HESI RN Med Surg Exam Guide Questions
and Answers ACTUAL EXAM 2026/2027 |
HESI Med Surg Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–50)
Q1: A nurse is caring for a client with COPD who suddenly becomes dyspneic with an oxygen saturation
of 84% on 2 L/min nasal cannula. The client is alert and able to follow commands. Which action should
the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Assist the client to a sitting position and reassess breath sounds [CORRECT]
C. Notify the respiratory therapist to obtain an ABG
D. Document the findings and continue current monitoring
Correct Answer: B
Rationale: In COPD, acute dyspnea requires immediate positioning to maximize diaphragmatic excursion
and lung expansion. Sitting upright reduces abdominal pressure on the diaphragm and improves
ventilation. Assessment of breath sounds follows to identify causes such as bronchospasm, mucus
plugging, or pneumothorax before escalating interventions
.
Q2: A client admitted with acute myocardial infarction reports chest pain rated 8/10. Vital signs: BP
92/58, HR 110, RR 24, SpO₂ 91%. Which action is the nurse's priority?
A. Administer morphine sulfate 2 mg IV for pain
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Start a second large-bore IV and prepare for possible vasopressor support [CORRECT]
D. Obtain a 12-lead ECG
Correct Answer: C
Rationale: Hypotension (systolic <90 mmHg) with tachycardia in a client with MI indicates cardiogenic
,shock, the most immediate threat to survival. Establishing adequate IV access for fluid resuscitation and
vasopressor administration takes priority over pain management, oxygen, or diagnostic testing.
Circulatory collapse must be addressed first per the ABCs and acute versus chronic framework
.
Q3: A nurse is reviewing morning laboratory results for four clients. Which client should the nurse assess
first?
A. Client with chronic kidney disease: BUN 82 mg/dL, creatinine 3.5 mg/dL
B. Client with heart failure: potassium 3.2 mEq/L
C. Client receiving heparin: platelet count 78,000/mm³ (baseline 210,000) [CORRECT]
D. Client with diabetes: fasting glucose 185 mg/dL
Correct Answer: C
Rationale: A platelet count decline >50% from baseline in a client receiving heparin is highly suggestive
of heparin-induced thrombocytopenia (HIT), a life-threatening prothrombotic condition. Despite low
platelets, HIT causes thrombosis rather than bleeding. Immediate discontinuation of all heparin and
initiation of alternative anticoagulation is required to prevent arterial and venous thromboembolism
.
Q4: A client with diabetic ketoacidosis (DKA) has the following arterial blood gas: pH 7.22, PaCO₂ 28
mmHg, HCO₃⁻ 12 mEq/L, PaO₂ 88 mmHg. Which interpretation is correct?
A. Metabolic alkalosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation [CORRECT]
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The low pH (7.22) indicates acidosis. The low HCO₃⁻ (12) confirms a metabolic origin. The low
PaCO₂ (28) represents hyperventilation (Kussmaul respirations) as the respiratory system's
compensatory mechanism to blow off carbonic acid. This classic ABG pattern confirms metabolic
acidosis with appropriate respiratory compensation in DKA
.
Q5: A nurse is caring for a client with neutropenia (ANC 400 cells/mm³) who develops a temperature of
101.2°F (38.4°C). Which action should the nurse take first?
,A. Administer acetaminophen and reassess in 1 hour
B. Draw blood cultures and notify the provider immediately [CORRECT]
C. Place the client in a negative pressure room
D. Begin broad-spectrum antibiotics per protocol without cultures
Correct Answer: B
Rationale: Fever in neutropenic clients may be the only sign of infection due to blunted immune
response. Neutropenic fever is a medical emergency requiring immediate blood cultures (before
antibiotics) to identify the causative organism, followed by prompt antibiotic administration. Delayed
treatment can lead to rapid progression to sepsis and death
.
Q6: A client with a new ileostomy reports the effluent is watery and frequent. Which dietary
recommendation should the nurse provide?
A. "Increase your intake of raw fruits and vegetables."
B. "Try adding applesauce, bananas, and white rice to your diet." [CORRECT]
C. "Drink at least 3 liters of fluid daily to maintain hydration."
D. "Avoid all fiber to prevent obstruction."
Correct Answer: B
Rationale: Low-fiber, starchy foods and soluble fiber sources like applesauce and bananas absorb fluid
and thicken ileostomy output. High-fiber raw foods increase output volume and obstruction risk. While
hydration is important, excessive fluid intake further liquefies effluent. Complete fiber avoidance is
unnecessary and can cause constipation or blockage
.
Q7: A client with Crohn's disease is receiving total parenteral nutrition (TPN) via a central line. The client
suddenly reports shortness of breath and shoulder pain. Which complication should the nurse suspect?
A. Hyperglycemia
B. Air embolism [CORRECT]
C. Catheter-related bloodstream infection
D. Fluid overload
Correct Answer: B
Rationale: Sudden dyspnea and shoulder pain in a client with a central venous catheter are hallmark
signs of air embolism. The nurse should immediately place the client in left lateral Trendelenburg
, position to trap air in the right ventricle and prevent pulmonary artery entry. This is a life-threatening
emergency requiring rapid intervention
.
Q8: A nurse is delegating tasks on a busy medical-surgical unit. Which task is most appropriate to assign
to the LPN?
A. Initial admission assessment of a newly admitted client with chest pain
B. Administration of an enteral feeding to a stable client with a gastrostomy tube [CORRECT]
C. Discharge teaching for a client starting warfarin therapy
D. Assessment of a client with new-onset confusion and hypotension
Correct Answer: B
Rationale: LPNs can manage chronic stable patients, perform routine procedures, and assist with basic
assessments, but must report changes to the RN. Enteral feeding administration to a stable client is
within LPN scope. Initial assessments, discharge teaching for high-alert medications, and unstable
patient evaluations require RN-level clinical judgment and scope
.
Q9: A client with pneumonia is placed on droplet precautions. Which PPE should the nurse wear when
entering the room?
A. N95 respirator, gown, and gloves
B. Surgical mask, gown, and gloves [CORRECT]
C. Surgical mask only
D. Gown and gloves only
Correct Answer: B
Rationale: Droplet precautions require a surgical mask (not N95, which is reserved for airborne
pathogens), gown, and gloves when within 3 feet of the patient or when contact with respiratory
secretions or contaminated surfaces is anticipated. Hand hygiene is performed before and after PPE
removal
.
Q10: A client with heart failure has the following laboratory results: BNP 1,200 pg/mL, potassium 5.8
mEq/L, creatinine 2.3 mg/dL. The client is prescribed spironolactone 25 mg daily. Which action should
the nurse take?
and Answers ACTUAL EXAM 2026/2027 |
HESI Med Surg Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–50)
Q1: A nurse is caring for a client with COPD who suddenly becomes dyspneic with an oxygen saturation
of 84% on 2 L/min nasal cannula. The client is alert and able to follow commands. Which action should
the nurse take first?
A. Increase the oxygen flow rate to 6 L/min
B. Assist the client to a sitting position and reassess breath sounds [CORRECT]
C. Notify the respiratory therapist to obtain an ABG
D. Document the findings and continue current monitoring
Correct Answer: B
Rationale: In COPD, acute dyspnea requires immediate positioning to maximize diaphragmatic excursion
and lung expansion. Sitting upright reduces abdominal pressure on the diaphragm and improves
ventilation. Assessment of breath sounds follows to identify causes such as bronchospasm, mucus
plugging, or pneumothorax before escalating interventions
.
Q2: A client admitted with acute myocardial infarction reports chest pain rated 8/10. Vital signs: BP
92/58, HR 110, RR 24, SpO₂ 91%. Which action is the nurse's priority?
A. Administer morphine sulfate 2 mg IV for pain
B. Apply supplemental oxygen at 2 L/min via nasal cannula
C. Start a second large-bore IV and prepare for possible vasopressor support [CORRECT]
D. Obtain a 12-lead ECG
Correct Answer: C
Rationale: Hypotension (systolic <90 mmHg) with tachycardia in a client with MI indicates cardiogenic
,shock, the most immediate threat to survival. Establishing adequate IV access for fluid resuscitation and
vasopressor administration takes priority over pain management, oxygen, or diagnostic testing.
Circulatory collapse must be addressed first per the ABCs and acute versus chronic framework
.
Q3: A nurse is reviewing morning laboratory results for four clients. Which client should the nurse assess
first?
A. Client with chronic kidney disease: BUN 82 mg/dL, creatinine 3.5 mg/dL
B. Client with heart failure: potassium 3.2 mEq/L
C. Client receiving heparin: platelet count 78,000/mm³ (baseline 210,000) [CORRECT]
D. Client with diabetes: fasting glucose 185 mg/dL
Correct Answer: C
Rationale: A platelet count decline >50% from baseline in a client receiving heparin is highly suggestive
of heparin-induced thrombocytopenia (HIT), a life-threatening prothrombotic condition. Despite low
platelets, HIT causes thrombosis rather than bleeding. Immediate discontinuation of all heparin and
initiation of alternative anticoagulation is required to prevent arterial and venous thromboembolism
.
Q4: A client with diabetic ketoacidosis (DKA) has the following arterial blood gas: pH 7.22, PaCO₂ 28
mmHg, HCO₃⁻ 12 mEq/L, PaO₂ 88 mmHg. Which interpretation is correct?
A. Metabolic alkalosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation [CORRECT]
D. Respiratory alkalosis with metabolic compensation
Correct Answer: C
Rationale: The low pH (7.22) indicates acidosis. The low HCO₃⁻ (12) confirms a metabolic origin. The low
PaCO₂ (28) represents hyperventilation (Kussmaul respirations) as the respiratory system's
compensatory mechanism to blow off carbonic acid. This classic ABG pattern confirms metabolic
acidosis with appropriate respiratory compensation in DKA
.
Q5: A nurse is caring for a client with neutropenia (ANC 400 cells/mm³) who develops a temperature of
101.2°F (38.4°C). Which action should the nurse take first?
,A. Administer acetaminophen and reassess in 1 hour
B. Draw blood cultures and notify the provider immediately [CORRECT]
C. Place the client in a negative pressure room
D. Begin broad-spectrum antibiotics per protocol without cultures
Correct Answer: B
Rationale: Fever in neutropenic clients may be the only sign of infection due to blunted immune
response. Neutropenic fever is a medical emergency requiring immediate blood cultures (before
antibiotics) to identify the causative organism, followed by prompt antibiotic administration. Delayed
treatment can lead to rapid progression to sepsis and death
.
Q6: A client with a new ileostomy reports the effluent is watery and frequent. Which dietary
recommendation should the nurse provide?
A. "Increase your intake of raw fruits and vegetables."
B. "Try adding applesauce, bananas, and white rice to your diet." [CORRECT]
C. "Drink at least 3 liters of fluid daily to maintain hydration."
D. "Avoid all fiber to prevent obstruction."
Correct Answer: B
Rationale: Low-fiber, starchy foods and soluble fiber sources like applesauce and bananas absorb fluid
and thicken ileostomy output. High-fiber raw foods increase output volume and obstruction risk. While
hydration is important, excessive fluid intake further liquefies effluent. Complete fiber avoidance is
unnecessary and can cause constipation or blockage
.
Q7: A client with Crohn's disease is receiving total parenteral nutrition (TPN) via a central line. The client
suddenly reports shortness of breath and shoulder pain. Which complication should the nurse suspect?
A. Hyperglycemia
B. Air embolism [CORRECT]
C. Catheter-related bloodstream infection
D. Fluid overload
Correct Answer: B
Rationale: Sudden dyspnea and shoulder pain in a client with a central venous catheter are hallmark
signs of air embolism. The nurse should immediately place the client in left lateral Trendelenburg
, position to trap air in the right ventricle and prevent pulmonary artery entry. This is a life-threatening
emergency requiring rapid intervention
.
Q8: A nurse is delegating tasks on a busy medical-surgical unit. Which task is most appropriate to assign
to the LPN?
A. Initial admission assessment of a newly admitted client with chest pain
B. Administration of an enteral feeding to a stable client with a gastrostomy tube [CORRECT]
C. Discharge teaching for a client starting warfarin therapy
D. Assessment of a client with new-onset confusion and hypotension
Correct Answer: B
Rationale: LPNs can manage chronic stable patients, perform routine procedures, and assist with basic
assessments, but must report changes to the RN. Enteral feeding administration to a stable client is
within LPN scope. Initial assessments, discharge teaching for high-alert medications, and unstable
patient evaluations require RN-level clinical judgment and scope
.
Q9: A client with pneumonia is placed on droplet precautions. Which PPE should the nurse wear when
entering the room?
A. N95 respirator, gown, and gloves
B. Surgical mask, gown, and gloves [CORRECT]
C. Surgical mask only
D. Gown and gloves only
Correct Answer: B
Rationale: Droplet precautions require a surgical mask (not N95, which is reserved for airborne
pathogens), gown, and gloves when within 3 feet of the patient or when contact with respiratory
secretions or contaminated surfaces is anticipated. Hand hygiene is performed before and after PPE
removal
.
Q10: A client with heart failure has the following laboratory results: BNP 1,200 pg/mL, potassium 5.8
mEq/L, creatinine 2.3 mg/dL. The client is prescribed spironolactone 25 mg daily. Which action should
the nurse take?
