GNIRPS • GRUS-DEM
HESI
HESI Health Education Systems Incorporated
EXCELLENCE IN NURSING ASSESSMENT
EST. 1983
Medical-Surgical Nursing Spring
H E S I CO M P R E H E N S I V E E X A M I N AT I O N — V E R I F I E D A N S W E R S & R AT I O N A L E S
INSTITUTION HESI / Elsevier Health Sciences COURSE CODE HESI-MS-SPRING
PROGRAM Nursing — NCLEX Preparation ACADEMIC YEAR
EXAM TITLE Hesi Med Surg Spring TOTAL QUESTIONS 55+ Questions
COURSE TITLE Medical-Surgical Nursing FORMAT Multiple Choice / Select All That Apply /
Case Studies
EXAMINATION INSTRUCTIONS
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Questions cover medical-surgical nursing, pharmacology, prioritization, and clinical judgment.
▸ Verified answers with detailed rationales are provided for comprehensive review.
▸ Pay close attention to prioritization, emergency interventions, and medication safety.
HESI MED SURG SPRING — COMPREHENSIVE EXAMINATION Questions 1 – 55+
1. Which question has the most importance when the nurse admits a patient with a diagnosis of acute
glomerulonephritis?
A. "Have you recently had strep throat?"
B. "Do you have susceptibility to allergies?"
C. "How much fluid do you drink in a day?"
D. "Have you had any contact with anyone who has measles?"
CORRECT ANSWER A — "Have you recently had strep throat?"
RATIONALE Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is caused by
an antigen-antibody reaction to Group A beta-hemolytic streptococcus. Identifying recent strep infection is
key to confirming the etiology.
,2. Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been
successful?
A. Split-pea soup, English muffin, and nonfat milk
B. Oatmeal with cream, half a banana, and herbal tea
C. Cheese sandwich, tomato soup, and cranberry juice
D. Poached eggs, whole-wheat toast, and apple juice
CORRECT ANSWER D — Poached eggs, whole-wheat toast, and apple juice
RATIONALE Hemodialysis clients need a high-quality protein, low-potassium, low-phosphorus, and low-sodium diet.
Poached eggs provide high-quality protein, whole-wheat toast is low in potassium, and apple juice is low in
potassium. Split-pea soup, banana, and tomato soup are high in potassium.
3. After receiving change-of-shift report, which patient would the nurse assess first?
A. Patient with stage 4 CKD who has an elevated phosphate level
B. Patient with stage 5 CKD who has a potassium level of 3.4 mEq/L
C. Patient who has just returned from hemodialysis with a heart rate of 110/min
D. Patient scheduled for the drain phase of a peritoneal dialysis exchange
CORRECT ANSWER C — Patient who has just returned from hemodialysis with a heart rate of 110/min
RATIONALE Tachycardia after hemodialysis may indicate hypovolemia, bleeding from the access site, or cardiac
dysrhythmia. This patient requires immediate assessment as these are potentially life-threatening
complications. The other patients are more stable.
4. The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which would
the nurse expect to note in this client?
A. Decreased serum lipids
B. Signs of fluid volume deficit
C. Decreased protein in the urine
D. Decreased serum albumin levels
CORRECT ANSWER D — Decreased serum albumin levels
RATIONALE Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia (decreased serum albumin),
hyperlipidemia, and edema. The loss of protein (primarily albumin) in the urine leads to decreased serum
albumin, which causes decreased oncotic pressure and edema.
5. The laboratory reports of a patient brought to the ED with symptoms of dehydration show high glucose, large
ketone bodies in urine, decreased serum bicarbonate, and acidic blood pH. Administration of which prescribed
intervention would help stabilize this patient? (Select all that apply.)
A. Glucagon IM
B. 50% Glucose IV
C. Short-acting (Regular) insulin IV
D. Fluids IV
CORRECT ANSWER C, D
RATIONALE The lab results indicate diabetic ketoacidosis (DKA). Treatment requires IV fluids to correct dehydration and IV
regular insulin to lower blood glucose and reverse ketosis. Glucagon would raise glucose further. 50% glucose
IV is for hypoglycemia, not hyperglycemia.
, 6. A nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the
insulin dose appropriate for a reading over 200 mg/dL before breakfast. Which is the nurse's priority action?
A. Give the client 15 to 20 g of carbohydrate.
B. Notify the nurse manager.
C. Complete an incident report.
D. Monitor the client for hypoglycemia.
CORRECT ANSWER D — Monitor the client for hypoglycemia
RATIONALE The client received excessive insulin based on an incorrect reading. The priority is monitoring for
hypoglycemia, which can occur rapidly. The nurse should check blood glucose frequently and be prepared to
administer carbohydrates if hypoglycemia develops.
7. A 46-year-old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and
sulfamethoxazole for 3 days. Which action will the nurse plan to take?
A. Remind the patient about the need to drink 1000 mL of fluids daily.
B. Obtain a midstream urine specimen for culture and sensitivity testing.
C. Suggest that the patient use acetaminophen to relieve symptoms.
D. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days.
CORRECT ANSWER B — Obtain a midstream urine specimen for culture and sensitivity testing
RATIONALE Because uncomplicated UTIs are usually successfully treated with 3 days of antibiotics, persistent symptoms
suggest treatment failure. A urine culture and sensitivity is needed to identify the organism and determine
appropriate antibiotic therapy.
8. Which statement by a 22-year-old female patient with cystitis indicates that instruction about preventing future
UTIs has been effective?
A. "I can use vaginal antiseptic sprays to reduce bacteria."
B. "I will drink a quart of water or other fluids every day."
C. "I will wash with soap and water before sexual intercourse."
D. "I will empty my bladder every 3 to 4 hours during the day."
CORRECT ANSWER D — "I will empty my bladder every 3 to 4 hours during the day."
RATIONALE Voiding every 3-4 hours prevents urinary stasis and bacterial growth. Vaginal sprays are discouraged. A quart
of fluid is insufficient for adequate urine output to prevent UTI. Washing with soap before intercourse is not
necessary.
9. Which information about phenazopyridine will the nurse teach the patient with a UTI?
A. Take the drug for at least 7 days.
B. The drug may cause photosensitivity.
C. The drug may change your urine color.
D. Take the drug before sexual intercourse.
CORRECT ANSWER C — The drug may change your urine color
RATIONALE Phenazopyridine (Pyridium) is a urinary analgesic that turns urine a deep orange-red color. Patients should be
informed of this expected effect to avoid alarm. It does not cause photosensitivity and is taken only as needed
for dysuria, not as a preventive.
HESI
HESI Health Education Systems Incorporated
EXCELLENCE IN NURSING ASSESSMENT
EST. 1983
Medical-Surgical Nursing Spring
H E S I CO M P R E H E N S I V E E X A M I N AT I O N — V E R I F I E D A N S W E R S & R AT I O N A L E S
INSTITUTION HESI / Elsevier Health Sciences COURSE CODE HESI-MS-SPRING
PROGRAM Nursing — NCLEX Preparation ACADEMIC YEAR
EXAM TITLE Hesi Med Surg Spring TOTAL QUESTIONS 55+ Questions
COURSE TITLE Medical-Surgical Nursing FORMAT Multiple Choice / Select All That Apply /
Case Studies
EXAMINATION INSTRUCTIONS
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Questions cover medical-surgical nursing, pharmacology, prioritization, and clinical judgment.
▸ Verified answers with detailed rationales are provided for comprehensive review.
▸ Pay close attention to prioritization, emergency interventions, and medication safety.
HESI MED SURG SPRING — COMPREHENSIVE EXAMINATION Questions 1 – 55+
1. Which question has the most importance when the nurse admits a patient with a diagnosis of acute
glomerulonephritis?
A. "Have you recently had strep throat?"
B. "Do you have susceptibility to allergies?"
C. "How much fluid do you drink in a day?"
D. "Have you had any contact with anyone who has measles?"
CORRECT ANSWER A — "Have you recently had strep throat?"
RATIONALE Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is caused by
an antigen-antibody reaction to Group A beta-hemolytic streptococcus. Identifying recent strep infection is
key to confirming the etiology.
,2. Which menu choice by the patient who is receiving hemodialysis indicates that the nurse's teaching has been
successful?
A. Split-pea soup, English muffin, and nonfat milk
B. Oatmeal with cream, half a banana, and herbal tea
C. Cheese sandwich, tomato soup, and cranberry juice
D. Poached eggs, whole-wheat toast, and apple juice
CORRECT ANSWER D — Poached eggs, whole-wheat toast, and apple juice
RATIONALE Hemodialysis clients need a high-quality protein, low-potassium, low-phosphorus, and low-sodium diet.
Poached eggs provide high-quality protein, whole-wheat toast is low in potassium, and apple juice is low in
potassium. Split-pea soup, banana, and tomato soup are high in potassium.
3. After receiving change-of-shift report, which patient would the nurse assess first?
A. Patient with stage 4 CKD who has an elevated phosphate level
B. Patient with stage 5 CKD who has a potassium level of 3.4 mEq/L
C. Patient who has just returned from hemodialysis with a heart rate of 110/min
D. Patient scheduled for the drain phase of a peritoneal dialysis exchange
CORRECT ANSWER C — Patient who has just returned from hemodialysis with a heart rate of 110/min
RATIONALE Tachycardia after hemodialysis may indicate hypovolemia, bleeding from the access site, or cardiac
dysrhythmia. This patient requires immediate assessment as these are potentially life-threatening
complications. The other patients are more stable.
4. The nurse is reviewing the assessment findings for a client with a diagnosis of nephrotic syndrome. Which would
the nurse expect to note in this client?
A. Decreased serum lipids
B. Signs of fluid volume deficit
C. Decreased protein in the urine
D. Decreased serum albumin levels
CORRECT ANSWER D — Decreased serum albumin levels
RATIONALE Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia (decreased serum albumin),
hyperlipidemia, and edema. The loss of protein (primarily albumin) in the urine leads to decreased serum
albumin, which causes decreased oncotic pressure and edema.
5. The laboratory reports of a patient brought to the ED with symptoms of dehydration show high glucose, large
ketone bodies in urine, decreased serum bicarbonate, and acidic blood pH. Administration of which prescribed
intervention would help stabilize this patient? (Select all that apply.)
A. Glucagon IM
B. 50% Glucose IV
C. Short-acting (Regular) insulin IV
D. Fluids IV
CORRECT ANSWER C, D
RATIONALE The lab results indicate diabetic ketoacidosis (DKA). Treatment requires IV fluids to correct dehydration and IV
regular insulin to lower blood glucose and reverse ketosis. Glucagon would raise glucose further. 50% glucose
IV is for hypoglycemia, not hyperglycemia.
, 6. A nurse misread the client's morning blood glucose level as 210 mg/dL instead of 120 mg/dL and administered the
insulin dose appropriate for a reading over 200 mg/dL before breakfast. Which is the nurse's priority action?
A. Give the client 15 to 20 g of carbohydrate.
B. Notify the nurse manager.
C. Complete an incident report.
D. Monitor the client for hypoglycemia.
CORRECT ANSWER D — Monitor the client for hypoglycemia
RATIONALE The client received excessive insulin based on an incorrect reading. The priority is monitoring for
hypoglycemia, which can occur rapidly. The nurse should check blood glucose frequently and be prepared to
administer carbohydrates if hypoglycemia develops.
7. A 46-year-old female patient returns to the clinic with continued dysuria after being treated with trimethoprim and
sulfamethoxazole for 3 days. Which action will the nurse plan to take?
A. Remind the patient about the need to drink 1000 mL of fluids daily.
B. Obtain a midstream urine specimen for culture and sensitivity testing.
C. Suggest that the patient use acetaminophen to relieve symptoms.
D. Tell the patient to take the trimethoprim and sulfamethoxazole for 3 more days.
CORRECT ANSWER B — Obtain a midstream urine specimen for culture and sensitivity testing
RATIONALE Because uncomplicated UTIs are usually successfully treated with 3 days of antibiotics, persistent symptoms
suggest treatment failure. A urine culture and sensitivity is needed to identify the organism and determine
appropriate antibiotic therapy.
8. Which statement by a 22-year-old female patient with cystitis indicates that instruction about preventing future
UTIs has been effective?
A. "I can use vaginal antiseptic sprays to reduce bacteria."
B. "I will drink a quart of water or other fluids every day."
C. "I will wash with soap and water before sexual intercourse."
D. "I will empty my bladder every 3 to 4 hours during the day."
CORRECT ANSWER D — "I will empty my bladder every 3 to 4 hours during the day."
RATIONALE Voiding every 3-4 hours prevents urinary stasis and bacterial growth. Vaginal sprays are discouraged. A quart
of fluid is insufficient for adequate urine output to prevent UTI. Washing with soap before intercourse is not
necessary.
9. Which information about phenazopyridine will the nurse teach the patient with a UTI?
A. Take the drug for at least 7 days.
B. The drug may cause photosensitivity.
C. The drug may change your urine color.
D. Take the drug before sexual intercourse.
CORRECT ANSWER C — The drug may change your urine color
RATIONALE Phenazopyridine (Pyridium) is a urinary analgesic that turns urine a deep orange-red color. Patients should be
informed of this expected effect to avoid alarm. It does not cause photosensitivity and is taken only as needed
for dysuria, not as a preventive.
