HESI Med-Surg Exam Practice
2026/2027
100 Comprehensive Questions, Answers & Detailed Rationales
1. A client is 24 hours post-permanent pacemaker insertion. Which
nursing intervention is most important?
A. Encourage range-of-motion exercises of the affected arm.
B. Monitor the incision site for redness and swelling.
C. Immobilize the affected arm with a sling.
D. Assist the client to ambulate immediately.
Correct Answer: C
Rationale: The affected arm should be immobilized with a sling for the first 24-48 hours
to prevent the newly implanted leads from becoming dislodged.
2. A client is diagnosed with Left-Sided Heart Failure. Which clinical
manifestation should the nurse expect?
A. Peripheral edema
B. Jugular venous distention
C. Crackles in the lungs
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to crackles,
dyspnea, and orthopnea. Options A, B, and D are signs of right-sided failure.
,3. Which EKG finding is most indicative of myocardial infarction (MI)?
A. Prolonged PR interval
B. ST-segment elevation
C. Peaked T waves
D. Widened QRS complex
Correct Answer: B
Rationale: ST-segment elevation (STEMI) indicates acute myocardial injury/infarction.
Peaked T waves are common in hyperkalemia.
4. A nurse is caring for a client with Deep Vein Thrombosis (DVT). Which
action is contraindicated?
A. Elevating the affected extremity
B. Administering anticoagulants
C. Massaging the affected leg
D. Applying warm compresses
Correct Answer: C
Rationale: Massaging the leg of a client with DVT can dislodge the clot, leading to a
pulmonary embolism.
5. A client with COPD is receiving oxygen via nasal cannula at 2L/min.
The nurse notes the client's SpO2 is 91%. What is the best action?
A. Increase oxygen to 6L/min.
B. Continue to monitor the client.
C. Switch to a non-rebreather mask.
D. Notify the physician immediately.
Correct Answer: B
Rationale: In COPD patients, a 'normal' SpO2 range is often 88-92%. Providing too much
oxygen can suppress their hypoxic drive to breathe.
,6. Which position is best for a client experiencing an acute asthma
attack?
A. Supine
B. High-Fowler's
C. Semi-Fowler's
D. Trendelenburg
Correct Answer: B
Rationale: High-Fowler's or sitting upright allows for maximum chest expansion and
eases breathing during an attack.
7. A client is 2 hours post-thoracentesis. Which finding requires
immediate notification of the provider?
A. Diminished breath sounds on the affected side
B. Small amount of serosanguinous drainage on the dressing
C. Pain at the puncture site
D. Respiratory rate of 18
Correct Answer: A
Rationale: Diminished breath sounds after a thoracentesis could indicate a
pneumothorax (collapsed lung), a serious complication.
8. A client with Type 1 Diabetes is found unconscious and clammy.
What should the nurse administer first?
A. Regular insulin IV
B. Glucagon IM
C. 4 oz of orange juice
D. Metformin orally
Correct Answer: B
Rationale: If the client is unconscious (severe hypoglycemia), they cannot swallow safely.
Glucagon IM or IV Dextrose is required. Juice is only for conscious patients.
, 9. Which lab result is the most important to monitor in a client with
SIADH?
A. Serum potassium
B. Serum sodium
C. Blood glucose
D. Creatinine
Correct Answer: B
Rationale: SIADH causes water retention, leading to dilutional hyponatremia (low
sodium), which can cause seizures and coma.
10. A client with Hyperthyroidism is experiencing a 'Thyroid Storm.'
Which vital sign is most concerning?
A. Heart rate 160 bpm
B. Blood pressure 110/70
C. Temperature 105°F (40.5°C)
D. Respiratory rate 20
Correct Answer: C
Rationale: Hyperpyrexia (very high fever) is a hallmark of thyroid storm and can lead to
death if not treated aggressively.
11. A client with cirrhosis has developed esophageal varices. Which
food should the nurse tell the client to avoid?
A. Soft mashed potatoes
B. Tortilla chips
C. Vanilla pudding
D. Apple juice
Correct Answer: B
Rationale: Clients with esophageal varices must avoid hard, scratchy foods (like chips)
that could rupture the fragile vessels and cause life-threatening bleeding.
2026/2027
100 Comprehensive Questions, Answers & Detailed Rationales
1. A client is 24 hours post-permanent pacemaker insertion. Which
nursing intervention is most important?
A. Encourage range-of-motion exercises of the affected arm.
B. Monitor the incision site for redness and swelling.
C. Immobilize the affected arm with a sling.
D. Assist the client to ambulate immediately.
Correct Answer: C
Rationale: The affected arm should be immobilized with a sling for the first 24-48 hours
to prevent the newly implanted leads from becoming dislodged.
2. A client is diagnosed with Left-Sided Heart Failure. Which clinical
manifestation should the nurse expect?
A. Peripheral edema
B. Jugular venous distention
C. Crackles in the lungs
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to crackles,
dyspnea, and orthopnea. Options A, B, and D are signs of right-sided failure.
,3. Which EKG finding is most indicative of myocardial infarction (MI)?
A. Prolonged PR interval
B. ST-segment elevation
C. Peaked T waves
D. Widened QRS complex
Correct Answer: B
Rationale: ST-segment elevation (STEMI) indicates acute myocardial injury/infarction.
Peaked T waves are common in hyperkalemia.
4. A nurse is caring for a client with Deep Vein Thrombosis (DVT). Which
action is contraindicated?
A. Elevating the affected extremity
B. Administering anticoagulants
C. Massaging the affected leg
D. Applying warm compresses
Correct Answer: C
Rationale: Massaging the leg of a client with DVT can dislodge the clot, leading to a
pulmonary embolism.
5. A client with COPD is receiving oxygen via nasal cannula at 2L/min.
The nurse notes the client's SpO2 is 91%. What is the best action?
A. Increase oxygen to 6L/min.
B. Continue to monitor the client.
C. Switch to a non-rebreather mask.
D. Notify the physician immediately.
Correct Answer: B
Rationale: In COPD patients, a 'normal' SpO2 range is often 88-92%. Providing too much
oxygen can suppress their hypoxic drive to breathe.
,6. Which position is best for a client experiencing an acute asthma
attack?
A. Supine
B. High-Fowler's
C. Semi-Fowler's
D. Trendelenburg
Correct Answer: B
Rationale: High-Fowler's or sitting upright allows for maximum chest expansion and
eases breathing during an attack.
7. A client is 2 hours post-thoracentesis. Which finding requires
immediate notification of the provider?
A. Diminished breath sounds on the affected side
B. Small amount of serosanguinous drainage on the dressing
C. Pain at the puncture site
D. Respiratory rate of 18
Correct Answer: A
Rationale: Diminished breath sounds after a thoracentesis could indicate a
pneumothorax (collapsed lung), a serious complication.
8. A client with Type 1 Diabetes is found unconscious and clammy.
What should the nurse administer first?
A. Regular insulin IV
B. Glucagon IM
C. 4 oz of orange juice
D. Metformin orally
Correct Answer: B
Rationale: If the client is unconscious (severe hypoglycemia), they cannot swallow safely.
Glucagon IM or IV Dextrose is required. Juice is only for conscious patients.
, 9. Which lab result is the most important to monitor in a client with
SIADH?
A. Serum potassium
B. Serum sodium
C. Blood glucose
D. Creatinine
Correct Answer: B
Rationale: SIADH causes water retention, leading to dilutional hyponatremia (low
sodium), which can cause seizures and coma.
10. A client with Hyperthyroidism is experiencing a 'Thyroid Storm.'
Which vital sign is most concerning?
A. Heart rate 160 bpm
B. Blood pressure 110/70
C. Temperature 105°F (40.5°C)
D. Respiratory rate 20
Correct Answer: C
Rationale: Hyperpyrexia (very high fever) is a hallmark of thyroid storm and can lead to
death if not treated aggressively.
11. A client with cirrhosis has developed esophageal varices. Which
food should the nurse tell the client to avoid?
A. Soft mashed potatoes
B. Tortilla chips
C. Vanilla pudding
D. Apple juice
Correct Answer: B
Rationale: Clients with esophageal varices must avoid hard, scratchy foods (like chips)
that could rupture the fragile vessels and cause life-threatening bleeding.
