HESI Medical Surgical Exit Exam | 2024 |
Med Surg Exit Exam V1 (Version 1) 55
Questions and Answers ( NEW FULL Exam )
Guaranteed A+
SECTION I: PERIOPERATIVE CARE (Questions 1–12)
1. A client is scheduled for surgery in 4 hours. The nurse reviews the consent form and notes the
surgeon signed the form but the client has not yet signed. What is the nurse's priority action?
A. Witness the client's signature immediately
B. Notify the surgeon that the consent is incomplete
C. Send the client to surgery as scheduled
D. Ask the client's spouse to sign as a witness
Correct Answer: B
Rationale: The client must give informed consent after the surgeon explains the procedure
and answers questions. If the client hasn't signed, the nurse should ensure the client
understands and signs voluntarily. If the client has unanswered questions, the surgeon must be
notified. The nurse's role is to witness the signature, not obtain consent, and the nurse cannot
witness a signature if the client hasn't been properly informed. A spouse cannot sign for an
adult competent client.
2. A postoperative client who had general anesthesia is drowsy with a respiratory rate of 9/min.
Which action should the nurse take first?
A. Administer naloxone (Narcan)
B. Stimulate the client and encourage deep breathing
C. Document the finding and reassess in 30 minutes
D. Place the client in a supine position
Correct Answer: B
Rationale: The priority is to maintain the airway and improve ventilation. Stimulating the
client and encouraging deep breathing is the least invasive first intervention. Naloxone is
,reserved for opioid-induced respiratory depression unresponsive to stimulation. Supine
positioning can worsen airway obstruction. Documentation alone delays intervention.
3. A client scheduled for surgery takes warfarin (Coumadin). Which lab value is most important
for the nurse to review before surgery?
A. Hemoglobin 13 g/dL
B. INR 3.2
C. Platelet count 250,000/mm³
D. WBC 7,000/mm³
Correct Answer: B
Rationale: An INR of 3.2 indicates the blood is too thin for surgery (therapeutic range 2–3;
surgery usually requires INR <1.5). The surgeon may prescribe vitamin K or fresh frozen plasma.
The other values are within normal limits and don't pose the same bleeding risk.
4. Which client is at highest risk for malignant hyperthermia during surgery? (SATA)
A. Client with a family history of malignant hyperthermia
B. Client receiving halothane anesthesia
C. Client receiving succinylcholine
D. Client with a history of asthma
E. Client taking beta-blockers
Correct Answers: A, B, C
Rationale: Malignant hyperthermia is a genetic disorder triggered by inhaled anesthetics
(e.g., halothane) and depolarizing muscle relaxants (succinylcholine). A family history increases
risk. Asthma and beta-blockers are not triggers. The antidote is dantrolene sodium.
5. The nurse is preparing a client for surgery. Which actions are included in the preoperative
checklist? (SATA)
A. Verify NPO status
B. Remove jewelry and dentures
C. Obtain informed consent
D. Administer preoperative antibiotics if ordered
,E. Verify blood type and crossmatch
F. Provide a full meal to maintain strength
Correct Answers: A, B, C, D, E
Rationale: F is incorrect—clients must be NPO to prevent aspiration. All other items are
standard preoperative checklist components.
6. A client is 24 hours postoperative after abdominal surgery. The nurse notes the dressing is
saturated with bright red blood. What is the priority action?
A. Reinforce the dressing
B. Apply pressure and notify the surgeon
C. Change the dressing and document
D. Elevate the client's legs
Correct Answer: B
Rationale: Bright red bleeding indicates active hemorrhage. The nurse should apply direct
pressure and notify the surgeon immediately. Reinforcing or changing the dressing without
addressing the source delays intervention. Elevating legs does not address the bleeding.
7. A client recovering from surgery reports sudden shortness of breath and chest pain. Vital
signs: HR 120, RR 28, BP 100/60, SpO₂ 88%. What is the nurse's priority action?
A. Administer a bronchodilator
B. Apply oxygen and notify the provider
C. Encourage coughing and deep breathing
D. Position the client supine
Correct Answer: B
Rationale: These signs suggest pulmonary embolism. Applying oxygen and notifying the
provider are immediate priorities. Bronchodilators are for asthma/COPD. Positioning supine can
worsen respiratory distress. Coughing is not effective for PE.
8. Which finding in a postoperative client requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Temperature 99.2°F (37.3°C)
, C. Urine output 20 mL/hr over 2 hours
D. Blood pressure 90/50 with HR 130
Correct Answer: D
Rationale: Hypotension with tachycardia indicates hypovolemic shock (likely hemorrhage).
The other findings are common and less urgent. Urine output <30 mL/hr is concerning but not
immediately life-threatening.
9. A client is scheduled for outpatient surgery. Which instruction is most important for the nurse
to include?
A. "You may drive yourself home."
B. "Do not eat or drink after midnight."
C. "Take your aspirin the morning of surgery."
D. "You can resume normal activities immediately."
Correct Answer: B
Rationale: NPO status prevents aspiration during anesthesia. Clients cannot drive after
sedation. Aspirin increases bleeding risk. Normal activities are restricted post-surgery.
10. During the immediate postoperative period, which assessment is the highest priority?
A. Pain level
B. Airway patency
C. Urinary output
D. Wound appearance
Correct Answer: B
Rationale: Using ABC (Airway, Breathing, Circulation) priority, airway is always first. Pain,
urine output, and wound appearance are important but secondary to airway.
11. A client who had spinal anesthesia reports a severe headache when sitting up. Which
intervention should the nurse implement?
A. Encourage ambulation
B. Keep the client flat and increase fluids
C. Administer a stimulant
D. Apply a cold compress to the forehead
Med Surg Exit Exam V1 (Version 1) 55
Questions and Answers ( NEW FULL Exam )
Guaranteed A+
SECTION I: PERIOPERATIVE CARE (Questions 1–12)
1. A client is scheduled for surgery in 4 hours. The nurse reviews the consent form and notes the
surgeon signed the form but the client has not yet signed. What is the nurse's priority action?
A. Witness the client's signature immediately
B. Notify the surgeon that the consent is incomplete
C. Send the client to surgery as scheduled
D. Ask the client's spouse to sign as a witness
Correct Answer: B
Rationale: The client must give informed consent after the surgeon explains the procedure
and answers questions. If the client hasn't signed, the nurse should ensure the client
understands and signs voluntarily. If the client has unanswered questions, the surgeon must be
notified. The nurse's role is to witness the signature, not obtain consent, and the nurse cannot
witness a signature if the client hasn't been properly informed. A spouse cannot sign for an
adult competent client.
2. A postoperative client who had general anesthesia is drowsy with a respiratory rate of 9/min.
Which action should the nurse take first?
A. Administer naloxone (Narcan)
B. Stimulate the client and encourage deep breathing
C. Document the finding and reassess in 30 minutes
D. Place the client in a supine position
Correct Answer: B
Rationale: The priority is to maintain the airway and improve ventilation. Stimulating the
client and encouraging deep breathing is the least invasive first intervention. Naloxone is
,reserved for opioid-induced respiratory depression unresponsive to stimulation. Supine
positioning can worsen airway obstruction. Documentation alone delays intervention.
3. A client scheduled for surgery takes warfarin (Coumadin). Which lab value is most important
for the nurse to review before surgery?
A. Hemoglobin 13 g/dL
B. INR 3.2
C. Platelet count 250,000/mm³
D. WBC 7,000/mm³
Correct Answer: B
Rationale: An INR of 3.2 indicates the blood is too thin for surgery (therapeutic range 2–3;
surgery usually requires INR <1.5). The surgeon may prescribe vitamin K or fresh frozen plasma.
The other values are within normal limits and don't pose the same bleeding risk.
4. Which client is at highest risk for malignant hyperthermia during surgery? (SATA)
A. Client with a family history of malignant hyperthermia
B. Client receiving halothane anesthesia
C. Client receiving succinylcholine
D. Client with a history of asthma
E. Client taking beta-blockers
Correct Answers: A, B, C
Rationale: Malignant hyperthermia is a genetic disorder triggered by inhaled anesthetics
(e.g., halothane) and depolarizing muscle relaxants (succinylcholine). A family history increases
risk. Asthma and beta-blockers are not triggers. The antidote is dantrolene sodium.
5. The nurse is preparing a client for surgery. Which actions are included in the preoperative
checklist? (SATA)
A. Verify NPO status
B. Remove jewelry and dentures
C. Obtain informed consent
D. Administer preoperative antibiotics if ordered
,E. Verify blood type and crossmatch
F. Provide a full meal to maintain strength
Correct Answers: A, B, C, D, E
Rationale: F is incorrect—clients must be NPO to prevent aspiration. All other items are
standard preoperative checklist components.
6. A client is 24 hours postoperative after abdominal surgery. The nurse notes the dressing is
saturated with bright red blood. What is the priority action?
A. Reinforce the dressing
B. Apply pressure and notify the surgeon
C. Change the dressing and document
D. Elevate the client's legs
Correct Answer: B
Rationale: Bright red bleeding indicates active hemorrhage. The nurse should apply direct
pressure and notify the surgeon immediately. Reinforcing or changing the dressing without
addressing the source delays intervention. Elevating legs does not address the bleeding.
7. A client recovering from surgery reports sudden shortness of breath and chest pain. Vital
signs: HR 120, RR 28, BP 100/60, SpO₂ 88%. What is the nurse's priority action?
A. Administer a bronchodilator
B. Apply oxygen and notify the provider
C. Encourage coughing and deep breathing
D. Position the client supine
Correct Answer: B
Rationale: These signs suggest pulmonary embolism. Applying oxygen and notifying the
provider are immediate priorities. Bronchodilators are for asthma/COPD. Positioning supine can
worsen respiratory distress. Coughing is not effective for PE.
8. Which finding in a postoperative client requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Temperature 99.2°F (37.3°C)
, C. Urine output 20 mL/hr over 2 hours
D. Blood pressure 90/50 with HR 130
Correct Answer: D
Rationale: Hypotension with tachycardia indicates hypovolemic shock (likely hemorrhage).
The other findings are common and less urgent. Urine output <30 mL/hr is concerning but not
immediately life-threatening.
9. A client is scheduled for outpatient surgery. Which instruction is most important for the nurse
to include?
A. "You may drive yourself home."
B. "Do not eat or drink after midnight."
C. "Take your aspirin the morning of surgery."
D. "You can resume normal activities immediately."
Correct Answer: B
Rationale: NPO status prevents aspiration during anesthesia. Clients cannot drive after
sedation. Aspirin increases bleeding risk. Normal activities are restricted post-surgery.
10. During the immediate postoperative period, which assessment is the highest priority?
A. Pain level
B. Airway patency
C. Urinary output
D. Wound appearance
Correct Answer: B
Rationale: Using ABC (Airway, Breathing, Circulation) priority, airway is always first. Pain,
urine output, and wound appearance are important but secondary to airway.
11. A client who had spinal anesthesia reports a severe headache when sitting up. Which
intervention should the nurse implement?
A. Encourage ambulation
B. Keep the client flat and increase fluids
C. Administer a stimulant
D. Apply a cold compress to the forehead
