HESI MEDICAL SURGICAL EXAM 2026/2027 QUESTIONS
AND SOLUTIONS RATED A+
✔✔A nurse is caring for several clients. Which client does the nurse assess most
carefully for hyperkalemia?
a. client with type 2 diabetes taking an oral anti-diabetic agent
b. client with heart failure using a salt substitute
c. client taking a thiazide diuretic for hypertension
d. client taking non-steroidal anti-inflammatory drugs daily - ✔✔B
Many salt substitutes are composed of potassium chloride. Heavy use cna contribute to
the development of hyperkalemia. The client should be taught to read labels and to
choose a salt substitute that does not contain potassium. NSAIDs promote the retention
of sodium but not potassium.
✔✔An older adult client presents with signs and symptoms related to dig toxicity. Which
age related change may have contributed to this problem?
a. decreased renal blood flow
b. increased gastrointestinal motility
c. decreased ratio of adipose tissue to lean body mass
d. increased total body water - ✔✔A
Decreased renal blood flow and reduced glomerular filtration can result in slower
medication excretion time, potentially leading to toxic drug accumulation. Aging results
in decreased total body water and gastrointestinal motility and an increase in the ratio of
adipose tissue to lean body mass, but is not related to dig toxicity.
✔✔A client is being treated for dehydration. Which statement made by the client
indicates understanding of this condition?
a. I will use a salt substitute when making and eating my meals.
b. I must drink a quart of water or other liquid each day.
c. I will not drink liquids after 6 PM so I won't have to get up at night.
d. I will weigh myself each morning before I eat or drink. - ✔✔D
Because 1 L of water weighs 1 kg, change in body weight is a good measure of excess
fluid loss or fluid retention. Weight loss greater than 0.5 lb daily is indicative of
excessive fluid loss. The other statements are not indicative of practices that will
prevent dehydration.
✔✔The nurse notes that the handgrip of the client with hypokalemia has diminished
since the previous assessment one hour ago. Which intervention by the nurse is the
priority?
,a. assess the client's respiratory rate, rhythm, and depth
b. document findings and monitor the client
c. measure the client's pulse and blood pressure
d. call the health care provider - ✔✔A
In a client with hypokkalemia, progressive skeletal muscle weakness is associated with
increasing severity of hypokalemia. The most life-threatening complication of
hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a
respiratory assessment first to make sure that the client is not in immediate jeopardy.
Next, the nurse would call the health care provider to obtain orders for potassium
replacement.
✔✔The physician orders Lasix (furosemide) 60 mg po every day for your patient. On
hand you have Lasix 40 mg. How many tablets will you give the patient?
a. 3
b. 1
c. 1 1/2
d. 2 1/5 - ✔✔C
60/40 (desired/have)
✔✔A client has been taught to restrict dietary sodium. Which food selection by the client
indicates to the nurse that teaching has been effective?
a. a grilled cheese sandwich with tomato soup
b. Chinese take-out, including steamed rice
c. a chicken leg, one slice of bread with butter, and steamed carrots
d. slices of ham and cheese on whole grain crackers - ✔✔C
Clients on restricted sodium diets generally should avoid processed, smoked, and
pickled foods and those with sauces and other condiments. Foods lowest in sodium
include fish, poultry, and fresh produce. The chinese food likely would have soy sauce,
the tomato soup is processed, and the crackers are a snack food - a category of foods
often high in sodium.
✔✔When a client is assessed, which behavior best indicates that he or she is
experiencing changes associated with acute pain?
a. inability to concentrate
b. expressed hopelessness
c. psychosocial withdrawal
d. anger and hostility - ✔✔A
,The characteristics most common to chronic pain are psychosocial withdrawal, anger
and hostility, depression, and hopelessness. The inability to concentrate is associated
much more with acute pain, before any physiologic or behavioral adaptation has
occurred.
✔✔A nurse is caring for several clients at risk for overhydration. The nurse assesses
the older client with which finding first?
A) Has had diabetes mellitus for 12 years
B) Had abdominal surgery and has a nasogastric tube
C) Just received 3 units of packed red blood cells
D) Uses sodium-containing antacids frequently - ✔✔C
Blood replacement therapy involves intravenous fluid administration, which inherently
increases the risk for overhydration. The fact that the fluid consists of packed red blood
cells greatly increases the risk, because this fluid increases the colloidal oncotic
pressure of the blood, causing fluid to move from interstitial and intracellular spaces into
the plasma volume. An older adult may not have sufficient cardiac or renal reserve to
manage this extra fluid.
✔✔The client with a stroke was admitted to a medical-surgical unit. Which tasks does
the nurse delegate to the unlicensed assistive personnel?
A) Assess level of consciousness.
B) Evaluate the pulse oximetry reading.
C) Assist the client with meals.
D) Complete the nursing care plan. - ✔✔C
The nurse needs to know the five rights of delegation: right task, right circumstances,
right person, right communication, and right supervision. Unlicensed assistive personnel
can help with feeding, but only the nurse can care plan, assess the level of
consciousness, and evaluate the oxygenation of the client.
✔✔Interrelated concepts to the professional nursing role a nurse manager would
consider when addressing concerns about the quality of patient education include:
A) adherence.
B) developmental level.
C) motivation.
D) technology. - ✔✔D
The interrelated concepts to the professional role of a nurse include health promotion,
leadership, technology/informatics, quality, collaboration, and communication.
Adherence, culture, developmental level, family dynamics, and motivation are
considered interrelated concepts to patient attributes and preference.
, ✔✔During orientation to an emergency department, the nurse educator would be
concerned if the new nurse listed which of the following as a risk factor for impaired
thermoregulation?
A) Temperature extremes
B) Occupational exposure
C) Impaired cognition
D) Physical agility - ✔✔D
Physical agility is not a risk factor for impaired thermoregulation. The nurse educator
would use this information to plan additional teaching to include medical conditions and
gait disturbance as risk factors for hypothermia, because their bodies have a reduced
ability to generate heat. Impaired cognition is a risk factor. Recreational or occupational
exposure is a risk factor. Temperature extremes are risk factors for impaired
thermoregulation.
✔✔An older adult client is in physical restraints. Which intervention by the nurse is the
priority?
A) Assess the client hourly while keeping the restraints in place.
B) Assess the client once each shift, releasing the restraints for feeding.
C) Assess the client twice each shift while keeping the restraints in place.
D) Assess the client every 30 to 60 minutes, releasing restraints every 2 hours. - ✔✔D
The application of restraints can have serious consequences. Thus, the nurse should
check the client every 30 to 60 minutes, releasing the restraints every 2 hours for
positioning and toileting. The other answers would not be appropriate because the client
would not be assessed frequently enough, and circulation to the limbs could be
compromised. Assessing every hour and releasing the restraints every 2 hours is in
compliance with federal policy for monitoring clients in restraints.
✔✔The nurse is assessing a client with a long-term history of arthritic pain. Assessment
reveals a heart rate of 115 beats/min and blood pressure of 170/80 mm Hg. Which
intervention will the nurse carry out first?
A) Administer blood pressure medication.
B) Administer a drug to lower the heart rate.
C) Continue to assess for possible causes of elevated vital signs.
D) Assess whether the client needs anti-arthritis medication. - ✔✔C
Arthritis is categorized as chronic pain. With chronic pain, the body adapts by blocking
the sympathetic nervous system; this normally causes tachycardia and increased blood
pressure. Therefore, this client's high blood pressure and heart rate are not caused by
chronic pain and may be a result of a more acute type of pain. Therefore, the best
intervention is for the nurse to establish whether the client is having pain other than
arthritic pain, and then to decide which intervention should be carried out.
AND SOLUTIONS RATED A+
✔✔A nurse is caring for several clients. Which client does the nurse assess most
carefully for hyperkalemia?
a. client with type 2 diabetes taking an oral anti-diabetic agent
b. client with heart failure using a salt substitute
c. client taking a thiazide diuretic for hypertension
d. client taking non-steroidal anti-inflammatory drugs daily - ✔✔B
Many salt substitutes are composed of potassium chloride. Heavy use cna contribute to
the development of hyperkalemia. The client should be taught to read labels and to
choose a salt substitute that does not contain potassium. NSAIDs promote the retention
of sodium but not potassium.
✔✔An older adult client presents with signs and symptoms related to dig toxicity. Which
age related change may have contributed to this problem?
a. decreased renal blood flow
b. increased gastrointestinal motility
c. decreased ratio of adipose tissue to lean body mass
d. increased total body water - ✔✔A
Decreased renal blood flow and reduced glomerular filtration can result in slower
medication excretion time, potentially leading to toxic drug accumulation. Aging results
in decreased total body water and gastrointestinal motility and an increase in the ratio of
adipose tissue to lean body mass, but is not related to dig toxicity.
✔✔A client is being treated for dehydration. Which statement made by the client
indicates understanding of this condition?
a. I will use a salt substitute when making and eating my meals.
b. I must drink a quart of water or other liquid each day.
c. I will not drink liquids after 6 PM so I won't have to get up at night.
d. I will weigh myself each morning before I eat or drink. - ✔✔D
Because 1 L of water weighs 1 kg, change in body weight is a good measure of excess
fluid loss or fluid retention. Weight loss greater than 0.5 lb daily is indicative of
excessive fluid loss. The other statements are not indicative of practices that will
prevent dehydration.
✔✔The nurse notes that the handgrip of the client with hypokalemia has diminished
since the previous assessment one hour ago. Which intervention by the nurse is the
priority?
,a. assess the client's respiratory rate, rhythm, and depth
b. document findings and monitor the client
c. measure the client's pulse and blood pressure
d. call the health care provider - ✔✔A
In a client with hypokkalemia, progressive skeletal muscle weakness is associated with
increasing severity of hypokalemia. The most life-threatening complication of
hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a
respiratory assessment first to make sure that the client is not in immediate jeopardy.
Next, the nurse would call the health care provider to obtain orders for potassium
replacement.
✔✔The physician orders Lasix (furosemide) 60 mg po every day for your patient. On
hand you have Lasix 40 mg. How many tablets will you give the patient?
a. 3
b. 1
c. 1 1/2
d. 2 1/5 - ✔✔C
60/40 (desired/have)
✔✔A client has been taught to restrict dietary sodium. Which food selection by the client
indicates to the nurse that teaching has been effective?
a. a grilled cheese sandwich with tomato soup
b. Chinese take-out, including steamed rice
c. a chicken leg, one slice of bread with butter, and steamed carrots
d. slices of ham and cheese on whole grain crackers - ✔✔C
Clients on restricted sodium diets generally should avoid processed, smoked, and
pickled foods and those with sauces and other condiments. Foods lowest in sodium
include fish, poultry, and fresh produce. The chinese food likely would have soy sauce,
the tomato soup is processed, and the crackers are a snack food - a category of foods
often high in sodium.
✔✔When a client is assessed, which behavior best indicates that he or she is
experiencing changes associated with acute pain?
a. inability to concentrate
b. expressed hopelessness
c. psychosocial withdrawal
d. anger and hostility - ✔✔A
,The characteristics most common to chronic pain are psychosocial withdrawal, anger
and hostility, depression, and hopelessness. The inability to concentrate is associated
much more with acute pain, before any physiologic or behavioral adaptation has
occurred.
✔✔A nurse is caring for several clients at risk for overhydration. The nurse assesses
the older client with which finding first?
A) Has had diabetes mellitus for 12 years
B) Had abdominal surgery and has a nasogastric tube
C) Just received 3 units of packed red blood cells
D) Uses sodium-containing antacids frequently - ✔✔C
Blood replacement therapy involves intravenous fluid administration, which inherently
increases the risk for overhydration. The fact that the fluid consists of packed red blood
cells greatly increases the risk, because this fluid increases the colloidal oncotic
pressure of the blood, causing fluid to move from interstitial and intracellular spaces into
the plasma volume. An older adult may not have sufficient cardiac or renal reserve to
manage this extra fluid.
✔✔The client with a stroke was admitted to a medical-surgical unit. Which tasks does
the nurse delegate to the unlicensed assistive personnel?
A) Assess level of consciousness.
B) Evaluate the pulse oximetry reading.
C) Assist the client with meals.
D) Complete the nursing care plan. - ✔✔C
The nurse needs to know the five rights of delegation: right task, right circumstances,
right person, right communication, and right supervision. Unlicensed assistive personnel
can help with feeding, but only the nurse can care plan, assess the level of
consciousness, and evaluate the oxygenation of the client.
✔✔Interrelated concepts to the professional nursing role a nurse manager would
consider when addressing concerns about the quality of patient education include:
A) adherence.
B) developmental level.
C) motivation.
D) technology. - ✔✔D
The interrelated concepts to the professional role of a nurse include health promotion,
leadership, technology/informatics, quality, collaboration, and communication.
Adherence, culture, developmental level, family dynamics, and motivation are
considered interrelated concepts to patient attributes and preference.
, ✔✔During orientation to an emergency department, the nurse educator would be
concerned if the new nurse listed which of the following as a risk factor for impaired
thermoregulation?
A) Temperature extremes
B) Occupational exposure
C) Impaired cognition
D) Physical agility - ✔✔D
Physical agility is not a risk factor for impaired thermoregulation. The nurse educator
would use this information to plan additional teaching to include medical conditions and
gait disturbance as risk factors for hypothermia, because their bodies have a reduced
ability to generate heat. Impaired cognition is a risk factor. Recreational or occupational
exposure is a risk factor. Temperature extremes are risk factors for impaired
thermoregulation.
✔✔An older adult client is in physical restraints. Which intervention by the nurse is the
priority?
A) Assess the client hourly while keeping the restraints in place.
B) Assess the client once each shift, releasing the restraints for feeding.
C) Assess the client twice each shift while keeping the restraints in place.
D) Assess the client every 30 to 60 minutes, releasing restraints every 2 hours. - ✔✔D
The application of restraints can have serious consequences. Thus, the nurse should
check the client every 30 to 60 minutes, releasing the restraints every 2 hours for
positioning and toileting. The other answers would not be appropriate because the client
would not be assessed frequently enough, and circulation to the limbs could be
compromised. Assessing every hour and releasing the restraints every 2 hours is in
compliance with federal policy for monitoring clients in restraints.
✔✔The nurse is assessing a client with a long-term history of arthritic pain. Assessment
reveals a heart rate of 115 beats/min and blood pressure of 170/80 mm Hg. Which
intervention will the nurse carry out first?
A) Administer blood pressure medication.
B) Administer a drug to lower the heart rate.
C) Continue to assess for possible causes of elevated vital signs.
D) Assess whether the client needs anti-arthritis medication. - ✔✔C
Arthritis is categorized as chronic pain. With chronic pain, the body adapts by blocking
the sympathetic nervous system; this normally causes tachycardia and increased blood
pressure. Therefore, this client's high blood pressure and heart rate are not caused by
chronic pain and may be a result of a more acute type of pain. Therefore, the best
intervention is for the nurse to establish whether the client is having pain other than
arthritic pain, and then to decide which intervention should be carried out.
