HESI Medical Surgical Final Exam Test 2024–2025
Latest Update Comprehensive Questions and
Verified Detailed Answers | HESI Med-Surg Exam
Study Guide | Most Tested HESI Medical Surgical
Questions and Solutions | Complete HESI Medical
Surgical Practice Test and Exam Preparation
Bundle | Updated HESI Med-Surg Review Notes for
Nursing Students | Comprehensive HESI Medical
Surgical Exam Prep to Pass on First Attempt
Question 1: A nurse is caring for a client with heart failure who reports increased shortness of breath.
The nurse notes bilateral crackles in the lungs and 3+ pitting edema in the lower extremities. Which
intervention should the nurse implement first?
A. Administer the scheduled dose of furosemide
B. Elevate the client's legs above heart level
C. Place the client in high-Fowler's position
D. Obtain a STAT chest x-ray
CORRECT ANSWER: C. Place the client in high-Fowler's position
RATIONALE: Positioning the client in high-Fowler's position is the priority intervention because it
maximizes lung expansion and improves oxygenation by reducing pressure on the diaphragm from
abdominal contents. While administering furosemide and elevating legs are appropriate interventions
for fluid overload, optimizing airway and breathing takes precedence according to the ABC (Airway,
Breathing, Circulation) prioritization framework. Obtaining a chest x-ray is diagnostic and not an
immediate nursing intervention for respiratory distress.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The client's spouse asks why the oxygen flow rate cannot be increased to help the
client breathe easier. Which response by the nurse is most appropriate?
A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
B. "The physician has ordered this specific flow rate for safety reasons."
C. "Increasing oxygen may cause the client to become dependent on supplemental oxygen."
D. "The client's lungs cannot absorb oxygen at higher flow rates."
CORRECT ANSWER: A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
RATIONALE: Clients with COPD often have chronic hypercapnia and rely on hypoxic drive to stimulate
respiration. Administering high concentrations of oxygen can suppress this drive, leading to further
carbon dioxide retention and potential respiratory acidosis. This physiological principle is critical in COPD
management. Options B, C, and D provide inaccurate or incomplete explanations that do not address
the underlying pathophysiology.
,Question 3: A nurse is assessing a client who is 24 hours postoperative from a total hip arthroplasty.
Which finding requires immediate notification of the healthcare provider?
A. Mild pain at the surgical site rated 4/10
B. Slight swelling and bruising around the incision
C. Sudden onset of chest pain and dyspnea
D. Temperature of 100.4°F (38°C)
CORRECT ANSWER: C. Sudden onset of chest pain and dyspnea
RATIONALE: Sudden chest pain and dyspnea in a postoperative orthopedic client are classic signs of
pulmonary embolism, a life-threatening complication associated with immobility and venous
thromboembolism risk. This requires immediate intervention. Mild pain, expected postoperative
swelling, and low-grade fever within the first 48 hours are common findings that do not require
emergent notification.
Question 4: A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The
nurse anticipates that the initial priority prescription will include which intervention?
A. Subcutaneous insulin administration
B. Intravenous fluid resuscitation with normal saline
C. Potassium chloride supplementation
D. Sodium bicarbonate infusion
CORRECT ANSWER: B. Intravenous fluid resuscitation with normal saline
RATIONALE: The initial priority in DKA management is aggressive fluid resuscitation to restore
intravascular volume, improve tissue perfusion, and help lower blood glucose through dilution. IV fluids
precede insulin administration because insulin can worsen hypovolemia and electrolyte shifts if given
before adequate hydration. Potassium supplementation is important but follows fluid resuscitation, and
sodium bicarbonate is rarely indicated except in severe acidosis with hemodynamic instability.
Question 5: A nurse is preparing to administer enoxaparin to a client following knee replacement
surgery. Which assessment finding should cause the nurse to hold the medication and contact the
provider?
A. Platelet count of 140,000/mm³
B. Hemoglobin of 11 g/dL
C. Presence of petechiae on the lower extremities
D. INR of 1.2
CORRECT ANSWER: C. Presence of petechiae on the lower extremities
RATIONALE: Petechiae may indicate heparin-induced thrombocytopenia (HIT) or excessive
anticoagulation, both serious complications requiring immediate evaluation before administering
additional doses of enoxaparin. A platelet count of 140,000/mm³ is within normal limits, hemoglobin of
11 g/dL may be expected postoperatively, and an INR of 1.2 is not clinically significant for a client
receiving low-molecular-weight heparin, which does not significantly affect INR.
,Question 6: A client with acute kidney injury has a serum potassium level of 6.8 mEq/L. The nurse
anticipates preparing to administer which medication first?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Insulin with dextrose
D. Furosemide
CORRECT ANSWER: B. Calcium gluconate
RATIONALE: In severe hyperkalemia with ECG changes or levels >6.5 mEq/L, calcium gluconate is
administered first to stabilize the cardiac membrane and prevent life-threatening arrhythmias. This is a
cardioprotective measure that acts within minutes. Insulin with dextrose and sodium polystyrene
sulfonate help shift or remove potassium but do not provide immediate cardiac protection. Furosemide
may enhance potassium excretion but is less effective in acute kidney injury and is not the priority
intervention.
Question 7: A nurse is caring for a client with a suspected stroke. Which assessment finding indicates
involvement of the right hemisphere of the brain?
A. Right-sided hemiparesis and aphasia
B. Left-sided neglect and impulsivity
C. Difficulty with speech comprehension
D. Right visual field deficit
CORRECT ANSWER: B. Left-sided neglect and impulsivity
RATIONALE: The right cerebral hemisphere controls the left side of the body and is responsible for
spatial awareness, judgment, and impulse control. Damage to the right hemisphere typically causes left-
sided neglect, poor judgment, and impulsivity. Right-sided deficits and aphasia are associated with left
hemisphere strokes. Difficulty with speech comprehension (receptive aphasia) and right visual field
deficits also indicate left hemisphere involvement.
Question 8: A client with pneumonia has an oxygen saturation of 89% on room air. After applying
supplemental oxygen at 2 L/min via nasal cannula, the saturation improves to 94%. Which action
should the nurse take next?
A. Increase oxygen to 4 L/min to achieve 100% saturation
B. Document the findings and continue monitoring
C. Notify the provider of the initial low saturation
D. Prepare for arterial blood gas analysis
CORRECT ANSWER: B. Document the findings and continue monitoring
RATIONALE: An oxygen saturation of 94% is within the acceptable target range for most clients,
including those with pneumonia. The nurse should document the response to intervention and continue
routine monitoring. Increasing oxygen unnecessarily can cause oxygen toxicity, and the improvement
, indicates the current intervention is effective. Notification or ABG analysis is not indicated when the
client is responding appropriately to treatment.
Question 9: A nurse is teaching a client with gastroesophageal reflux disease (GERD) about lifestyle
modifications. Which statement by the client indicates a need for further teaching?
A. "I will avoid eating within 3 hours of bedtime."
B. "I can drink coffee as long as it is decaffeinated."
C. "I should elevate the head of my bed on blocks."
D. "I will take my antacid medication only when I have heartburn."
CORRECT ANSWER: D. "I will take my antacid medication only when I have heartburn."
RATIONALE: Antacids provide symptomatic relief but do not prevent reflux; however, many GERD
medications such as proton pump inhibitors or H2 blockers should be taken consistently as prescribed,
not just PRN, to effectively reduce gastric acid production and promote healing. The other statements
reflect appropriate lifestyle modifications: avoiding late meals, limiting caffeine, and elevating the head
of the bed are evidence-based strategies for managing GERD.
Question 10: A client receiving a blood transfusion develops chills, fever, and back pain 30 minutes
after initiation. The nurse stops the transfusion and primes new tubing with normal saline. What is
the next priority action?
A. Administer acetaminophen for fever
B. Notify the healthcare provider immediately
C. Send the blood bag and tubing to the laboratory
D. Obtain vital signs and assess urine output
CORRECT ANSWER: D. Obtain vital signs and assess urine output
RATIONALE: After stopping a suspected transfusion reaction and maintaining IV access with normal
saline, the nurse's next priority is to assess the client's hemodynamic status and renal function, as acute
hemolytic reactions can cause hypotension, disseminated intravascular coagulation, and acute kidney
injury. Vital signs and urine output provide critical data for guiding further interventions. Notifying the
provider and sending specimens are important but follow immediate client assessment.
Question 11: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates that the chest tube is functioning properly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with respiration
C. Absence of drainage in the collection chamber for 8 hours
D. Constant suction pressure of -40 cm H₂O
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber with respiration
RATIONALE: Tidaling (fluctuation) of the fluid level in the water-seal chamber with inspiration and
expiration indicates that the chest tube is patent and the pleural space is responding to respiratory
pressure changes. Continuous bubbling in the water-seal chamber suggests an air leak. Absence of
Latest Update Comprehensive Questions and
Verified Detailed Answers | HESI Med-Surg Exam
Study Guide | Most Tested HESI Medical Surgical
Questions and Solutions | Complete HESI Medical
Surgical Practice Test and Exam Preparation
Bundle | Updated HESI Med-Surg Review Notes for
Nursing Students | Comprehensive HESI Medical
Surgical Exam Prep to Pass on First Attempt
Question 1: A nurse is caring for a client with heart failure who reports increased shortness of breath.
The nurse notes bilateral crackles in the lungs and 3+ pitting edema in the lower extremities. Which
intervention should the nurse implement first?
A. Administer the scheduled dose of furosemide
B. Elevate the client's legs above heart level
C. Place the client in high-Fowler's position
D. Obtain a STAT chest x-ray
CORRECT ANSWER: C. Place the client in high-Fowler's position
RATIONALE: Positioning the client in high-Fowler's position is the priority intervention because it
maximizes lung expansion and improves oxygenation by reducing pressure on the diaphragm from
abdominal contents. While administering furosemide and elevating legs are appropriate interventions
for fluid overload, optimizing airway and breathing takes precedence according to the ABC (Airway,
Breathing, Circulation) prioritization framework. Obtaining a chest x-ray is diagnostic and not an
immediate nursing intervention for respiratory distress.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The client's spouse asks why the oxygen flow rate cannot be increased to help the
client breathe easier. Which response by the nurse is most appropriate?
A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
B. "The physician has ordered this specific flow rate for safety reasons."
C. "Increasing oxygen may cause the client to become dependent on supplemental oxygen."
D. "The client's lungs cannot absorb oxygen at higher flow rates."
CORRECT ANSWER: A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
RATIONALE: Clients with COPD often have chronic hypercapnia and rely on hypoxic drive to stimulate
respiration. Administering high concentrations of oxygen can suppress this drive, leading to further
carbon dioxide retention and potential respiratory acidosis. This physiological principle is critical in COPD
management. Options B, C, and D provide inaccurate or incomplete explanations that do not address
the underlying pathophysiology.
,Question 3: A nurse is assessing a client who is 24 hours postoperative from a total hip arthroplasty.
Which finding requires immediate notification of the healthcare provider?
A. Mild pain at the surgical site rated 4/10
B. Slight swelling and bruising around the incision
C. Sudden onset of chest pain and dyspnea
D. Temperature of 100.4°F (38°C)
CORRECT ANSWER: C. Sudden onset of chest pain and dyspnea
RATIONALE: Sudden chest pain and dyspnea in a postoperative orthopedic client are classic signs of
pulmonary embolism, a life-threatening complication associated with immobility and venous
thromboembolism risk. This requires immediate intervention. Mild pain, expected postoperative
swelling, and low-grade fever within the first 48 hours are common findings that do not require
emergent notification.
Question 4: A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The
nurse anticipates that the initial priority prescription will include which intervention?
A. Subcutaneous insulin administration
B. Intravenous fluid resuscitation with normal saline
C. Potassium chloride supplementation
D. Sodium bicarbonate infusion
CORRECT ANSWER: B. Intravenous fluid resuscitation with normal saline
RATIONALE: The initial priority in DKA management is aggressive fluid resuscitation to restore
intravascular volume, improve tissue perfusion, and help lower blood glucose through dilution. IV fluids
precede insulin administration because insulin can worsen hypovolemia and electrolyte shifts if given
before adequate hydration. Potassium supplementation is important but follows fluid resuscitation, and
sodium bicarbonate is rarely indicated except in severe acidosis with hemodynamic instability.
Question 5: A nurse is preparing to administer enoxaparin to a client following knee replacement
surgery. Which assessment finding should cause the nurse to hold the medication and contact the
provider?
A. Platelet count of 140,000/mm³
B. Hemoglobin of 11 g/dL
C. Presence of petechiae on the lower extremities
D. INR of 1.2
CORRECT ANSWER: C. Presence of petechiae on the lower extremities
RATIONALE: Petechiae may indicate heparin-induced thrombocytopenia (HIT) or excessive
anticoagulation, both serious complications requiring immediate evaluation before administering
additional doses of enoxaparin. A platelet count of 140,000/mm³ is within normal limits, hemoglobin of
11 g/dL may be expected postoperatively, and an INR of 1.2 is not clinically significant for a client
receiving low-molecular-weight heparin, which does not significantly affect INR.
,Question 6: A client with acute kidney injury has a serum potassium level of 6.8 mEq/L. The nurse
anticipates preparing to administer which medication first?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Insulin with dextrose
D. Furosemide
CORRECT ANSWER: B. Calcium gluconate
RATIONALE: In severe hyperkalemia with ECG changes or levels >6.5 mEq/L, calcium gluconate is
administered first to stabilize the cardiac membrane and prevent life-threatening arrhythmias. This is a
cardioprotective measure that acts within minutes. Insulin with dextrose and sodium polystyrene
sulfonate help shift or remove potassium but do not provide immediate cardiac protection. Furosemide
may enhance potassium excretion but is less effective in acute kidney injury and is not the priority
intervention.
Question 7: A nurse is caring for a client with a suspected stroke. Which assessment finding indicates
involvement of the right hemisphere of the brain?
A. Right-sided hemiparesis and aphasia
B. Left-sided neglect and impulsivity
C. Difficulty with speech comprehension
D. Right visual field deficit
CORRECT ANSWER: B. Left-sided neglect and impulsivity
RATIONALE: The right cerebral hemisphere controls the left side of the body and is responsible for
spatial awareness, judgment, and impulse control. Damage to the right hemisphere typically causes left-
sided neglect, poor judgment, and impulsivity. Right-sided deficits and aphasia are associated with left
hemisphere strokes. Difficulty with speech comprehension (receptive aphasia) and right visual field
deficits also indicate left hemisphere involvement.
Question 8: A client with pneumonia has an oxygen saturation of 89% on room air. After applying
supplemental oxygen at 2 L/min via nasal cannula, the saturation improves to 94%. Which action
should the nurse take next?
A. Increase oxygen to 4 L/min to achieve 100% saturation
B. Document the findings and continue monitoring
C. Notify the provider of the initial low saturation
D. Prepare for arterial blood gas analysis
CORRECT ANSWER: B. Document the findings and continue monitoring
RATIONALE: An oxygen saturation of 94% is within the acceptable target range for most clients,
including those with pneumonia. The nurse should document the response to intervention and continue
routine monitoring. Increasing oxygen unnecessarily can cause oxygen toxicity, and the improvement
, indicates the current intervention is effective. Notification or ABG analysis is not indicated when the
client is responding appropriately to treatment.
Question 9: A nurse is teaching a client with gastroesophageal reflux disease (GERD) about lifestyle
modifications. Which statement by the client indicates a need for further teaching?
A. "I will avoid eating within 3 hours of bedtime."
B. "I can drink coffee as long as it is decaffeinated."
C. "I should elevate the head of my bed on blocks."
D. "I will take my antacid medication only when I have heartburn."
CORRECT ANSWER: D. "I will take my antacid medication only when I have heartburn."
RATIONALE: Antacids provide symptomatic relief but do not prevent reflux; however, many GERD
medications such as proton pump inhibitors or H2 blockers should be taken consistently as prescribed,
not just PRN, to effectively reduce gastric acid production and promote healing. The other statements
reflect appropriate lifestyle modifications: avoiding late meals, limiting caffeine, and elevating the head
of the bed are evidence-based strategies for managing GERD.
Question 10: A client receiving a blood transfusion develops chills, fever, and back pain 30 minutes
after initiation. The nurse stops the transfusion and primes new tubing with normal saline. What is
the next priority action?
A. Administer acetaminophen for fever
B. Notify the healthcare provider immediately
C. Send the blood bag and tubing to the laboratory
D. Obtain vital signs and assess urine output
CORRECT ANSWER: D. Obtain vital signs and assess urine output
RATIONALE: After stopping a suspected transfusion reaction and maintaining IV access with normal
saline, the nurse's next priority is to assess the client's hemodynamic status and renal function, as acute
hemolytic reactions can cause hypotension, disseminated intravascular coagulation, and acute kidney
injury. Vital signs and urine output provide critical data for guiding further interventions. Notifying the
provider and sending specimens are important but follow immediate client assessment.
Question 11: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding indicates that the chest tube is functioning properly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with respiration
C. Absence of drainage in the collection chamber for 8 hours
D. Constant suction pressure of -40 cm H₂O
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber with respiration
RATIONALE: Tidaling (fluctuation) of the fluid level in the water-seal chamber with inspiration and
expiration indicates that the chest tube is patent and the pleural space is responding to respiratory
pressure changes. Continuous bubbling in the water-seal chamber suggests an air leak. Absence of
