HESI Med-Surg Exit Exam Study Bank 2026 | Advanced
Medical-Surgical Nursing Practice Questions, Rationales &
Exam Prep
Q1. A hospitalized adult client reports a sudden onset of chest pain and
dyspnea following surgery. The client appears anxious, restless, and mildly
cyanotic. The nurse should prioritize further assessment for which condition?
A. Myocardial infarction
B. Pulmonary embolism
C. Atelectasis
D. Spontaneous pneumothorax
CORRECT ANSWER: B
RATIONALE: Sudden onset of chest pain, dyspnea, anxiety, restlessness, and
mild cyanosis in a postoperative client are classic hallmarks of a pulmonary
embolism (PE). Postoperative immobility significantly elevates the risk for deep
vein thrombosis (DVT), which can dislodge and occlude the pulmonary arterial
bed, causing an acute ventilation-perfusion mismatch. While myocardial infarction
causes chest pain, it typically presents with radiating substernal pressure and
diaphoresis rather than sudden severe dyspnea and rapid cyanosis. Atelectasis and
pneumothorax can cause respiratory distress but do not typically manifest with this
hyperacute, classic triad of symptoms following surgical immobility.
Q2. Which information should the nurse obtain when performing an initial
assessment of a client who presents to the emergency department with a
painful ankle injury? (Select all that apply)
A. Quality of the pain
B. Signs of inflammation
C. Ankle range of motion
D. Visible deformities of the joint
CORRECT ANSWER: A, B, C, D
RATIONALE: A comprehensive musculoskeletal assessment for an acute
ankle injury requires evaluating the quality of the pain, signs of inflammation
,(such as erythema, localized heat, and edema), ankle range of motion, and visible
deformities of the joint. These baseline elements help the clinician differentiate
between a simple ligamentous sprain, a severe tendon tear, or an underlying bone
fracture, guiding subsequent diagnostic imaging choices.
Q3. Which description of pain is consistent with a diagnosis of rheumatoid
arthritis?
A. Joint pain is worse in the morning and involves symmetric joints
B. Joint pain increases with activity and is relieved by rest
C. Joint pain is asymmetric and primarily affects large weight-bearing joints
D. Joint pain is sharp, localized, and accompanied by unilateral numbness
CORRECT ANSWER: A
RATIONALE: Rheumatoid arthritis (RA) is a systemic autoimmune disease
characterized by chronic synovial inflammation that classically causes joint pain
that is worse in the morning and involves symmetric joints. Morning stiffness
lasting longer than 1 hour is a hallmark of RA. In contrast, joint pain that increases
with activity and is relieved by rest, or pain that is asymmetric and involves
weight-bearing joints, characterizes osteoarthritis (OA), which is a degenerative
joint disease rather than a systemic autoimmune process.
Q4. Which physical assessment finding should the nurse anticipate in a client
with long-term gastroesophageal reflux disease (GERD)?
A. Hoarseness
B. Dysphagia to liquids only
C. Projectile vomiting
D. Hemoptysis
CORRECT ANSWER: A
RATIONALE: Long-term gastroesophageal reflux disease (GERD) exposes
the upper airway and vocal cords to chronic gastric acid wash, leading to
laryngopharyngeal reflux, irritation, and inflammation that presents clinically as
hoarseness. Dysphagia in chronic GERD usually signifies a peptic stricture and
affects solid foods first, not liquids only. Projectile vomiting points toward gastric
,outlet obstruction, while hemoptysis indicates a pulmonary origin rather than
gastric acid reflux.
Q5. A client presents with chronic venous insufficiency. Which assessment
finding should the nurse anticipate?
A. Unilateral pale, cold extremity with absent pulses
B. Bilateral lower leg stasis dermatitis
C. Well-demarcated punched-out painful ulcers on the toes
D. Intermittent claudication during short ambulation periods
CORRECT ANSWER: B
RATIONALE: Chronic venous insufficiency results from valvular
incompetence, leading to venous hypertension and blood pooling in the lower
extremities. This chronic pooling causes extravasation of red blood cells into the
subcutaneous tissue, where breakdown of hemoglobin produces hemosiderin
staining, leading to bilateral lower leg stasis dermatitis (browning, scaling, and
thickened skin). Pale, cold extremities, punched-out arterial ulcers, and intermittent
claudication are classic assessment signs of peripheral arterial disease (PAD), not
venous disease.
Q6. A client has been hospitalized with a femur fracture and is being treated
with traction. Which action by the nurse is the priority when caring for this
client?
A. Assess neurovascular status
B. Ensure the weights are resting flat on the floor
C. Perform pin care every 2 hours
D. Adjust the traction pulleys to facilitate independent turning
CORRECT ANSWER: A
RATIONALE: For a client with a femur fracture managed in traction, the
absolute nursing priority is to assess neurovascular status (evaluating the 6 P's:
pain, pallor, pulses, paresthesia, paralysis, and poikilothermia) to prevent
compartment syndrome or nerve entrapment. Traction weights must hang freely
and never rest on the floor, as this defeats the therapeutic mechanism. Pin care is
, typically performed every 8 to 12 hours rather than every 2 hours, and traction
setups should never be adjusted by the nurse without an explicit prescription.
Q7. Which statement made by a client with chronic pancreatitis indicates that
further education is needed?
A. "I will take my pancreatic enzyme replacements with every single meal."
B. "I will cut back on smoking cigarettes daily."
C. "I must completely avoid alcohol consumption."
D. "I need to consume a low-fat, high-carbohydrate diet."
CORRECT ANSWER: B
RATIONALE: The statement "I will cut back on smoking cigarettes daily"
indicates that further education is needed because total smoking cessation—not
merely cutting back—is required. Nicotine accelerates pancreatic inflammation,
impairs bicarb secretion, and drastically increases the risk of pancreatic
malignancy in clients with chronic pancreatitis. Pancreatic enzymes must be
taken with all meals/snacks, alcohol must be strictly avoided, and a low-fat diet is
appropriate to prevent steatorrhea.
Q8. The nurse is teaching a female client who uses a contraceptive diaphragm
about reducing the risk for toxic shock syndrome (TSS). Which information
should the nurse include? (Select all that apply)
A. Do not leave the diaphragm in place longer than 8 hours after intercourse
B. Replace the old diaphragm every 3 months
C. Wash the diaphragm thoroughly with boiling water after each use
D. Apply oil-based lubricants generously to the rim before insertion
CORRECT ANSWER: A, B
RATIONALE: To minimize the risk of toxic shock syndrome (TSS), a
diaphragm should not be left in place longer than 8 hours following intercourse.
The device should be regularly inspected and replaced every 3 months (or if weight
fluctuations occur) to maintain proper fit and integrity. Washing with boiling water
ruins the latex/silicone structure (warm water and mild soap should be used
instead), and oil-based lubricants deteriorate the product material, risking
unexpected failure.
Medical-Surgical Nursing Practice Questions, Rationales &
Exam Prep
Q1. A hospitalized adult client reports a sudden onset of chest pain and
dyspnea following surgery. The client appears anxious, restless, and mildly
cyanotic. The nurse should prioritize further assessment for which condition?
A. Myocardial infarction
B. Pulmonary embolism
C. Atelectasis
D. Spontaneous pneumothorax
CORRECT ANSWER: B
RATIONALE: Sudden onset of chest pain, dyspnea, anxiety, restlessness, and
mild cyanosis in a postoperative client are classic hallmarks of a pulmonary
embolism (PE). Postoperative immobility significantly elevates the risk for deep
vein thrombosis (DVT), which can dislodge and occlude the pulmonary arterial
bed, causing an acute ventilation-perfusion mismatch. While myocardial infarction
causes chest pain, it typically presents with radiating substernal pressure and
diaphoresis rather than sudden severe dyspnea and rapid cyanosis. Atelectasis and
pneumothorax can cause respiratory distress but do not typically manifest with this
hyperacute, classic triad of symptoms following surgical immobility.
Q2. Which information should the nurse obtain when performing an initial
assessment of a client who presents to the emergency department with a
painful ankle injury? (Select all that apply)
A. Quality of the pain
B. Signs of inflammation
C. Ankle range of motion
D. Visible deformities of the joint
CORRECT ANSWER: A, B, C, D
RATIONALE: A comprehensive musculoskeletal assessment for an acute
ankle injury requires evaluating the quality of the pain, signs of inflammation
,(such as erythema, localized heat, and edema), ankle range of motion, and visible
deformities of the joint. These baseline elements help the clinician differentiate
between a simple ligamentous sprain, a severe tendon tear, or an underlying bone
fracture, guiding subsequent diagnostic imaging choices.
Q3. Which description of pain is consistent with a diagnosis of rheumatoid
arthritis?
A. Joint pain is worse in the morning and involves symmetric joints
B. Joint pain increases with activity and is relieved by rest
C. Joint pain is asymmetric and primarily affects large weight-bearing joints
D. Joint pain is sharp, localized, and accompanied by unilateral numbness
CORRECT ANSWER: A
RATIONALE: Rheumatoid arthritis (RA) is a systemic autoimmune disease
characterized by chronic synovial inflammation that classically causes joint pain
that is worse in the morning and involves symmetric joints. Morning stiffness
lasting longer than 1 hour is a hallmark of RA. In contrast, joint pain that increases
with activity and is relieved by rest, or pain that is asymmetric and involves
weight-bearing joints, characterizes osteoarthritis (OA), which is a degenerative
joint disease rather than a systemic autoimmune process.
Q4. Which physical assessment finding should the nurse anticipate in a client
with long-term gastroesophageal reflux disease (GERD)?
A. Hoarseness
B. Dysphagia to liquids only
C. Projectile vomiting
D. Hemoptysis
CORRECT ANSWER: A
RATIONALE: Long-term gastroesophageal reflux disease (GERD) exposes
the upper airway and vocal cords to chronic gastric acid wash, leading to
laryngopharyngeal reflux, irritation, and inflammation that presents clinically as
hoarseness. Dysphagia in chronic GERD usually signifies a peptic stricture and
affects solid foods first, not liquids only. Projectile vomiting points toward gastric
,outlet obstruction, while hemoptysis indicates a pulmonary origin rather than
gastric acid reflux.
Q5. A client presents with chronic venous insufficiency. Which assessment
finding should the nurse anticipate?
A. Unilateral pale, cold extremity with absent pulses
B. Bilateral lower leg stasis dermatitis
C. Well-demarcated punched-out painful ulcers on the toes
D. Intermittent claudication during short ambulation periods
CORRECT ANSWER: B
RATIONALE: Chronic venous insufficiency results from valvular
incompetence, leading to venous hypertension and blood pooling in the lower
extremities. This chronic pooling causes extravasation of red blood cells into the
subcutaneous tissue, where breakdown of hemoglobin produces hemosiderin
staining, leading to bilateral lower leg stasis dermatitis (browning, scaling, and
thickened skin). Pale, cold extremities, punched-out arterial ulcers, and intermittent
claudication are classic assessment signs of peripheral arterial disease (PAD), not
venous disease.
Q6. A client has been hospitalized with a femur fracture and is being treated
with traction. Which action by the nurse is the priority when caring for this
client?
A. Assess neurovascular status
B. Ensure the weights are resting flat on the floor
C. Perform pin care every 2 hours
D. Adjust the traction pulleys to facilitate independent turning
CORRECT ANSWER: A
RATIONALE: For a client with a femur fracture managed in traction, the
absolute nursing priority is to assess neurovascular status (evaluating the 6 P's:
pain, pallor, pulses, paresthesia, paralysis, and poikilothermia) to prevent
compartment syndrome or nerve entrapment. Traction weights must hang freely
and never rest on the floor, as this defeats the therapeutic mechanism. Pin care is
, typically performed every 8 to 12 hours rather than every 2 hours, and traction
setups should never be adjusted by the nurse without an explicit prescription.
Q7. Which statement made by a client with chronic pancreatitis indicates that
further education is needed?
A. "I will take my pancreatic enzyme replacements with every single meal."
B. "I will cut back on smoking cigarettes daily."
C. "I must completely avoid alcohol consumption."
D. "I need to consume a low-fat, high-carbohydrate diet."
CORRECT ANSWER: B
RATIONALE: The statement "I will cut back on smoking cigarettes daily"
indicates that further education is needed because total smoking cessation—not
merely cutting back—is required. Nicotine accelerates pancreatic inflammation,
impairs bicarb secretion, and drastically increases the risk of pancreatic
malignancy in clients with chronic pancreatitis. Pancreatic enzymes must be
taken with all meals/snacks, alcohol must be strictly avoided, and a low-fat diet is
appropriate to prevent steatorrhea.
Q8. The nurse is teaching a female client who uses a contraceptive diaphragm
about reducing the risk for toxic shock syndrome (TSS). Which information
should the nurse include? (Select all that apply)
A. Do not leave the diaphragm in place longer than 8 hours after intercourse
B. Replace the old diaphragm every 3 months
C. Wash the diaphragm thoroughly with boiling water after each use
D. Apply oil-based lubricants generously to the rim before insertion
CORRECT ANSWER: A, B
RATIONALE: To minimize the risk of toxic shock syndrome (TSS), a
diaphragm should not be left in place longer than 8 hours following intercourse.
The device should be regularly inspected and replaced every 3 months (or if weight
fluctuations occur) to maintain proper fit and integrity. Washing with boiling water
ruins the latex/silicone structure (warm water and mild soap should be used
instead), and oil-based lubricants deteriorate the product material, risking
unexpected failure.
