HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
HESI Med Surg Final Exam Questions and
Answers Latest (2026/2027)
Verified Answers | Medical-Surgical Nursing Comprehensive Exam
This comprehensive exam contains 140 multiple-choice questions spanning the nine core domains of the HESI
Medical-Surgical Nursing Final Examination, calibrated to the 2026/2027 academic cycle. Each question is
labeled with a competency tag (e.g., Cardiovascular – Acute MI Recognition) and a cognitive level (Recall,
Application, Analysis) so that you can target review efficiently. The cognitive distribution is approximately 30%
recall, 50% application, and 20% analysis, mirroring the structure of the HESI Med-Surg specialty final.
Approximately 75% of items are scenario-based and 25% test direct recall of pathophysiology, medications,
and assessment findings. Each rationale doubles as study content: it explains why the correct answer is correct and
why each distractor is wrong, including pathophysiological basis, assessment findings, nursing interventions, and
safety priorities. Use this document as a self-assessment, then return to the rationales for targeted study.
How to use this exam:
1. Answer all 140 questions before consulting the rationales to simulate exam conditions.
2. After completing, review rationales for items you missed; pay attention to the pathophysiological basis,
assessment findings, nursing interventions, and safety priorities flagged in the rationale.
3. Watch for commonly confused pairs: DKA vs. HHS, SIADH vs. diabetes insipidus, left vs. right heart
failure, Crohn's vs. ulcerative colitis, and hypovolemic vs. cardiogenic vs. septic vs. anaphylactic shock.
4. For prioritization questions, apply ABCs first, then Maslow's hierarchy, then safety, then non-urgent needs.
5. Each section heading below lists the competencies covered for targeted review.
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, Postoperative, & Complications (Q1–Q16)
Competencies covered: Informed Consent; Preop Assessment; NPO/ASA Guidelines; Bowel Prep; Surgical
Site Prep; Intraop Positioning; Malignant Hyperthermia; Postop Airway; Aldrete Score; Postop Bleeding;
Atelectasis Prevention; DVT Prophylaxis; Wound Dehiscence/Evisceration; Postop Fever Timing; Anesthesia
Reversal; Discharge Teaching.
Q1. [Perioperative – Informed Consent] Cognitive: Application
A 55-year-old client scheduled for an elective cholecystectomy at 0700 has not yet signed the consent
form. The nurse's most appropriate action is to:
A. Have the client sign the consent form immediately
B. Notify the surgeon so that the surgeon can explain the procedure and obtain consent before
sedation is given [CORRECT]
C. Witness the consent after the nurse explains risks
D. Cancel the surgery
Page 1
,HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
Correct Answer: B
Rationale: Informed consent is the surgeon's legal responsibility — the surgeon must explain the procedure, risks,
benefits, and alternatives. The nurse's role is to witness the signature and verify the client's understanding; the nurse
does not obtain consent. Sedation must not be given until consent is signed. Canceling surgery (D) is unnecessary.
Q2. [Perioperative – Preop Assessment] Cognitive: Application
Which preoperative finding requires immediate provider notification before elective surgery?
A. Potassium 3.5 mEq/L
B. International normalized ratio (INR) 1.0
C. Potassium 5.9 mEq/L, indicating hyperkalemia that can cause cardiac dysrhythmias under
anesthesia [CORRECT]
D. Hemoglobin 13 g/dL
Correct Answer: C
Rationale: Hyperkalemia (K > 5.5 mEq/L) increases the risk of life-threatening dysrhythmias during anesthesia.
Normal INR is ~1.0 (B), normal Hgb ~12–16 g/dL (D), and K 3.5 (A) is at the low end of normal. Surgery should be
postponed until hyperkalemia is corrected.
Q3. [Perioperative – NPO Status] Cognitive: Recall
Current evidence-based guidelines for preoperative fasting recommend:
A. NPO for 12 hours for solid food and 8 hours for clear liquids
B. NPO for 6 hours for light meals/solid food, and 2 hours for clear liquids (ASA guidelines)
[CORRECT]
C. NPO for 24 hours
D. No fasting required before anesthesia
Correct Answer: B
Rationale: The American Society of Anesthesiologists (ASA) recommends fasting from solid food/light meals for at
least 6 hours and clear liquids for at least 2 hours before elective surgery. The traditional "NPO after midnight" has
been replaced. Water may be allowed up to 2 hours before.
Q4. [Perioperative – Bowel Prep] Cognitive: Recall
A client scheduled for bowel surgery asks why antibiotics are prescribed before surgery. The nurse's
best response is:
A. To prevent postoperative pneumonia
B. To reduce bacterial load in the bowel and lower the risk of surgical site infection from
contamination during the procedure [CORRECT]
C. To treat an existing infection
D. To decrease postoperative pain
Correct Answer: B
Rationale: Preoperative antibiotics for bowel surgery (e.g., oral neomycin + erythromycin or mechanical bowel prep
with polyethylene glycol) reduce the bacterial load and surgical site infection rates. They are prophylactic, not
therapeutic. Pneumonia prevention (A) requires incentive spirometry, not preop antibiotics.
Page 2
,HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
Q5. [Perioperative – Surgical Site Prep] Cognitive: Application
The nurse is preparing to scrub a surgical site with chlorhexidine. Which technique is correct?
A. Scrub from the outer area toward the incision site in concentric circles
B. Scrub from the incision site outward in concentric circles, using a new swab for each circle
[CORRECT]
C. Scrub in random patterns to cover the entire area
D. Scrub only the incision site itself
Correct Answer: B
Rationale: Surgical site prep uses a clean-to-dirty technique: scrub from the incision site outward in concentric
circles. Never move from contaminated outer areas toward the clean incision site (A). A new swab is used for each
pass to prevent recontamination.
Q6. [Perioperative – Intraoperative Positioning] Cognitive: Recall
During surgery, the most common position-related complications include all EXCEPT:
A. Brachial plexus injury from overextension of the arm
B. Pressure ulcers from prolonged immobility
C. Peripheral nerve injury from compression
D. Myocardial infarction from lateral positioning [CORRECT]
Correct Answer: D
Rationale: Positioning complications include nerve injuries (brachial plexus, ulnar, common peroneal), pressure
ulcers, compartment syndrome, and venous pooling. Lateral positioning does not cause MI. The other options (A, B,
C) are recognized positioning complications.
Q7. [Perioperative – Malignant Hyperthermia] Cognitive: Application
An anesthetized client suddenly develops a rapidly rising end-tidal CO2, muscle rigidity,
tachycardia, and a temperature rising to 39.5°C. The nurse's priority action is to:
A. Administer succinylcholine
B. Stop triggering agents (volatile anesthetics, succinylcholine), notify anesthesia, and prepare to
administer dantrolene [CORRECT]
C. Increase the volatile anesthetic concentration
D. Apply cooling blankets and continue surgery
Correct Answer: B
Rationale: This is malignant hyperthermia, a life-threatening hypermetabolic crisis triggered by volatile anesthetics
and succinylcholine. Stop triggering agents, hyperventilate with 100% oxygen, administer dantrolene (the antidote),
cool the patient, and treat complications. Continuing volatile anesthetics (C) is dangerous; succinylcholine (A) worsens
the crisis.
Q8. [Perioperative – Postop Airway] Cognitive: Application
A client in the PACU has just had general anesthesia extubated. The client's oxygen saturation is
92%, with audible stridor and suprasternal retractions. The nurse's priority action is to:
A. Apply supplemental oxygen via nasal cannula
Page 3
, HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
B. Position the client in lateral Sims' position with the head turned, suction the airway, and apply
jaw-thrust maneuver; prepare for reintubation if not resolved [CORRECT]
C. Administer naloxone IV
D. Increase the rate of patient-controlled analgesia (PCA)
Correct Answer: B
Rationale: Stridor and retractions indicate upper airway obstruction. The priority is to open the airway using
jaw-thrust (head-tilt is contraindicated after cervical considerations), suction secretions, and position to maintain
airway patency. Naloxone (C) reverses opioids but does not address mechanical obstruction. Oxygen alone (A) does
not address the obstruction.
Q9. [Perioperative – PACU Aldrete Score] Cognitive: Recall
The Aldrete Score is used in the PACU to assess readiness for discharge based on which
parameters?
A. Activity, respiration, circulation, consciousness, oxygen saturation [CORRECT]
B. Heart rate only
C. Pain score only
D. Urine output only
Correct Answer: A
Rationale: The Aldrete Score (modified) evaluates 5 parameters (0–2 points each, max 10): activity (movement),
respiration, circulation (BP), consciousness, and oxygen saturation (SpO2). A score of ≥ 8–9 typically indicates
readiness for discharge from PACU.
Q10. [Perioperative – Postop Bleeding] Cognitive: Application
A postoperative client has a Jackson-Pratt drain that suddenly fills with 200 mL of bright red blood
in 1 hour. The nurse's priority action is to:
A. Empty the drain and reassess in 1 hour
B. Notify the surgeon immediately, monitor vital signs, assess for hypovolemic shock, and ensure
IV access [CORRECT]
C. Increase the suction on the drain
D. Clamp the drain
Correct Answer: B
Rationale: Bright red blood > 100 mL/hr in a surgical drain suggests active hemorrhage — a surgical emergency.
Notify the surgeon, assess for shock (tachycardia, hypotension, decreased urine output), maintain IV access, and
prepare for possible return to surgery. Clamping (D) prevents drainage and worsens the situation.
Q11. [Perioperative – Atelectasis Prevention] Cognitive: Application
To prevent atelectasis in a postoperative client, the nurse should:
A. Encourage early ambulation and the use of the incentive spirometer 10 times every hour while
awake [CORRECT]
B. Keep the client flat in bed
C. Limit oral intake to clear liquids
D. Administer opioids frequently
Page 4
HESI Med Surg Final Exam Questions and
Answers Latest (2026/2027)
Verified Answers | Medical-Surgical Nursing Comprehensive Exam
This comprehensive exam contains 140 multiple-choice questions spanning the nine core domains of the HESI
Medical-Surgical Nursing Final Examination, calibrated to the 2026/2027 academic cycle. Each question is
labeled with a competency tag (e.g., Cardiovascular – Acute MI Recognition) and a cognitive level (Recall,
Application, Analysis) so that you can target review efficiently. The cognitive distribution is approximately 30%
recall, 50% application, and 20% analysis, mirroring the structure of the HESI Med-Surg specialty final.
Approximately 75% of items are scenario-based and 25% test direct recall of pathophysiology, medications,
and assessment findings. Each rationale doubles as study content: it explains why the correct answer is correct and
why each distractor is wrong, including pathophysiological basis, assessment findings, nursing interventions, and
safety priorities. Use this document as a self-assessment, then return to the rationales for targeted study.
How to use this exam:
1. Answer all 140 questions before consulting the rationales to simulate exam conditions.
2. After completing, review rationales for items you missed; pay attention to the pathophysiological basis,
assessment findings, nursing interventions, and safety priorities flagged in the rationale.
3. Watch for commonly confused pairs: DKA vs. HHS, SIADH vs. diabetes insipidus, left vs. right heart
failure, Crohn's vs. ulcerative colitis, and hypovolemic vs. cardiogenic vs. septic vs. anaphylactic shock.
4. For prioritization questions, apply ABCs first, then Maslow's hierarchy, then safety, then non-urgent needs.
5. Each section heading below lists the competencies covered for targeted review.
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, Postoperative, & Complications (Q1–Q16)
Competencies covered: Informed Consent; Preop Assessment; NPO/ASA Guidelines; Bowel Prep; Surgical
Site Prep; Intraop Positioning; Malignant Hyperthermia; Postop Airway; Aldrete Score; Postop Bleeding;
Atelectasis Prevention; DVT Prophylaxis; Wound Dehiscence/Evisceration; Postop Fever Timing; Anesthesia
Reversal; Discharge Teaching.
Q1. [Perioperative – Informed Consent] Cognitive: Application
A 55-year-old client scheduled for an elective cholecystectomy at 0700 has not yet signed the consent
form. The nurse's most appropriate action is to:
A. Have the client sign the consent form immediately
B. Notify the surgeon so that the surgeon can explain the procedure and obtain consent before
sedation is given [CORRECT]
C. Witness the consent after the nurse explains risks
D. Cancel the surgery
Page 1
,HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
Correct Answer: B
Rationale: Informed consent is the surgeon's legal responsibility — the surgeon must explain the procedure, risks,
benefits, and alternatives. The nurse's role is to witness the signature and verify the client's understanding; the nurse
does not obtain consent. Sedation must not be given until consent is signed. Canceling surgery (D) is unnecessary.
Q2. [Perioperative – Preop Assessment] Cognitive: Application
Which preoperative finding requires immediate provider notification before elective surgery?
A. Potassium 3.5 mEq/L
B. International normalized ratio (INR) 1.0
C. Potassium 5.9 mEq/L, indicating hyperkalemia that can cause cardiac dysrhythmias under
anesthesia [CORRECT]
D. Hemoglobin 13 g/dL
Correct Answer: C
Rationale: Hyperkalemia (K > 5.5 mEq/L) increases the risk of life-threatening dysrhythmias during anesthesia.
Normal INR is ~1.0 (B), normal Hgb ~12–16 g/dL (D), and K 3.5 (A) is at the low end of normal. Surgery should be
postponed until hyperkalemia is corrected.
Q3. [Perioperative – NPO Status] Cognitive: Recall
Current evidence-based guidelines for preoperative fasting recommend:
A. NPO for 12 hours for solid food and 8 hours for clear liquids
B. NPO for 6 hours for light meals/solid food, and 2 hours for clear liquids (ASA guidelines)
[CORRECT]
C. NPO for 24 hours
D. No fasting required before anesthesia
Correct Answer: B
Rationale: The American Society of Anesthesiologists (ASA) recommends fasting from solid food/light meals for at
least 6 hours and clear liquids for at least 2 hours before elective surgery. The traditional "NPO after midnight" has
been replaced. Water may be allowed up to 2 hours before.
Q4. [Perioperative – Bowel Prep] Cognitive: Recall
A client scheduled for bowel surgery asks why antibiotics are prescribed before surgery. The nurse's
best response is:
A. To prevent postoperative pneumonia
B. To reduce bacterial load in the bowel and lower the risk of surgical site infection from
contamination during the procedure [CORRECT]
C. To treat an existing infection
D. To decrease postoperative pain
Correct Answer: B
Rationale: Preoperative antibiotics for bowel surgery (e.g., oral neomycin + erythromycin or mechanical bowel prep
with polyethylene glycol) reduce the bacterial load and surgical site infection rates. They are prophylactic, not
therapeutic. Pneumonia prevention (A) requires incentive spirometry, not preop antibiotics.
Page 2
,HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
Q5. [Perioperative – Surgical Site Prep] Cognitive: Application
The nurse is preparing to scrub a surgical site with chlorhexidine. Which technique is correct?
A. Scrub from the outer area toward the incision site in concentric circles
B. Scrub from the incision site outward in concentric circles, using a new swab for each circle
[CORRECT]
C. Scrub in random patterns to cover the entire area
D. Scrub only the incision site itself
Correct Answer: B
Rationale: Surgical site prep uses a clean-to-dirty technique: scrub from the incision site outward in concentric
circles. Never move from contaminated outer areas toward the clean incision site (A). A new swab is used for each
pass to prevent recontamination.
Q6. [Perioperative – Intraoperative Positioning] Cognitive: Recall
During surgery, the most common position-related complications include all EXCEPT:
A. Brachial plexus injury from overextension of the arm
B. Pressure ulcers from prolonged immobility
C. Peripheral nerve injury from compression
D. Myocardial infarction from lateral positioning [CORRECT]
Correct Answer: D
Rationale: Positioning complications include nerve injuries (brachial plexus, ulnar, common peroneal), pressure
ulcers, compartment syndrome, and venous pooling. Lateral positioning does not cause MI. The other options (A, B,
C) are recognized positioning complications.
Q7. [Perioperative – Malignant Hyperthermia] Cognitive: Application
An anesthetized client suddenly develops a rapidly rising end-tidal CO2, muscle rigidity,
tachycardia, and a temperature rising to 39.5°C. The nurse's priority action is to:
A. Administer succinylcholine
B. Stop triggering agents (volatile anesthetics, succinylcholine), notify anesthesia, and prepare to
administer dantrolene [CORRECT]
C. Increase the volatile anesthetic concentration
D. Apply cooling blankets and continue surgery
Correct Answer: B
Rationale: This is malignant hyperthermia, a life-threatening hypermetabolic crisis triggered by volatile anesthetics
and succinylcholine. Stop triggering agents, hyperventilate with 100% oxygen, administer dantrolene (the antidote),
cool the patient, and treat complications. Continuing volatile anesthetics (C) is dangerous; succinylcholine (A) worsens
the crisis.
Q8. [Perioperative – Postop Airway] Cognitive: Application
A client in the PACU has just had general anesthesia extubated. The client's oxygen saturation is
92%, with audible stridor and suprasternal retractions. The nurse's priority action is to:
A. Apply supplemental oxygen via nasal cannula
Page 3
, HESI Med Surg Final Exam Questions and Answers Latest (2026/2027) | Verified Answers Medical-Surgical Nursing
B. Position the client in lateral Sims' position with the head turned, suction the airway, and apply
jaw-thrust maneuver; prepare for reintubation if not resolved [CORRECT]
C. Administer naloxone IV
D. Increase the rate of patient-controlled analgesia (PCA)
Correct Answer: B
Rationale: Stridor and retractions indicate upper airway obstruction. The priority is to open the airway using
jaw-thrust (head-tilt is contraindicated after cervical considerations), suction secretions, and position to maintain
airway patency. Naloxone (C) reverses opioids but does not address mechanical obstruction. Oxygen alone (A) does
not address the obstruction.
Q9. [Perioperative – PACU Aldrete Score] Cognitive: Recall
The Aldrete Score is used in the PACU to assess readiness for discharge based on which
parameters?
A. Activity, respiration, circulation, consciousness, oxygen saturation [CORRECT]
B. Heart rate only
C. Pain score only
D. Urine output only
Correct Answer: A
Rationale: The Aldrete Score (modified) evaluates 5 parameters (0–2 points each, max 10): activity (movement),
respiration, circulation (BP), consciousness, and oxygen saturation (SpO2). A score of ≥ 8–9 typically indicates
readiness for discharge from PACU.
Q10. [Perioperative – Postop Bleeding] Cognitive: Application
A postoperative client has a Jackson-Pratt drain that suddenly fills with 200 mL of bright red blood
in 1 hour. The nurse's priority action is to:
A. Empty the drain and reassess in 1 hour
B. Notify the surgeon immediately, monitor vital signs, assess for hypovolemic shock, and ensure
IV access [CORRECT]
C. Increase the suction on the drain
D. Clamp the drain
Correct Answer: B
Rationale: Bright red blood > 100 mL/hr in a surgical drain suggests active hemorrhage — a surgical emergency.
Notify the surgeon, assess for shock (tachycardia, hypotension, decreased urine output), maintain IV access, and
prepare for possible return to surgery. Clamping (D) prevents drainage and worsens the situation.
Q11. [Perioperative – Atelectasis Prevention] Cognitive: Application
To prevent atelectasis in a postoperative client, the nurse should:
A. Encourage early ambulation and the use of the incentive spirometer 10 times every hour while
awake [CORRECT]
B. Keep the client flat in bed
C. Limit oral intake to clear liquids
D. Administer opioids frequently
Page 4
