HESI Medical-Surgical V3 | 2026 Q&A with
Rationale
1. A client is 12 hours post-total hip replacement. Which intervention is most important for
the nurse to implement?
A. Encouraging deep breathing and coughing every 4 hours.
B. Keeping the client in a high Fowler’s position for meals.
C. Massaging the affected leg to promote circulation.
D. Placing an abduction pillow between the legs while in bed.
Correct Answer: D
Rationale: After a total hip replacement, it is crucial to maintain the hip in an abducted
position to prevent dislocation of the prosthesis. The abduction pillow ensures the legs stay
apart and prevents adduction, which is a primary risk factor for dislocation. Massaging the
leg is contraindicated because it could dislodge a potential deep vein thrombosis.
2. Which clinical manifestation should the nurse expect to find in a client diagnosed with
Cushing’s syndrome?
A. Central obesity and a buffalo hump.
B. Hyperpigmentation of the skin.
C. Hypotension and weight loss.
,D. Increased muscle mass in the extremities.
Correct Answer: A
Rationale: Cushing’s syndrome results from excessive cortisol, leading to a redistribution
of fat in the central body areas, including the face (moon face) and upper back (buffalo
hump). Clients typically exhibit thin extremities due to muscle wasting and protein
catabolism. Hypotension and weight loss are more characteristic of Addison’s disease, the
opposite of Cushing’s.
3. A client with heart failure is prescribed Digoxin 0.25 mg daily. Which assessment finding
requires the nurse to hold the medication?
A. Blood pressure of 140/90 mmHg.
B. Potassium level of 4.2 mEq/L.
C. Respiratory rate of 22 breaths per minute.
D. Apical heart rate of 52 beats per minute.
Correct Answer: D
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, the apical
pulse must be assessed for one full minute prior to administration. The medication should
be held and the provider notified if the heart rate is below 60 bpm in adults. A potassium
level of 4.2 is within normal range, though hypokalemia increases the risk of digoxin
toxicity.
,4. Which interventions should the nurse include in the plan of care for a client at risk for
developing a deep vein thrombosis (DVT)? (Select all that apply.)
A. Apply sequential compression devices (SCDs) while in bed.
B. Encourage active range-of-motion exercises of the ankles.
C. Place pillows under the knees to keep them slightly flexed.
D. Administer prophylactic low-molecular-weight heparin as ordered.
E. Limit fluid intake to reduce blood volume.
F. Ambulate the client as soon as possible after surgery.
Correct Answer: ABDF
Rationale: Prevention of DVT involves promoting venous return and preventing stasis
through SCDs, exercises, anticoagulants, and early ambulation. Placing pillows under the
knees should be avoided because it can compress the popliteal vessels and impede blood
flow. Adequate hydration, not fluid limitation, is necessary to prevent hemoconcentration
and clotting.
5. A nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding.
B. Check the system for an air leak.
C. Increase the suction level on the drainage unit.
, D. Clamp the chest tube close to the insertion site.
Correct Answer: B
Rationale: Intermittent bubbling in the water-seal chamber is normal during expiration or
coughing, but continuous bubbling indicates an air leak in the system or the client’s lung.
The nurse must systematically check the tubing and the client’s insertion site to locate the
leak. Clamping the tube is generally avoided unless checking for a leak or changing the
system because it can cause a tension pneumothorax.
6. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at 2L/min
via nasal cannula. Which finding is the most concerning?
A. Oxygen saturation of 91%.
B. A productive cough with clear sputum.
C. Anteroposterior diameter of the chest is increased.
D. Respiratory rate of 10 breaths per minute.
Correct Answer: D
Rationale: Clients with COPD often rely on a hypoxic drive to breathe; excessive oxygen
administration can depress this drive, leading to respiratory depression. A respiratory rate
of 10 is low and may indicate the client is hypoventilating due to decreased drive. An
oxygen saturation of 91% and a ‘barrel chest’ (increased AP diameter) are expected
findings in chronic COPD.
Rationale
1. A client is 12 hours post-total hip replacement. Which intervention is most important for
the nurse to implement?
A. Encouraging deep breathing and coughing every 4 hours.
B. Keeping the client in a high Fowler’s position for meals.
C. Massaging the affected leg to promote circulation.
D. Placing an abduction pillow between the legs while in bed.
Correct Answer: D
Rationale: After a total hip replacement, it is crucial to maintain the hip in an abducted
position to prevent dislocation of the prosthesis. The abduction pillow ensures the legs stay
apart and prevents adduction, which is a primary risk factor for dislocation. Massaging the
leg is contraindicated because it could dislodge a potential deep vein thrombosis.
2. Which clinical manifestation should the nurse expect to find in a client diagnosed with
Cushing’s syndrome?
A. Central obesity and a buffalo hump.
B. Hyperpigmentation of the skin.
C. Hypotension and weight loss.
,D. Increased muscle mass in the extremities.
Correct Answer: A
Rationale: Cushing’s syndrome results from excessive cortisol, leading to a redistribution
of fat in the central body areas, including the face (moon face) and upper back (buffalo
hump). Clients typically exhibit thin extremities due to muscle wasting and protein
catabolism. Hypotension and weight loss are more characteristic of Addison’s disease, the
opposite of Cushing’s.
3. A client with heart failure is prescribed Digoxin 0.25 mg daily. Which assessment finding
requires the nurse to hold the medication?
A. Blood pressure of 140/90 mmHg.
B. Potassium level of 4.2 mEq/L.
C. Respiratory rate of 22 breaths per minute.
D. Apical heart rate of 52 beats per minute.
Correct Answer: D
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, the apical
pulse must be assessed for one full minute prior to administration. The medication should
be held and the provider notified if the heart rate is below 60 bpm in adults. A potassium
level of 4.2 is within normal range, though hypokalemia increases the risk of digoxin
toxicity.
,4. Which interventions should the nurse include in the plan of care for a client at risk for
developing a deep vein thrombosis (DVT)? (Select all that apply.)
A. Apply sequential compression devices (SCDs) while in bed.
B. Encourage active range-of-motion exercises of the ankles.
C. Place pillows under the knees to keep them slightly flexed.
D. Administer prophylactic low-molecular-weight heparin as ordered.
E. Limit fluid intake to reduce blood volume.
F. Ambulate the client as soon as possible after surgery.
Correct Answer: ABDF
Rationale: Prevention of DVT involves promoting venous return and preventing stasis
through SCDs, exercises, anticoagulants, and early ambulation. Placing pillows under the
knees should be avoided because it can compress the popliteal vessels and impede blood
flow. Adequate hydration, not fluid limitation, is necessary to prevent hemoconcentration
and clotting.
5. A nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding.
B. Check the system for an air leak.
C. Increase the suction level on the drainage unit.
, D. Clamp the chest tube close to the insertion site.
Correct Answer: B
Rationale: Intermittent bubbling in the water-seal chamber is normal during expiration or
coughing, but continuous bubbling indicates an air leak in the system or the client’s lung.
The nurse must systematically check the tubing and the client’s insertion site to locate the
leak. Clamping the tube is generally avoided unless checking for a leak or changing the
system because it can cause a tension pneumothorax.
6. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at 2L/min
via nasal cannula. Which finding is the most concerning?
A. Oxygen saturation of 91%.
B. A productive cough with clear sputum.
C. Anteroposterior diameter of the chest is increased.
D. Respiratory rate of 10 breaths per minute.
Correct Answer: D
Rationale: Clients with COPD often rely on a hypoxic drive to breathe; excessive oxygen
administration can depress this drive, leading to respiratory depression. A respiratory rate
of 10 is low and may indicate the client is hypoventilating due to decreased drive. An
oxygen saturation of 91% and a ‘barrel chest’ (increased AP diameter) are expected
findings in chronic COPD.
