[HESI Medical-Surgical Nursing] COMPLETE EXAM
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
SECTION ONE: QUESTIONS 1-100
1. The nurse is assessing a client with hyperkalemia. Which electrocardiogram (ECG) change is most
indicative of this electrolyte disturbance?
A. Flat T waves
B. Prolonged PR interval
C. Peaked T waves
D. Prominent U waves
Correct Answer: C. Peaked T waves
*Rationale: Peaked, tented, or tall, narrow T waves are the earliest and most characteristic ECG
change in hyperkalemia. Flat T waves are associated with hypokalemia. A prolonged PR interval can
occur in hyperkalemia but is a later finding. Prominent U waves are indicative of hypokalemia.
2. A client is admitted with a diagnosis of acute pancreatitis. Which serum laboratory value would
the nurse expect to be most significantly elevated?
A. Serum calcium
B. Serum glucose
C. Serum amylase
D. Serum potassium
Correct Answer: C. Serum amylase
*Rationale: Serum amylase and lipase are the key diagnostic markers for acute pancreatitis. Amylase
rises within 6-12 hours of onset. Serum calcium may be decreased due to fat necrosis, not elevated.
Serum glucose is often elevated due to impaired insulin release, but amylase is the more specific and
classic finding. Serum potassium is not directly affected by pancreatitis.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The nurse assesses the client and finds them lethargic with a respiratory rate of 8
breaths/min. What is the nurse's priority action?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
,C. Prepare to assist with intubation and mechanical ventilation.
D. Discontinue the oxygen and notify the healthcare provider.
Correct Answer: D. Discontinue the oxygen and notify the healthcare provider.
*Rationale: The client is exhibiting signs of oxygen-induced hypoventilation, a dangerous
complication in clients with COPD who retain CO2 and rely on a hypoxic drive to breathe. The priority
is to discontinue the oxygen to restore the hypoxic stimulus and notify the provider immediately.
Increasing oxygen would worsen the hypoventilation. High-Fowler's position is a supportive measure
but not the priority. Intubation may become necessary, but is not the first step; it might be required if
the client does not respond to oxygen removal.
4. The nurse is providing discharge teaching to a client who had a myocardial infarction (MI) and
has a new prescription for clopidogrel. Which statement by the client indicates a need for further
teaching?
A. "I will need to have my blood drawn regularly to check my blood levels."
B. "I should avoid taking aspirin with this medication."
C. "I will notify my dentist that I am taking this medication before any procedure."
D. "I should report any unusual bleeding or bruising to my doctor."
Correct Answer: B. "I should avoid taking aspirin with this medication."
*Rationale: This statement is incorrect and indicates a need for further teaching. A client on
clopidogrel is often prescribed a low dose of aspirin (e.g., 81 mg) to be taken concurrently for dual
antiplatelet therapy. Clopidogrel does not require routine blood level monitoring, but may require
monitoring for bleeding. It is crucial to notify healthcare providers about the medication before
procedures. Reporting bleeding is a correct action.
5. A nurse is caring for a client with diabetes insipidus. Which finding would be most consistent
with this diagnosis?
A. Serum sodium of 145 mEq/L and urine specific gravity of 1.002
B. Serum sodium of 130 mEq/L and urine specific gravity of 1.030
C. Serum glucose of 250 mg/dL and urine specific gravity of 1.015
D. Serum potassium of 5.5 mEq/L and urine output of 400 mL in 8 hours
Correct Answer: A. Serum sodium of 145 mEq/L and urine specific gravity of 1.002
*Rationale: Diabetes insipidus is characterized by a deficiency of antidiuretic hormone (ADH) or a lack
of kidney response to it, leading to the excretion of large volumes of dilute urine. This results in
hypernatremia (elevated serum sodium) and a low urine specific gravity (dilute urine). The other
options are incorrect: SIADH would present with hyponatremia and high urine specific gravity;
hyperglycemia indicates diabetes mellitus; elevated potassium and low urine output are not
hallmarks of diabetes insipidus.
6. A client is scheduled for a colonoscopy. Which instruction should the nurse include in the client's
preoperative teaching?
,A. "You will need to drink a gallon of a polyethylene glycol solution the evening before the
procedure."
B. "You may have a clear liquid breakfast the morning of the procedure."
C. "You will be given a sedative, so you must arrange for a driver to take you home."
D. "You will need to consume a full liquid diet for 3 days before the procedure."
Correct Answer: C. "You will be given a sedative, so you must arrange for a driver to take you
home."
*Rationale: A driver is required because the client will be sedated for the procedure. The client
typically follows a clear liquid diet for 1-2 days prior, not a full liquid diet, and is NPO after midnight.
While a polyethylene glycol solution is a common bowel prep, not all clients drink a full gallon; there
are various types and volumes of prep.
7. The nurse is assessing a client who has just returned to the unit after a thyroidectomy. Which
finding requires immediate intervention?
A. Pain of 4 on a 0-10 pain scale at the incision site
B. Hoarse voice
C. Heart rate of 110 beats/min
D. Complaints of a sore throat
Correct Answer: C. Heart rate of 110 beats/min
*Rationale: Tachycardia after a thyroidectomy can be a sign of thyroid storm, a life-threatening
hypermetabolic state. Pain, a hoarse voice (which may be temporary or due to laryngeal nerve
damage), and a sore throat are expected postoperative findings, though they should be managed
and monitored. Tachycardia requires immediate assessment and intervention for potential thyroid
storm or hemorrhage.
8. A client with a history of heart failure is prescribed furosemide. The nurse should monitor for
which adverse effect?
A. Hyperkalemia
B. Hyperglycemia
C. Hypokalemia
D. Hypocalcemia
Correct Answer: C. Hypokalemia
*Rationale: Furosemide is a loop diuretic that causes potassium loss in the urine, leading to
hypokalemia. It may also cause hyperglycemia, but hypokalemia is a more common and direct
adverse effect. It does not directly cause hyperkalemia or hypocalcemia.
9. A client with a new colostomy is learning to irrigate it. The nurse observes that the client is
placing the irrigation bag 30 inches above the stoma. What action should the nurse take?
, A. Inform the client that this is the correct technique.
B. Instruct the client to lower the bag to 18 inches above the stoma.
C. Have the client raise the bag to 40 inches to facilitate better flow.
D. Remind the client that irrigation should only be performed by a healthcare provider.
Correct Answer: B. Instruct the client to lower the bag to 18 inches above the stoma.
*Rationale: The standard height for a colostomy irrigation bag is 18 inches above the stoma. A height
of 30 inches is too high and may cause the water to flow too quickly, which can lead to cramping and
a less effective irrigation, as the solution might enter the colon too rapidly or at too high a pressure.
10. Which finding is most suggestive of a pulmonary embolism (PE) in a client who is 3 days post-
operative from a total hip replacement?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Pain and swelling in the calf of the operative leg
C. Decreased hemoglobin and hematocrit levels
D. Bradycardia and hypotension
Correct Answer: A. Sudden onset of pleuritic chest pain and dyspnea
*Rationale: Sudden pleuritic chest pain and dyspnea are classic symptoms of a pulmonary embolism.
While the client is at risk for a deep vein thrombosis (DVT) in the operative leg (pain and swelling),
this is a precursor to the PE. The PE itself presents with respiratory and cardiac symptoms. Decreased
hemoglobin and hematocrit are not associated with PE. Tachycardia, not bradycardia, is common.
11. The nurse is administering a blood transfusion to a client. Fifteen minutes after the start of the
infusion, the client reports chills and low back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed diphenhydramine.
C. Stop the transfusion.
D. Notify the healthcare provider.
Correct Answer: C. Stop the transfusion.
*Rationale: This client is showing signs of a possible acute hemolytic transfusion reaction (chills, low
back pain). The immediate priority is to stop the transfusion to prevent further complications and
then maintain the IV line with normal saline, notify the provider, and monitor the client. Slowing the
infusion or administering diphenhydramine would be inappropriate as the first action, as the priority
is to stop the incompatible blood from entering the client's system.
12. A client is receiving intravenous heparin. The nurse notes the activated partial thromboplastin
time (aPTT) is 110 seconds (therapeutic range is 60-80 seconds). Which medication should the
nurse prepare to administer?
A. Vitamin K
B. Protamine sulfate
QUESTIONS AND VERIFIED ANSWERS | 2026–2027 LATEST
UPDATE | GUARANTEED PASS | DETAILED RATIONALES |
FULL STUDY GUIDE | EXAM PREP | PRACTICE TEST |
CERTIFICATION PREPARATION
SECTION ONE: QUESTIONS 1-100
1. The nurse is assessing a client with hyperkalemia. Which electrocardiogram (ECG) change is most
indicative of this electrolyte disturbance?
A. Flat T waves
B. Prolonged PR interval
C. Peaked T waves
D. Prominent U waves
Correct Answer: C. Peaked T waves
*Rationale: Peaked, tented, or tall, narrow T waves are the earliest and most characteristic ECG
change in hyperkalemia. Flat T waves are associated with hypokalemia. A prolonged PR interval can
occur in hyperkalemia but is a later finding. Prominent U waves are indicative of hypokalemia.
2. A client is admitted with a diagnosis of acute pancreatitis. Which serum laboratory value would
the nurse expect to be most significantly elevated?
A. Serum calcium
B. Serum glucose
C. Serum amylase
D. Serum potassium
Correct Answer: C. Serum amylase
*Rationale: Serum amylase and lipase are the key diagnostic markers for acute pancreatitis. Amylase
rises within 6-12 hours of onset. Serum calcium may be decreased due to fat necrosis, not elevated.
Serum glucose is often elevated due to impaired insulin release, but amylase is the more specific and
classic finding. Serum potassium is not directly affected by pancreatitis.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The nurse assesses the client and finds them lethargic with a respiratory rate of 8
breaths/min. What is the nurse's priority action?
A. Increase the oxygen flow rate to 4 L/min.
B. Place the client in a high-Fowler's position.
,C. Prepare to assist with intubation and mechanical ventilation.
D. Discontinue the oxygen and notify the healthcare provider.
Correct Answer: D. Discontinue the oxygen and notify the healthcare provider.
*Rationale: The client is exhibiting signs of oxygen-induced hypoventilation, a dangerous
complication in clients with COPD who retain CO2 and rely on a hypoxic drive to breathe. The priority
is to discontinue the oxygen to restore the hypoxic stimulus and notify the provider immediately.
Increasing oxygen would worsen the hypoventilation. High-Fowler's position is a supportive measure
but not the priority. Intubation may become necessary, but is not the first step; it might be required if
the client does not respond to oxygen removal.
4. The nurse is providing discharge teaching to a client who had a myocardial infarction (MI) and
has a new prescription for clopidogrel. Which statement by the client indicates a need for further
teaching?
A. "I will need to have my blood drawn regularly to check my blood levels."
B. "I should avoid taking aspirin with this medication."
C. "I will notify my dentist that I am taking this medication before any procedure."
D. "I should report any unusual bleeding or bruising to my doctor."
Correct Answer: B. "I should avoid taking aspirin with this medication."
*Rationale: This statement is incorrect and indicates a need for further teaching. A client on
clopidogrel is often prescribed a low dose of aspirin (e.g., 81 mg) to be taken concurrently for dual
antiplatelet therapy. Clopidogrel does not require routine blood level monitoring, but may require
monitoring for bleeding. It is crucial to notify healthcare providers about the medication before
procedures. Reporting bleeding is a correct action.
5. A nurse is caring for a client with diabetes insipidus. Which finding would be most consistent
with this diagnosis?
A. Serum sodium of 145 mEq/L and urine specific gravity of 1.002
B. Serum sodium of 130 mEq/L and urine specific gravity of 1.030
C. Serum glucose of 250 mg/dL and urine specific gravity of 1.015
D. Serum potassium of 5.5 mEq/L and urine output of 400 mL in 8 hours
Correct Answer: A. Serum sodium of 145 mEq/L and urine specific gravity of 1.002
*Rationale: Diabetes insipidus is characterized by a deficiency of antidiuretic hormone (ADH) or a lack
of kidney response to it, leading to the excretion of large volumes of dilute urine. This results in
hypernatremia (elevated serum sodium) and a low urine specific gravity (dilute urine). The other
options are incorrect: SIADH would present with hyponatremia and high urine specific gravity;
hyperglycemia indicates diabetes mellitus; elevated potassium and low urine output are not
hallmarks of diabetes insipidus.
6. A client is scheduled for a colonoscopy. Which instruction should the nurse include in the client's
preoperative teaching?
,A. "You will need to drink a gallon of a polyethylene glycol solution the evening before the
procedure."
B. "You may have a clear liquid breakfast the morning of the procedure."
C. "You will be given a sedative, so you must arrange for a driver to take you home."
D. "You will need to consume a full liquid diet for 3 days before the procedure."
Correct Answer: C. "You will be given a sedative, so you must arrange for a driver to take you
home."
*Rationale: A driver is required because the client will be sedated for the procedure. The client
typically follows a clear liquid diet for 1-2 days prior, not a full liquid diet, and is NPO after midnight.
While a polyethylene glycol solution is a common bowel prep, not all clients drink a full gallon; there
are various types and volumes of prep.
7. The nurse is assessing a client who has just returned to the unit after a thyroidectomy. Which
finding requires immediate intervention?
A. Pain of 4 on a 0-10 pain scale at the incision site
B. Hoarse voice
C. Heart rate of 110 beats/min
D. Complaints of a sore throat
Correct Answer: C. Heart rate of 110 beats/min
*Rationale: Tachycardia after a thyroidectomy can be a sign of thyroid storm, a life-threatening
hypermetabolic state. Pain, a hoarse voice (which may be temporary or due to laryngeal nerve
damage), and a sore throat are expected postoperative findings, though they should be managed
and monitored. Tachycardia requires immediate assessment and intervention for potential thyroid
storm or hemorrhage.
8. A client with a history of heart failure is prescribed furosemide. The nurse should monitor for
which adverse effect?
A. Hyperkalemia
B. Hyperglycemia
C. Hypokalemia
D. Hypocalcemia
Correct Answer: C. Hypokalemia
*Rationale: Furosemide is a loop diuretic that causes potassium loss in the urine, leading to
hypokalemia. It may also cause hyperglycemia, but hypokalemia is a more common and direct
adverse effect. It does not directly cause hyperkalemia or hypocalcemia.
9. A client with a new colostomy is learning to irrigate it. The nurse observes that the client is
placing the irrigation bag 30 inches above the stoma. What action should the nurse take?
, A. Inform the client that this is the correct technique.
B. Instruct the client to lower the bag to 18 inches above the stoma.
C. Have the client raise the bag to 40 inches to facilitate better flow.
D. Remind the client that irrigation should only be performed by a healthcare provider.
Correct Answer: B. Instruct the client to lower the bag to 18 inches above the stoma.
*Rationale: The standard height for a colostomy irrigation bag is 18 inches above the stoma. A height
of 30 inches is too high and may cause the water to flow too quickly, which can lead to cramping and
a less effective irrigation, as the solution might enter the colon too rapidly or at too high a pressure.
10. Which finding is most suggestive of a pulmonary embolism (PE) in a client who is 3 days post-
operative from a total hip replacement?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Pain and swelling in the calf of the operative leg
C. Decreased hemoglobin and hematocrit levels
D. Bradycardia and hypotension
Correct Answer: A. Sudden onset of pleuritic chest pain and dyspnea
*Rationale: Sudden pleuritic chest pain and dyspnea are classic symptoms of a pulmonary embolism.
While the client is at risk for a deep vein thrombosis (DVT) in the operative leg (pain and swelling),
this is a precursor to the PE. The PE itself presents with respiratory and cardiac symptoms. Decreased
hemoglobin and hematocrit are not associated with PE. Tachycardia, not bradycardia, is common.
11. The nurse is administering a blood transfusion to a client. Fifteen minutes after the start of the
infusion, the client reports chills and low back pain. What is the nurse's priority action?
A. Slow the infusion rate.
B. Administer prescribed diphenhydramine.
C. Stop the transfusion.
D. Notify the healthcare provider.
Correct Answer: C. Stop the transfusion.
*Rationale: This client is showing signs of a possible acute hemolytic transfusion reaction (chills, low
back pain). The immediate priority is to stop the transfusion to prevent further complications and
then maintain the IV line with normal saline, notify the provider, and monitor the client. Slowing the
infusion or administering diphenhydramine would be inappropriate as the first action, as the priority
is to stop the incompatible blood from entering the client's system.
12. A client is receiving intravenous heparin. The nurse notes the activated partial thromboplastin
time (aPTT) is 110 seconds (therapeutic range is 60-80 seconds). Which medication should the
nurse prepare to administer?
A. Vitamin K
B. Protamine sulfate
