HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
,HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
Question 1
A client is admitted with severe vomiting and diarrhea for 3 days. Which
laboratory finding should the nurse anticipate?
• A) Decreased hematocrit and hypokalemia.
• B) Elevated hematocrit, high specific gravity, and metabolic
alkalosis or acidosis depending on losses.
• C) Decreased blood urea nitrogen (BUN).
• D) Hypernatremia alone with normal hematocrit.
Correct Answer: B) Elevated hematocrit, high specific gravity, and
metabolic alkalosis or acidosis depending on losses.
• Rationale: Fluid volume deficit (dehydration) concentrates blood
components, resulting in hemoconcentration (elevated
hematocrit) and high urine specific gravity. Vomiting causes loss of
gastric acid (metabolic alkalosis), while diarrhea causes loss of
bicarbonate (metabolic acidosis).
Question 2
An arterial blood gas (ABG) report for a client shows: pH 7.30, PaCO2 55
mmHg, HCO3 24 mEq/L. How should the nurse interpret these results?
• A) Metabolic acidosis, uncompensated.
• B) Respiratory acidosis, uncompensated.
• C) Respiratory alkalosis, partially compensated.
• D) Metabolic alkalosis, fully compensated.
Correct Answer: B) Respiratory acidosis, uncompensated.
,HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
• Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is
elevated above 45 mmHg (indicating a respiratory cause), while
the HCO3 is normal (22-26 mEq/L), meaning the kidneys have not
yet had time to compensate. This is uncompensated respiratory
acidosis.
Question 3
A nurse is preparing a client for an elective surgical procedure. Who
holds the ultimate legal responsibility for obtaining informed consent
from the client?
• A) The staff registered nurse caring for the client on the unit.
• B) The surgeon or healthcare provider performing the procedure.
• C) The hospital risk manager or legal counsel.
• D) The surgical unit charge nurse.
Correct Answer: B) The surgeon or healthcare provider performing the
procedure.
• Rationale: The provider performing the procedure is legally
responsible for explaining the risks, benefits, and alternatives and
obtaining informed consent. The nurse's role is to witness the
client's signature and verify that the client is informed and
competent.
Question 4
A postoperative client on the medical-surgical unit suddenly reports a
"pop" sensation after coughing violently, followed by visceral organs
, HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
protruding through the abdominal surgical wound. What is the nurse's
immediate action?
• A) Push the protruding organs gently back into the abdominal
cavity and apply pressure.
• B) Call for help, stay with the client, cover the exposed organs with
sterile saline-soaked gauze, and place the client in a low Fowler's
position with knees flexed.
• C) Administer a strong oral pain medication immediately.
• D) Leave the client alone to find the surgeon immediately.
Correct Answer: B) Call for help, stay with the client, cover the
exposed organs with sterile saline-soaked gauze, and place the client
in a low Fowler's position with knees flexed.
• Rationale: Wound evisceration is a medical emergency. The nurse
must never push organs back in (risk of contamination/damage).
Sterile saline-soaked dressings keep tissues moist, and low
Fowler's position with flexed knees reduces tension on the
abdominal suture line.
Question 5
A client receiving a blood transfusion develops a sudden febrile reaction
with a temperature spike of 2°F above baseline, chills, and headache,
but no hypotension or bronchospasm. What type of transfusion
reaction is most likely?
• A) Acute hemolytic transfusion reaction.
• B) Febrile non-hemolytic transfusion reaction.
detailed answers
,HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
Question 1
A client is admitted with severe vomiting and diarrhea for 3 days. Which
laboratory finding should the nurse anticipate?
• A) Decreased hematocrit and hypokalemia.
• B) Elevated hematocrit, high specific gravity, and metabolic
alkalosis or acidosis depending on losses.
• C) Decreased blood urea nitrogen (BUN).
• D) Hypernatremia alone with normal hematocrit.
Correct Answer: B) Elevated hematocrit, high specific gravity, and
metabolic alkalosis or acidosis depending on losses.
• Rationale: Fluid volume deficit (dehydration) concentrates blood
components, resulting in hemoconcentration (elevated
hematocrit) and high urine specific gravity. Vomiting causes loss of
gastric acid (metabolic alkalosis), while diarrhea causes loss of
bicarbonate (metabolic acidosis).
Question 2
An arterial blood gas (ABG) report for a client shows: pH 7.30, PaCO2 55
mmHg, HCO3 24 mEq/L. How should the nurse interpret these results?
• A) Metabolic acidosis, uncompensated.
• B) Respiratory acidosis, uncompensated.
• C) Respiratory alkalosis, partially compensated.
• D) Metabolic alkalosis, fully compensated.
Correct Answer: B) Respiratory acidosis, uncompensated.
,HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
• Rationale: A pH below 7.35 indicates acidosis. The PaCO2 is
elevated above 45 mmHg (indicating a respiratory cause), while
the HCO3 is normal (22-26 mEq/L), meaning the kidneys have not
yet had time to compensate. This is uncompensated respiratory
acidosis.
Question 3
A nurse is preparing a client for an elective surgical procedure. Who
holds the ultimate legal responsibility for obtaining informed consent
from the client?
• A) The staff registered nurse caring for the client on the unit.
• B) The surgeon or healthcare provider performing the procedure.
• C) The hospital risk manager or legal counsel.
• D) The surgical unit charge nurse.
Correct Answer: B) The surgeon or healthcare provider performing the
procedure.
• Rationale: The provider performing the procedure is legally
responsible for explaining the risks, benefits, and alternatives and
obtaining informed consent. The nurse's role is to witness the
client's signature and verify that the client is informed and
competent.
Question 4
A postoperative client on the medical-surgical unit suddenly reports a
"pop" sensation after coughing violently, followed by visceral organs
, HESI Medical-Surgical Actual Exam 2026 questions and well
detailed answers
protruding through the abdominal surgical wound. What is the nurse's
immediate action?
• A) Push the protruding organs gently back into the abdominal
cavity and apply pressure.
• B) Call for help, stay with the client, cover the exposed organs with
sterile saline-soaked gauze, and place the client in a low Fowler's
position with knees flexed.
• C) Administer a strong oral pain medication immediately.
• D) Leave the client alone to find the surgeon immediately.
Correct Answer: B) Call for help, stay with the client, cover the
exposed organs with sterile saline-soaked gauze, and place the client
in a low Fowler's position with knees flexed.
• Rationale: Wound evisceration is a medical emergency. The nurse
must never push organs back in (risk of contamination/damage).
Sterile saline-soaked dressings keep tissues moist, and low
Fowler's position with flexed knees reduces tension on the
abdominal suture line.
Question 5
A client receiving a blood transfusion develops a sudden febrile reaction
with a temperature spike of 2°F above baseline, chills, and headache,
but no hypotension or bronchospasm. What type of transfusion
reaction is most likely?
• A) Acute hemolytic transfusion reaction.
• B) Febrile non-hemolytic transfusion reaction.
