HESI Medical-Surgical Nursing
Exam 1 Practice Test: Foundations of Adult Care
Fluid & Electrolyte Imbalances
1. A nurse is caring for a client who is 4 hours postoperative
following abdominal surgery. The client's blood pressure has
dropped from 120/80 to 90/60 mmHg, and the pulse has increased
from 80 to 110 bpm. Which action should the nurse take first?
A. Administer the prescribed PRN pain medication.
B. Increase the rate of the intravenous (IV) fluids.
C. Place the client in the Trendelenburg position.
D. Notify the surgeon and rapid response team.
Correct Answer: B
Rationale: Tachycardia and hypotension in the early postoperative period
are classic signs of hypovolemic shock. Increasing IV fluid rate is the
priority implementation to restore volume, followed immediately by
notifying the provider.
HESI Med-Surg Exam 1 - Page 1
,Acid-Base Balance & ABGs
2. A client with a history of heart failure reports feeling 'weak' and
having 'skipped heartbeats.' The nurse notes the client is taking a
loop diuretic. Which laboratory value should the nurse check first?
A. Serum Sodium
B. Serum Potassium
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium
Correct Answer: B
Rationale: Loop diuretics (like Furosemide) cause significant potassium
wasting. Hypokalemia (low potassium) causes muscle weakness and life-
threatening cardiac dysrhythmias.
Pain Management (Acute vs Chronic)
3. The nurse is reviewing the arterial blood gas (ABG) results for a
client with COPD: pH 7.31, PaCO2 52, HCO3 28. How should the nurse
interpret these findings?
A. Uncompensated Metabolic Acidosis
B. Partially Compensated Respiratory Acidosis
C. Fully Compensated Respiratory Alkalosis
D. Uncompensated Respiratory Acidosis
Correct Answer: B
Rationale: pH is low (Acidosis). PaCO2 is high (Respiratory). The HCO3 is
elevated above normal (26), which means the kidneys are attempting to
compensate (Partially Compensated).
HESI Med-Surg Exam 1 - Page 2
,Palliative & End-of-Life Care
4. A client is scheduled for surgery in two hours. While performing
the preoperative checklist, the nurse notes the client has not
signed the informed consent form. Which action is the nurse's
responsibility?
A. Explain the risks and benefits of the surgery to the client.
B. Witness the client's signature on the consent form.
C. Tell the client that they must sign the form to have the surgery.
D. Sign the form for the client if they are unable to.
Correct Answer: B
Rationale: The nurse's role is to witness the signature and ensure the
client is competent and doing so voluntarily. Explaining risks/benefits is the
surgeon's responsibility.
Oncology & Cancer Treatment
5. An oncology client is experiencing severe 'breakthrough pain.'
Which medication delivery method is most appropriate for this type
of pain?
A. Around-the-clock (ATC) oral tablets
B. Transdermal patch
C. Immediate-release IV or transmucosal opioid
D. Intramuscular (IM) injection
Correct Answer: C
Rationale: Breakthrough pain requires a medication with a rapid onset. IV
or transmucosal (under the tongue) immediate-release opioids are
preferred. Patches are for long-term, stable pain.
HESI Med-Surg Exam 1 - Page 3
, Shock & MODS Foundations
6. HESI Med-Surg Question 6: A client with a diagnosis related to
Shock & MODS Foundations is exhibiting signs of physiological
distress. Which assessment is the priority?
A. Vital signs and oxygen saturation
B. History of the current illness
C. Psychosocial support systems
D. Level of pain on a 0-10 scale
Correct Answer: A
Rationale: In any Medical-Surgical emergency or distress situation,
checking the 'ABCs' (Airway, Breathing, Circulation) via vital signs and O2
saturation is always the first priority assessment.
Immune Disorders (HIV/AIDS)
7. HESI Med-Surg Question 7: A client with a diagnosis related to
Immune Disorders (HIV/AIDS) is exhibiting signs of physiological
distress. Which assessment is the priority?
A. Vital signs and oxygen saturation
B. History of the current illness
C. Psychosocial support systems
D. Level of pain on a 0-10 scale
Correct Answer: A
Rationale: In any Medical-Surgical emergency or distress situation,
checking the 'ABCs' (Airway, Breathing, Circulation) via vital signs and O2
saturation is always the first priority assessment.
HESI Med-Surg Exam 1 - Page 4
Exam 1 Practice Test: Foundations of Adult Care
Fluid & Electrolyte Imbalances
1. A nurse is caring for a client who is 4 hours postoperative
following abdominal surgery. The client's blood pressure has
dropped from 120/80 to 90/60 mmHg, and the pulse has increased
from 80 to 110 bpm. Which action should the nurse take first?
A. Administer the prescribed PRN pain medication.
B. Increase the rate of the intravenous (IV) fluids.
C. Place the client in the Trendelenburg position.
D. Notify the surgeon and rapid response team.
Correct Answer: B
Rationale: Tachycardia and hypotension in the early postoperative period
are classic signs of hypovolemic shock. Increasing IV fluid rate is the
priority implementation to restore volume, followed immediately by
notifying the provider.
HESI Med-Surg Exam 1 - Page 1
,Acid-Base Balance & ABGs
2. A client with a history of heart failure reports feeling 'weak' and
having 'skipped heartbeats.' The nurse notes the client is taking a
loop diuretic. Which laboratory value should the nurse check first?
A. Serum Sodium
B. Serum Potassium
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium
Correct Answer: B
Rationale: Loop diuretics (like Furosemide) cause significant potassium
wasting. Hypokalemia (low potassium) causes muscle weakness and life-
threatening cardiac dysrhythmias.
Pain Management (Acute vs Chronic)
3. The nurse is reviewing the arterial blood gas (ABG) results for a
client with COPD: pH 7.31, PaCO2 52, HCO3 28. How should the nurse
interpret these findings?
A. Uncompensated Metabolic Acidosis
B. Partially Compensated Respiratory Acidosis
C. Fully Compensated Respiratory Alkalosis
D. Uncompensated Respiratory Acidosis
Correct Answer: B
Rationale: pH is low (Acidosis). PaCO2 is high (Respiratory). The HCO3 is
elevated above normal (26), which means the kidneys are attempting to
compensate (Partially Compensated).
HESI Med-Surg Exam 1 - Page 2
,Palliative & End-of-Life Care
4. A client is scheduled for surgery in two hours. While performing
the preoperative checklist, the nurse notes the client has not
signed the informed consent form. Which action is the nurse's
responsibility?
A. Explain the risks and benefits of the surgery to the client.
B. Witness the client's signature on the consent form.
C. Tell the client that they must sign the form to have the surgery.
D. Sign the form for the client if they are unable to.
Correct Answer: B
Rationale: The nurse's role is to witness the signature and ensure the
client is competent and doing so voluntarily. Explaining risks/benefits is the
surgeon's responsibility.
Oncology & Cancer Treatment
5. An oncology client is experiencing severe 'breakthrough pain.'
Which medication delivery method is most appropriate for this type
of pain?
A. Around-the-clock (ATC) oral tablets
B. Transdermal patch
C. Immediate-release IV or transmucosal opioid
D. Intramuscular (IM) injection
Correct Answer: C
Rationale: Breakthrough pain requires a medication with a rapid onset. IV
or transmucosal (under the tongue) immediate-release opioids are
preferred. Patches are for long-term, stable pain.
HESI Med-Surg Exam 1 - Page 3
, Shock & MODS Foundations
6. HESI Med-Surg Question 6: A client with a diagnosis related to
Shock & MODS Foundations is exhibiting signs of physiological
distress. Which assessment is the priority?
A. Vital signs and oxygen saturation
B. History of the current illness
C. Psychosocial support systems
D. Level of pain on a 0-10 scale
Correct Answer: A
Rationale: In any Medical-Surgical emergency or distress situation,
checking the 'ABCs' (Airway, Breathing, Circulation) via vital signs and O2
saturation is always the first priority assessment.
Immune Disorders (HIV/AIDS)
7. HESI Med-Surg Question 7: A client with a diagnosis related to
Immune Disorders (HIV/AIDS) is exhibiting signs of physiological
distress. Which assessment is the priority?
A. Vital signs and oxygen saturation
B. History of the current illness
C. Psychosocial support systems
D. Level of pain on a 0-10 scale
Correct Answer: A
Rationale: In any Medical-Surgical emergency or distress situation,
checking the 'ABCs' (Airway, Breathing, Circulation) via vital signs and O2
saturation is always the first priority assessment.
HESI Med-Surg Exam 1 - Page 4
