,HESI Exit Exam Medical-Surgical Nursing Questions
and Answers with Rationale 2026/2027
Question 1
A client is admitted to the medical-surgical unit with a diagnosis of
acute pancreatitis. Which clinical manifestation should the nurse expect
to find during the initial assessment?
A. Left upper quadrant abdominal pain that radiates to the back
B. Right lower quadrant pain accompanied by rebound tenderness
C. Painless jaundice and clay-colored stools
D. Colicky flank pain radiating to the groin
Correct Answer: A. Left upper quadrant abdominal pain that radiates to
the back
Rationale: Acute pancreatitis is characterized by severe, constant,
boring pain located in the epigastric region or left upper quadrant that
frequently radiates straight through to the back. It is often aggravated by
eating and lying supine.
Question 2
A client with chronic kidney disease (CKD) is admitted with a serum
potassium level of 6.2 mEq/L. Which electrocardiogram (ECG) change
should the nurse anticipate observing as a result of this severe
hyperkalemia?
A. Prominent U waves and flattened T waves
B. Tall, peaked T waves and widened QRS complexes
C. Prolonged QT intervals with normal T waves
D. Atrial fibrillation with a slow ventricular response
Correct Answer: B. Tall, peaked T waves and widened QRS complexes
, Rationale: Hyperkalemia profoundly affects myocardial
depolarization and repolarization. Early ECG changes include tall,
peaked T waves, followed by prolonged PR intervals, widened
QRS complexes, and potentially fatal ventricular arrhythmias.
Question 3
A client is recovering in the surgical unit following a subtotal
thyroidectomy. Upon entering the room, the nurse notes the client is
experiencing stridor, muscle twitching around the mouth, and numbness
in the fingertips. What is the immediate priority nursing action?
A. Elevate the head of the bed to 90 degrees and encourage deep
breathing
B. Notify the surgeon immediately and ensure intravenous calcium
gluconate is readily available at the bedside
C. Administer oral acetaminophen for incisional pain
D. Apply an ice pack to the anterior neck dressing
Correct Answer: B. Notify the surgeon immediately and ensure
intravenous calcium gluconate is readily available at the bedside
Rationale: Inadvertent trauma or removal of the parathyroid glands
during a thyroidectomy causes hypocalcemia, manifesting as
tetany (muscle twitching, tingling) and laryngeal stridor. This is a
medical emergency requiring immediate calcium gluconate
administration and airway readiness.
Question 4
A nurse is caring for a client admitted with a suspected pulmonary
embolism (PE). Which arterial blood gas (ABG) result should the nurse
expect upon initial evaluation?
A. Respiratory alkalosis due to tachypnea and hyperventilation
B. Respiratory acidosis due to alveolar hypoventilation
C. Metabolic alkalosis due to gastric fluid loss
, D. Metabolic acidosis due to tissue hypoxia
Correct Answer: A. Respiratory alkalosis due to tachypnea and
hyperventilation
Rationale: Clients experiencing a pulmonary embolism typically
present with sudden dyspnea, anxiety, and tachypnea.
Hyperventilation causes "blowing off" of carbon dioxide, leading
to initial acute respiratory alkalosis (elevated pH, decreased
PaCO2).
Question 5
A client with cirrhosis of the liver and severe ascites is scheduled for a
paracentesis. What is the most critical nursing intervention immediately
before the procedure?
A. Instruct the client to drink 500 mL of water
B. Have the client empty their urinary bladder to reduce the risk of
bladder perforation
C. Place the client in a flat supine position
D. Administer a cleansing soap suds enema
Correct Answer: B. Have the client empty their urinary bladder to
reduce the risk of bladder perforation
Rationale: Because an enlarged, fluid-filled bladder can be
displaced or elevated in clients with ascites and pelvic fullness,
asking the client to void immediately prior to a paracentesis
significantly reduces the risk of accidental bladder puncture during
needle insertion.
Question 6
A client is admitted with a diagnosis of diabetic ketoacidosis (DKA).
Which clinical finding should the nurse expect to assess during the
physical examination?
and Answers with Rationale 2026/2027
Question 1
A client is admitted to the medical-surgical unit with a diagnosis of
acute pancreatitis. Which clinical manifestation should the nurse expect
to find during the initial assessment?
A. Left upper quadrant abdominal pain that radiates to the back
B. Right lower quadrant pain accompanied by rebound tenderness
C. Painless jaundice and clay-colored stools
D. Colicky flank pain radiating to the groin
Correct Answer: A. Left upper quadrant abdominal pain that radiates to
the back
Rationale: Acute pancreatitis is characterized by severe, constant,
boring pain located in the epigastric region or left upper quadrant that
frequently radiates straight through to the back. It is often aggravated by
eating and lying supine.
Question 2
A client with chronic kidney disease (CKD) is admitted with a serum
potassium level of 6.2 mEq/L. Which electrocardiogram (ECG) change
should the nurse anticipate observing as a result of this severe
hyperkalemia?
A. Prominent U waves and flattened T waves
B. Tall, peaked T waves and widened QRS complexes
C. Prolonged QT intervals with normal T waves
D. Atrial fibrillation with a slow ventricular response
Correct Answer: B. Tall, peaked T waves and widened QRS complexes
, Rationale: Hyperkalemia profoundly affects myocardial
depolarization and repolarization. Early ECG changes include tall,
peaked T waves, followed by prolonged PR intervals, widened
QRS complexes, and potentially fatal ventricular arrhythmias.
Question 3
A client is recovering in the surgical unit following a subtotal
thyroidectomy. Upon entering the room, the nurse notes the client is
experiencing stridor, muscle twitching around the mouth, and numbness
in the fingertips. What is the immediate priority nursing action?
A. Elevate the head of the bed to 90 degrees and encourage deep
breathing
B. Notify the surgeon immediately and ensure intravenous calcium
gluconate is readily available at the bedside
C. Administer oral acetaminophen for incisional pain
D. Apply an ice pack to the anterior neck dressing
Correct Answer: B. Notify the surgeon immediately and ensure
intravenous calcium gluconate is readily available at the bedside
Rationale: Inadvertent trauma or removal of the parathyroid glands
during a thyroidectomy causes hypocalcemia, manifesting as
tetany (muscle twitching, tingling) and laryngeal stridor. This is a
medical emergency requiring immediate calcium gluconate
administration and airway readiness.
Question 4
A nurse is caring for a client admitted with a suspected pulmonary
embolism (PE). Which arterial blood gas (ABG) result should the nurse
expect upon initial evaluation?
A. Respiratory alkalosis due to tachypnea and hyperventilation
B. Respiratory acidosis due to alveolar hypoventilation
C. Metabolic alkalosis due to gastric fluid loss
, D. Metabolic acidosis due to tissue hypoxia
Correct Answer: A. Respiratory alkalosis due to tachypnea and
hyperventilation
Rationale: Clients experiencing a pulmonary embolism typically
present with sudden dyspnea, anxiety, and tachypnea.
Hyperventilation causes "blowing off" of carbon dioxide, leading
to initial acute respiratory alkalosis (elevated pH, decreased
PaCO2).
Question 5
A client with cirrhosis of the liver and severe ascites is scheduled for a
paracentesis. What is the most critical nursing intervention immediately
before the procedure?
A. Instruct the client to drink 500 mL of water
B. Have the client empty their urinary bladder to reduce the risk of
bladder perforation
C. Place the client in a flat supine position
D. Administer a cleansing soap suds enema
Correct Answer: B. Have the client empty their urinary bladder to
reduce the risk of bladder perforation
Rationale: Because an enlarged, fluid-filled bladder can be
displaced or elevated in clients with ascites and pelvic fullness,
asking the client to void immediately prior to a paracentesis
significantly reduces the risk of accidental bladder puncture during
needle insertion.
Question 6
A client is admitted with a diagnosis of diabetic ketoacidosis (DKA).
Which clinical finding should the nurse expect to assess during the
physical examination?
