HESI RN MEDICAL-SURGICAL SET 1 EXAM
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
During prioritization, the nurse receives four handoffs; one involves a patient being treated
for hip arthroplasty dislocation risk. Which patient should be assessed first based on the
change described?
A. A patient with osteoporosis who is stable while being monitored for height, fracture
history, fall risk, medication adherence, renal considerations, and bone-density follow-up
B. A patient with rheumatoid arthritis flare who is stable while being monitored for joint
swelling, pain, function, infection risk, blood counts or liver tests for relevant drugs, and
extra-articular symptoms
C. A patient with hip arthroplasty dislocation risk who now has sudden severe pain with
deformity, loss of function, or new neurovascular deficit
D. A patient with acute compartment syndrome who is stable while being monitored for
pain pattern, sensory and motor function, capillary refill, pulses, swelling, and
compartment pressure when measured
Correct Answer: C. A patient with hip arthroplasty dislocation risk who now has
sudden severe pain with deformity, loss of function, or new neurovascular
deficit
Explanation: The patient with sudden severe pain with deformity, loss of function, or new
neurovascular deficit requires immediate assessment because this change can represent a
life-threatening complication of hip arthroplasty dislocation risk. Priority decisions are
based on threat to airway, breathing, circulation, neurologic function, or rapidly worsening
instability rather than diagnosis alone. The other patients are described as stable and are
already undergoing appropriate monitoring. After addressing the unstable patient, the
nurse should return to the remaining patients according to acuity and scheduled needs.
Question 2.
After initial stabilization of a 46-year-old adult with upper gastrointestinal bleeding, which
assessment should the nurse prioritize during ongoing care?
A. pain, fever, liver tests, bilirubin, hydration, and signs of obstruction or pancreatitis
B. abdominal findings, pain pattern, emesis, bowel function, fluid balance, electrolytes,
and signs of strangulation
C. pain, hemodynamics, respiratory status, glucose, calcium, renal function, and fluid
balance
D. vital signs, mental status, urine output, hemoglobin trend, stool/emesis appearance,
and response to fluids or blood
Correct Answer: D. vital signs, mental status, urine output, hemoglobin trend,
stool/emesis appearance, and response to fluids or blood
Explanation: Ongoing evaluation should focus on vital signs, mental status, urine output,
hemoglobin trend, stool/emesis appearance, and response to fluids or blood. These data
show whether the patient is stabilizing and can reveal complications before they become
,irreversible. Other measurements may also be appropriate, but they are less directly tied
to the expected threats and treatment effects in this condition. A worsening trend should
prompt immediate reassessment and escalation rather than waiting for the next routine
check.
Question 3.
After community-acquired pneumonia has been identified in a 55-year-old woman and
immediate ABC threats have been assessed. Several findings are present, and the nurse
must distinguish the most urgent problem from plausible but lower-priority concerns.
Which intervention should now be incorporated into the care plan?
A. support oxygenation, obtain indicated cultures promptly, and administer prescribed
antimicrobials without avoidable delay
B. rapidly assess airway patency and oxygenation, suction if indicated, and prepare for
emergency airway management
C. treat as an immediate emergency and prepare for urgent decompression without
waiting for routine imaging
D. give rapid-acting inhaled bronchodilator therapy and oxygen as indicated while
assessing for impending respiratory failure
Correct Answer: A. support oxygenation, obtain indicated cultures promptly, and
administer prescribed antimicrobials without avoidable delay
Explanation: The priority is to support oxygenation, obtain indicated cultures promptly,
and administer prescribed antimicrobials without avoidable delay. That response
addresses the immediate physiologic threat or moves the patient directly toward
time-sensitive definitive care. Several alternatives may be reasonable in a different
condition or later in the sequence, but delaying this step can increase risk. After the initial
action, the nurse should reassess the patient and continue cause-specific management.
Question 4.
After initial stabilization of a 52-year-old woman with acute pericarditis, which assessment
should the nurse prioritize during ongoing care?
A. blood pressure trend, neurologic status, urine output, ECG, and symptoms of organ
injury
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. distal pulses, color, temperature, capillary refill, skin integrity, and walking tolerance
D. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
Correct Answer: B. blood pressure, heart sounds, jugular venous pressure, ECG
changes, and symptoms
Explanation: Ongoing evaluation should focus on blood pressure, heart sounds, jugular
venous pressure, ECG changes, and symptoms. These data show whether the patient is
stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
,immediate reassessment and escalation rather than waiting for the next routine check.
Question 5.
The nurse is reassessing a 55-year-old woman with tension pneumothorax. The patient has
just arrived, so the nurse must translate the findings into an immediate nursing decision.
Which finding requires the most immediate escalation?
A. new confusion, hypotension, escalating oxygen need, oliguria, or signs of sepsis
B. acute dyspnea with absent breath sounds, rapidly increasing bright-red drainage, or
tube dislodgement
C. rapid hemodynamic collapse, worsening hypoxemia, distended neck veins, or loss of
consciousness
D. increasing somnolence, silent chest, severe fatigue, or rapidly worsening gas exchange
Correct Answer: C. rapid hemodynamic collapse, worsening hypoxemia,
distended neck veins, or loss of consciousness
Explanation: The most urgent finding is rapid hemodynamic collapse, worsening
hypoxemia, distended neck veins, or loss of consciousness. It suggests a time-sensitive
complication or loss of physiologic reserve rather than an expected or lower-priority
feature. The nurse should respond using ABCs, safety principles, and the condition-specific
emergency pathway. Delay could allow rapid progression to organ dysfunction, respiratory
failure, shock, or irreversible injury.
Question 6.
Which statement by a patient or caregiver after teaching about bacterial meningitis best
shows correct understanding?
A. close contacts may need public-health evaluation for prophylaxis depending on the
organism
B. avoid straining and report worsening headache, repeated vomiting, new weakness, or
confusion
C. do not stop dopaminergic medication abruptly and use deliberate movement strategies
and home fall prevention
D. for injuries at risk of autonomic dysreflexia, address bladder and bowel triggers and
know emergency warning signs
Correct Answer: A. close contacts may need public-health evaluation for
prophylaxis depending on the organism
Explanation: Effective teaching for bacterial meningitis includes the instruction to close
contacts may need public-health evaluation for prophylaxis depending on the organism.
This guidance targets recurrence prevention, early recognition of deterioration, or safe
self-management. The other statements may apply to different disorders and should not
replace condition-specific teaching. Teach-back should be used so the nurse can confirm
that the patient or caregiver can apply the plan correctly.
, Question 7.
During prioritization, the nurse receives four handoffs; one involves a patient being treated
for peripheral arterial disease. Which patient should be assessed first based on the change
described?
A. A patient with acute decompensated heart failure who is stable while being monitored
for daily weight, intake and output, lung sounds, oxygenation, renal function, and
electrolytes
B. A patient with peripheral arterial disease who now has new rest pain, pallor,
pulselessness, paresthesia, paralysis, or a cool limb
C. A patient with atrial fibrillation who is stable while being monitored for heart rate, blood
pressure, symptoms, rhythm, and bleeding risk when anticoagulated
D. A patient with hypertensive emergency who is stable while being monitored for blood
pressure trend, neurologic status, urine output, ECG, and symptoms of organ injury
Correct Answer: B. A patient with peripheral arterial disease who now has new
rest pain, pallor, pulselessness, paresthesia, paralysis, or a cool limb
Explanation: The patient with new rest pain, pallor, pulselessness, paresthesia, paralysis,
or a cool limb requires immediate assessment because this change can represent a
life-threatening complication of peripheral arterial disease. Priority decisions are based on
threat to airway, breathing, circulation, neurologic function, or rapidly worsening instability
rather than diagnosis alone. The other patients are described as stable and are already
undergoing appropriate monitoring. After addressing the unstable patient, the nurse
should return to the remaining patients according to acuity and scheduled needs.
Question 8.
After initial stabilization of a 49-year-old woman with thyroid storm, which assessment
should the nurse prioritize during ongoing care?
A. osmolality, sodium, glucose decline, potassium, neurologic status, renal function, and
fluid balance
B. temperature, respiratory status, heart rate, sodium, glucose, and mental status
C. repeat glucose after treatment, mental status, recurrence risk, and the cause of the low
glucose
D. temperature, rhythm, blood pressure, mental status, glucose, and signs of heart failure
Correct Answer: D. temperature, rhythm, blood pressure, mental status,
glucose, and signs of heart failure
Explanation: Ongoing evaluation should focus on temperature, rhythm, blood pressure,
mental status, glucose, and signs of heart failure. These data show whether the patient is
stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
During prioritization, the nurse receives four handoffs; one involves a patient being treated
for hip arthroplasty dislocation risk. Which patient should be assessed first based on the
change described?
A. A patient with osteoporosis who is stable while being monitored for height, fracture
history, fall risk, medication adherence, renal considerations, and bone-density follow-up
B. A patient with rheumatoid arthritis flare who is stable while being monitored for joint
swelling, pain, function, infection risk, blood counts or liver tests for relevant drugs, and
extra-articular symptoms
C. A patient with hip arthroplasty dislocation risk who now has sudden severe pain with
deformity, loss of function, or new neurovascular deficit
D. A patient with acute compartment syndrome who is stable while being monitored for
pain pattern, sensory and motor function, capillary refill, pulses, swelling, and
compartment pressure when measured
Correct Answer: C. A patient with hip arthroplasty dislocation risk who now has
sudden severe pain with deformity, loss of function, or new neurovascular
deficit
Explanation: The patient with sudden severe pain with deformity, loss of function, or new
neurovascular deficit requires immediate assessment because this change can represent a
life-threatening complication of hip arthroplasty dislocation risk. Priority decisions are
based on threat to airway, breathing, circulation, neurologic function, or rapidly worsening
instability rather than diagnosis alone. The other patients are described as stable and are
already undergoing appropriate monitoring. After addressing the unstable patient, the
nurse should return to the remaining patients according to acuity and scheduled needs.
Question 2.
After initial stabilization of a 46-year-old adult with upper gastrointestinal bleeding, which
assessment should the nurse prioritize during ongoing care?
A. pain, fever, liver tests, bilirubin, hydration, and signs of obstruction or pancreatitis
B. abdominal findings, pain pattern, emesis, bowel function, fluid balance, electrolytes,
and signs of strangulation
C. pain, hemodynamics, respiratory status, glucose, calcium, renal function, and fluid
balance
D. vital signs, mental status, urine output, hemoglobin trend, stool/emesis appearance,
and response to fluids or blood
Correct Answer: D. vital signs, mental status, urine output, hemoglobin trend,
stool/emesis appearance, and response to fluids or blood
Explanation: Ongoing evaluation should focus on vital signs, mental status, urine output,
hemoglobin trend, stool/emesis appearance, and response to fluids or blood. These data
show whether the patient is stabilizing and can reveal complications before they become
,irreversible. Other measurements may also be appropriate, but they are less directly tied
to the expected threats and treatment effects in this condition. A worsening trend should
prompt immediate reassessment and escalation rather than waiting for the next routine
check.
Question 3.
After community-acquired pneumonia has been identified in a 55-year-old woman and
immediate ABC threats have been assessed. Several findings are present, and the nurse
must distinguish the most urgent problem from plausible but lower-priority concerns.
Which intervention should now be incorporated into the care plan?
A. support oxygenation, obtain indicated cultures promptly, and administer prescribed
antimicrobials without avoidable delay
B. rapidly assess airway patency and oxygenation, suction if indicated, and prepare for
emergency airway management
C. treat as an immediate emergency and prepare for urgent decompression without
waiting for routine imaging
D. give rapid-acting inhaled bronchodilator therapy and oxygen as indicated while
assessing for impending respiratory failure
Correct Answer: A. support oxygenation, obtain indicated cultures promptly, and
administer prescribed antimicrobials without avoidable delay
Explanation: The priority is to support oxygenation, obtain indicated cultures promptly,
and administer prescribed antimicrobials without avoidable delay. That response
addresses the immediate physiologic threat or moves the patient directly toward
time-sensitive definitive care. Several alternatives may be reasonable in a different
condition or later in the sequence, but delaying this step can increase risk. After the initial
action, the nurse should reassess the patient and continue cause-specific management.
Question 4.
After initial stabilization of a 52-year-old woman with acute pericarditis, which assessment
should the nurse prioritize during ongoing care?
A. blood pressure trend, neurologic status, urine output, ECG, and symptoms of organ
injury
B. blood pressure, heart sounds, jugular venous pressure, ECG changes, and symptoms
C. distal pulses, color, temperature, capillary refill, skin integrity, and walking tolerance
D. leg symptoms, bleeding indicators, platelet count when appropriate, and
anticoagulation parameters
Correct Answer: B. blood pressure, heart sounds, jugular venous pressure, ECG
changes, and symptoms
Explanation: Ongoing evaluation should focus on blood pressure, heart sounds, jugular
venous pressure, ECG changes, and symptoms. These data show whether the patient is
stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
,immediate reassessment and escalation rather than waiting for the next routine check.
Question 5.
The nurse is reassessing a 55-year-old woman with tension pneumothorax. The patient has
just arrived, so the nurse must translate the findings into an immediate nursing decision.
Which finding requires the most immediate escalation?
A. new confusion, hypotension, escalating oxygen need, oliguria, or signs of sepsis
B. acute dyspnea with absent breath sounds, rapidly increasing bright-red drainage, or
tube dislodgement
C. rapid hemodynamic collapse, worsening hypoxemia, distended neck veins, or loss of
consciousness
D. increasing somnolence, silent chest, severe fatigue, or rapidly worsening gas exchange
Correct Answer: C. rapid hemodynamic collapse, worsening hypoxemia,
distended neck veins, or loss of consciousness
Explanation: The most urgent finding is rapid hemodynamic collapse, worsening
hypoxemia, distended neck veins, or loss of consciousness. It suggests a time-sensitive
complication or loss of physiologic reserve rather than an expected or lower-priority
feature. The nurse should respond using ABCs, safety principles, and the condition-specific
emergency pathway. Delay could allow rapid progression to organ dysfunction, respiratory
failure, shock, or irreversible injury.
Question 6.
Which statement by a patient or caregiver after teaching about bacterial meningitis best
shows correct understanding?
A. close contacts may need public-health evaluation for prophylaxis depending on the
organism
B. avoid straining and report worsening headache, repeated vomiting, new weakness, or
confusion
C. do not stop dopaminergic medication abruptly and use deliberate movement strategies
and home fall prevention
D. for injuries at risk of autonomic dysreflexia, address bladder and bowel triggers and
know emergency warning signs
Correct Answer: A. close contacts may need public-health evaluation for
prophylaxis depending on the organism
Explanation: Effective teaching for bacterial meningitis includes the instruction to close
contacts may need public-health evaluation for prophylaxis depending on the organism.
This guidance targets recurrence prevention, early recognition of deterioration, or safe
self-management. The other statements may apply to different disorders and should not
replace condition-specific teaching. Teach-back should be used so the nurse can confirm
that the patient or caregiver can apply the plan correctly.
, Question 7.
During prioritization, the nurse receives four handoffs; one involves a patient being treated
for peripheral arterial disease. Which patient should be assessed first based on the change
described?
A. A patient with acute decompensated heart failure who is stable while being monitored
for daily weight, intake and output, lung sounds, oxygenation, renal function, and
electrolytes
B. A patient with peripheral arterial disease who now has new rest pain, pallor,
pulselessness, paresthesia, paralysis, or a cool limb
C. A patient with atrial fibrillation who is stable while being monitored for heart rate, blood
pressure, symptoms, rhythm, and bleeding risk when anticoagulated
D. A patient with hypertensive emergency who is stable while being monitored for blood
pressure trend, neurologic status, urine output, ECG, and symptoms of organ injury
Correct Answer: B. A patient with peripheral arterial disease who now has new
rest pain, pallor, pulselessness, paresthesia, paralysis, or a cool limb
Explanation: The patient with new rest pain, pallor, pulselessness, paresthesia, paralysis,
or a cool limb requires immediate assessment because this change can represent a
life-threatening complication of peripheral arterial disease. Priority decisions are based on
threat to airway, breathing, circulation, neurologic function, or rapidly worsening instability
rather than diagnosis alone. The other patients are described as stable and are already
undergoing appropriate monitoring. After addressing the unstable patient, the nurse
should return to the remaining patients according to acuity and scheduled needs.
Question 8.
After initial stabilization of a 49-year-old woman with thyroid storm, which assessment
should the nurse prioritize during ongoing care?
A. osmolality, sodium, glucose decline, potassium, neurologic status, renal function, and
fluid balance
B. temperature, respiratory status, heart rate, sodium, glucose, and mental status
C. repeat glucose after treatment, mental status, recurrence risk, and the cause of the low
glucose
D. temperature, rhythm, blood pressure, mental status, glucose, and signs of heart failure
Correct Answer: D. temperature, rhythm, blood pressure, mental status,
glucose, and signs of heart failure
Explanation: Ongoing evaluation should focus on temperature, rhythm, blood pressure,
mental status, glucose, and signs of heart failure. These data show whether the patient is
stabilizing and can reveal complications before they become irreversible. Other
measurements may also be appropriate, but they are less directly tied to the expected
threats and treatment effects in this condition. A worsening trend should prompt
immediate reassessment and escalation rather than waiting for the next routine check.
