HESI MEDICAL-SURGICAL EXAM – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
*CORE DOMAINS*
*Fluid and Electrolyte Balance*
*Perioperative Nursing Care*
*Cardiovascular and Hematologic Disorders*
*Respiratory System Management*
*Gastrointestinal and Metabolic Disorders*
*Neurological and Sensory Systems*
*Musculoskeletal and Integumentary Health*
*Renal and Urinary Function*
*Oncology and Immune System Disorders*
*Endocrine System Regulation*
*INTRODUCTION*
This comprehensive assessment is designed to evaluate a candidate’s proficiency in medical-surgical nursing, focusing on the critical knowledge required for safe and effective patient
care. The exam assesses a wide range of skills, including clinical judgment, prioritization, and the application of nursing theory to diverse clinical settings. Comprised of multiple-
choice questions and complex, scenario-based items, this tool challenges the learner to apply evidence-based practice and decision-making skills in real-world situations. The content
emphasizes patient safety, health promotion, and the management of acute and chronic health conditions, ensuring readiness for professional licensure and high-stakes clinical
practice.
*SECTION ONE*
1. A nurse is caring for a patient who is 24 hours postoperative following a total hip arthroplasty. Which of the following actions should the nurse prioritize to prevent deep
vein thrombosis (DVT)?
A. Encouraging frequent use of the incentive spirometer
B. Placing a pillow under the patient's knees
C. Assisting the patient with early ambulation
D. Maintaining strict bed rest for 48 hours
🟢 C. Assisting the patient with early ambulation
🔴 RATIONALE: Early ambulation is the most effective nursing intervention to promote venous return and prevent the formation of blood clots. Placing pillows under knees can
actually impede venous flow.
, 2. A patient with a history of chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal cannula at 2 L/min. The nurse notes the patient’s oxygen saturation
is 89%. Which action should the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Perform a focused respiratory assessment
C. Administer a PRN dose of albuterol
D. Notify the healthcare provider immediately
🟢 B. Perform a focused respiratory assessment
🔴 RATIONALE: Assessment is the first step of the nursing process. For a COPD patient, a saturation of 88-92% is often targeted. The nurse must assess the patient's clinical
status before intervening.
3. Which of the following laboratory values should a nurse report to the provider for a patient receiving heparin therapy via continuous IV infusion?
A. Platelet count 160,000/mm3
B. aPTT 75 seconds
C. PT 12 seconds
D. aPTT 110 seconds
🟢 D. aPTT 110 seconds
🔴 RATIONALE: An aPTT of 110 seconds is significantly above the therapeutic range (usually 1.5 to 2.5 times the normal value), indicating a high risk for spontaneous bleeding.
4. A nurse is assessing a patient with Graves' disease. Which of the following clinical manifestations should the nurse expect to find?
A. Bradycardia
B. Weight gain
C. Exophthalmos
D. Cold intolerance
🟢 C. Exophthalmos
🔴 RATIONALE: Graves' disease is a form of hyperthyroidism. Exophthalmos (bulging eyes) is a classic sign. Other signs include tachycardia, weight loss, and heat intolerance.
5. A patient is admitted with a diagnosis of acute pancreatitis. Which of the following physician orders should the nurse implement first?
A. Administer IV morphine for pain
B. Initiate NPO status
C. Insert a nasogastric (NG) tube
D. Start IV fluids at 150 mL/hr
🟢 B. Initiate NPO status
, 🔴 RATIONALE: The primary goal in treating acute pancreatitis is to rest the pancreas by minimizing stimulation. Making the patient NPO is the first step in stopping the
secretion of digestive enzymes.
6. A nurse is teaching a patient about the management of newly diagnosed Type 1 Diabetes Mellitus. Which statement by the patient indicates a need for further teaching?
A. "I will check my blood sugar before every meal."
B. "I should rotate my injection sites within the same anatomical area."
C. "I can skip my insulin if I am too sick to eat."
D. "I will carry a fast-acting carbohydrate with me at all times."
🟢 C. "I can skip my insulin if I am too sick to eat."
🔴 RATIONALE: Patients with Type 1 Diabetes must never skip insulin even when ill, as they are at high risk for Diabetic Ketoacidosis (DKA). They should follow "sick day rules."
7. A patient presents to the emergency department with suspected appendicitis. Which of the following nursing interventions is contraindicated?
A. Applying a cold pack to the abdomen
B. Administering IV fluids
C. Applying a heating pad to the lower right quadrant
D. Maintaining NPO status
🟢 C. Applying a heating pad to the lower right quadrant
🔴 RATIONALE: Applying heat to the abdomen in suspected appendicitis increases blood flow and can lead to rupture of the appendix and subsequent peritonitis.
8. When caring for a patient with a chest tube, the nurse notes continuous bubbling in the water seal chamber. What does this finding indicate?
A. The system is functioning normally
B. The lung has fully re-expanded
C. There is an air leak in the system
D. The suction pressure is too high
🟢 C. There is an air leak in the system
🔴 RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak between the patient and the drainage system. Intermittent bubbling is normal during
expiration or coughing.
9. A patient is prescribed lisinopril for hypertension. Which side effect should the nurse instruct the patient to report immediately?
A. Excessive urination
B. Swelling of the tongue or lips
C. Increased appetite
D. Yellowing of the sclera
*CORE DOMAINS*
*Fluid and Electrolyte Balance*
*Perioperative Nursing Care*
*Cardiovascular and Hematologic Disorders*
*Respiratory System Management*
*Gastrointestinal and Metabolic Disorders*
*Neurological and Sensory Systems*
*Musculoskeletal and Integumentary Health*
*Renal and Urinary Function*
*Oncology and Immune System Disorders*
*Endocrine System Regulation*
*INTRODUCTION*
This comprehensive assessment is designed to evaluate a candidate’s proficiency in medical-surgical nursing, focusing on the critical knowledge required for safe and effective patient
care. The exam assesses a wide range of skills, including clinical judgment, prioritization, and the application of nursing theory to diverse clinical settings. Comprised of multiple-
choice questions and complex, scenario-based items, this tool challenges the learner to apply evidence-based practice and decision-making skills in real-world situations. The content
emphasizes patient safety, health promotion, and the management of acute and chronic health conditions, ensuring readiness for professional licensure and high-stakes clinical
practice.
*SECTION ONE*
1. A nurse is caring for a patient who is 24 hours postoperative following a total hip arthroplasty. Which of the following actions should the nurse prioritize to prevent deep
vein thrombosis (DVT)?
A. Encouraging frequent use of the incentive spirometer
B. Placing a pillow under the patient's knees
C. Assisting the patient with early ambulation
D. Maintaining strict bed rest for 48 hours
🟢 C. Assisting the patient with early ambulation
🔴 RATIONALE: Early ambulation is the most effective nursing intervention to promote venous return and prevent the formation of blood clots. Placing pillows under knees can
actually impede venous flow.
, 2. A patient with a history of chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal cannula at 2 L/min. The nurse notes the patient’s oxygen saturation
is 89%. Which action should the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Perform a focused respiratory assessment
C. Administer a PRN dose of albuterol
D. Notify the healthcare provider immediately
🟢 B. Perform a focused respiratory assessment
🔴 RATIONALE: Assessment is the first step of the nursing process. For a COPD patient, a saturation of 88-92% is often targeted. The nurse must assess the patient's clinical
status before intervening.
3. Which of the following laboratory values should a nurse report to the provider for a patient receiving heparin therapy via continuous IV infusion?
A. Platelet count 160,000/mm3
B. aPTT 75 seconds
C. PT 12 seconds
D. aPTT 110 seconds
🟢 D. aPTT 110 seconds
🔴 RATIONALE: An aPTT of 110 seconds is significantly above the therapeutic range (usually 1.5 to 2.5 times the normal value), indicating a high risk for spontaneous bleeding.
4. A nurse is assessing a patient with Graves' disease. Which of the following clinical manifestations should the nurse expect to find?
A. Bradycardia
B. Weight gain
C. Exophthalmos
D. Cold intolerance
🟢 C. Exophthalmos
🔴 RATIONALE: Graves' disease is a form of hyperthyroidism. Exophthalmos (bulging eyes) is a classic sign. Other signs include tachycardia, weight loss, and heat intolerance.
5. A patient is admitted with a diagnosis of acute pancreatitis. Which of the following physician orders should the nurse implement first?
A. Administer IV morphine for pain
B. Initiate NPO status
C. Insert a nasogastric (NG) tube
D. Start IV fluids at 150 mL/hr
🟢 B. Initiate NPO status
, 🔴 RATIONALE: The primary goal in treating acute pancreatitis is to rest the pancreas by minimizing stimulation. Making the patient NPO is the first step in stopping the
secretion of digestive enzymes.
6. A nurse is teaching a patient about the management of newly diagnosed Type 1 Diabetes Mellitus. Which statement by the patient indicates a need for further teaching?
A. "I will check my blood sugar before every meal."
B. "I should rotate my injection sites within the same anatomical area."
C. "I can skip my insulin if I am too sick to eat."
D. "I will carry a fast-acting carbohydrate with me at all times."
🟢 C. "I can skip my insulin if I am too sick to eat."
🔴 RATIONALE: Patients with Type 1 Diabetes must never skip insulin even when ill, as they are at high risk for Diabetic Ketoacidosis (DKA). They should follow "sick day rules."
7. A patient presents to the emergency department with suspected appendicitis. Which of the following nursing interventions is contraindicated?
A. Applying a cold pack to the abdomen
B. Administering IV fluids
C. Applying a heating pad to the lower right quadrant
D. Maintaining NPO status
🟢 C. Applying a heating pad to the lower right quadrant
🔴 RATIONALE: Applying heat to the abdomen in suspected appendicitis increases blood flow and can lead to rupture of the appendix and subsequent peritonitis.
8. When caring for a patient with a chest tube, the nurse notes continuous bubbling in the water seal chamber. What does this finding indicate?
A. The system is functioning normally
B. The lung has fully re-expanded
C. There is an air leak in the system
D. The suction pressure is too high
🟢 C. There is an air leak in the system
🔴 RATIONALE: Continuous bubbling in the water seal chamber indicates an air leak between the patient and the drainage system. Intermittent bubbling is normal during
expiration or coughing.
9. A patient is prescribed lisinopril for hypertension. Which side effect should the nurse instruct the patient to report immediately?
A. Excessive urination
B. Swelling of the tongue or lips
C. Increased appetite
D. Yellowing of the sclera
