HESI MEDICAL-SURGICAL NURSING EXAM
PREP 2026/2027 | 200 PRACTICE
QUESTIONS, CORRECT ANSWERS & DETAILED
RATIONALES | HESI/ELSEVIER REVIEW GUIDE
||NEWEST!!
Questions 1–200
1. A client with heart failure reports increasing shortness of breath and difficulty
sleeping flat. Which finding requires the nurse's immediate attention?
A. 2+ bilateral ankle edema
B. Oxygen saturation of 88%
C. Weight gain of 1 kg in 3 days
D. Fatigue with activity
Answer: B. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia and requires
immediate assessment and intervention. The other findings are also consistent with
worsening heart failure but are less immediately threatening.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which prescription should the nurse implement first?
A. Encourage oral fluids
B. Administer prescribed bronchodilator
C. Place the client in high-Fowler's position
D. Obtain a sputum specimen
Answer: C. Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases the work of
breathing. It is an immediate, independent intervention for respiratory distress.
3. A client with diabetes mellitus is diaphoretic, shaky, and confused. What should the
nurse do first?
A. Administer regular insulin
B. Check the blood glucose level
C. Give the client a high-protein meal
D. Notify the healthcare provider
Answer: B. Check the blood glucose level
Rationale: The symptoms suggest hypoglycemia. Blood glucose should be checked promptly
when possible to confirm the condition and guide treatment.
,4. A client receiving digoxin reports nausea and seeing yellow halos around lights.
Which action is most appropriate?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased potassium intake immediately
D. Administer an antiemetic
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, visual disturbances, and dysrhythmias can indicate digoxin toxicity. The
medication should be withheld and the provider notified.
5. Which assessment finding is most concerning in a client with a suspected pulmonary
embolism?
A. Sudden dyspnea
B. Mild anxiety
C. Temperature of 37.4°C (99.3°F)
D. Nonproductive cough
Answer: A. Sudden dyspnea
Rationale: Sudden unexplained dyspnea is a classic manifestation of pulmonary embolism
and may indicate acute respiratory compromise.
6. A client with a myocardial infarction develops chest pain. Which medication should
the nurse anticipate administering to reduce platelet aggregation?
A. Aspirin
B. Furosemide
C. Digoxin
D. Atorvastatin
Answer: A. Aspirin
Rationale: Aspirin inhibits platelet aggregation and is routinely used during suspected acute
coronary syndrome unless contraindicated.
7. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which
finding should the nurse anticipate?
A. Peaked T waves
B. Flattened T waves
C. Increased bowel sounds only
D. Severe hypertension without ECG changes
Answer: A. Peaked T waves
Rationale: Hyperkalemia can produce characteristic ECG changes, especially tall, peaked T
waves, and can progress to life-threatening dysrhythmias.
8. A client is admitted with an acute exacerbation of asthma. Which assessment finding
indicates worsening airway obstruction?
,A. Expiratory wheezing
B. Productive cough
C. Diminished or absent breath sounds
D. Respiratory rate of 20/min
Answer: C. Diminished or absent breath sounds
Rationale: A "silent chest" can indicate severely reduced airflow and impending respiratory
failure. This is more concerning than audible wheezing.
9. A client with cirrhosis develops confusion and asterixis. Which laboratory value is
most relevant?
A. Serum ammonia
B. Serum calcium
C. Hemoglobin
D. Troponin
Answer: A. Serum ammonia
Rationale: Hepatic encephalopathy is associated with impaired ammonia metabolism.
Confusion and asterixis are characteristic findings.
10. A client with a gastrointestinal bleed has a blood pressure of 84/50 mmHg and a
heart rate of 124/min. Which action is the priority?
A. Offer clear liquids
B. Establish or maintain large-bore IV access
C. Administer an oral antacid
D. Encourage ambulation
Answer: B. Establish or maintain large-bore IV access
Rationale: The client is showing signs of hypovolemic shock. Rapid IV access is essential for
fluid and blood-product resuscitation.
11. Which finding is expected in a client with hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Diarrhea
Answer: C. Bradycardia
Rationale: Hypothyroidism decreases metabolic activity and commonly causes fatigue,
weight gain, cold intolerance, constipation, and bradycardia.
12. Which finding is most consistent with hyperthyroidism?
A. Cold intolerance
B. Bradycardia
C. Weight gain
D. Heat intolerance
, Answer: D. Heat intolerance
Rationale: Increased thyroid hormone raises metabolic activity, commonly causing heat
intolerance, weight loss, tachycardia, and increased appetite.
13. A client with Addison disease is at risk for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia only
D. Hypermagnesemia only
Answer: A. Hyperkalemia
Rationale: Reduced aldosterone secretion decreases potassium excretion, increasing the risk
for hyperkalemia.
14. Which finding is characteristic of Cushing syndrome?
A. Weight loss and hypotension
B. Moon face and truncal obesity
C. Hyperpigmentation with dehydration
D. Severe hypoglycemia
Answer: B. Moon face and truncal obesity
Rationale: Excess cortisol causes characteristic findings such as truncal obesity, moon
facies, hypertension, hyperglycemia, and muscle weakness.
15. A client with a new tracheostomy has noisy respirations and increasing respiratory
effort. What should the nurse do first?
A. Remove the tracheostomy tube
B. Assess tube patency
C. Give oral fluids
D. Place the client supine
Answer: B. Assess tube patency
Rationale: Noisy respirations and increased work of breathing may indicate obstruction from
secretions or tube displacement. Airway patency must be assessed immediately.
16. A client with pneumonia has thick respiratory secretions. Which intervention is
appropriate if not contraindicated?
A. Restrict fluids
B. Encourage adequate hydration
C. Keep the client flat
D. Avoid coughing
Answer: B. Encourage adequate hydration
Rationale: Adequate hydration helps thin respiratory secretions and promotes more effective
coughing and airway clearance.
PREP 2026/2027 | 200 PRACTICE
QUESTIONS, CORRECT ANSWERS & DETAILED
RATIONALES | HESI/ELSEVIER REVIEW GUIDE
||NEWEST!!
Questions 1–200
1. A client with heart failure reports increasing shortness of breath and difficulty
sleeping flat. Which finding requires the nurse's immediate attention?
A. 2+ bilateral ankle edema
B. Oxygen saturation of 88%
C. Weight gain of 1 kg in 3 days
D. Fatigue with activity
Answer: B. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia and requires
immediate assessment and intervention. The other findings are also consistent with
worsening heart failure but are less immediately threatening.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen.
Which prescription should the nurse implement first?
A. Encourage oral fluids
B. Administer prescribed bronchodilator
C. Place the client in high-Fowler's position
D. Obtain a sputum specimen
Answer: C. Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases the work of
breathing. It is an immediate, independent intervention for respiratory distress.
3. A client with diabetes mellitus is diaphoretic, shaky, and confused. What should the
nurse do first?
A. Administer regular insulin
B. Check the blood glucose level
C. Give the client a high-protein meal
D. Notify the healthcare provider
Answer: B. Check the blood glucose level
Rationale: The symptoms suggest hypoglycemia. Blood glucose should be checked promptly
when possible to confirm the condition and guide treatment.
,4. A client receiving digoxin reports nausea and seeing yellow halos around lights.
Which action is most appropriate?
A. Administer the next dose with food
B. Hold the medication and notify the provider
C. Encourage increased potassium intake immediately
D. Administer an antiemetic
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, visual disturbances, and dysrhythmias can indicate digoxin toxicity. The
medication should be withheld and the provider notified.
5. Which assessment finding is most concerning in a client with a suspected pulmonary
embolism?
A. Sudden dyspnea
B. Mild anxiety
C. Temperature of 37.4°C (99.3°F)
D. Nonproductive cough
Answer: A. Sudden dyspnea
Rationale: Sudden unexplained dyspnea is a classic manifestation of pulmonary embolism
and may indicate acute respiratory compromise.
6. A client with a myocardial infarction develops chest pain. Which medication should
the nurse anticipate administering to reduce platelet aggregation?
A. Aspirin
B. Furosemide
C. Digoxin
D. Atorvastatin
Answer: A. Aspirin
Rationale: Aspirin inhibits platelet aggregation and is routinely used during suspected acute
coronary syndrome unless contraindicated.
7. A client with chronic kidney disease has a potassium level of 6.4 mEq/L. Which
finding should the nurse anticipate?
A. Peaked T waves
B. Flattened T waves
C. Increased bowel sounds only
D. Severe hypertension without ECG changes
Answer: A. Peaked T waves
Rationale: Hyperkalemia can produce characteristic ECG changes, especially tall, peaked T
waves, and can progress to life-threatening dysrhythmias.
8. A client is admitted with an acute exacerbation of asthma. Which assessment finding
indicates worsening airway obstruction?
,A. Expiratory wheezing
B. Productive cough
C. Diminished or absent breath sounds
D. Respiratory rate of 20/min
Answer: C. Diminished or absent breath sounds
Rationale: A "silent chest" can indicate severely reduced airflow and impending respiratory
failure. This is more concerning than audible wheezing.
9. A client with cirrhosis develops confusion and asterixis. Which laboratory value is
most relevant?
A. Serum ammonia
B. Serum calcium
C. Hemoglobin
D. Troponin
Answer: A. Serum ammonia
Rationale: Hepatic encephalopathy is associated with impaired ammonia metabolism.
Confusion and asterixis are characteristic findings.
10. A client with a gastrointestinal bleed has a blood pressure of 84/50 mmHg and a
heart rate of 124/min. Which action is the priority?
A. Offer clear liquids
B. Establish or maintain large-bore IV access
C. Administer an oral antacid
D. Encourage ambulation
Answer: B. Establish or maintain large-bore IV access
Rationale: The client is showing signs of hypovolemic shock. Rapid IV access is essential for
fluid and blood-product resuscitation.
11. Which finding is expected in a client with hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Diarrhea
Answer: C. Bradycardia
Rationale: Hypothyroidism decreases metabolic activity and commonly causes fatigue,
weight gain, cold intolerance, constipation, and bradycardia.
12. Which finding is most consistent with hyperthyroidism?
A. Cold intolerance
B. Bradycardia
C. Weight gain
D. Heat intolerance
, Answer: D. Heat intolerance
Rationale: Increased thyroid hormone raises metabolic activity, commonly causing heat
intolerance, weight loss, tachycardia, and increased appetite.
13. A client with Addison disease is at risk for which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia only
D. Hypermagnesemia only
Answer: A. Hyperkalemia
Rationale: Reduced aldosterone secretion decreases potassium excretion, increasing the risk
for hyperkalemia.
14. Which finding is characteristic of Cushing syndrome?
A. Weight loss and hypotension
B. Moon face and truncal obesity
C. Hyperpigmentation with dehydration
D. Severe hypoglycemia
Answer: B. Moon face and truncal obesity
Rationale: Excess cortisol causes characteristic findings such as truncal obesity, moon
facies, hypertension, hyperglycemia, and muscle weakness.
15. A client with a new tracheostomy has noisy respirations and increasing respiratory
effort. What should the nurse do first?
A. Remove the tracheostomy tube
B. Assess tube patency
C. Give oral fluids
D. Place the client supine
Answer: B. Assess tube patency
Rationale: Noisy respirations and increased work of breathing may indicate obstruction from
secretions or tube displacement. Airway patency must be assessed immediately.
16. A client with pneumonia has thick respiratory secretions. Which intervention is
appropriate if not contraindicated?
A. Restrict fluids
B. Encourage adequate hydration
C. Keep the client flat
D. Avoid coughing
Answer: B. Encourage adequate hydration
Rationale: Adequate hydration helps thin respiratory secretions and promotes more effective
coughing and airway clearance.
