HESI MED-SURG QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM
UPDATE 2026/2027
Section One: Questions 1–100
Question 1
A nurse is assessing a client who is 4 hours postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the
fingers and around the mouth. Which of the following actions should the nurse take first?
A. Check the client's serum potassium level.
B. Assess the client for Chvostek's sign.
C. Administer an oral calcium supplement.
D. Intubate the client immediately.
🟢 B. Assess the client for Chvostek's sign.
🔴 RATIONALE: These findings indicate hypocalcemia, a potential complication of thyroid surgery due to accidental removal or damage to
the parathyroid glands. Assessing for Chvostek's sign confirms neuromuscular irritability before obtaining medical intervention.
Question 2
A client with acute pancreatitis is admitted to the medical-surgical unit. Which of the following laboratory values should the nurse expect to
find?
A. Decreased serum amylase
B. Decreased WBC count
🟢 C. Increased serum lipase
D. Increased serum calcium
🔴 RATIONALE: Serum lipase and amylase elevate significantly in acute pancreatitis due to pancreatic inflammation and autodigestion.
Calcium levels usually decrease rather than increase.
Question 3
A nurse is caring for a client with a history of deep vein thrombosis who is receiving a continuous intravenous heparin infusion. Which of the
following laboratory tests should the nurse monitor to adjust the infusion rate?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
🟢 C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🔴 RATIONALE: Continuous IV heparin infusions are managed and adjusted based on the client's aPTT values to maintain a therapeutic
range. PT and INR are used for warfarin therapy.
Question 4
A nurse is providing discharge teaching to a client newly diagnosed with type 1 diabetes mellitus. Which of the following instructions should
the nurse include regarding exercise?
🟢 A. Avoid exercise if blood glucose is greater than 250 mg/dL with ketones present.
,B. Inject insulin into the muscle group that will be exercised immediately before working out.
C. Decrease fluid intake during exercise to prevent fluid overload.
D. Exercise only when blood glucose levels are at their lowest point of the day.
🔴 RATIONALE: Exercising when blood glucose is markedly elevated and ketones are present can worsen hyperglycemia and promote
ketoacidosis because the body lacks insulin to utilize the glucose.
Question 5
A nurse is assigned to care for a group of clients on a medical-surgical floor. Which of the following clients should the nurse assess first?
A. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 89% on room air.
B. A client who had an open cholecystectomy 24 hours ago and reports pain as 7 on a scale of 0 to 10.
🟢 C. A client with an abdominal aortic aneurysm who reports sudden, severe lower back pain.
D. A client with diabetes mellitus whose fasting blood glucose level is 140 mg/dL.
🔴 RATIONALE: Sudden, severe lower back or abdominal pain in a client with a known abdominal aortic aneurysm indicates an impending
or active rupture, which is a life-threatening emergency requiring immediate intervention.
Question 6
A nurse is caring for a client who is experiencing an acute asthma attack. Which of the following medications should the nurse administer
first?
🟢 A. Albuterol inhaler
B. Fluticasone propionate
C. Salmeterol
D. Oral prednisone
🔴 RATIONALE: Albuterol is a short-acting beta2-agonist that provides rapid bronchodilation during an acute asthma attack. Fluticasone
and salmeterol are for long-term control, and oral prednisone takes hours to effect change.
Question 7
A nurse is planning care for a client who is scheduled for a lumbar puncture. Which of the following interventions should the nurse include in
the plan?
A. Keep the client in a high-Fowler's position for 4 hours before the procedure.
B. Instruct the client to restrict fluids for 12 hours after the procedure.
🟢 C. Encourage the client to lie flat in bed for several hours following the procedure.
D. Apply a warm compress to the puncture site immediately after the needle is removed.
🔴 RATIONALE: Remaining flat in bed after a lumbar puncture helps minimize the risk of post-dural puncture headache by reducing
cerebrospinal fluid leakage from the puncture site.
Question 8
A client who has stage IV colon cancer decides to stop all chemotherapy treatments and requests a referral to hospice. The family objects
strongly to this decision. Which of the following ethical principles guides the nurse in supporting the client's choice?
🟢 A. Autonomy
, B. Beneficence
C. Nonmaleficence
D. Justice
🔴 RATIONALE: Autonomy recognizes the right of an individual to make self-determining choices about their medical care, provided they
have decision-making capacity, even if the family disagrees.
Question 9
A nurse is caring for a client with liver cirrhosis who exhibits asterixis and confusion. Which of the following medications should the nurse
anticipate administering?
A. Spironolactone
B. Furosemide
🟢 C. Lactulose
D. Propranolol
🔴 RATIONALE: Asterixis and confusion indicate hepatic encephalopathy caused by elevated serum ammonia levels. Lactulose promotes
the excretion of ammonia via the stool.
Question 10
A nurse enters the room of a client who is 1 day postoperative following a total hip arthroplasty and finds the client gasping for air and
clutching their chest. The client's vital signs are: HR 118/min, RR 28/min, BP 94/60 mm Hg. Which condition should the nurse suspect?
A. Myocardial infarction
🟢 B. Pulmonary embolism
C. Hypovolemic shock
D. Atelectasis
🔴 RATIONALE: Postoperative orthopedic clients are at high risk for deep vein thrombosis and subsequent pulmonary embolism. Sudden
onset of dyspnea, tachycardia, tachypnea, and chest pain are classic manifestations.
Question 11
A nurse is reviewing the laboratory results of a client receiving mechanical ventilation. The arterial blood gas (ABG) results are: pH 7.31,
PaCO2 52 mm Hg, HCO3- 24 mEq/L. The nurse should interpret these findings as which of the following acid-base imbalances?
🟢 A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The PaCO2 is elevated above the normal range (35–45 mm Hg), while the HCO3- is
normal (22–26 mEq/L), indicating a primary respiratory problem.
Question 12
A nurse is preparing to administer blood to a client who has severe anemia. Which of the following actions must the nurse perform prior to
initiating the transfusion?
UPDATE 2026/2027
Section One: Questions 1–100
Question 1
A nurse is assessing a client who is 4 hours postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the
fingers and around the mouth. Which of the following actions should the nurse take first?
A. Check the client's serum potassium level.
B. Assess the client for Chvostek's sign.
C. Administer an oral calcium supplement.
D. Intubate the client immediately.
🟢 B. Assess the client for Chvostek's sign.
🔴 RATIONALE: These findings indicate hypocalcemia, a potential complication of thyroid surgery due to accidental removal or damage to
the parathyroid glands. Assessing for Chvostek's sign confirms neuromuscular irritability before obtaining medical intervention.
Question 2
A client with acute pancreatitis is admitted to the medical-surgical unit. Which of the following laboratory values should the nurse expect to
find?
A. Decreased serum amylase
B. Decreased WBC count
🟢 C. Increased serum lipase
D. Increased serum calcium
🔴 RATIONALE: Serum lipase and amylase elevate significantly in acute pancreatitis due to pancreatic inflammation and autodigestion.
Calcium levels usually decrease rather than increase.
Question 3
A nurse is caring for a client with a history of deep vein thrombosis who is receiving a continuous intravenous heparin infusion. Which of the
following laboratory tests should the nurse monitor to adjust the infusion rate?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
🟢 C. Activated partial thromboplastin time (aPTT)
D. Platelet count
🔴 RATIONALE: Continuous IV heparin infusions are managed and adjusted based on the client's aPTT values to maintain a therapeutic
range. PT and INR are used for warfarin therapy.
Question 4
A nurse is providing discharge teaching to a client newly diagnosed with type 1 diabetes mellitus. Which of the following instructions should
the nurse include regarding exercise?
🟢 A. Avoid exercise if blood glucose is greater than 250 mg/dL with ketones present.
,B. Inject insulin into the muscle group that will be exercised immediately before working out.
C. Decrease fluid intake during exercise to prevent fluid overload.
D. Exercise only when blood glucose levels are at their lowest point of the day.
🔴 RATIONALE: Exercising when blood glucose is markedly elevated and ketones are present can worsen hyperglycemia and promote
ketoacidosis because the body lacks insulin to utilize the glucose.
Question 5
A nurse is assigned to care for a group of clients on a medical-surgical floor. Which of the following clients should the nurse assess first?
A. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 89% on room air.
B. A client who had an open cholecystectomy 24 hours ago and reports pain as 7 on a scale of 0 to 10.
🟢 C. A client with an abdominal aortic aneurysm who reports sudden, severe lower back pain.
D. A client with diabetes mellitus whose fasting blood glucose level is 140 mg/dL.
🔴 RATIONALE: Sudden, severe lower back or abdominal pain in a client with a known abdominal aortic aneurysm indicates an impending
or active rupture, which is a life-threatening emergency requiring immediate intervention.
Question 6
A nurse is caring for a client who is experiencing an acute asthma attack. Which of the following medications should the nurse administer
first?
🟢 A. Albuterol inhaler
B. Fluticasone propionate
C. Salmeterol
D. Oral prednisone
🔴 RATIONALE: Albuterol is a short-acting beta2-agonist that provides rapid bronchodilation during an acute asthma attack. Fluticasone
and salmeterol are for long-term control, and oral prednisone takes hours to effect change.
Question 7
A nurse is planning care for a client who is scheduled for a lumbar puncture. Which of the following interventions should the nurse include in
the plan?
A. Keep the client in a high-Fowler's position for 4 hours before the procedure.
B. Instruct the client to restrict fluids for 12 hours after the procedure.
🟢 C. Encourage the client to lie flat in bed for several hours following the procedure.
D. Apply a warm compress to the puncture site immediately after the needle is removed.
🔴 RATIONALE: Remaining flat in bed after a lumbar puncture helps minimize the risk of post-dural puncture headache by reducing
cerebrospinal fluid leakage from the puncture site.
Question 8
A client who has stage IV colon cancer decides to stop all chemotherapy treatments and requests a referral to hospice. The family objects
strongly to this decision. Which of the following ethical principles guides the nurse in supporting the client's choice?
🟢 A. Autonomy
, B. Beneficence
C. Nonmaleficence
D. Justice
🔴 RATIONALE: Autonomy recognizes the right of an individual to make self-determining choices about their medical care, provided they
have decision-making capacity, even if the family disagrees.
Question 9
A nurse is caring for a client with liver cirrhosis who exhibits asterixis and confusion. Which of the following medications should the nurse
anticipate administering?
A. Spironolactone
B. Furosemide
🟢 C. Lactulose
D. Propranolol
🔴 RATIONALE: Asterixis and confusion indicate hepatic encephalopathy caused by elevated serum ammonia levels. Lactulose promotes
the excretion of ammonia via the stool.
Question 10
A nurse enters the room of a client who is 1 day postoperative following a total hip arthroplasty and finds the client gasping for air and
clutching their chest. The client's vital signs are: HR 118/min, RR 28/min, BP 94/60 mm Hg. Which condition should the nurse suspect?
A. Myocardial infarction
🟢 B. Pulmonary embolism
C. Hypovolemic shock
D. Atelectasis
🔴 RATIONALE: Postoperative orthopedic clients are at high risk for deep vein thrombosis and subsequent pulmonary embolism. Sudden
onset of dyspnea, tachycardia, tachypnea, and chest pain are classic manifestations.
Question 11
A nurse is reviewing the laboratory results of a client receiving mechanical ventilation. The arterial blood gas (ABG) results are: pH 7.31,
PaCO2 52 mm Hg, HCO3- 24 mEq/L. The nurse should interpret these findings as which of the following acid-base imbalances?
🟢 A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The PaCO2 is elevated above the normal range (35–45 mm Hg), while the HCO3- is
normal (22–26 mEq/L), indicating a primary respiratory problem.
Question 12
A nurse is preparing to administer blood to a client who has severe anemia. Which of the following actions must the nurse perform prior to
initiating the transfusion?
