss
B. Hyperglycemia and a "moon face" ✓
C. Hypokalemia and tremors
D. Hyponatremia and skin pallor
10. A client with a head injury has clear fluid draining from the nose. Which action should the
nurse take first?
A. Test the fluid for glucose. ✓
B. Plug the nose with gauze.
C. Suction the nares.
D. Place the client in a supine position.
,11. The nurse is teaching a client with Addison's disease about hormone replacement therapy.
The client demonstrates understanding by stating:
A. "I need to double my dose if I have a fever or infection." ✓
B. "I can stop taking my medication when my symptoms improve."
C. "I should take my medication at bedtime."
D. "I will take my medication on an empty stomach."
12. A client with a chest tube connected to a water-seal system is agitated and accidentally
pulls the tube out. The nurse's first action is to:
A. Notify the healthcare provider.
B. Apply a sterile occlusive dressing over the insertion site. ✓
C. Assess the client's respiratory status.
D. Prepare a new chest tube insertion tray.
13. A client with pancreatitis has a positive Cullen's sign. This indicates:
A. Inflammation of the pancreatic head.
B. Bleeding into the peritoneal cavity. ✓
C. Obstruction of the common bile duct.
D. Formation of a pancreatic pseudocyst.
14. The nurse is caring for a client in sickle cell crisis. The priority nursing intervention is:
A. Administering high-flow oxygen. ✓
B. Applying warm compresses to painful joints.
C. Encouraging fluid intake.
D. Administering meperidine (Demerol) for pain.
15. A client is receiving a unit of packed red blood cells. Fifteen minutes after the transfusion
begins, the client reports chills and low back pain. The nurse's first action is to:
A. Slow the infusion rate and monitor vital signs.
B. Stop the transfusion and keep the IV line open with normal saline. ✓
C. Administer diphenhydramine (Benadryl) as prescribed.
D. Notify the blood bank.
16. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. The
nurse should prepare to administer:
A. Sodium polystyrene sulfonate (Kayexalate). ✓
B. Furosemide (Lasix).
C. Calcium gluconate.
D. Regular insulin.
, 17. Which assessment finding is most characteristic of left-sided heart failure?
A. Jugular venous distension
B. Hepatomegaly
C. Dependent edema
D. Crackles in the lungs ✓
18. A client with a T4 spinal cord injury develops a headache and profuse sweating above the
level of injury. The nurse should first assess for:
A. Deep vein thrombosis.
B. Autonomic dysreflexia. ✓
C. Spinal shock.
D. Neurogenic shock.
19. The nurse is assessing a client with a new diagnosis of pericarditis. Which finding is most
expected?
A. A friction rub auscultated over the precordium. ✓
B. A holosystolic murmur at the apex.
C. Bilateral crackles in the lung bases.
D. Pitting edema in the lower extremities.
20. A client with diabetic ketoacidosis (DKA) has Kussmaul respirations. The physiological
purpose of this breathing pattern is to:
A. Increase oxygen saturation.
B. Compensate for metabolic alkalosis.
C. Compensate for metabolic acidosis. ✓
D. Decrease intracranial pressure.
21. A client is receiving continuous tube feedings. To prevent aspiration, the nurse should:
A. Place the client in a supine position.
B. Check for residual volume every 4-6 hours. ✓
C. Flush the tube with iced water before and after medication administration.
D. Administer the feeding via a nasogastric tube only.
22. A client with cirrhosis has ascites and is scheduled for a paracentesis. The nurse's priority
action before the procedure is to:
A. Administer a sedative.
B. Have the client empty their bladder. ✓
C. Place the client in the Trendelenburg position.
D. Cleanse the abdomen with povidone-iodine.
STUDY GUIDE & CLINICAL REVIEW (2025 PACKAGE
EDITION)
Advanced Med-Surg HESI Practice Questions
1. A client with a history of heart failure is admitted with acute shortness of breath. The nurse
auscultates crackles bilaterally and notes an S3 gallop. Which finding should the nurse
anticipate when assessing the client's blood pressure?
A. Hypertension due to anxiety
B. Hypotension due to decreased cardiac output
C. Widened pulse pressure
D. Paradoxical blood pressure
Answer: B. Hypotension due to decreased cardiac output ✓
2. A client with a permanent pacemaker is scheduled for discharge. Which client statement
indicates a need for further teaching?
A. "I will avoid leaning over a running microwave oven."
B. "I need to check my pulse every morning and report if it's below the set rate."
C. "I should avoid magnetic resonance imaging (MRI) scans."
D. "I can resume playing tennis and golf immediately."
Answer: D. "I can resume playing tennis and golf immediately." ✓
3. The nurse is caring for a client with a suspected pulmonary embolism. Which diagnostic
test is considered the gold standard for diagnosis?
A. D-dimer
B. Arterial Blood Gas (ABG)
C. Ventilation-Perfusion (V/Q) Scan
D. Pulmonary Angiography ✓
4. A client with Crohn's disease is receiving total parenteral nutrition (TPN). The nurse notices
that the client's blood glucose level is 250 mg/dL. What is the nurse's priority action?
A. Stop the TPN infusion immediately.
B. Administer sliding-scale insulin as prescribed. ✓
C. Increase the rate of the IV normal saline.
D. Notify the healthcare provider.
,5. Four hours after a total thyroidectomy, a client complains of tingling in their fingers and
around their mouth. The nurse's immediate action should be to:
A. Assess for Chvostek's sign. ✓
B. Administer prescribed pain medication.
C. Encourage deep breathing and coughing.
D. Check the surgical dressing for bleeding.
6. A client with Guillain-Barré syndrome is admitted to the ICU. The nurse's priority
assessment is:
A. Deep tendon reflexes
B. Sensory perception
C. Respiratory effort ✓
D. Cranial nerve function
7. The nurse is preparing to administer warfarin (Coumadin) to a client. Which laboratory
value is most critical to review before administration?
A. Prothrombin Time (PT) / International Normalized Ratio (INR) ✓
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Hemoglobin and Hematocrit
8. A client with Myasthenia Gravis is experiencing increased muscle weakness and difficulty
swallowing. The nurse should be prepared for which primary intervention?
A. Administer a dose of pyridostigmine.
B. Assist with intubation and mechanical ventilation. ✓
C. Perform nasotracheal suctioning.
D. Administer IV immunoglobulins.
9. When assessing a client with Cushing's syndrome, the nurse would expect to find:
A. Hypotension and weight loss
B. Hyperglycemia and a "moon face" ✓
C. Hypokalemia and tremors
D. Hyponatremia and skin pallor
10. A client with a head injury has clear fluid draining from the nose. Which action should the
nurse take first?
A. Test the fluid for glucose. ✓
B. Plug the nose with gauze.
C. Suction the nares.
D. Place the client in a supine position.
,11. The nurse is teaching a client with Addison's disease about hormone replacement therapy.
The client demonstrates understanding by stating:
A. "I need to double my dose if I have a fever or infection." ✓
B. "I can stop taking my medication when my symptoms improve."
C. "I should take my medication at bedtime."
D. "I will take my medication on an empty stomach."
12. A client with a chest tube connected to a water-seal system is agitated and accidentally
pulls the tube out. The nurse's first action is to:
A. Notify the healthcare provider.
B. Apply a sterile occlusive dressing over the insertion site. ✓
C. Assess the client's respiratory status.
D. Prepare a new chest tube insertion tray.
13. A client with pancreatitis has a positive Cullen's sign. This indicates:
A. Inflammation of the pancreatic head.
B. Bleeding into the peritoneal cavity. ✓
C. Obstruction of the common bile duct.
D. Formation of a pancreatic pseudocyst.
14. The nurse is caring for a client in sickle cell crisis. The priority nursing intervention is:
A. Administering high-flow oxygen. ✓
B. Applying warm compresses to painful joints.
C. Encouraging fluid intake.
D. Administering meperidine (Demerol) for pain.
15. A client is receiving a unit of packed red blood cells. Fifteen minutes after the transfusion
begins, the client reports chills and low back pain. The nurse's first action is to:
A. Slow the infusion rate and monitor vital signs.
B. Stop the transfusion and keep the IV line open with normal saline. ✓
C. Administer diphenhydramine (Benadryl) as prescribed.
D. Notify the blood bank.
16. A client with chronic kidney disease (CKD) has a serum potassium level of 6.2 mEq/L. The
nurse should prepare to administer:
A. Sodium polystyrene sulfonate (Kayexalate). ✓
B. Furosemide (Lasix).
C. Calcium gluconate.
D. Regular insulin.
, 17. Which assessment finding is most characteristic of left-sided heart failure?
A. Jugular venous distension
B. Hepatomegaly
C. Dependent edema
D. Crackles in the lungs ✓
18. A client with a T4 spinal cord injury develops a headache and profuse sweating above the
level of injury. The nurse should first assess for:
A. Deep vein thrombosis.
B. Autonomic dysreflexia. ✓
C. Spinal shock.
D. Neurogenic shock.
19. The nurse is assessing a client with a new diagnosis of pericarditis. Which finding is most
expected?
A. A friction rub auscultated over the precordium. ✓
B. A holosystolic murmur at the apex.
C. Bilateral crackles in the lung bases.
D. Pitting edema in the lower extremities.
20. A client with diabetic ketoacidosis (DKA) has Kussmaul respirations. The physiological
purpose of this breathing pattern is to:
A. Increase oxygen saturation.
B. Compensate for metabolic alkalosis.
C. Compensate for metabolic acidosis. ✓
D. Decrease intracranial pressure.
21. A client is receiving continuous tube feedings. To prevent aspiration, the nurse should:
A. Place the client in a supine position.
B. Check for residual volume every 4-6 hours. ✓
C. Flush the tube with iced water before and after medication administration.
D. Administer the feeding via a nasogastric tube only.
22. A client with cirrhosis has ascites and is scheduled for a paracentesis. The nurse's priority
action before the procedure is to:
A. Administer a sedative.
B. Have the client empty their bladder. ✓
C. Place the client in the Trendelenburg position.
D. Cleanse the abdomen with povidone-iodine.
