HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
HESI Medical-Surgical Nursing V1 Test Bank
Questions and Answers (2026/2027) | Verified Answers
175 Comprehensive Practice Questions with Detailed Rationales
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis • Format: 80% Scenario-Based, 20% Direct Recall
How to Use This Test Bank: Each question is followed by four options (A-D). The correct option is marked [CORRECT] in
green. A detailed rationale explains the medical-surgical reasoning, including pathophysiologic mechanisms, assessment
priorities, nursing interventions, and patient safety considerations — serving double duty as exam practice and study content.
The competency label identifies the HESI content domain. Work through all 175 questions organized by system, review
rationales for both correct and incorrect answers, and revisit sections where you missed multiple questions. NCLEX-style
formats used throughout include "Which finding requires IMMEDIATE follow-up?", "Which client should the nurse assess
FIRST?", and "Which intervention should the nurse implement?". Test-taking strategy notes are embedded in rationales for
HESI preparation.
Exam Sections Overview
Section 1: Perioperative Nursing and Surgical Care (Q1-19)
Section 2: Cardiovascular Disorders and Management (Q20-42)
Section 3: Respiratory Disorders and Management (Q43-63)
Section 4: Neurological Disorders and Management (Q64-84)
Section 5: Endocrine and Metabolic Disorders (Q85-105)
Section 6: Renal and Genitourinary Disorders (Q106-124)
Section 7: Gastrointestinal and Hepatobiliary Disorders (Q125-145)
Section 8: Musculoskeletal, Integumentary, and Oncologic Disorders (Q146-160)
Section 9: Emergency, Critical Care, and Fluid/Electrolyte Management (Q161-175)
Page 1
,HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Section 1: Perioperative Nursing and Surgical Care
Preoperative, Intraoperative, Postoperative, & Anesthesia | Questions 1-19
Q1: A client is scheduled for elective surgery in 2 weeks. During the preoperative assessment, the
client reports taking aspirin 81 mg daily, warfarin 5 mg daily, and ginkgo biloba. Which action by
the nurse is most appropriate?
A. Tell the client to continue all medications as ordered
B. Notify the surgeon and anesthesia provider immediately, as warfarin, aspirin, and ginkgo biloba all
increase bleeding risk and typically must be held or managed perioperatively [CORRECT]
C. Tell the client to stop all medications immediately without consulting the provider
D. Document the medications and continue with preoperative teaching
Correct Answer: B
Rationale: Warfarin (an anticoagulant), aspirin (antiplatelet), and ginkgo biloba (herbal with antiplatelet properties) all
increase perioperative bleeding risk. The surgeon and anesthesia provider must be notified to determine timing for holding
these medications (warfarin typically held 5 days preop with possible heparin bridge; aspirin held 7-10 days depending on
indication; ginkgo stopped at least 24-36 hours preop). The nurse should never independently instruct the client to stop or
continue medications. Options A, C, D are unsafe. Study tip: always review ALL medications (prescription, OTC, herbal) at
the preoperative visit; common herbals that increase bleeding: ginkgo, garlic, ginger, ginseng, feverfew, fish oil, vitamin E.
Competency: Preoperative Medication Review | Cognitive: Application
Q2: A client is receiving preoperative teaching for a total hip arthroplasty scheduled in 2 weeks.
Which statement by the client indicates understanding of postoperative precautions?
A. "I will cross my legs at the ankles when sitting in a chair."
B. "I will use a raised toilet seat and avoid bending my hip more than 90 degrees." [CORRECT]
C. "I will sleep on my operative side with a pillow between my legs."
D. "I will twist at the waist to reach items on my bedside table."
Correct Answer: B
Rationale: Posterior approach total hip arthroplasty requires hip precautions to prevent dislocation: (1) do not flex hip more
than 90 degrees (use raised toilet seat, chair with armrests, long-handled reacher); (2) do not adduct or cross legs (keep
abduction pillow between legs when in bed, no crossed legs); (3) do not internally rotate hip (keep toes pointing forward or
slightly outward); (4) use abduction pillow when sleeping; (5) avoid twisting at waist. Precautions typically continue 6-12
weeks postoperatively (sometimes longer). Anterior approach has fewer restrictions but still requires some precautions.
Options A, C, D violate hip precautions. Study tip: posterior approach = no bending > 90°, no crossing legs, no internal
rotation; anterior approach = avoid external rotation and extension.
Competency: Total Hip Precautions Teaching | Cognitive: Application
Page 2
,HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Q3: A client who had abdominal surgery 24 hours ago has not passed flatus. The client reports
abdominal distension and nausea. Bowel sounds are hypoactive. Vital signs: T 99.2°F, HR 96, BP
122/76, RR 18. Which action should the nurse implement FIRST?
A. Administer a prescribed ondansetron for nausea
B. Encourage ambulation in the hallway, which is the most effective intervention for postoperative ileus
[CORRECT]
C. Insert a nasogastric tube for decompression
D. Notify the surgeon of possible bowel obstruction
Correct Answer: B
Rationale: Postoperative ileus is common after abdominal surgery due to bowel manipulation, anesthesia, and opioids,
typically resolving in 2-3 days. Initial management is conservative: (1) encourage early and frequent ambulation (most
effective intervention to stimulate peristalsis); (2) limit opioids (use non-opioid analgesics when possible); (3) maintain NPO
or advance diet slowly as tolerated; (4) maintain IV fluids; (5) NG tube only for severe distension/vomiting (not first-line).
Options A treats symptom but doesn't address cause. Option C is too aggressive for early postop. Option D is premature
without trial of conservative management. Study tip: postoperative ileus — ambulation is first-line; NG tube reserved for
refractory cases; notify surgeon if ileus persists > 3-5 days or signs of obstruction develop.
Competency: Postoperative Ileus Management | Cognitive: Application
Q4: A client is in the post-anesthesia care unit (PACU) after general anesthesia. The client's
oxygen saturation is 92% on room air, respiratory rate is 8, and the client is difficult to arouse.
Which intervention should the nurse implement FIRST?
A. Apply supplemental oxygen via nasal cannula at 4 L/min
B. Position the client lateral with head tilted back (sniffing position) and apply a chin lift or jaw thrust
to open the airway; administer supplemental oxygen; encourage deep breathing; have naloxone ready if
opioid-related [CORRECT]
C. Administer naloxone 0.4 mg IV push
D. Call the anesthesia provider immediately
Correct Answer: B
Rationale: This client has post-anesthesia respiratory depression (RR 8, SpO2 92%, difficult to arouse). The FIRST priority is
airway opening (ABC): position lateral to prevent tongue obstruction, head tilt-chin lift (or jaw thrust if cervical spine
concern), administer supplemental oxygen. If opioid-related, naloxone may be needed but airway/breathing always come first.
The nurse should have naloxone available but not automatically administer (could precipitate severe pain and pulmonary
edema if given too rapidly). Calling anesthesia (option D) is appropriate if not responding, but airway management is first.
Option A addresses oxygen but not airway patency. Option C is premature without first opening airway. Study tip: ABCs first
— open airway, oxygenate, ventilate; THEN consider naloxone if opioid-related; never leave PACU client unattended.
Competency: PACU Respiratory Depression | Cognitive: Application
Page 3
, HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Q5: Which finding in a postoperative client on postoperative day 2 requires IMMEDIATE
notification of the surgeon?
A. Serous drainage on the surgical dressing
B. Serosanguineous wound drainage that has increased in amount over 4 hours, with new onset of
restlessness, tachycardia (HR 118), and hypotension (BP 92/58) [CORRECT]
C. Mild incisional pain rated 4/10
D. Oral temperature of 99.8°F (37.7°C)
Correct Answer: B
Rationale: Signs of internal bleeding/hemorrhage include: increased wound drainage (especially serosanguineous or
sanguineous), restlessness, tachycardia, hypotension, tachypnea, oliguria, pallor, cool/clammy skin, decreased level of
consciousness. This client shows classic signs of hemorrhage with hemodynamic instability — IMMEDIATE surgeon
notification and intervention (IV fluids, blood products, possible return to OR). Serous drainage (option A) is expected. Mild
pain (option C) is normal. Low-grade fever (option D) is common in first 24-48 hours (atelectasis). Study tip: postoperative
hemorrhage triad = restlessness + tachycardia + hypotension; always investigate restlessness in postoperative client (often
earliest sign of hypoxia or hemorrhage).
Competency: Postoperative Hemorrhage Recognition | Cognitive: Analysis
Q6: A client is receiving preoperative instructions for surgery under general anesthesia. The
client asks why they cannot eat or drink before surgery. Which response by the nurse is most
accurate?
A. "Fasting prevents dehydration during surgery."
B. "Fasting reduces the risk of aspiration of stomach contents into the lungs while you are under
anesthesia, since anesthesia suppresses your gag reflex and airway protective reflexes." [CORRECT]
C. "Fasting helps prevent postoperative nausea."
D. "Fasting ensures your blood sugar stays normal during surgery."
Correct Answer: B
Rationale: Preoperative fasting (NPO after midnight, or 2 hours for clear liquids and 6-8 hours for solids per ASA 2023
guidelines) is required to ensure the stomach is empty during anesthesia. General anesthesia suppresses protective airway
reflexes (gag, cough), so if the client vomits, stomach contents can be aspirated into the lungs causing aspiration pneumonitis
(Mendelson syndrome) — a life-threatening complication. Options A, C, D are incorrect rationale. ASA updated fasting
guidelines allow clear liquids up to 2 hours before anesthesia (not strict NPO after midnight), but solids still require 6-8 hours.
Study tip: ASA fasting guidelines: 2 hours clear liquids, 4 hours breast milk, 6 hours infant formula/light meal, 8 hours fatty
meal.
Competency: Preoperative NPO Rationale | Cognitive: Recall
Page 4
HESI Medical-Surgical Nursing V1 Test Bank
Questions and Answers (2026/2027) | Verified Answers
175 Comprehensive Practice Questions with Detailed Rationales
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis • Format: 80% Scenario-Based, 20% Direct Recall
How to Use This Test Bank: Each question is followed by four options (A-D). The correct option is marked [CORRECT] in
green. A detailed rationale explains the medical-surgical reasoning, including pathophysiologic mechanisms, assessment
priorities, nursing interventions, and patient safety considerations — serving double duty as exam practice and study content.
The competency label identifies the HESI content domain. Work through all 175 questions organized by system, review
rationales for both correct and incorrect answers, and revisit sections where you missed multiple questions. NCLEX-style
formats used throughout include "Which finding requires IMMEDIATE follow-up?", "Which client should the nurse assess
FIRST?", and "Which intervention should the nurse implement?". Test-taking strategy notes are embedded in rationales for
HESI preparation.
Exam Sections Overview
Section 1: Perioperative Nursing and Surgical Care (Q1-19)
Section 2: Cardiovascular Disorders and Management (Q20-42)
Section 3: Respiratory Disorders and Management (Q43-63)
Section 4: Neurological Disorders and Management (Q64-84)
Section 5: Endocrine and Metabolic Disorders (Q85-105)
Section 6: Renal and Genitourinary Disorders (Q106-124)
Section 7: Gastrointestinal and Hepatobiliary Disorders (Q125-145)
Section 8: Musculoskeletal, Integumentary, and Oncologic Disorders (Q146-160)
Section 9: Emergency, Critical Care, and Fluid/Electrolyte Management (Q161-175)
Page 1
,HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Section 1: Perioperative Nursing and Surgical Care
Preoperative, Intraoperative, Postoperative, & Anesthesia | Questions 1-19
Q1: A client is scheduled for elective surgery in 2 weeks. During the preoperative assessment, the
client reports taking aspirin 81 mg daily, warfarin 5 mg daily, and ginkgo biloba. Which action by
the nurse is most appropriate?
A. Tell the client to continue all medications as ordered
B. Notify the surgeon and anesthesia provider immediately, as warfarin, aspirin, and ginkgo biloba all
increase bleeding risk and typically must be held or managed perioperatively [CORRECT]
C. Tell the client to stop all medications immediately without consulting the provider
D. Document the medications and continue with preoperative teaching
Correct Answer: B
Rationale: Warfarin (an anticoagulant), aspirin (antiplatelet), and ginkgo biloba (herbal with antiplatelet properties) all
increase perioperative bleeding risk. The surgeon and anesthesia provider must be notified to determine timing for holding
these medications (warfarin typically held 5 days preop with possible heparin bridge; aspirin held 7-10 days depending on
indication; ginkgo stopped at least 24-36 hours preop). The nurse should never independently instruct the client to stop or
continue medications. Options A, C, D are unsafe. Study tip: always review ALL medications (prescription, OTC, herbal) at
the preoperative visit; common herbals that increase bleeding: ginkgo, garlic, ginger, ginseng, feverfew, fish oil, vitamin E.
Competency: Preoperative Medication Review | Cognitive: Application
Q2: A client is receiving preoperative teaching for a total hip arthroplasty scheduled in 2 weeks.
Which statement by the client indicates understanding of postoperative precautions?
A. "I will cross my legs at the ankles when sitting in a chair."
B. "I will use a raised toilet seat and avoid bending my hip more than 90 degrees." [CORRECT]
C. "I will sleep on my operative side with a pillow between my legs."
D. "I will twist at the waist to reach items on my bedside table."
Correct Answer: B
Rationale: Posterior approach total hip arthroplasty requires hip precautions to prevent dislocation: (1) do not flex hip more
than 90 degrees (use raised toilet seat, chair with armrests, long-handled reacher); (2) do not adduct or cross legs (keep
abduction pillow between legs when in bed, no crossed legs); (3) do not internally rotate hip (keep toes pointing forward or
slightly outward); (4) use abduction pillow when sleeping; (5) avoid twisting at waist. Precautions typically continue 6-12
weeks postoperatively (sometimes longer). Anterior approach has fewer restrictions but still requires some precautions.
Options A, C, D violate hip precautions. Study tip: posterior approach = no bending > 90°, no crossing legs, no internal
rotation; anterior approach = avoid external rotation and extension.
Competency: Total Hip Precautions Teaching | Cognitive: Application
Page 2
,HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Q3: A client who had abdominal surgery 24 hours ago has not passed flatus. The client reports
abdominal distension and nausea. Bowel sounds are hypoactive. Vital signs: T 99.2°F, HR 96, BP
122/76, RR 18. Which action should the nurse implement FIRST?
A. Administer a prescribed ondansetron for nausea
B. Encourage ambulation in the hallway, which is the most effective intervention for postoperative ileus
[CORRECT]
C. Insert a nasogastric tube for decompression
D. Notify the surgeon of possible bowel obstruction
Correct Answer: B
Rationale: Postoperative ileus is common after abdominal surgery due to bowel manipulation, anesthesia, and opioids,
typically resolving in 2-3 days. Initial management is conservative: (1) encourage early and frequent ambulation (most
effective intervention to stimulate peristalsis); (2) limit opioids (use non-opioid analgesics when possible); (3) maintain NPO
or advance diet slowly as tolerated; (4) maintain IV fluids; (5) NG tube only for severe distension/vomiting (not first-line).
Options A treats symptom but doesn't address cause. Option C is too aggressive for early postop. Option D is premature
without trial of conservative management. Study tip: postoperative ileus — ambulation is first-line; NG tube reserved for
refractory cases; notify surgeon if ileus persists > 3-5 days or signs of obstruction develop.
Competency: Postoperative Ileus Management | Cognitive: Application
Q4: A client is in the post-anesthesia care unit (PACU) after general anesthesia. The client's
oxygen saturation is 92% on room air, respiratory rate is 8, and the client is difficult to arouse.
Which intervention should the nurse implement FIRST?
A. Apply supplemental oxygen via nasal cannula at 4 L/min
B. Position the client lateral with head tilted back (sniffing position) and apply a chin lift or jaw thrust
to open the airway; administer supplemental oxygen; encourage deep breathing; have naloxone ready if
opioid-related [CORRECT]
C. Administer naloxone 0.4 mg IV push
D. Call the anesthesia provider immediately
Correct Answer: B
Rationale: This client has post-anesthesia respiratory depression (RR 8, SpO2 92%, difficult to arouse). The FIRST priority is
airway opening (ABC): position lateral to prevent tongue obstruction, head tilt-chin lift (or jaw thrust if cervical spine
concern), administer supplemental oxygen. If opioid-related, naloxone may be needed but airway/breathing always come first.
The nurse should have naloxone available but not automatically administer (could precipitate severe pain and pulmonary
edema if given too rapidly). Calling anesthesia (option D) is appropriate if not responding, but airway management is first.
Option A addresses oxygen but not airway patency. Option C is premature without first opening airway. Study tip: ABCs first
— open airway, oxygenate, ventilate; THEN consider naloxone if opioid-related; never leave PACU client unattended.
Competency: PACU Respiratory Depression | Cognitive: Application
Page 3
, HESI Med-Surg V1 Test Bank (2026/2027) | Verified Answers Questions & Rationales
Q5: Which finding in a postoperative client on postoperative day 2 requires IMMEDIATE
notification of the surgeon?
A. Serous drainage on the surgical dressing
B. Serosanguineous wound drainage that has increased in amount over 4 hours, with new onset of
restlessness, tachycardia (HR 118), and hypotension (BP 92/58) [CORRECT]
C. Mild incisional pain rated 4/10
D. Oral temperature of 99.8°F (37.7°C)
Correct Answer: B
Rationale: Signs of internal bleeding/hemorrhage include: increased wound drainage (especially serosanguineous or
sanguineous), restlessness, tachycardia, hypotension, tachypnea, oliguria, pallor, cool/clammy skin, decreased level of
consciousness. This client shows classic signs of hemorrhage with hemodynamic instability — IMMEDIATE surgeon
notification and intervention (IV fluids, blood products, possible return to OR). Serous drainage (option A) is expected. Mild
pain (option C) is normal. Low-grade fever (option D) is common in first 24-48 hours (atelectasis). Study tip: postoperative
hemorrhage triad = restlessness + tachycardia + hypotension; always investigate restlessness in postoperative client (often
earliest sign of hypoxia or hemorrhage).
Competency: Postoperative Hemorrhage Recognition | Cognitive: Analysis
Q6: A client is receiving preoperative instructions for surgery under general anesthesia. The
client asks why they cannot eat or drink before surgery. Which response by the nurse is most
accurate?
A. "Fasting prevents dehydration during surgery."
B. "Fasting reduces the risk of aspiration of stomach contents into the lungs while you are under
anesthesia, since anesthesia suppresses your gag reflex and airway protective reflexes." [CORRECT]
C. "Fasting helps prevent postoperative nausea."
D. "Fasting ensures your blood sugar stays normal during surgery."
Correct Answer: B
Rationale: Preoperative fasting (NPO after midnight, or 2 hours for clear liquids and 6-8 hours for solids per ASA 2023
guidelines) is required to ensure the stomach is empty during anesthesia. General anesthesia suppresses protective airway
reflexes (gag, cough), so if the client vomits, stomach contents can be aspirated into the lungs causing aspiration pneumonitis
(Mendelson syndrome) — a life-threatening complication. Options A, C, D are incorrect rationale. ASA updated fasting
guidelines allow clear liquids up to 2 hours before anesthesia (not strict NPO after midnight), but solids still require 6-8 hours.
Study tip: ASA fasting guidelines: 2 hours clear liquids, 4 hours breast milk, 6 hours infant formula/light meal, 8 hours fatty
meal.
Competency: Preoperative NPO Rationale | Cognitive: Recall
Page 4
