H
★ ★
HESI
2 GR U S - D E M
Health Education Systems, Inc. — An Elsevier Company
A S S E S S M E N T S O L U T I O N S F O R H E A LT H C A R E E D U C AT I O N
1974
HESI Medical-Surgical Nursing 2
COMPREHENSIVE PRACTICE EXAMINATION WITH DETAILED RATIONALES
INSTITUTION HESI — Health Education Systems, Inc. (Elsevier) COURSE HESI-MEDSURG-2
PROGRAM BSN Pre-Licensure Nursing Exit Exam YEAR
FORMAT Multiple Choice & Select All That Apply
INSTRUCTIONS
▸ Select the single best answer or all correct answers as directed. Covers endocrine, cardiac, respiratory, GI, renal, neurology, oncology, infectious disease, and
perioperative nursing.
▸ Correct answers with detailed rationales provided.
HESI MED-SURG 2 — COMPLETE EXAMINATION Full Set
1. A client is admitted after being lost for four days hiking. TSH is elevated. Which additional assessment should the nurse make?
A. Body mass index.
B. Exposure to cold environmental temperatures.
C. Skin elasticity and turgor.
D. Thought processes and speech.
B Exposure to cold environmental temperatures.
RATIONALE TSH influences thyroxine secretion which increases metabolism to maintain body temperature. Prolonged cold exposure stimulates the
hypothalamus to secrete TRH, increasing anterior pituitary TSH release.
2. A client asks about beginning chemotherapy because the tumor is still very small. Which information supports the explanation?
A. Side effects are less likely if therapy is started early.
B. The cell count of the tumor reduces by half with each dose.
C. Collateral circulation increases as the tumor grows.
D. Sensitivity of cancer cells to CT is based on cell cycle rate.
B 50% of cancer cells are killed with each dose; starting while the tumor is small provides a better chance of eradicating all cancer cells.
RATIONALE Chemotherapy follows first-order kinetics: a constant proportion (not number) of cells is killed with each cycle. A smaller tumor requires
fewer cycles to achieve complete remission.
3. Which finding should the nurse report for a client with a circumferential extremity burn?
A. Full thickness burns rather than partial thickness.
B. Slow capillary refill in the digits with absent distal pulse points.
C. Supinates extremity but unable to fully pronate.
D. Inability to distinguish sharp versus dull sensations.
B Slow capillary refill and absent distal pulses indicate compromised circulation requiring escharotomy.
RATIONALE A circumferential burn can form an eschar that acts as a tourniquet as edema increases tissue pressure, compromising distal blood flow.
4. A male client 3 hours post-inguinal herniorrhaphy has a distended lower abdomen with dullness to percussion. What is the priority
nursing action?
A. Assess vital signs.
B. Determine the time the client last voided.
C. Insert a rectal tube for flatus.
D. Document the finding.
B Swelling at the surgical site can impact the bladder and prostate, causing difficulty voiding. Determine last void time.
RATIONALE Postoperative swelling near the inguinal area can compress the urethra, causing urinary retention. Determining when the client last voided
provides data supporting bladder distention.
, 5. After a TURP, the client's urinary catheter is not draining. What should the nurse implement?
A. Reposition the catheter drainage tubing.
B. Irrigate the catheter.
C. Encourage oral fluids.
D. Change the drainage unit tubing.
B Sterile irrigation should be implemented to remove blood clots blocking the catheter.
RATIONALE Obstruction after TURP is most often due to blood clots. Sterile irrigation removes clots and restores catheter patency.
6. The nurse explains to a client with lung cancer that pleurodesis is performed to achieve which outcome?
A. Prevent the formation of effusion fluid.
B. Remove fluid from the intrapleural space.
C. Debulk tumor to maintain airway patency.
D. Relieve empyema after pneumonectomy.
A Instillation of a sclerosing agent seals the pleural spaces together, preventing fluid accumulation.
RATIONALE Pleurodesis creates adhesions between the visceral and parietal pleura, obliterating the pleural space and preventing recurrent effusion.
7. A college student has a vaginal infection with "cottage-cheese" discharge. Which prescription should the nurse implement first?
A. Cleanse perineum with warm soapy water.
B. Instill the first dose of nystatin (Mycostatin) vaginally per applicator.
C. Perform glucose measurement.
D. Obtain blood specimen for STDs.
B Candidiasis (yeast infection) — vaginal nystatin should be initiated first for symptom relief.
RATIONALE The characteristic "cottage-cheese" discharge confirms candidiasis. Nystatin is the first-line topical antifungal treatment.
8. A client with blunt abdominal injury has which assessment finding requiring immediate action?
A. Radiating abdominal pain with LLQ palpation.
B. Grimacing after palpation of the right hypochondriac region.
C. Rebound tenderness with abdominal palpation.
D. Bluish periumbilical skin discoloration.
D Periumbilical discoloration (Cullen's sign) indicates intraperitoneal hemorrhage and possible splenic rupture.
RATIONALE Cullen's sign is a life-threatening finding indicating retroperitoneal or intraperitoneal bleeding requiring immediate surgical evaluation.
9. Which observation should alert the nurse to call the Rapid Response Team for a client 2 days post-op?
A. Fresh bleeding on abdominal wound dressing.
B. Pulse change from 85 to 160 beats/minute lasting more than 10 minutes.
C. Temperature of 103.1°F and WBC 16,000.
D. Weakness, diaphoresis, BP 100/56.
B Sustained tachycardia for a prolonged period is an acute life-threatening change requiring RRT intervention.
RATIONALE A pulse increase from 85 to 160 sustained >10 minutes may indicate hemorrhage, sepsis, pulmonary embolism, or cardiac decompensation.
10. What assessment finding indicates an acute asthma exacerbation is improving after treatment?
A. Wheezing becomes louder.
B. Cough remains unproductive.
C. Vesicular breath sounds decrease.
D. Bronchodilators stimulate coughing.
A As airways open, airflow increases and wheezing becomes louder, indicating improvement.
RATIONALE In severe asthma, airflow may be so restricted that wheezing is diminished. Increasing wheeze indicates improved air movement through
narrowed airways.
11. A female client with type 2 DM reports dysuria. Which finding is most important to report?
A. Suprapubic pain and distention.
B. Bounding pulse at 100 beats/minute.
C. Fingerstick glucose of 300 mg/dL.
D. Small vesicular perineal lesions.
C Elevated glucose spills into urine, providing a medium for bacterial growth and requiring treatment adjustment.
RATIONALE Hyperglycemia promotes bacterial growth in the urinary tract. The glucose level must be reported so the plan of care can be adjusted.
★ ★
HESI
2 GR U S - D E M
Health Education Systems, Inc. — An Elsevier Company
A S S E S S M E N T S O L U T I O N S F O R H E A LT H C A R E E D U C AT I O N
1974
HESI Medical-Surgical Nursing 2
COMPREHENSIVE PRACTICE EXAMINATION WITH DETAILED RATIONALES
INSTITUTION HESI — Health Education Systems, Inc. (Elsevier) COURSE HESI-MEDSURG-2
PROGRAM BSN Pre-Licensure Nursing Exit Exam YEAR
FORMAT Multiple Choice & Select All That Apply
INSTRUCTIONS
▸ Select the single best answer or all correct answers as directed. Covers endocrine, cardiac, respiratory, GI, renal, neurology, oncology, infectious disease, and
perioperative nursing.
▸ Correct answers with detailed rationales provided.
HESI MED-SURG 2 — COMPLETE EXAMINATION Full Set
1. A client is admitted after being lost for four days hiking. TSH is elevated. Which additional assessment should the nurse make?
A. Body mass index.
B. Exposure to cold environmental temperatures.
C. Skin elasticity and turgor.
D. Thought processes and speech.
B Exposure to cold environmental temperatures.
RATIONALE TSH influences thyroxine secretion which increases metabolism to maintain body temperature. Prolonged cold exposure stimulates the
hypothalamus to secrete TRH, increasing anterior pituitary TSH release.
2. A client asks about beginning chemotherapy because the tumor is still very small. Which information supports the explanation?
A. Side effects are less likely if therapy is started early.
B. The cell count of the tumor reduces by half with each dose.
C. Collateral circulation increases as the tumor grows.
D. Sensitivity of cancer cells to CT is based on cell cycle rate.
B 50% of cancer cells are killed with each dose; starting while the tumor is small provides a better chance of eradicating all cancer cells.
RATIONALE Chemotherapy follows first-order kinetics: a constant proportion (not number) of cells is killed with each cycle. A smaller tumor requires
fewer cycles to achieve complete remission.
3. Which finding should the nurse report for a client with a circumferential extremity burn?
A. Full thickness burns rather than partial thickness.
B. Slow capillary refill in the digits with absent distal pulse points.
C. Supinates extremity but unable to fully pronate.
D. Inability to distinguish sharp versus dull sensations.
B Slow capillary refill and absent distal pulses indicate compromised circulation requiring escharotomy.
RATIONALE A circumferential burn can form an eschar that acts as a tourniquet as edema increases tissue pressure, compromising distal blood flow.
4. A male client 3 hours post-inguinal herniorrhaphy has a distended lower abdomen with dullness to percussion. What is the priority
nursing action?
A. Assess vital signs.
B. Determine the time the client last voided.
C. Insert a rectal tube for flatus.
D. Document the finding.
B Swelling at the surgical site can impact the bladder and prostate, causing difficulty voiding. Determine last void time.
RATIONALE Postoperative swelling near the inguinal area can compress the urethra, causing urinary retention. Determining when the client last voided
provides data supporting bladder distention.
, 5. After a TURP, the client's urinary catheter is not draining. What should the nurse implement?
A. Reposition the catheter drainage tubing.
B. Irrigate the catheter.
C. Encourage oral fluids.
D. Change the drainage unit tubing.
B Sterile irrigation should be implemented to remove blood clots blocking the catheter.
RATIONALE Obstruction after TURP is most often due to blood clots. Sterile irrigation removes clots and restores catheter patency.
6. The nurse explains to a client with lung cancer that pleurodesis is performed to achieve which outcome?
A. Prevent the formation of effusion fluid.
B. Remove fluid from the intrapleural space.
C. Debulk tumor to maintain airway patency.
D. Relieve empyema after pneumonectomy.
A Instillation of a sclerosing agent seals the pleural spaces together, preventing fluid accumulation.
RATIONALE Pleurodesis creates adhesions between the visceral and parietal pleura, obliterating the pleural space and preventing recurrent effusion.
7. A college student has a vaginal infection with "cottage-cheese" discharge. Which prescription should the nurse implement first?
A. Cleanse perineum with warm soapy water.
B. Instill the first dose of nystatin (Mycostatin) vaginally per applicator.
C. Perform glucose measurement.
D. Obtain blood specimen for STDs.
B Candidiasis (yeast infection) — vaginal nystatin should be initiated first for symptom relief.
RATIONALE The characteristic "cottage-cheese" discharge confirms candidiasis. Nystatin is the first-line topical antifungal treatment.
8. A client with blunt abdominal injury has which assessment finding requiring immediate action?
A. Radiating abdominal pain with LLQ palpation.
B. Grimacing after palpation of the right hypochondriac region.
C. Rebound tenderness with abdominal palpation.
D. Bluish periumbilical skin discoloration.
D Periumbilical discoloration (Cullen's sign) indicates intraperitoneal hemorrhage and possible splenic rupture.
RATIONALE Cullen's sign is a life-threatening finding indicating retroperitoneal or intraperitoneal bleeding requiring immediate surgical evaluation.
9. Which observation should alert the nurse to call the Rapid Response Team for a client 2 days post-op?
A. Fresh bleeding on abdominal wound dressing.
B. Pulse change from 85 to 160 beats/minute lasting more than 10 minutes.
C. Temperature of 103.1°F and WBC 16,000.
D. Weakness, diaphoresis, BP 100/56.
B Sustained tachycardia for a prolonged period is an acute life-threatening change requiring RRT intervention.
RATIONALE A pulse increase from 85 to 160 sustained >10 minutes may indicate hemorrhage, sepsis, pulmonary embolism, or cardiac decompensation.
10. What assessment finding indicates an acute asthma exacerbation is improving after treatment?
A. Wheezing becomes louder.
B. Cough remains unproductive.
C. Vesicular breath sounds decrease.
D. Bronchodilators stimulate coughing.
A As airways open, airflow increases and wheezing becomes louder, indicating improvement.
RATIONALE In severe asthma, airflow may be so restricted that wheezing is diminished. Increasing wheeze indicates improved air movement through
narrowed airways.
11. A female client with type 2 DM reports dysuria. Which finding is most important to report?
A. Suprapubic pain and distention.
B. Bounding pulse at 100 beats/minute.
C. Fingerstick glucose of 300 mg/dL.
D. Small vesicular perineal lesions.
C Elevated glucose spills into urine, providing a medium for bacterial growth and requiring treatment adjustment.
RATIONALE Hyperglycemia promotes bacterial growth in the urinary tract. The glucose level must be reported so the plan of care can be adjusted.
