HESI Med-Surg Exam Prep – Real Practice Questions, Answers & Detailed
Rationales (Updated 2026) | Cardiovascular, Respiratory &
Neurological Disorders, Endocrine & Gastrointestinal Nursing Care, Fluid
& Electrolyte Balance, Pharmacology & Medication Administration, Patient
Safety, Prioritization & Delegation, NCLEX-Style Clinical Judgment,
Medical-Surgical Nursing Review
Question 1: A nurse is caring for a client with heart failure who reports increased
shortness of breath. The nurse notes bilateral crackles in the lungs and 3+ pitting
edema in the lower extremities. Which intervention should the nurse implement
first?
A. Administer the scheduled dose of furosemide
B. Place the client in high Fowler's position
C. Obtain a stat chest x-ray
D. Notify the healthcare provider of the findings
CORRECT ANSWER: B. Place the client in high Fowler's position
Rationale: Positioning the client in high Fowler's position is the priority intervention
because it immediately improves lung expansion and reduces the work of breathing by
decreasing venous return to the heart. While administering diuretics, obtaining
diagnostic tests, and notifying the provider are important, optimizing the client's
respiratory status takes precedence according to the ABCs (Airway, Breathing,
Circulation) of nursing care.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse notes the client is
becoming increasingly confused and has a headache. Which action should the
nurse take first?
A. Increase the oxygen flow rate to 4 L/min
B. Assess the client's oxygen saturation level
C. Notify the healthcare provider immediately
D. Document the findings in the electronic health record
CORRECT ANSWER: B. Assess the client's oxygen saturation level
Rationale: Before implementing any interventions, the nurse must first assess the
client's current oxygen saturation level to determine if hypoxemia or hypercapnia is
causing the confusion and headache. In clients with COPD, excessive oxygen can
suppress the hypoxic drive to breathe, leading to carbon dioxide retention. Assessment
guides safe, evidence-based intervention.
Question 3: A nurse is preparing to administer digoxin 0.25 mg orally to a client with
atrial fibrillation. The client's apical pulse is 58 beats per minute. Which action
should the nurse take?
,A. Administer the medication as prescribed
B. Hold the medication and notify the healthcare provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes before administering
CORRECT ANSWER: B. Hold the medication and notify the healthcare provider
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats per minute in
adults due to the risk of severe bradycardia and heart block. The nurse must hold the
dose and notify the healthcare provider for further instructions, as administering digoxin
with a low heart rate can exacerbate bradyarrhythmias and cause life-threatening
complications.
Question 4: A client who had a total hip replacement 2 days ago suddenly reports
chest pain and shortness of breath. The nurse notes the client is tachycardic and
has an oxygen saturation of 88% on room air. Which condition should the nurse
suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumonia
D. Atelectasis
CORRECT ANSWER: B. Pulmonary embolism
Rationale: Following orthopedic surgery, particularly hip replacement, clients are at
high risk for deep vein thrombosis and subsequent pulmonary embolism. The sudden
onset of chest pain, dyspnea, tachycardia, and hypoxemia are classic signs of
pulmonary embolism. Immediate intervention is required, including administering
oxygen and notifying the healthcare provider.
Question 5: A nurse is caring for a client with a nasogastric tube connected to low
intermittent suction. Which assessment finding indicates the tube is functioning
properly?
A. The client reports feeling nauseated
B. Greenish-yellow drainage is present in the collection container
C. The client's abdomen is distended and firm
D. The suction gauge reads zero
CORRECT ANSWER: B. Greenish-yellow drainage is present in the collection
container
Rationale: The presence of greenish-yellow gastric drainage in the collection container
indicates that the nasogastric tube is patent and effectively removing gastric contents.
Nausea, abdominal distension, or a suction gauge reading zero suggest the tube may be
clogged, displaced, or not functioning properly and requires further assessment.
,Question 6: A client with type 1 diabetes mellitus is experiencing diaphoresis,
tremors, and confusion. The nurse checks the blood glucose level and obtains a
result of 48 mg/dL. Which intervention should the nurse implement first?
A. Administer 1 mg glucagon intramuscularly
B. Provide 4 ounces of orange juice orally
C. Start an intravenous line with normal saline
D. Recheck the blood glucose level in 15 minutes
CORRECT ANSWER: B. Provide 4 ounces of orange juice orally
Rationale: For a conscious client with mild to moderate hypoglycemia (blood glucose
<70 mg/dL), the first-line treatment is 15-20 grams of fast-acting carbohydrate orally,
such as 4 ounces of fruit juice. Glucagon is reserved for unconscious clients or those
unable to swallow. IV access may be needed if the client deteriorates, but oral glucose
is the priority for an alert client.
Question 7: A nurse is assessing a client who is 6 hours postoperative from a bowel
resection. Which finding requires immediate notification of the healthcare
provider?
A. Temperature of 99.2°F (37.3°C)
B. Absent bowel sounds in all four quadrants
C. Serous drainage on the abdominal dressing
D. Urine output of 25 mL in the past hour
CORRECT ANSWER: D. Urine output of 25 mL in the past hour
Rationale: Urine output less than 30 mL/hour in an adult indicates inadequate renal
perfusion and may signal hypovolemia, hemorrhage, or acute kidney injury. This finding
requires immediate notification of the healthcare provider. Absent bowel sounds are
expected in the immediate postoperative period, low-grade fever is common, and
serous drainage is normal.
Question 8: A client with chronic kidney disease has a serum potassium level of 6.8
mEq/L. Which electrocardiogram (ECG) change should the nurse anticipate?
A. Prolonged PR interval
B. Peaked T waves
C. Depressed ST segment
D. Prominent U waves
CORRECT ANSWER: B. Peaked T waves
Rationale: Hyperkalemia (potassium >5.0 mEq/L) causes characteristic ECG changes,
with peaked, narrow T waves being the earliest and most common finding. As
potassium levels rise further, additional changes include widened QRS complexes,
prolonged PR intervals, and eventually a sine wave pattern. Prompt treatment is
essential to prevent life-threatening arrhythmias.
, Question 9: A nurse is caring for a client with a closed chest tube drainage system.
Which action should the nurse take to ensure proper system function?
A. Clamp the chest tube when ambulating the client
B. Keep the drainage system below the level of the chest
C. Empty the collection chamber when it is completely full
D. Strip the chest tube every 2 hours to maintain patency
CORRECT ANSWER: B. Keep the drainage system below the level of the chest
Rationale: The chest tube drainage system must always be kept below the level of the
client's chest to prevent backflow of drainage into the pleural space, which could cause
infection or tension pneumothorax. Clamping a chest tube without a provider order is
dangerous, the collection chamber should be emptied before it is full, and stripping
chest tubes is no longer routinely recommended due to risk of tissue trauma.
Question 10: A client with a history of peptic ulcer disease reports sudden, severe
abdominal pain that radiates to the back. The abdomen is rigid and board-like.
Which complication should the nurse suspect?
A. Gastric hemorrhage
B. Bowel obstruction
C. Perforation
D. Pyloric stenosis
CORRECT ANSWER: C. Perforation
Rationale: Sudden, severe abdominal pain with a rigid, board-like abdomen is classic
for perforation of a peptic ulcer, which allows gastric contents to leak into the peritoneal
cavity causing peritonitis. This is a surgical emergency requiring immediate intervention.
Hemorrhage typically presents with hematemesis or melena, obstruction with vomiting
and distension, and stenosis with projectile vomiting.
Question 11: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Assess the client's IV site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse
Rationale: Before initiating any blood transfusion, two registered nurses must verify the
blood product against the client's identification, crossmatch report, and physician order
to prevent transfusion errors. While obtaining baseline vital signs, assessing IV patency,
and priming tubing with normal saline are important steps, the two-nurse verification is
the critical safety step that must occur immediately before starting the transfusion.
Rationales (Updated 2026) | Cardiovascular, Respiratory &
Neurological Disorders, Endocrine & Gastrointestinal Nursing Care, Fluid
& Electrolyte Balance, Pharmacology & Medication Administration, Patient
Safety, Prioritization & Delegation, NCLEX-Style Clinical Judgment,
Medical-Surgical Nursing Review
Question 1: A nurse is caring for a client with heart failure who reports increased
shortness of breath. The nurse notes bilateral crackles in the lungs and 3+ pitting
edema in the lower extremities. Which intervention should the nurse implement
first?
A. Administer the scheduled dose of furosemide
B. Place the client in high Fowler's position
C. Obtain a stat chest x-ray
D. Notify the healthcare provider of the findings
CORRECT ANSWER: B. Place the client in high Fowler's position
Rationale: Positioning the client in high Fowler's position is the priority intervention
because it immediately improves lung expansion and reduces the work of breathing by
decreasing venous return to the heart. While administering diuretics, obtaining
diagnostic tests, and notifying the provider are important, optimizing the client's
respiratory status takes precedence according to the ABCs (Airway, Breathing,
Circulation) of nursing care.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse notes the client is
becoming increasingly confused and has a headache. Which action should the
nurse take first?
A. Increase the oxygen flow rate to 4 L/min
B. Assess the client's oxygen saturation level
C. Notify the healthcare provider immediately
D. Document the findings in the electronic health record
CORRECT ANSWER: B. Assess the client's oxygen saturation level
Rationale: Before implementing any interventions, the nurse must first assess the
client's current oxygen saturation level to determine if hypoxemia or hypercapnia is
causing the confusion and headache. In clients with COPD, excessive oxygen can
suppress the hypoxic drive to breathe, leading to carbon dioxide retention. Assessment
guides safe, evidence-based intervention.
Question 3: A nurse is preparing to administer digoxin 0.25 mg orally to a client with
atrial fibrillation. The client's apical pulse is 58 beats per minute. Which action
should the nurse take?
,A. Administer the medication as prescribed
B. Hold the medication and notify the healthcare provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes before administering
CORRECT ANSWER: B. Hold the medication and notify the healthcare provider
Rationale: Digoxin should be withheld if the apical pulse is below 60 beats per minute in
adults due to the risk of severe bradycardia and heart block. The nurse must hold the
dose and notify the healthcare provider for further instructions, as administering digoxin
with a low heart rate can exacerbate bradyarrhythmias and cause life-threatening
complications.
Question 4: A client who had a total hip replacement 2 days ago suddenly reports
chest pain and shortness of breath. The nurse notes the client is tachycardic and
has an oxygen saturation of 88% on room air. Which condition should the nurse
suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumonia
D. Atelectasis
CORRECT ANSWER: B. Pulmonary embolism
Rationale: Following orthopedic surgery, particularly hip replacement, clients are at
high risk for deep vein thrombosis and subsequent pulmonary embolism. The sudden
onset of chest pain, dyspnea, tachycardia, and hypoxemia are classic signs of
pulmonary embolism. Immediate intervention is required, including administering
oxygen and notifying the healthcare provider.
Question 5: A nurse is caring for a client with a nasogastric tube connected to low
intermittent suction. Which assessment finding indicates the tube is functioning
properly?
A. The client reports feeling nauseated
B. Greenish-yellow drainage is present in the collection container
C. The client's abdomen is distended and firm
D. The suction gauge reads zero
CORRECT ANSWER: B. Greenish-yellow drainage is present in the collection
container
Rationale: The presence of greenish-yellow gastric drainage in the collection container
indicates that the nasogastric tube is patent and effectively removing gastric contents.
Nausea, abdominal distension, or a suction gauge reading zero suggest the tube may be
clogged, displaced, or not functioning properly and requires further assessment.
,Question 6: A client with type 1 diabetes mellitus is experiencing diaphoresis,
tremors, and confusion. The nurse checks the blood glucose level and obtains a
result of 48 mg/dL. Which intervention should the nurse implement first?
A. Administer 1 mg glucagon intramuscularly
B. Provide 4 ounces of orange juice orally
C. Start an intravenous line with normal saline
D. Recheck the blood glucose level in 15 minutes
CORRECT ANSWER: B. Provide 4 ounces of orange juice orally
Rationale: For a conscious client with mild to moderate hypoglycemia (blood glucose
<70 mg/dL), the first-line treatment is 15-20 grams of fast-acting carbohydrate orally,
such as 4 ounces of fruit juice. Glucagon is reserved for unconscious clients or those
unable to swallow. IV access may be needed if the client deteriorates, but oral glucose
is the priority for an alert client.
Question 7: A nurse is assessing a client who is 6 hours postoperative from a bowel
resection. Which finding requires immediate notification of the healthcare
provider?
A. Temperature of 99.2°F (37.3°C)
B. Absent bowel sounds in all four quadrants
C. Serous drainage on the abdominal dressing
D. Urine output of 25 mL in the past hour
CORRECT ANSWER: D. Urine output of 25 mL in the past hour
Rationale: Urine output less than 30 mL/hour in an adult indicates inadequate renal
perfusion and may signal hypovolemia, hemorrhage, or acute kidney injury. This finding
requires immediate notification of the healthcare provider. Absent bowel sounds are
expected in the immediate postoperative period, low-grade fever is common, and
serous drainage is normal.
Question 8: A client with chronic kidney disease has a serum potassium level of 6.8
mEq/L. Which electrocardiogram (ECG) change should the nurse anticipate?
A. Prolonged PR interval
B. Peaked T waves
C. Depressed ST segment
D. Prominent U waves
CORRECT ANSWER: B. Peaked T waves
Rationale: Hyperkalemia (potassium >5.0 mEq/L) causes characteristic ECG changes,
with peaked, narrow T waves being the earliest and most common finding. As
potassium levels rise further, additional changes include widened QRS complexes,
prolonged PR intervals, and eventually a sine wave pattern. Prompt treatment is
essential to prevent life-threatening arrhythmias.
, Question 9: A nurse is caring for a client with a closed chest tube drainage system.
Which action should the nurse take to ensure proper system function?
A. Clamp the chest tube when ambulating the client
B. Keep the drainage system below the level of the chest
C. Empty the collection chamber when it is completely full
D. Strip the chest tube every 2 hours to maintain patency
CORRECT ANSWER: B. Keep the drainage system below the level of the chest
Rationale: The chest tube drainage system must always be kept below the level of the
client's chest to prevent backflow of drainage into the pleural space, which could cause
infection or tension pneumothorax. Clamping a chest tube without a provider order is
dangerous, the collection chamber should be emptied before it is full, and stripping
chest tubes is no longer routinely recommended due to risk of tissue trauma.
Question 10: A client with a history of peptic ulcer disease reports sudden, severe
abdominal pain that radiates to the back. The abdomen is rigid and board-like.
Which complication should the nurse suspect?
A. Gastric hemorrhage
B. Bowel obstruction
C. Perforation
D. Pyloric stenosis
CORRECT ANSWER: C. Perforation
Rationale: Sudden, severe abdominal pain with a rigid, board-like abdomen is classic
for perforation of a peptic ulcer, which allows gastric contents to leak into the peritoneal
cavity causing peritonitis. This is a surgical emergency requiring immediate intervention.
Hemorrhage typically presents with hematemesis or melena, obstruction with vomiting
and distension, and stenosis with projectile vomiting.
Question 11: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take immediately before starting the transfusion?
A. Prime the blood tubing with normal saline
B. Verify the blood product with another registered nurse
C. Obtain baseline vital signs
D. Assess the client's IV site for patency
CORRECT ANSWER: B. Verify the blood product with another registered nurse
Rationale: Before initiating any blood transfusion, two registered nurses must verify the
blood product against the client's identification, crossmatch report, and physician order
to prevent transfusion errors. While obtaining baseline vital signs, assessing IV patency,
and priming tubing with normal saline are important steps, the two-nurse verification is
the critical safety step that must occur immediately before starting the transfusion.
