HESI Med-Surg Exit Exam Bank - Study
Guide & Practice Questions
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam bank assesses application-level medical-surgical nursing knowledge across cardiovascular,
respiratory, endocrine, renal, gastrointestinal, neurologic, musculoskeletal, hematologic, oncologic, and
perioperative domains. Items emphasize clinical judgment, prioritization, and evidence-based nursing
interventions consistent with NCLEX-RN and HESI exit exam blueprints.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (standardized HESI benchmark).
HIGHP - Page 1 of 46
,1. A patient with heart failure is prescribed furosemide 40 mg IV push. Which assessment
finding most urgently requires the nurse to hold the dose and notify the provider?
[ ] A. Serum potassium 2.9 mEq/L
[ ] B. Blood pressure 108/68 mm Hg
[ ] C. Urine output 40 mL/hr
[ ] D. Heart rate 92 beats/min
CORRECT: A. Serum potassium 2.9 mEq/L
Furosemide is a loop diuretic that causes potassium loss; a serum potassium of 2.9 mEq/L is critically low
and increases risk of fatal dysrhythmias, so the dose should be held. The other values are within acceptable
ranges and do not require withholding the medication.
2. A patient with type 1 diabetes has a blood glucose of 52 mg/dL and is alert and able to
swallow. Which action should the nurse take first?
[ ] A. Administer 1 mg glucagon IM
[ ] B. Give 15 g of a fast-acting carbohydrate orally
[ ] C. Start an IV infusion of D5W
[ ] D. Recheck blood glucose in 30 minutes
CORRECT: B. Give 15 g of a fast-acting carbohydrate orally
For conscious hypoglycemia, the initial treatment is 15 g of oral fast-acting carbohydrate (Rule of 15),
followed by recheck in 15 minutes. Glucagon and IV dextrose are reserved for unresponsive patients or those
unable to swallow; waiting 30 minutes delays treatment.
3. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which
intervention should the nurse anticipate as the priority?
[ ] A. Administer sodium polystyrene sulfonate orally
[ ] B. Administer IV calcium gluconate
[ ] C. Restrict dietary potassium
[ ] D. Prepare for hemodialysis
CORRECT: B. Administer IV calcium gluconate
IV calcium gluconate is the immediate treatment for hyperkalemia with cardiac instability because it stabilizes
the myocardium without lowering potassium. Sodium polystyrene sulfonate and dietary restriction lower
potassium slowly; dialysis is definitive but not the first emergency drug.
4. A patient is receiving a blood transfusion and develops fever, chills, and low back pain
15 minutes into the infusion. Which action should the nurse take first?
[ ] A. Administer acetaminophen
[ ] B. Stop the transfusion and maintain IV access with normal saline
HIGHP - Page 2 of 46
, [ ] C. Slow the transfusion rate
[ ] D. Obtain a urine specimen
CORRECT: B. Stop the transfusion and maintain IV access with normal saline
These signs suggest an acute hemolytic transfusion reaction; the first action is to stop the transfusion
immediately and keep the IV line patent with normal saline. Slowing the rate or giving antipyretics delays
essential treatment; urine collection is secondary.
5. A patient with a new colostomy is being taught about stoma care. Which statement by
the patient indicates correct understanding?
[ ] A. I should clean the stoma with alcohol pads.
[ ] B. I will change the pouch every day.
[ ] C. I should expect the stoma to be pale and dry.
[ ] D. I will cut the wafer to fit the stoma size.
CORRECT: D. I will cut the wafer to fit the stoma size.
The skin barrier wafer must be cut to fit the stoma to prevent skin irritation and leakage. Alcohol is drying and
should not be used; pouches are changed every 3-7 days; a healthy stoma is pink and moist, not pale and
dry.
6. A patient is prescribed enoxaparin 40 mg subcutaneously daily for DVT prophylaxis.
Which laboratory value should the nurse monitor to evaluate therapeutic safety?
[ ] A. Platelet count
[ ] B. INR
[ ] C. aPTT
[ ] D. D-dimer
CORRECT: A. Platelet count
Enoxaparin can cause heparin-induced thrombocytopenia, so platelet counts should be monitored. INR and
aPTT are used for warfarin and unfractionated heparin, respectively; D-dimer assesses clot presence, not
drug safety.
7. A patient with increased intracranial pressure from a traumatic brain injury is being
cared for. Which nursing intervention is appropriate to help reduce ICP?
[ ] A. Elevate the head of the bed to 30 degrees
[ ] B. Cluster nursing care to allow rest
[ ] C. Administer hypotonic IV fluids
[ ] D. Maintain neck flexion for comfort
HIGHP - Page 3 of 46
, CORRECT: A. Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage and reduces ICP. Clustering care
increases ICP; hypotonic fluids worsen cerebral edema; neck flexion impedes venous return and raises ICP.
8. A patient with a below-the-knee amputation is being evaluated for discharge. Which
finding indicates the patient needs further teaching about residual limb care?
[ ] A. The patient elevates the residual limb on a pillow for prolonged periods.
[ ] B. The patient performs range-of-motion exercises on the residual limb.
[ ] C. The patient inspects the residual limb daily for redness.
[ ] D. The patient wraps the residual limb with an elastic bandage.
CORRECT: A. The patient elevates the residual limb on a pillow for prolonged periods.
Prolonged elevation of the residual limb can cause hip flexion contracture, so this indicates a need for further
teaching. ROM, daily inspection, and elastic wrapping are appropriate measures to promote healing and
prevent complications.
9. A patient with neutropenia from chemotherapy is admitted. Which instruction should
the nurse include in the plan of care?
[ ] A. Avoid fresh flowers and raw fruits and vegetables.
[ ] B. Use a razor blade for shaving.
[ ] C. Take rectal temperatures every 4 hours.
[ ] D. Receive live attenuated vaccines.
CORRECT: A. Avoid fresh flowers and raw fruits and vegetables.
Neutropenic patients must avoid sources of infection such as fresh flowers and raw produce. Razor blades
and rectal thermometers can cause breaks in skin or mucosa; live vaccines are contraindicated due to
immunosuppression.
10. A patient with acute decompensated heart failure has been receiving IV furosemide.
Which assessment finding most urgently indicates a need to hold the next dose and notify
the provider?
[ ] A. Serum potassium of 3.1 mEq/L with new-onset muscle weakness
[ ] B. Urine output of 90 mL/hr over the past 3 hours
[ ] C. Weight loss of 1 kg since admission
[ ] D. Blood pressure of 108/68 mm Hg
CORRECT: A. Serum potassium of 3.1 mEq/L with new-onset muscle weakness
Loop diuretics cause potassium wasting; a K+ of 3.1 with weakness signals hypokalemia that can precipitate
dysrhythmias and requires holding the dose and notifying the provider. Urine output and modest weight loss
HIGHP - Page 4 of 46
Guide & Practice Questions
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam bank assesses application-level medical-surgical nursing knowledge across cardiovascular,
respiratory, endocrine, renal, gastrointestinal, neurologic, musculoskeletal, hematologic, oncologic, and
perioperative domains. Items emphasize clinical judgment, prioritization, and evidence-based nursing
interventions consistent with NCLEX-RN and HESI exit exam blueprints.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (standardized HESI benchmark).
HIGHP - Page 1 of 46
,1. A patient with heart failure is prescribed furosemide 40 mg IV push. Which assessment
finding most urgently requires the nurse to hold the dose and notify the provider?
[ ] A. Serum potassium 2.9 mEq/L
[ ] B. Blood pressure 108/68 mm Hg
[ ] C. Urine output 40 mL/hr
[ ] D. Heart rate 92 beats/min
CORRECT: A. Serum potassium 2.9 mEq/L
Furosemide is a loop diuretic that causes potassium loss; a serum potassium of 2.9 mEq/L is critically low
and increases risk of fatal dysrhythmias, so the dose should be held. The other values are within acceptable
ranges and do not require withholding the medication.
2. A patient with type 1 diabetes has a blood glucose of 52 mg/dL and is alert and able to
swallow. Which action should the nurse take first?
[ ] A. Administer 1 mg glucagon IM
[ ] B. Give 15 g of a fast-acting carbohydrate orally
[ ] C. Start an IV infusion of D5W
[ ] D. Recheck blood glucose in 30 minutes
CORRECT: B. Give 15 g of a fast-acting carbohydrate orally
For conscious hypoglycemia, the initial treatment is 15 g of oral fast-acting carbohydrate (Rule of 15),
followed by recheck in 15 minutes. Glucagon and IV dextrose are reserved for unresponsive patients or those
unable to swallow; waiting 30 minutes delays treatment.
3. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L. Which
intervention should the nurse anticipate as the priority?
[ ] A. Administer sodium polystyrene sulfonate orally
[ ] B. Administer IV calcium gluconate
[ ] C. Restrict dietary potassium
[ ] D. Prepare for hemodialysis
CORRECT: B. Administer IV calcium gluconate
IV calcium gluconate is the immediate treatment for hyperkalemia with cardiac instability because it stabilizes
the myocardium without lowering potassium. Sodium polystyrene sulfonate and dietary restriction lower
potassium slowly; dialysis is definitive but not the first emergency drug.
4. A patient is receiving a blood transfusion and develops fever, chills, and low back pain
15 minutes into the infusion. Which action should the nurse take first?
[ ] A. Administer acetaminophen
[ ] B. Stop the transfusion and maintain IV access with normal saline
HIGHP - Page 2 of 46
, [ ] C. Slow the transfusion rate
[ ] D. Obtain a urine specimen
CORRECT: B. Stop the transfusion and maintain IV access with normal saline
These signs suggest an acute hemolytic transfusion reaction; the first action is to stop the transfusion
immediately and keep the IV line patent with normal saline. Slowing the rate or giving antipyretics delays
essential treatment; urine collection is secondary.
5. A patient with a new colostomy is being taught about stoma care. Which statement by
the patient indicates correct understanding?
[ ] A. I should clean the stoma with alcohol pads.
[ ] B. I will change the pouch every day.
[ ] C. I should expect the stoma to be pale and dry.
[ ] D. I will cut the wafer to fit the stoma size.
CORRECT: D. I will cut the wafer to fit the stoma size.
The skin barrier wafer must be cut to fit the stoma to prevent skin irritation and leakage. Alcohol is drying and
should not be used; pouches are changed every 3-7 days; a healthy stoma is pink and moist, not pale and
dry.
6. A patient is prescribed enoxaparin 40 mg subcutaneously daily for DVT prophylaxis.
Which laboratory value should the nurse monitor to evaluate therapeutic safety?
[ ] A. Platelet count
[ ] B. INR
[ ] C. aPTT
[ ] D. D-dimer
CORRECT: A. Platelet count
Enoxaparin can cause heparin-induced thrombocytopenia, so platelet counts should be monitored. INR and
aPTT are used for warfarin and unfractionated heparin, respectively; D-dimer assesses clot presence, not
drug safety.
7. A patient with increased intracranial pressure from a traumatic brain injury is being
cared for. Which nursing intervention is appropriate to help reduce ICP?
[ ] A. Elevate the head of the bed to 30 degrees
[ ] B. Cluster nursing care to allow rest
[ ] C. Administer hypotonic IV fluids
[ ] D. Maintain neck flexion for comfort
HIGHP - Page 3 of 46
, CORRECT: A. Elevate the head of the bed to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage and reduces ICP. Clustering care
increases ICP; hypotonic fluids worsen cerebral edema; neck flexion impedes venous return and raises ICP.
8. A patient with a below-the-knee amputation is being evaluated for discharge. Which
finding indicates the patient needs further teaching about residual limb care?
[ ] A. The patient elevates the residual limb on a pillow for prolonged periods.
[ ] B. The patient performs range-of-motion exercises on the residual limb.
[ ] C. The patient inspects the residual limb daily for redness.
[ ] D. The patient wraps the residual limb with an elastic bandage.
CORRECT: A. The patient elevates the residual limb on a pillow for prolonged periods.
Prolonged elevation of the residual limb can cause hip flexion contracture, so this indicates a need for further
teaching. ROM, daily inspection, and elastic wrapping are appropriate measures to promote healing and
prevent complications.
9. A patient with neutropenia from chemotherapy is admitted. Which instruction should
the nurse include in the plan of care?
[ ] A. Avoid fresh flowers and raw fruits and vegetables.
[ ] B. Use a razor blade for shaving.
[ ] C. Take rectal temperatures every 4 hours.
[ ] D. Receive live attenuated vaccines.
CORRECT: A. Avoid fresh flowers and raw fruits and vegetables.
Neutropenic patients must avoid sources of infection such as fresh flowers and raw produce. Razor blades
and rectal thermometers can cause breaks in skin or mucosa; live vaccines are contraindicated due to
immunosuppression.
10. A patient with acute decompensated heart failure has been receiving IV furosemide.
Which assessment finding most urgently indicates a need to hold the next dose and notify
the provider?
[ ] A. Serum potassium of 3.1 mEq/L with new-onset muscle weakness
[ ] B. Urine output of 90 mL/hr over the past 3 hours
[ ] C. Weight loss of 1 kg since admission
[ ] D. Blood pressure of 108/68 mm Hg
CORRECT: A. Serum potassium of 3.1 mEq/L with new-onset muscle weakness
Loop diuretics cause potassium wasting; a K+ of 3.1 with weakness signals hypokalemia that can precipitate
dysrhythmias and requires holding the dose and notifying the provider. Urine output and modest weight loss
HIGHP - Page 4 of 46
