,Table of contents
HESI RN Medical-Surgical V1 ................................................................... 2
HESI RN Medical-Surgical v2 ............................................................. 243
HESI RN Med-Surg V3 .................................................................... 328
HESI RN Med-Surg V4 ......................................................................... 539
HESI RN Med-Surg V5 ...................................................................... 610
HESI RN Med-Surg V6 .................................................................... 780
HESI RN Med-Surg Additional revision MOST TESTED FROM PASTPAPERS
............................................................................................................ 941
HESI RN Medical-Surgical V1
1. A client with heart failure suddenly develops pink-tinged frothy sputum, severe dyspnea, and
anxiety. Which action should the nurse take first?
a. Increase IV fluids
b. Place the client in high Fowler's position
c. Obtain a sputum sample
d. Administer PRN antianxiety medication
Correct Answer: b. Place the client in high Fowler's position
Expert Rationale
These symptoms indicate acute pulmonary edema. High-Fowler's position improves oxygenation
,and decreases venous return to the heart, reducing pulmonary congestion. Option a (Increase IV
fluids) would worsen fluid overload. Option c (Sputum sample) is not the priority. Option d
(Antianxiety medication) may be given later but does not address the underlying pathophysiology.
The nurse should position the client, administer oxygen, and prepare for diuretics.
DIF: Cognitive Level: Apply (Application) OBJ: Prioritize respiratory distress interventions TOP:
Cardiac/Respiratory Failure/Safety MSC: NCLEX: Physiological Integrity
2. A postoperative client has a blood pressure of 88/52, a heart rate of 132/min, and cool,
clammy skin. Which action is priority?
a. Increase oral fluids
b. Check urine sample
c. Notify the provider
d. Reposition the client for comfort
Correct Answer: c. Notify the provider
Expert Rationale
These findings indicate possible shock (hypotension, tachycardia, cool/clammy skin). Rapid provider
notification is essential for life-saving intervention. Option a (Oral fluids) is not appropriate in a
postoperative client with possible hemorrhage or hypovolemia. Option b (Urine sample) is not the
priority. Option d (Reposition) does not address the underlying hemodynamic instability. The nurse
should notify the provider immediately and prepare for IV fluid resuscitation.
DIF: Cognitive Level: Analyze (Analysis) OBJ: Recognize early signs of shock TOP: Post-operative
Complications/Safety MSC: NCLEX: Physiological Integrity
3. A client with COPD becomes confused and drowsy. ABGs show pH 7.28, PaCO₂ 65, PaO₂ 60.
What action should the nurse anticipate?
a. Withhold oxygen
b. Prepare for possible ventilation support
c. Encourage pursed-lip breathing only
, d. Decrease fluid intake
Correct Answer: b. Prepare for possible ventilation support
Expert Rationale
Elevated CO₂ (65 mmHg) with declining mental status indicates CO₂ narcosis, requiring ventilatory
assistance. Option a (Withhold oxygen) is dangerous; oxygen should be administered cautiously.
Option c (Pursed-lip breathing) is not sufficient for this level of respiratory acidosis. Option d
(Decrease fluids) is unrelated. The nurse should anticipate non-invasive or mechanical ventilation.
DIF: Cognitive Level: Analyze (Analysis) OBJ: Interpret ABGs TOP: Respiratory/COPD Exacerbation
MSC: NCLEX: Physiological Integrity
4. A client with DKA has a glucose level of 520 mg/dL, deep rapid respirations, and dry mucous
membranes. Which is the priority?
a. Administer insulin infusion
b. Provide warm blankets
c. Start IV isotonic fluids
d. Give sodium bicarbonate
Correct Answer: c. Start IV isotonic fluids
Expert Rationale
Severe dehydration is the immediate life threat in DKA; fluids must be restored before insulin
therapy. Option a (Insulin infusion) is important but follows fluid resuscitation. Option b (Warm
blankets) is not a priority. Option d (Sodium bicarbonate) is rarely indicated and can worsen
acidosis. The nurse should start IV isotonic fluids (0.9% NS) immediately.
DIF: Cognitive Level: Apply (Application) OBJ: Prioritize DKA management TOP: Endocrine/Diabetes
MSC: NCLEX: Physiological Integrity
5. A client receiving IV potassium reports burning at the IV site. What should the nurse do first?
a. Stop the infusion
HESI RN Medical-Surgical V1 ................................................................... 2
HESI RN Medical-Surgical v2 ............................................................. 243
HESI RN Med-Surg V3 .................................................................... 328
HESI RN Med-Surg V4 ......................................................................... 539
HESI RN Med-Surg V5 ...................................................................... 610
HESI RN Med-Surg V6 .................................................................... 780
HESI RN Med-Surg Additional revision MOST TESTED FROM PASTPAPERS
............................................................................................................ 941
HESI RN Medical-Surgical V1
1. A client with heart failure suddenly develops pink-tinged frothy sputum, severe dyspnea, and
anxiety. Which action should the nurse take first?
a. Increase IV fluids
b. Place the client in high Fowler's position
c. Obtain a sputum sample
d. Administer PRN antianxiety medication
Correct Answer: b. Place the client in high Fowler's position
Expert Rationale
These symptoms indicate acute pulmonary edema. High-Fowler's position improves oxygenation
,and decreases venous return to the heart, reducing pulmonary congestion. Option a (Increase IV
fluids) would worsen fluid overload. Option c (Sputum sample) is not the priority. Option d
(Antianxiety medication) may be given later but does not address the underlying pathophysiology.
The nurse should position the client, administer oxygen, and prepare for diuretics.
DIF: Cognitive Level: Apply (Application) OBJ: Prioritize respiratory distress interventions TOP:
Cardiac/Respiratory Failure/Safety MSC: NCLEX: Physiological Integrity
2. A postoperative client has a blood pressure of 88/52, a heart rate of 132/min, and cool,
clammy skin. Which action is priority?
a. Increase oral fluids
b. Check urine sample
c. Notify the provider
d. Reposition the client for comfort
Correct Answer: c. Notify the provider
Expert Rationale
These findings indicate possible shock (hypotension, tachycardia, cool/clammy skin). Rapid provider
notification is essential for life-saving intervention. Option a (Oral fluids) is not appropriate in a
postoperative client with possible hemorrhage or hypovolemia. Option b (Urine sample) is not the
priority. Option d (Reposition) does not address the underlying hemodynamic instability. The nurse
should notify the provider immediately and prepare for IV fluid resuscitation.
DIF: Cognitive Level: Analyze (Analysis) OBJ: Recognize early signs of shock TOP: Post-operative
Complications/Safety MSC: NCLEX: Physiological Integrity
3. A client with COPD becomes confused and drowsy. ABGs show pH 7.28, PaCO₂ 65, PaO₂ 60.
What action should the nurse anticipate?
a. Withhold oxygen
b. Prepare for possible ventilation support
c. Encourage pursed-lip breathing only
, d. Decrease fluid intake
Correct Answer: b. Prepare for possible ventilation support
Expert Rationale
Elevated CO₂ (65 mmHg) with declining mental status indicates CO₂ narcosis, requiring ventilatory
assistance. Option a (Withhold oxygen) is dangerous; oxygen should be administered cautiously.
Option c (Pursed-lip breathing) is not sufficient for this level of respiratory acidosis. Option d
(Decrease fluids) is unrelated. The nurse should anticipate non-invasive or mechanical ventilation.
DIF: Cognitive Level: Analyze (Analysis) OBJ: Interpret ABGs TOP: Respiratory/COPD Exacerbation
MSC: NCLEX: Physiological Integrity
4. A client with DKA has a glucose level of 520 mg/dL, deep rapid respirations, and dry mucous
membranes. Which is the priority?
a. Administer insulin infusion
b. Provide warm blankets
c. Start IV isotonic fluids
d. Give sodium bicarbonate
Correct Answer: c. Start IV isotonic fluids
Expert Rationale
Severe dehydration is the immediate life threat in DKA; fluids must be restored before insulin
therapy. Option a (Insulin infusion) is important but follows fluid resuscitation. Option b (Warm
blankets) is not a priority. Option d (Sodium bicarbonate) is rarely indicated and can worsen
acidosis. The nurse should start IV isotonic fluids (0.9% NS) immediately.
DIF: Cognitive Level: Apply (Application) OBJ: Prioritize DKA management TOP: Endocrine/Diabetes
MSC: NCLEX: Physiological Integrity
5. A client receiving IV potassium reports burning at the IV site. What should the nurse do first?
a. Stop the infusion
