HESI MED SURG EXAMS V1 LATEST 2025 REAL ACTUAL
SCREENSHOTS VERIFIED QUESTIONS AND ANSWERS GRADED A
Question 1
A nurse is caring for a client admitted with acute exacerbation of heart failure. Which assessment
finding is the most critical to report immediately to the healthcare provider?
A) Bilateral +2 pitting edema in the lower extremities.
B) Client reports increasing shortness of breath and frothy pink sputum.
C) Weight gain of 1 kg (2.2 lbs) in 24 hours.
D) Auscultation of S3 heart sound.
E) Crackles heard bilaterally in lung bases.
Correct Answer: B) Client reports increasing shortness of breath and frothy pink sputum.
Rationale: Frothy pink sputum is a hallmark sign of acute pulmonary edema, a life-
threatening complication of severe left-sided heart failure. This indicates fluid backing up
into the lungs, impairing gas exchange and potentially leading to respiratory arrest. While
other options are signs of worsening heart failure, this finding signifies an acute, emergent
deterioration.
Question 2
A client with chronic kidney disease is scheduled for hemodialysis. The nurse notes the client's
blood pressure is 88/52 mmHg. What is the most appropriate action for the nurse to take?
A) Administer a prescribed antihypertensive medication.
B) Notify the hemodialysis unit and prepare for immediate treatment.
C) Administer a bolus of normal saline as prescribed.
D) Hold the client's regularly scheduled hemodialysis.
E) Assess the client's access site for a thrill and bruit.
Correct Answer: C) Administer a bolus of normal saline as prescribed.
Rationale: Hypotension (88/52 mmHg) is a common complication before or during
hemodialysis due to fluid shifts or medications. Administering a bolus of normal saline (if
prescribed and appropriate for the client's fluid status) would be the most direct
intervention to raise the blood pressure before or to safely proceed with dialysis. Holding
dialysis without further intervention or an order would be inappropriate.
Antihypertensives would worsen hypotension.
Question 3
A client is admitted with diabetic ketoacidosis (DKA). The nurse anticipates which primary
intravenous fluid to be administered initially?
A) 0.45% Sodium Chloride (half-normal saline).
B) 0.9% Sodium Chloride (normal saline).
C) 5% Dextrose in Water (D5W).
D) Lactated Ringer's solution.
E) 5% Dextrose in 0.45% Sodium Chloride.
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Correct Answer: B) 0.9% Sodium Chloride (normal saline).
Rationale: The initial priority in DKA is aggressive fluid resuscitation to correct severe
dehydration and restore intravascular volume. 0.9% Sodium Chloride (normal saline) is
the isotonic solution of choice for rapid volume expansion. Once blood glucose levels fall to
approximately 200-250 mg/dL, dextrose-containing fluids are typically added to prevent
hypoglycemia.
Question 4
The nurse is providing discharge teaching to a client with newly diagnosed asthma. Which
statement indicates the client understands how to use a rescue inhaler (albuterol)?
A) "I should use my albuterol inhaler every morning to prevent attacks."
B) "I will use two puffs of albuterol if I feel short of breath or start wheezing."
C) "My albuterol inhaler is for preventing inflammation in my lungs."
D) "I need to rinse my mouth after using albuterol to prevent thrush."
E) "I will only use my albuterol inhaler if my other medications fail."
Correct Answer: B) "I will use two puffs of albuterol if I feel short of breath or start
wheezing."
Rationale: Albuterol is a short-acting beta-agonist (SABA) used as a rescue medication for
acute asthma symptoms like shortness of breath, wheezing, or chest tightness. It acts as a
bronchodilator. Daily use for prevention, prevention of inflammation, or only after other
medications fail indicates a misunderstanding. Rinsing the mouth is for steroid inhalers
(e.g., fluticasone), not albuterol.
Question 5
A client with a history of peptic ulcer disease (PUD) reports severe, sharp abdominal pain that
suddenly started, radiating to the right shoulder. On assessment, the abdomen is rigid and board-
like. What is the nurse's priority action?
A) Administer a prescribed antacid.
B) Insert a nasogastric tube.
C) Prepare the client for emergency surgery.
D) Obtain a complete set of vital signs.
E) Administer IV opioid analgesics.
Correct Answer: D) Obtain a complete set of vital signs.
Rationale: The client's symptoms (sudden severe pain, rigid/board-like abdomen, shoulder
pain) are highly indicative of a perforated ulcer, a surgical emergency. While emergency
surgery will be necessary, the immediate nursing priority is to obtain a complete set of vital
signs to assess for signs of shock (e.g., hypotension, tachycardia, fever) resulting from
peritonitis or hemorrhage, which guides subsequent rapid interventions and
communication with the provider.
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Question 6
The nurse is caring for a client immediately post-thyroidectomy. Which assessment finding
requires immediate intervention?
A) Client reports mild neck pain.
B) Temperature of 99.0°F (37.2°C).
C) Frequent swallowing and vocal changes.
D) Clear liquid intake of 240 mL.
E) Mild hoarseness when speaking.
Correct Answer: C) Frequent swallowing and vocal changes.
Rationale: Frequent swallowing can indicate bleeding and hematoma formation in the
surgical site, which could compromise the airway. Vocal changes, beyond mild hoarseness,
could suggest laryngeal nerve damage or airway swelling. Airway compromise is the most
critical complication post-thyroidectomy, requiring immediate assessment and
intervention.
Question 7
A client with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. The nurse should
include which instruction in the client's teaching plan?
A) "Take this medication at bedtime to prevent orthostatic hypotension."
B) "This medication will shrink the size of your prostate."
C) "Report any sudden decrease in urine output to your healthcare provider."
D) "Avoid grapefruit juice while taking this medication."
E) "It may take several weeks to see an improvement in urinary symptoms."
Correct Answer: A) "Take this medication at bedtime to prevent orthostatic hypotension."
Rationale: Tamsulosin is an alpha-adrenergic blocker that relaxes smooth muscle in the
prostate and bladder neck, improving urine flow. A common side effect is orthostatic
hypotension (dizziness upon standing). Taking it at bedtime minimizes the risk of falls
related to this side effect. It does not shrink the prostate; that is the role of 5-alpha-
reductase inhibitors. Its effect is usually seen within days, not weeks. Grapefruit juice
interaction is more common with other drugs.
Question 8
A client with an exacerbation of ulcerative colitis is experiencing severe abdominal cramping
and diarrhea. Which food choice, if selected by the client, indicates a need for further dietary
teaching?
A) Baked chicken.
B) White rice.
C) Fresh apple.
D) Plain pasta.
E) Mashed potatoes.
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Correct Answer: C) Fresh apple.
Rationale: During an exacerbation of ulcerative colitis, clients should follow a low-fiber,
low-residue diet to reduce irritation to the inflamed bowel and minimize diarrhea. Fresh
fruits, especially with skins, are high in fiber and would worsen symptoms. Baked chicken,
white rice, plain pasta, and mashed potatoes are low-fiber options.
Question 9
The nurse is assessing a client with a new onset of sudden, severe, unilateral flank pain radiating
to the groin, accompanied by hematuria. The client is restless and unable to find a comfortable
position. The nurse suspects:
A) Pyelonephritis.
B) Glomerulonephritis.
C) Nephrolithiasis (kidney stones).
D) Urinary tract infection (UTI).
E) Benign prostatic hyperplasia (BPH).
Correct Answer: C) Nephrolithiasis (kidney stones).
Rationale: Sudden, severe, unilateral flank pain radiating to the groin (renal colic),
restlessness, and hematuria are classic signs and symptoms of nephrolithiasis (kidney
stones) obstructing the ureter.
Question 10
A client with cirrhosis develops asterixis and a flapping tremor of the hands. The nurse
anticipates which medication will be prescribed?
A) Furosemide.
B) Lactulose.
C) Spironolactone.
D) Propranolol.
E) Vitamin K.
Correct Answer: B) Lactulose.
Rationale: Asterixis (flapping tremor) is a sign of hepatic encephalopathy, caused by the
accumulation of ammonia in the blood due to impaired liver function. Lactulose is a
laxative that works by trapping ammonia in the gut and promoting its excretion in the
feces, thereby reducing serum ammonia levels.
Question 11
A nurse is preparing to administer an intravenous push medication to a client. Which action is the
most important to ensure client safety?
A) Inject the medication over 10 seconds.
B) Check the client's allergy band.
C) Dilute the medication with 10 mL of normal saline.
SCREENSHOTS VERIFIED QUESTIONS AND ANSWERS GRADED A
Question 1
A nurse is caring for a client admitted with acute exacerbation of heart failure. Which assessment
finding is the most critical to report immediately to the healthcare provider?
A) Bilateral +2 pitting edema in the lower extremities.
B) Client reports increasing shortness of breath and frothy pink sputum.
C) Weight gain of 1 kg (2.2 lbs) in 24 hours.
D) Auscultation of S3 heart sound.
E) Crackles heard bilaterally in lung bases.
Correct Answer: B) Client reports increasing shortness of breath and frothy pink sputum.
Rationale: Frothy pink sputum is a hallmark sign of acute pulmonary edema, a life-
threatening complication of severe left-sided heart failure. This indicates fluid backing up
into the lungs, impairing gas exchange and potentially leading to respiratory arrest. While
other options are signs of worsening heart failure, this finding signifies an acute, emergent
deterioration.
Question 2
A client with chronic kidney disease is scheduled for hemodialysis. The nurse notes the client's
blood pressure is 88/52 mmHg. What is the most appropriate action for the nurse to take?
A) Administer a prescribed antihypertensive medication.
B) Notify the hemodialysis unit and prepare for immediate treatment.
C) Administer a bolus of normal saline as prescribed.
D) Hold the client's regularly scheduled hemodialysis.
E) Assess the client's access site for a thrill and bruit.
Correct Answer: C) Administer a bolus of normal saline as prescribed.
Rationale: Hypotension (88/52 mmHg) is a common complication before or during
hemodialysis due to fluid shifts or medications. Administering a bolus of normal saline (if
prescribed and appropriate for the client's fluid status) would be the most direct
intervention to raise the blood pressure before or to safely proceed with dialysis. Holding
dialysis without further intervention or an order would be inappropriate.
Antihypertensives would worsen hypotension.
Question 3
A client is admitted with diabetic ketoacidosis (DKA). The nurse anticipates which primary
intravenous fluid to be administered initially?
A) 0.45% Sodium Chloride (half-normal saline).
B) 0.9% Sodium Chloride (normal saline).
C) 5% Dextrose in Water (D5W).
D) Lactated Ringer's solution.
E) 5% Dextrose in 0.45% Sodium Chloride.
,[Type here]
Correct Answer: B) 0.9% Sodium Chloride (normal saline).
Rationale: The initial priority in DKA is aggressive fluid resuscitation to correct severe
dehydration and restore intravascular volume. 0.9% Sodium Chloride (normal saline) is
the isotonic solution of choice for rapid volume expansion. Once blood glucose levels fall to
approximately 200-250 mg/dL, dextrose-containing fluids are typically added to prevent
hypoglycemia.
Question 4
The nurse is providing discharge teaching to a client with newly diagnosed asthma. Which
statement indicates the client understands how to use a rescue inhaler (albuterol)?
A) "I should use my albuterol inhaler every morning to prevent attacks."
B) "I will use two puffs of albuterol if I feel short of breath or start wheezing."
C) "My albuterol inhaler is for preventing inflammation in my lungs."
D) "I need to rinse my mouth after using albuterol to prevent thrush."
E) "I will only use my albuterol inhaler if my other medications fail."
Correct Answer: B) "I will use two puffs of albuterol if I feel short of breath or start
wheezing."
Rationale: Albuterol is a short-acting beta-agonist (SABA) used as a rescue medication for
acute asthma symptoms like shortness of breath, wheezing, or chest tightness. It acts as a
bronchodilator. Daily use for prevention, prevention of inflammation, or only after other
medications fail indicates a misunderstanding. Rinsing the mouth is for steroid inhalers
(e.g., fluticasone), not albuterol.
Question 5
A client with a history of peptic ulcer disease (PUD) reports severe, sharp abdominal pain that
suddenly started, radiating to the right shoulder. On assessment, the abdomen is rigid and board-
like. What is the nurse's priority action?
A) Administer a prescribed antacid.
B) Insert a nasogastric tube.
C) Prepare the client for emergency surgery.
D) Obtain a complete set of vital signs.
E) Administer IV opioid analgesics.
Correct Answer: D) Obtain a complete set of vital signs.
Rationale: The client's symptoms (sudden severe pain, rigid/board-like abdomen, shoulder
pain) are highly indicative of a perforated ulcer, a surgical emergency. While emergency
surgery will be necessary, the immediate nursing priority is to obtain a complete set of vital
signs to assess for signs of shock (e.g., hypotension, tachycardia, fever) resulting from
peritonitis or hemorrhage, which guides subsequent rapid interventions and
communication with the provider.
,[Type here]
Question 6
The nurse is caring for a client immediately post-thyroidectomy. Which assessment finding
requires immediate intervention?
A) Client reports mild neck pain.
B) Temperature of 99.0°F (37.2°C).
C) Frequent swallowing and vocal changes.
D) Clear liquid intake of 240 mL.
E) Mild hoarseness when speaking.
Correct Answer: C) Frequent swallowing and vocal changes.
Rationale: Frequent swallowing can indicate bleeding and hematoma formation in the
surgical site, which could compromise the airway. Vocal changes, beyond mild hoarseness,
could suggest laryngeal nerve damage or airway swelling. Airway compromise is the most
critical complication post-thyroidectomy, requiring immediate assessment and
intervention.
Question 7
A client with benign prostatic hyperplasia (BPH) is prescribed tamsulosin. The nurse should
include which instruction in the client's teaching plan?
A) "Take this medication at bedtime to prevent orthostatic hypotension."
B) "This medication will shrink the size of your prostate."
C) "Report any sudden decrease in urine output to your healthcare provider."
D) "Avoid grapefruit juice while taking this medication."
E) "It may take several weeks to see an improvement in urinary symptoms."
Correct Answer: A) "Take this medication at bedtime to prevent orthostatic hypotension."
Rationale: Tamsulosin is an alpha-adrenergic blocker that relaxes smooth muscle in the
prostate and bladder neck, improving urine flow. A common side effect is orthostatic
hypotension (dizziness upon standing). Taking it at bedtime minimizes the risk of falls
related to this side effect. It does not shrink the prostate; that is the role of 5-alpha-
reductase inhibitors. Its effect is usually seen within days, not weeks. Grapefruit juice
interaction is more common with other drugs.
Question 8
A client with an exacerbation of ulcerative colitis is experiencing severe abdominal cramping
and diarrhea. Which food choice, if selected by the client, indicates a need for further dietary
teaching?
A) Baked chicken.
B) White rice.
C) Fresh apple.
D) Plain pasta.
E) Mashed potatoes.
, [Type here]
Correct Answer: C) Fresh apple.
Rationale: During an exacerbation of ulcerative colitis, clients should follow a low-fiber,
low-residue diet to reduce irritation to the inflamed bowel and minimize diarrhea. Fresh
fruits, especially with skins, are high in fiber and would worsen symptoms. Baked chicken,
white rice, plain pasta, and mashed potatoes are low-fiber options.
Question 9
The nurse is assessing a client with a new onset of sudden, severe, unilateral flank pain radiating
to the groin, accompanied by hematuria. The client is restless and unable to find a comfortable
position. The nurse suspects:
A) Pyelonephritis.
B) Glomerulonephritis.
C) Nephrolithiasis (kidney stones).
D) Urinary tract infection (UTI).
E) Benign prostatic hyperplasia (BPH).
Correct Answer: C) Nephrolithiasis (kidney stones).
Rationale: Sudden, severe, unilateral flank pain radiating to the groin (renal colic),
restlessness, and hematuria are classic signs and symptoms of nephrolithiasis (kidney
stones) obstructing the ureter.
Question 10
A client with cirrhosis develops asterixis and a flapping tremor of the hands. The nurse
anticipates which medication will be prescribed?
A) Furosemide.
B) Lactulose.
C) Spironolactone.
D) Propranolol.
E) Vitamin K.
Correct Answer: B) Lactulose.
Rationale: Asterixis (flapping tremor) is a sign of hepatic encephalopathy, caused by the
accumulation of ammonia in the blood due to impaired liver function. Lactulose is a
laxative that works by trapping ammonia in the gut and promoting its excretion in the
feces, thereby reducing serum ammonia levels.
Question 11
A nurse is preparing to administer an intravenous push medication to a client. Which action is the
most important to ensure client safety?
A) Inject the medication over 10 seconds.
B) Check the client's allergy band.
C) Dilute the medication with 10 mL of normal saline.
