HESI Medical-Surgical V1 | 2026 Q&A with
Rationale
1. A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and
requests assistance with breathing. Which action should the nurse implement first?
A. Assist the client into a high-Fowler’s position.
B. Increase the oxygen flow rate to 6 L/min via nasal cannula.
C. Administer a PRN dose of an oral corticosteroid.
D. Perform chest physiotherapy to mobilize secretions.
Correct Answer: A
Rationale: Positioning the client in a high-Fowler’s position or orthopneic position allows
for maximum chest expansion and eases the work of breathing. Increasing oxygen to a high
level in COPD clients can potentially suppress the hypoxic drive to breathe. While
medications and chest physiotherapy are important, immediate physical positioning is the
most rapid nursing intervention to improve ventilation.
2. The nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports a
tingling sensation around the mouth and in the fingertips. Which action is most important for
the nurse to take?
A. Assess for Chvostek’s and Trousseau’s signs.
B. Check the client’s temperature for signs of a thyroid storm.
,C. Encourage the client to use an incentive spirometer.
D. Document the finding as a normal postoperative occurrence.
Correct Answer: A
Rationale: Tingling around the mouth and in the extremities is a classic sign of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. The nurse should immediately assess for neuromuscular
irritability using Chvostek’s and Trousseau’s signs to determine the severity. Hypocalcemia
is a medical emergency that can lead to tetany and respiratory distress if left untreated.
3. A client is admitted with an acute exacerbation of heart failure. Which clinical findings
should the nurse expect to observe? (Select All That Apply)
A. Bibasilar crackles upon auscultation.
B. Increased jugular venous distention.
C. Bradycardia and hypertension.
D. Dependent peripheral edema.
E. Weight loss of 2 pounds in 24 hours.
F. Orthopnea and nocturnal dyspnea.
Correct Answer: A,B,D,F
Rationale: Heart failure exacerbation typically involves fluid volume overload, manifesting
as crackles in the lungs, jugular venous distention, and peripheral edema. Orthopnea is
,common as the client feels unable to breathe while lying flat due to fluid redistribution.
Weight gain, rather than weight loss, and tachycardia, rather than bradycardia, are
expected findings in acute heart failure.
4. The nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding should lead the nurse to withhold the medication and notify the
healthcare provider?
A. Blood pressure of 140/90 mmHg.
B. Respiratory rate of 18 breaths per minute.
C. Potassium level of 4.8 mEq/L.
D. Apical heart rate of 54 beats per minute.
Correct Answer: D
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases the force
of contraction. It should be withheld if the heart rate is below 60 beats per minute to
prevent further bradycardia. The nurse must assess the apical pulse for one full minute
prior to administration to ensure safe dosing.
5. A client with Type 1 Diabetes Mellitus is found unconscious and diaphoretic. What is the
nurse’s priority action?
A. Administer intramuscular glucagon per protocol.
B. Administer 15 grams of simple carbohydrates orally.
C. Obtain a blood glucose reading.
, D. Call for a STAT metabolic panel lab draw.
Correct Answer: A
Rationale: In an unconscious client suspected of hypoglycemia, the priority is to restore
blood glucose safely and quickly. Since the client is unconscious and cannot swallow, oral
carbohydrates are contraindicated due to the risk of aspiration. Glucagon or intravenous
dextrose is the standard emergency treatment to elevate blood sugar levels in this scenario.
6. Which teaching should the nurse provide to a client newly diagnosed with systemic lupus
erythematosus (SLE) to prevent exacerbations?
A. Increase intake of high-protein, low-fat dairy products.
B. Avoid exposure to direct sunlight and use sunscreen.
C. Engage in high-impact aerobic exercise daily.
D. Apply warm compresses to joints every morning.
Correct Answer: B
Rationale: Ultraviolet (UV) light exposure is a known trigger for SLE flares and can worsen
skin lesions and systemic symptoms. Clients should be taught to wear protective clothing
and apply high-SPF sunscreen when outdoors. While joint care is important, sun protection
is a specific preventative measure against systemic exacerbations in lupus.
Rationale
1. A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and
requests assistance with breathing. Which action should the nurse implement first?
A. Assist the client into a high-Fowler’s position.
B. Increase the oxygen flow rate to 6 L/min via nasal cannula.
C. Administer a PRN dose of an oral corticosteroid.
D. Perform chest physiotherapy to mobilize secretions.
Correct Answer: A
Rationale: Positioning the client in a high-Fowler’s position or orthopneic position allows
for maximum chest expansion and eases the work of breathing. Increasing oxygen to a high
level in COPD clients can potentially suppress the hypoxic drive to breathe. While
medications and chest physiotherapy are important, immediate physical positioning is the
most rapid nursing intervention to improve ventilation.
2. The nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports a
tingling sensation around the mouth and in the fingertips. Which action is most important for
the nurse to take?
A. Assess for Chvostek’s and Trousseau’s signs.
B. Check the client’s temperature for signs of a thyroid storm.
,C. Encourage the client to use an incentive spirometer.
D. Document the finding as a normal postoperative occurrence.
Correct Answer: A
Rationale: Tingling around the mouth and in the extremities is a classic sign of
hypocalcemia, which can occur if the parathyroid glands are accidentally damaged or
removed during a thyroidectomy. The nurse should immediately assess for neuromuscular
irritability using Chvostek’s and Trousseau’s signs to determine the severity. Hypocalcemia
is a medical emergency that can lead to tetany and respiratory distress if left untreated.
3. A client is admitted with an acute exacerbation of heart failure. Which clinical findings
should the nurse expect to observe? (Select All That Apply)
A. Bibasilar crackles upon auscultation.
B. Increased jugular venous distention.
C. Bradycardia and hypertension.
D. Dependent peripheral edema.
E. Weight loss of 2 pounds in 24 hours.
F. Orthopnea and nocturnal dyspnea.
Correct Answer: A,B,D,F
Rationale: Heart failure exacerbation typically involves fluid volume overload, manifesting
as crackles in the lungs, jugular venous distention, and peripheral edema. Orthopnea is
,common as the client feels unable to breathe while lying flat due to fluid redistribution.
Weight gain, rather than weight loss, and tachycardia, rather than bradycardia, are
expected findings in acute heart failure.
4. The nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding should lead the nurse to withhold the medication and notify the
healthcare provider?
A. Blood pressure of 140/90 mmHg.
B. Respiratory rate of 18 breaths per minute.
C. Potassium level of 4.8 mEq/L.
D. Apical heart rate of 54 beats per minute.
Correct Answer: D
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases the force
of contraction. It should be withheld if the heart rate is below 60 beats per minute to
prevent further bradycardia. The nurse must assess the apical pulse for one full minute
prior to administration to ensure safe dosing.
5. A client with Type 1 Diabetes Mellitus is found unconscious and diaphoretic. What is the
nurse’s priority action?
A. Administer intramuscular glucagon per protocol.
B. Administer 15 grams of simple carbohydrates orally.
C. Obtain a blood glucose reading.
, D. Call for a STAT metabolic panel lab draw.
Correct Answer: A
Rationale: In an unconscious client suspected of hypoglycemia, the priority is to restore
blood glucose safely and quickly. Since the client is unconscious and cannot swallow, oral
carbohydrates are contraindicated due to the risk of aspiration. Glucagon or intravenous
dextrose is the standard emergency treatment to elevate blood sugar levels in this scenario.
6. Which teaching should the nurse provide to a client newly diagnosed with systemic lupus
erythematosus (SLE) to prevent exacerbations?
A. Increase intake of high-protein, low-fat dairy products.
B. Avoid exposure to direct sunlight and use sunscreen.
C. Engage in high-impact aerobic exercise daily.
D. Apply warm compresses to joints every morning.
Correct Answer: B
Rationale: Ultraviolet (UV) light exposure is a known trigger for SLE flares and can worsen
skin lesions and systemic symptoms. Clients should be taught to wear protective clothing
and apply high-SPF sunscreen when outdoors. While joint care is important, sun protection
is a specific preventative measure against systemic exacerbations in lupus.
