HESI Medical-Surgical Nursing
2026/2027
150 Comprehensive Practice Questions & Answers
1. A nurse is caring for a client with a chest tube. The nurse notes continuous
bubbling in the water seal chamber. What is the priority action?
A. Document as a normal finding
B. Check the system for an air leak
C. Increase the suction pressure
D. Clamp the tube immediately
Answer: B
Rationale: Intermittent bubbling is normal (with respiration/coughing), but continuous
bubbling indicates an air leak in the system or from the client.
2. Which clinical manifestation is a classic sign of Autonomic Dysreflexia in a
client with a T6 spinal cord injury?
A. Hypotension and tachycardia
B. Extreme hypertension and pounding headache
C. Pale, dry skin below the injury
D. Diarrhea
Answer: B
Rationale: Autonomic dysreflexia is a medical emergency characterized by severe
hypertension, bradycardia, and a pounding headache, often triggered by a full bladder.
3. A client with Chronic Renal Failure is scheduled for hemodialysis. Which
medication should the nurse withhold until after the procedure?
A. Insulin
B. Lisinopril
C. Calcium carbonate
D. Famotidine
Answer: B
Rationale: Antihypertensives are typically withheld before dialysis because the procedure
can cause hypotension; additionally, many medications are filtered out during dialysis.
,4. A nurse is teaching a client with Addison's disease about their condition.
Which statement indicates the need for further teaching?
A. 'I should carry a medical alert bracelet.'
B. 'I will need to take steroid replacements for the rest of my life.'
C. 'I can skip my medication if I feel well.'
D. 'I should increase my salt intake during hot weather.'
Answer: C
Rationale: Abruptly stopping corticosteroids can lead to an Addisonian crisis, which is
life-threatening.
5. A client is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse anticipate first?
A. D5W
B. 0.9% Normal Saline
C. 0.45% Normal Saline
D. D5LR
Answer: B
Rationale: The initial priority in DKA is volume rehydration with isotonic saline (0.9%
NaCl) to restore circulatory volume.
6. Which lab value is most important to monitor for a client receiving Heparin
for a pulmonary embolism?
A. PT
B. INR
C. aPTT
D. Platelet count
Answer: C
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effect of Heparin.
7. A client is 1-day post-thyroidectomy. The nurse notes the client has muscle
twitching and a positive Chvostek's sign. Which medication should be
available?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B
Rationale: Hypocalcemia can occur if the parathyroid glands are accidentally damaged
or removed during thyroidectomy. Signs include Chvostek's/Trousseau's signs.
,8. What is the priority assessment for a client with a potassium level of 6.8
mEq/L?
A. Bowel sounds
B. Muscle strength
C. Cardiac rhythm
D. Urine output
Answer: C
Rationale: Hyperkalemia poses a risk for lethal cardiac arrhythmias; EKG monitoring is
the priority.
9. A nurse is caring for a client with Cirrhosis. The nurse notes the client is
increasingly confused and has asterixis. Which medication is most
appropriate?
A. Spironolactone
B. Lactulose
C. Propranolol
D. Furosemide
Answer: B
Rationale: Confusion and 'liver flap' (asterixis) are signs of hepatic encephalopathy
caused by high ammonia. Lactulose promotes ammonia excretion.
10. A client has a fractured femur and suddenly develops chest pain, dyspnea,
and petechiae on the chest. What does the nurse suspect?
A. Myocardial infarction
B. Fat embolism
C. Pneumonia
D. Deep vein thrombosis
Answer: B
Rationale: Petechiae on the chest/neck combined with respiratory distress after a long
bone fracture is classic for a fat embolism.
11. Med-Surg Q11: Compartment Syndrome symptom?
A. Pain unrelieved by opioids
B. Warmth
C. Physical therapy
D. Laboratory testing
Answer: A
Rationale: Ischemic pain is intense and resistant to meds.
, 12. Med-Surg Q12: Guillain-Barré major risk?
A. Skin breakdown
B. Respiratory failure
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Ascending paralysis can reach the diaphragm.
13. Med-Surg Q13: Pancreatitis pain is often:
A. RLQ
B. Epigastric radiating to back
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Severe pain that worsens after eating.
14. Med-Surg Q14: Dumping Syndrome advice?
A. Drink water with meals
B. Avoid fluids with meals
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Fluids speed up gastric emptying.
15. Med-Surg Q15: Sign of Cushing's Syndrome?
A. Moon face
B. Weight loss
C. Physical therapy
D. Laboratory testing
Answer: A
Rationale: Moon face, buffalo hump, and central obesity are classic.
16. Med-Surg Q16: Post-op hip: Avoid what movement?
A. Abduction
B. Adduction/Crossing legs
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Crossing legs can cause prosthesis dislocation.
2026/2027
150 Comprehensive Practice Questions & Answers
1. A nurse is caring for a client with a chest tube. The nurse notes continuous
bubbling in the water seal chamber. What is the priority action?
A. Document as a normal finding
B. Check the system for an air leak
C. Increase the suction pressure
D. Clamp the tube immediately
Answer: B
Rationale: Intermittent bubbling is normal (with respiration/coughing), but continuous
bubbling indicates an air leak in the system or from the client.
2. Which clinical manifestation is a classic sign of Autonomic Dysreflexia in a
client with a T6 spinal cord injury?
A. Hypotension and tachycardia
B. Extreme hypertension and pounding headache
C. Pale, dry skin below the injury
D. Diarrhea
Answer: B
Rationale: Autonomic dysreflexia is a medical emergency characterized by severe
hypertension, bradycardia, and a pounding headache, often triggered by a full bladder.
3. A client with Chronic Renal Failure is scheduled for hemodialysis. Which
medication should the nurse withhold until after the procedure?
A. Insulin
B. Lisinopril
C. Calcium carbonate
D. Famotidine
Answer: B
Rationale: Antihypertensives are typically withheld before dialysis because the procedure
can cause hypotension; additionally, many medications are filtered out during dialysis.
,4. A nurse is teaching a client with Addison's disease about their condition.
Which statement indicates the need for further teaching?
A. 'I should carry a medical alert bracelet.'
B. 'I will need to take steroid replacements for the rest of my life.'
C. 'I can skip my medication if I feel well.'
D. 'I should increase my salt intake during hot weather.'
Answer: C
Rationale: Abruptly stopping corticosteroids can lead to an Addisonian crisis, which is
life-threatening.
5. A client is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse anticipate first?
A. D5W
B. 0.9% Normal Saline
C. 0.45% Normal Saline
D. D5LR
Answer: B
Rationale: The initial priority in DKA is volume rehydration with isotonic saline (0.9%
NaCl) to restore circulatory volume.
6. Which lab value is most important to monitor for a client receiving Heparin
for a pulmonary embolism?
A. PT
B. INR
C. aPTT
D. Platelet count
Answer: C
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effect of Heparin.
7. A client is 1-day post-thyroidectomy. The nurse notes the client has muscle
twitching and a positive Chvostek's sign. Which medication should be
available?
A. Potassium chloride
B. Calcium gluconate
C. Magnesium sulfate
D. Sodium bicarbonate
Answer: B
Rationale: Hypocalcemia can occur if the parathyroid glands are accidentally damaged
or removed during thyroidectomy. Signs include Chvostek's/Trousseau's signs.
,8. What is the priority assessment for a client with a potassium level of 6.8
mEq/L?
A. Bowel sounds
B. Muscle strength
C. Cardiac rhythm
D. Urine output
Answer: C
Rationale: Hyperkalemia poses a risk for lethal cardiac arrhythmias; EKG monitoring is
the priority.
9. A nurse is caring for a client with Cirrhosis. The nurse notes the client is
increasingly confused and has asterixis. Which medication is most
appropriate?
A. Spironolactone
B. Lactulose
C. Propranolol
D. Furosemide
Answer: B
Rationale: Confusion and 'liver flap' (asterixis) are signs of hepatic encephalopathy
caused by high ammonia. Lactulose promotes ammonia excretion.
10. A client has a fractured femur and suddenly develops chest pain, dyspnea,
and petechiae on the chest. What does the nurse suspect?
A. Myocardial infarction
B. Fat embolism
C. Pneumonia
D. Deep vein thrombosis
Answer: B
Rationale: Petechiae on the chest/neck combined with respiratory distress after a long
bone fracture is classic for a fat embolism.
11. Med-Surg Q11: Compartment Syndrome symptom?
A. Pain unrelieved by opioids
B. Warmth
C. Physical therapy
D. Laboratory testing
Answer: A
Rationale: Ischemic pain is intense and resistant to meds.
, 12. Med-Surg Q12: Guillain-Barré major risk?
A. Skin breakdown
B. Respiratory failure
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Ascending paralysis can reach the diaphragm.
13. Med-Surg Q13: Pancreatitis pain is often:
A. RLQ
B. Epigastric radiating to back
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Severe pain that worsens after eating.
14. Med-Surg Q14: Dumping Syndrome advice?
A. Drink water with meals
B. Avoid fluids with meals
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Fluids speed up gastric emptying.
15. Med-Surg Q15: Sign of Cushing's Syndrome?
A. Moon face
B. Weight loss
C. Physical therapy
D. Laboratory testing
Answer: A
Rationale: Moon face, buffalo hump, and central obesity are classic.
16. Med-Surg Q16: Post-op hip: Avoid what movement?
A. Abduction
B. Adduction/Crossing legs
C. Physical therapy
D. Laboratory testing
Answer: B
Rationale: Crossing legs can cause prosthesis dislocation.
