2023/2024 Hesi Med Surg Questions And
Answers LATEST VERIFIED VERSION
Section 1: Perioperative Care & Surgical Nursing
1. A patient is 6 hours postoperative from an open cholecystectomy. Which assessment
finding requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Respiratory rate 24/min with shallow breathing
C. Blood pressure 108/68 mmHg
D. Incisional pain rated 5/10
Correct Answer: B
Rationale: Shallow respirations at 24/min suggest splinting, atelectasis, or impending
respiratory compromise—common after upper abdominal surgery. Serosanguineous drainage is
expected, BP is within normal limits, and moderate pain is expected. Airway/breathing always
takes priority.
2. Which nursing action is priority when a postoperative patient reports sudden "popping" at
the incision site with serosanguineous discharge?
A. Apply a sterile dressing and notify the surgeon
B. Place the patient in high-Fowler's and irrigate the wound
C. Support the wound with a sterile saline-soaked dressing and position in low-Fowler's
D. Encourage coughing and deep breathing to relieve pressure
Correct Answer: C
Rationale: This describes wound dehiscence. Cover the wound with sterile saline-soaked
dressings to keep tissue moist, position in low-Fowler's to reduce tension on the incision, and
notify the surgeon immediately. Irrigation and coughing increase tension and risk evisceration.
3. SATA: Which findings indicate the patient is ready for discharge teaching after spinal
anesthesia?
A. Full return of sensation and motor function
B. Ability to void without difficulty
C. Absence of positional headache
,D. Drowsiness when undisturbed
E. Stable vital signs
Correct Answer: A, B, C, E
Rationale: Discharge readiness after spinal anesthesia requires return of sensation/motor
function, spontaneous voiding, absence of spinal headache, and stable vitals. Drowsiness may
indicate residual sedation and warrants further monitoring.
4. A patient scheduled for surgery takes metformin. Which instruction is correct?
A. Continue metformin the morning of surgery
B. Hold metformin 24 hours before surgery
C. Double the dose the night before
D. Take metformin with a sip of water the morning of surgery
Correct Answer: B
Rationale: Metformin is typically held 24–48 hours before surgery due to the risk of lactic
acidosis, especially with contrast dyes or altered renal perfusion. The surgeon/anesthesia
provider gives specific instructions.
5. Which patient is at highest risk for malignant hyperthermia during surgery?
A. Patient with a history of asthma
B. Patient with a family history of reaction to succinylcholine
C. Patient taking beta blockers
D. Patient with type 2 diabetes
Correct Answer: B
Rationale: Malignant hyperthermia is an autosomal dominant disorder triggered by volatile
anesthetics and depolarizing muscle relaxants (succinylcholine). Family history is a key risk
factor. Dantrolene is the antidote.
6. A patient in the PACU has a pulse oximetry reading of 89% on 2 L nasal cannula. What is the
priority action?
A. Increase oxygen to 6 L and reassess
B. Reposition the patient and encourage deep breathing
C. Document and continue monitoring
D. Notify the surgeon immediately
, Correct Answer: B
Rationale: First-line action for hypoxemia in PACU is repositioning (side-lying or semi-
Fowler's), encouraging deep breathing/coughing, and ensuring airway patency. Increasing O2
without addressing the cause delays definitive care.
7. SATA: Which are signs of hypovolemic shock in the postoperative patient?
A. Tachycardia
B. Bounding pulses
C. Decreased urine output
D. Warm, flushed skin
E. Restlessness and anxiety
Correct Answer: A, C, E
Rationale: Hypovolemic shock presents with tachycardia, oliguria, restlessness,
cool/clammy skin, and decreased CVP. Bounding pulses and warm flushed skin are signs of fluid
overload or early septic shock.
8. A patient is being taught to use an incentive spirometer. Which instruction is correct?
A. Inhale slowly and deeply, hold breath 3 seconds, then exhale
B. Exhale forcefully into the device
C. Use the device only when short of breath
D. Take rapid, shallow breaths through the device
Correct Answer: A
Rationale: Correct technique: sit upright, exhale normally, seal lips around mouthpiece,
inhale slowly and deeply to raise the indicator, hold 3 seconds, then exhale. This promotes
alveolar expansion and prevents atelectasis.
9. Which lab value is most concerning in a patient 24 hours post–abdominal surgery?
A. WBC 11,000/mm³
B. Hemoglobin 10.2 g/dL
C. Potassium 3.1 mEq/L
D. Glucose 150 mg/dL
Correct Answer: C
Rationale: Hypokalemia (K+ <3.5) can cause dysrhythmias and muscle weakness, especially
, after surgery with NG suction or fluid shifts. Mild leukocytosis, anemia, and mild hyperglycemia
are expected postoperatively.
10. A patient scheduled for surgery reports taking ginkgo biloba. What is the priority concern?
A. Increased risk of bleeding
B. Increased risk of infection
C. Hypotension
D. Hyperkalemia
Correct Answer: A
Rationale: Ginkgo biloba, garlic, ginger, ginseng, and ginkgo increase bleeding risk by
inhibiting platelet aggregation. They should be discontinued 1–2 weeks before surgery.
11. Which position is contraindicated immediately after a lumbar laminectomy?
A. Supine with a pillow under the head
B. Side-lying with a pillow between the knees
C. High-Fowler's
D. Supine with legs slightly elevated
Correct Answer: C
Rationale: After lumbar laminectomy, high-Fowler's increases spinal flexion and pressure at
the surgical site. Log-rolling and flat/semi-Fowler's positions are preferred.
12. A patient's preoperative consent form is signed, but the patient states, "I don't really
understand what they're going to do." What is the nurse's priority action?
A. Have the patient sign again
B. Notify the surgeon to clarify the procedure
C. Proceed with surgery as scheduled
D. Ask the family to explain the procedure
Correct Answer: B
Rationale: Informed consent requires the patient understands the procedure, risks, and
alternatives. The nurse's role is to witness the signature and ensure understanding—not to
obtain consent. Notify the surgeon to re-explain.
Answers LATEST VERIFIED VERSION
Section 1: Perioperative Care & Surgical Nursing
1. A patient is 6 hours postoperative from an open cholecystectomy. Which assessment
finding requires immediate intervention?
A. Serosanguineous drainage on the dressing
B. Respiratory rate 24/min with shallow breathing
C. Blood pressure 108/68 mmHg
D. Incisional pain rated 5/10
Correct Answer: B
Rationale: Shallow respirations at 24/min suggest splinting, atelectasis, or impending
respiratory compromise—common after upper abdominal surgery. Serosanguineous drainage is
expected, BP is within normal limits, and moderate pain is expected. Airway/breathing always
takes priority.
2. Which nursing action is priority when a postoperative patient reports sudden "popping" at
the incision site with serosanguineous discharge?
A. Apply a sterile dressing and notify the surgeon
B. Place the patient in high-Fowler's and irrigate the wound
C. Support the wound with a sterile saline-soaked dressing and position in low-Fowler's
D. Encourage coughing and deep breathing to relieve pressure
Correct Answer: C
Rationale: This describes wound dehiscence. Cover the wound with sterile saline-soaked
dressings to keep tissue moist, position in low-Fowler's to reduce tension on the incision, and
notify the surgeon immediately. Irrigation and coughing increase tension and risk evisceration.
3. SATA: Which findings indicate the patient is ready for discharge teaching after spinal
anesthesia?
A. Full return of sensation and motor function
B. Ability to void without difficulty
C. Absence of positional headache
,D. Drowsiness when undisturbed
E. Stable vital signs
Correct Answer: A, B, C, E
Rationale: Discharge readiness after spinal anesthesia requires return of sensation/motor
function, spontaneous voiding, absence of spinal headache, and stable vitals. Drowsiness may
indicate residual sedation and warrants further monitoring.
4. A patient scheduled for surgery takes metformin. Which instruction is correct?
A. Continue metformin the morning of surgery
B. Hold metformin 24 hours before surgery
C. Double the dose the night before
D. Take metformin with a sip of water the morning of surgery
Correct Answer: B
Rationale: Metformin is typically held 24–48 hours before surgery due to the risk of lactic
acidosis, especially with contrast dyes or altered renal perfusion. The surgeon/anesthesia
provider gives specific instructions.
5. Which patient is at highest risk for malignant hyperthermia during surgery?
A. Patient with a history of asthma
B. Patient with a family history of reaction to succinylcholine
C. Patient taking beta blockers
D. Patient with type 2 diabetes
Correct Answer: B
Rationale: Malignant hyperthermia is an autosomal dominant disorder triggered by volatile
anesthetics and depolarizing muscle relaxants (succinylcholine). Family history is a key risk
factor. Dantrolene is the antidote.
6. A patient in the PACU has a pulse oximetry reading of 89% on 2 L nasal cannula. What is the
priority action?
A. Increase oxygen to 6 L and reassess
B. Reposition the patient and encourage deep breathing
C. Document and continue monitoring
D. Notify the surgeon immediately
, Correct Answer: B
Rationale: First-line action for hypoxemia in PACU is repositioning (side-lying or semi-
Fowler's), encouraging deep breathing/coughing, and ensuring airway patency. Increasing O2
without addressing the cause delays definitive care.
7. SATA: Which are signs of hypovolemic shock in the postoperative patient?
A. Tachycardia
B. Bounding pulses
C. Decreased urine output
D. Warm, flushed skin
E. Restlessness and anxiety
Correct Answer: A, C, E
Rationale: Hypovolemic shock presents with tachycardia, oliguria, restlessness,
cool/clammy skin, and decreased CVP. Bounding pulses and warm flushed skin are signs of fluid
overload or early septic shock.
8. A patient is being taught to use an incentive spirometer. Which instruction is correct?
A. Inhale slowly and deeply, hold breath 3 seconds, then exhale
B. Exhale forcefully into the device
C. Use the device only when short of breath
D. Take rapid, shallow breaths through the device
Correct Answer: A
Rationale: Correct technique: sit upright, exhale normally, seal lips around mouthpiece,
inhale slowly and deeply to raise the indicator, hold 3 seconds, then exhale. This promotes
alveolar expansion and prevents atelectasis.
9. Which lab value is most concerning in a patient 24 hours post–abdominal surgery?
A. WBC 11,000/mm³
B. Hemoglobin 10.2 g/dL
C. Potassium 3.1 mEq/L
D. Glucose 150 mg/dL
Correct Answer: C
Rationale: Hypokalemia (K+ <3.5) can cause dysrhythmias and muscle weakness, especially
, after surgery with NG suction or fluid shifts. Mild leukocytosis, anemia, and mild hyperglycemia
are expected postoperatively.
10. A patient scheduled for surgery reports taking ginkgo biloba. What is the priority concern?
A. Increased risk of bleeding
B. Increased risk of infection
C. Hypotension
D. Hyperkalemia
Correct Answer: A
Rationale: Ginkgo biloba, garlic, ginger, ginseng, and ginkgo increase bleeding risk by
inhibiting platelet aggregation. They should be discontinued 1–2 weeks before surgery.
11. Which position is contraindicated immediately after a lumbar laminectomy?
A. Supine with a pillow under the head
B. Side-lying with a pillow between the knees
C. High-Fowler's
D. Supine with legs slightly elevated
Correct Answer: C
Rationale: After lumbar laminectomy, high-Fowler's increases spinal flexion and pressure at
the surgical site. Log-rolling and flat/semi-Fowler's positions are preferred.
12. A patient's preoperative consent form is signed, but the patient states, "I don't really
understand what they're going to do." What is the nurse's priority action?
A. Have the patient sign again
B. Notify the surgeon to clarify the procedure
C. Proceed with surgery as scheduled
D. Ask the family to explain the procedure
Correct Answer: B
Rationale: Informed consent requires the patient understands the procedure, risks, and
alternatives. The nurse's role is to witness the signature and ensure understanding—not to
obtain consent. Notify the surgeon to re-explain.
