HESI Medical-Surgical Nursing Exam Prep
Lewis's Medical-Surgical Nursing 12th Edition
by Mariann M. Harding, Jeffrey Kwong, Dottie
Roberts, Debra Hagler, and Courtney Reinisch
latest edition with answers and rationales
qualified 100% pass!!!!!
,NGN-style clinical judgment questions
• Prioritization (who to see first)
• Safety and risk reduction
• Delegation (RN vs LPN vs UAP)
• Complex case studies
• Pharmacology in medical-surgical settings
• Fluid, electrolyte, and acid-base balance
SECTION 1: NGN-STYLE CASE STUDY (MEDICAL-SURGICAL CORE)
Scenario: Acute Heart Failure Exacerbation
A 68-year-old patient is admitted with worsening shortness of breath.
Assessment Findings:
• BP: 90/60 mmHg
• HR: 118 bpm
• RR: 32/min
• SpO₂: 86% on room air
• Crackles in both lungs
• 3+ pitting edema
Question 1: Recognizing Cues
Which findings are MOST concerning?
A. Bilateral crackles
B. SpO₂ 86%
C. 3+ edema
D. Fatigue
✔ Correct Answer: B. SpO₂ 86%
Rationale:
,Low oxygen saturation indicates immediate respiratory compromise, making it the highest
priority.
Question 2: Prioritization
What is the nurse’s FIRST action?
A. Give IV diuretics
B. Apply oxygen
C. Raise head of bed
D. Notify provider
✔ Correct Answer: B. Apply oxygen
Rationale:
ABCs apply—oxygenation comes first before medications or notifications.
Question 3: Nursing Action
Which intervention will MOST improve fluid overload?
A. Restrict sodium
B. Administer furosemide
C. Increase oral fluids
D. Encourage ambulation
✔ Correct Answer: B. Administer furosemide
Rationale:
Loop diuretics remove excess fluid, improving pulmonary congestion.
SECTION 2: CARDIOVASCULAR SYSTEM
Myocardial Infarction (MI)
Classic Symptoms:
• Chest pain radiating to left arm/jaw
• Diaphoresis
, • Nausea
• Shortness of breath
HESI Question:
A patient reports chest pain 9/10. What should the nurse do first?
✔ Answer: Administer oxygen and obtain ECG
Rationale:
Cardiac tissue is oxygen-sensitive; immediate oxygen improves perfusion.
Heart Failure Key Concept:
Left-sided failure → pulmonary edema
Right-sided failure → peripheral edema
SECTION 3: RESPIRATORY SYSTEM
COPD Exacerbation
ABG Pattern:
• ↑ CO₂
• ↓ pH
• Respiratory acidosis
Priority Question:
Which patient requires immediate intervention?
A. COPD patient with oxygen saturation 90%
B. COPD patient using accessory muscles
C. COPD patient coughing sputum
D. COPD patient requesting inhaler
✔ Correct Answer: B
Lewis's Medical-Surgical Nursing 12th Edition
by Mariann M. Harding, Jeffrey Kwong, Dottie
Roberts, Debra Hagler, and Courtney Reinisch
latest edition with answers and rationales
qualified 100% pass!!!!!
,NGN-style clinical judgment questions
• Prioritization (who to see first)
• Safety and risk reduction
• Delegation (RN vs LPN vs UAP)
• Complex case studies
• Pharmacology in medical-surgical settings
• Fluid, electrolyte, and acid-base balance
SECTION 1: NGN-STYLE CASE STUDY (MEDICAL-SURGICAL CORE)
Scenario: Acute Heart Failure Exacerbation
A 68-year-old patient is admitted with worsening shortness of breath.
Assessment Findings:
• BP: 90/60 mmHg
• HR: 118 bpm
• RR: 32/min
• SpO₂: 86% on room air
• Crackles in both lungs
• 3+ pitting edema
Question 1: Recognizing Cues
Which findings are MOST concerning?
A. Bilateral crackles
B. SpO₂ 86%
C. 3+ edema
D. Fatigue
✔ Correct Answer: B. SpO₂ 86%
Rationale:
,Low oxygen saturation indicates immediate respiratory compromise, making it the highest
priority.
Question 2: Prioritization
What is the nurse’s FIRST action?
A. Give IV diuretics
B. Apply oxygen
C. Raise head of bed
D. Notify provider
✔ Correct Answer: B. Apply oxygen
Rationale:
ABCs apply—oxygenation comes first before medications or notifications.
Question 3: Nursing Action
Which intervention will MOST improve fluid overload?
A. Restrict sodium
B. Administer furosemide
C. Increase oral fluids
D. Encourage ambulation
✔ Correct Answer: B. Administer furosemide
Rationale:
Loop diuretics remove excess fluid, improving pulmonary congestion.
SECTION 2: CARDIOVASCULAR SYSTEM
Myocardial Infarction (MI)
Classic Symptoms:
• Chest pain radiating to left arm/jaw
• Diaphoresis
, • Nausea
• Shortness of breath
HESI Question:
A patient reports chest pain 9/10. What should the nurse do first?
✔ Answer: Administer oxygen and obtain ECG
Rationale:
Cardiac tissue is oxygen-sensitive; immediate oxygen improves perfusion.
Heart Failure Key Concept:
Left-sided failure → pulmonary edema
Right-sided failure → peripheral edema
SECTION 3: RESPIRATORY SYSTEM
COPD Exacerbation
ABG Pattern:
• ↑ CO₂
• ↓ pH
• Respiratory acidosis
Priority Question:
Which patient requires immediate intervention?
A. COPD patient with oxygen saturation 90%
B. COPD patient using accessory muscles
C. COPD patient coughing sputum
D. COPD patient requesting inhaler
✔ Correct Answer: B
