HESI Med-Surg RN Specialty Exam 2026 |
Practice Questions & Verified Answers |
Comprehensive Medical-Surgical Nursing
Review
SECTION 1: MANAGEMENT OF CARE, DELEGATION, PRIORITIZATION, ETHICS (Q1–Q15)
Q1. A charge nurse is assigning clients. Which client is most appropriate to assign to the
LPN/LVN under RN supervision?
A. A client 12 hours post-thyroidectomy reporting tingling in the fingers
B. A client with heart failure receiving IV furosemide who has new crackles
C. A client 2 days post-appendectomy with stable vital signs needing a dressing change
D. A client admitted with new-onset atrial fibrillation and a heart rate of 138
Correct Answer: C
Rationale: The LPN can perform routine, stable dressing changes and monitor vital signs. The
post-thyroidectomy client with tingling may be developing hypocalcemia and needs RN
assessment. The heart failure client with new crackles requires IV push medication and
assessment. The new atrial fibrillation client is unstable and requires RN priority assessment
and intervention.
Distractors: A: Tingling after thyroidectomy suggests hypocalcemia, an unstable finding. B:
New crackles and IV furosemide require RN assessment and IV push administration. D: New
dysrhythmia with tachycardia requires RN clinical judgment.
Clinical Pearl: Delegate stable, predictable tasks to LPNs; unstable assessments stay with the
RN.
Learning Objective: Apply delegation principles according to scope of practice.
Difficulty: Moderate
Cognitive Level: Application
,Q2. A nurse is caring for four clients. Which client should the nurse assess first?
A. Client with COPD reporting a headache and confusion
B. Client with a fractured femur requesting pain medication
C. Client with diabetes reporting hunger and diaphoresis
D. Client with pneumonia who has a temperature of 101.2°F
Correct Answer: A
Rationale: Headache and confusion in COPD suggest hypercapnia and possible respiratory
failure, requiring immediate assessment and intervention. Hunger and diaphoresis suggest
hypoglycemia, but the COPD client has a more immediately life-threatening neurologic
change. Pain and fever are important but not first priority.
Distractors: B: Pain is important but not immediately life-threatening. C: Hypoglycemia is
urgent, but confusion in COPD indicates possible CO₂ narcosis. D: Low-grade fever in
pneumonia is expected and not the first priority.
Clinical Pearl: In COPD, new confusion or headache is a red flag for hypercapnia.
Learning Objective: Prioritize assessment based on airway, breathing, and circulation.
Difficulty: Moderate
Cognitive Level: Clinical Judgment
Q3. A nurse is caring for a client who refuses a blood transfusion based on religious beliefs.
The client’s hemoglobin is 6.8 g/dL and the client is symptomatic. What is the nurse’s priority
action?
A. Administer the transfusion against the client’s will
B. Notify the provider and document the refusal
C. Ask the family to convince the client
D. Tell the client they will die without the transfusion
,Correct Answer: B
Rationale: The nurse must respect client autonomy and religious beliefs, notify the provider,
and document the refusal. Administering against the client’s will is battery. Family
involvement should not override the client’s decision. Threatening the client is coercive.
Distractors: A: Battery and violation of autonomy. C: Family cannot consent for a competent
adult. D: Coercion and inappropriate communication.
Clinical Pearl: A competent adult has the right to refuse any treatment.
Learning Objective: Apply ethical principles of autonomy and informed refusal.
Difficulty: Easy
Cognitive Level: Application
Q4. A nurse is preparing a client for surgery. The client asks, “What exactly will the surgeon
do?” What is the nurse’s best response?
A. “The surgeon will explain the procedure to you.”
B. “I can explain the procedure in detail.”
C. “You signed the consent, so you already know.”
D. “Don’t worry; it is a routine surgery.”
Correct Answer: A
Rationale: Informed consent requires the surgeon to explain the procedure, risks, benefits,
and alternatives. The nurse witnesses the consent and clarifies the client’s understanding but
does not provide the surgical explanation.
Distractors: B: Nurses do not obtain surgical informed consent. C: Dismissive and inaccurate.
D: False reassurance.
Clinical Pearl: The surgeon explains; the nurse witnesses and reinforces.
Learning Objective: Differentiate nursing and provider roles in informed consent.
Difficulty: Easy
, Cognitive Level: Recall
Q5. A client with a terminal illness asks the nurse about advance directives. Which statement
by the nurse is accurate?
A. “Advance directives allow you to state your wishes for end-of-life care.”
B. “Advance directives are only for clients over 65.”
C. “You must have a lawyer to complete an advance directive.”
D. “Advance directives mean you cannot change your mind later.”
Correct Answer: A
Rationale: Advance directives are legal documents that communicate a client’s wishes for
care if they cannot speak for themselves. They are not age-restricted, do not require a lawyer
in most states, and can be changed or revoked at any time.
Distractors: B: Any competent adult can complete one. C: Most states do not require a lawyer.
D: They can be revised.
Clinical Pearl: Advance directives are revocable and patient-centered.
Learning Objective: Educate clients about advance directives.
Difficulty: Easy
Cognitive Level: Recall
Q6. A case manager is coordinating care for a client with repeated heart failure admissions.
Which action best reflects case management?
A. Performing daily assessments in the hospital
B. Arranging home health, medication reconciliation, and follow-up appointments
C. Administering IV diuretics in the clinic
D. Teaching the client about a low-sodium diet during admission
Practice Questions & Verified Answers |
Comprehensive Medical-Surgical Nursing
Review
SECTION 1: MANAGEMENT OF CARE, DELEGATION, PRIORITIZATION, ETHICS (Q1–Q15)
Q1. A charge nurse is assigning clients. Which client is most appropriate to assign to the
LPN/LVN under RN supervision?
A. A client 12 hours post-thyroidectomy reporting tingling in the fingers
B. A client with heart failure receiving IV furosemide who has new crackles
C. A client 2 days post-appendectomy with stable vital signs needing a dressing change
D. A client admitted with new-onset atrial fibrillation and a heart rate of 138
Correct Answer: C
Rationale: The LPN can perform routine, stable dressing changes and monitor vital signs. The
post-thyroidectomy client with tingling may be developing hypocalcemia and needs RN
assessment. The heart failure client with new crackles requires IV push medication and
assessment. The new atrial fibrillation client is unstable and requires RN priority assessment
and intervention.
Distractors: A: Tingling after thyroidectomy suggests hypocalcemia, an unstable finding. B:
New crackles and IV furosemide require RN assessment and IV push administration. D: New
dysrhythmia with tachycardia requires RN clinical judgment.
Clinical Pearl: Delegate stable, predictable tasks to LPNs; unstable assessments stay with the
RN.
Learning Objective: Apply delegation principles according to scope of practice.
Difficulty: Moderate
Cognitive Level: Application
,Q2. A nurse is caring for four clients. Which client should the nurse assess first?
A. Client with COPD reporting a headache and confusion
B. Client with a fractured femur requesting pain medication
C. Client with diabetes reporting hunger and diaphoresis
D. Client with pneumonia who has a temperature of 101.2°F
Correct Answer: A
Rationale: Headache and confusion in COPD suggest hypercapnia and possible respiratory
failure, requiring immediate assessment and intervention. Hunger and diaphoresis suggest
hypoglycemia, but the COPD client has a more immediately life-threatening neurologic
change. Pain and fever are important but not first priority.
Distractors: B: Pain is important but not immediately life-threatening. C: Hypoglycemia is
urgent, but confusion in COPD indicates possible CO₂ narcosis. D: Low-grade fever in
pneumonia is expected and not the first priority.
Clinical Pearl: In COPD, new confusion or headache is a red flag for hypercapnia.
Learning Objective: Prioritize assessment based on airway, breathing, and circulation.
Difficulty: Moderate
Cognitive Level: Clinical Judgment
Q3. A nurse is caring for a client who refuses a blood transfusion based on religious beliefs.
The client’s hemoglobin is 6.8 g/dL and the client is symptomatic. What is the nurse’s priority
action?
A. Administer the transfusion against the client’s will
B. Notify the provider and document the refusal
C. Ask the family to convince the client
D. Tell the client they will die without the transfusion
,Correct Answer: B
Rationale: The nurse must respect client autonomy and religious beliefs, notify the provider,
and document the refusal. Administering against the client’s will is battery. Family
involvement should not override the client’s decision. Threatening the client is coercive.
Distractors: A: Battery and violation of autonomy. C: Family cannot consent for a competent
adult. D: Coercion and inappropriate communication.
Clinical Pearl: A competent adult has the right to refuse any treatment.
Learning Objective: Apply ethical principles of autonomy and informed refusal.
Difficulty: Easy
Cognitive Level: Application
Q4. A nurse is preparing a client for surgery. The client asks, “What exactly will the surgeon
do?” What is the nurse’s best response?
A. “The surgeon will explain the procedure to you.”
B. “I can explain the procedure in detail.”
C. “You signed the consent, so you already know.”
D. “Don’t worry; it is a routine surgery.”
Correct Answer: A
Rationale: Informed consent requires the surgeon to explain the procedure, risks, benefits,
and alternatives. The nurse witnesses the consent and clarifies the client’s understanding but
does not provide the surgical explanation.
Distractors: B: Nurses do not obtain surgical informed consent. C: Dismissive and inaccurate.
D: False reassurance.
Clinical Pearl: The surgeon explains; the nurse witnesses and reinforces.
Learning Objective: Differentiate nursing and provider roles in informed consent.
Difficulty: Easy
, Cognitive Level: Recall
Q5. A client with a terminal illness asks the nurse about advance directives. Which statement
by the nurse is accurate?
A. “Advance directives allow you to state your wishes for end-of-life care.”
B. “Advance directives are only for clients over 65.”
C. “You must have a lawyer to complete an advance directive.”
D. “Advance directives mean you cannot change your mind later.”
Correct Answer: A
Rationale: Advance directives are legal documents that communicate a client’s wishes for
care if they cannot speak for themselves. They are not age-restricted, do not require a lawyer
in most states, and can be changed or revoked at any time.
Distractors: B: Any competent adult can complete one. C: Most states do not require a lawyer.
D: They can be revised.
Clinical Pearl: Advance directives are revocable and patient-centered.
Learning Objective: Educate clients about advance directives.
Difficulty: Easy
Cognitive Level: Recall
Q6. A case manager is coordinating care for a client with repeated heart failure admissions.
Which action best reflects case management?
A. Performing daily assessments in the hospital
B. Arranging home health, medication reconciliation, and follow-up appointments
C. Administering IV diuretics in the clinic
D. Teaching the client about a low-sodium diet during admission
