1
HESI Med-Surg Test Bank 2025–2026 | 110+
NCLEX-Style Questions & Rationales |
Systems-Based A+ Nursing Review
1. Neuro System
A nurse is caring for a 67-year-old male patient admitted with a stroke
affecting the left hemisphere of the brain. The patient has right-sided
hemiplegia and expressive aphasia. Which nursing intervention is the most
appropriate when communicating with this patient?
A. Speak loudly and repeat questions until he responds
B. Provide visual aids and ask open-ended questions
C. Use short, simple sentences and allow time for response
D. Complete all care without verbal interaction to reduce frustration
, 2
Correct Answer: C
Rationale: Expressive aphasia is common in left-sided stroke and affects
speech production. The nurse should use short, simple sentences, provide
time for processing, and encourage alternative forms of communication.
Loudness will not improve comprehension, and avoiding communication
increases isolation.
Reference: Lewis et al., Medical-Surgical Nursing, 11th ed.
2. Cardiac System
A patient with congestive heart failure (CHF) is prescribed furosemide 40
mg IV twice daily. On assessment, the nurse notes muscle weakness, leg
cramps, and an irregular pulse. Which lab value is the nurse most concerned
about?
A. Potassium 2.8 mEq/L
B. Sodium 135 mEq/L
C. Hemoglobin 13.5 g/dL
D. Calcium 9.0 mg/dL
Correct Answer: A
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. A level of 2.8 mEq/L is critically low and may cause cardiac
dysrhythmias, muscle cramps, and weakness.
Reference: Ignatavicius & Workman, Med-Surg Nursing, 9th ed.
3. Respiratory System
A nurse is caring for a patient with COPD who is receiving 2 L/min of
, 3
oxygen via nasal cannula. The patient reports increasing shortness of breath.
What is the nurse's priority action?
A. Increase oxygen to 4 L/min
B. Notify the healthcare provider immediately
C. Encourage pursed-lip breathing and reassess
D. Place the patient in supine position to rest
Correct Answer: C
Rationale: Pursed-lip breathing improves oxygenation and decreases CO₂
retention. COPD patients depend on hypoxic drive, and increasing oxygen
without order may suppress respiratory drive. Positioning upright, not
supine, improves breathing.
Reference: Potter & Perry, Fundamentals of Nursing, 10th ed.
4. GI System
A patient is post-op day 1 following a bowel resection. The nurse notes
abdominal distension and absence of bowel sounds. What should the nurse
do first?
A. Call the surgeon
B. Document the findings
C. Reposition the patient and encourage ambulation
D. Administer a laxative as prescribed
Correct Answer: C
Rationale: Post-op ileus is common after abdominal surgery. Early
ambulation and repositioning help stimulate peristalsis. There is no need to
call the surgeon unless obstruction is suspected or symptoms worsen.
Reference: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing
, 4
5. Renal System
A 70-year-old patient with chronic kidney disease has a serum creatinine of
3.4 mg/dL and BUN of 45 mg/dL. Which dietary instruction is most
appropriate?
A. Increase protein intake to promote healing
B. Avoid foods high in potassium and phosphorus
C. Drink more than 3 liters of fluid daily
D. Use salt substitutes to flavor food
Correct Answer: B
Rationale: Patients with CKD must restrict potassium and phosphorus to
prevent cardiac and bone complications. High-protein diets worsen kidney
workload. Salt substitutes often contain potassium and should be avoided.
Reference: ATI Nutrition for Nursing, 7th ed.
6. Endocrine System
A nurse is caring for a patient newly diagnosed with type 1 diabetes. The
patient becomes confused and diaphoretic during the morning assessment.
What is the nurse’s next best action?
A. Recheck blood glucose in 15 minutes
B. Notify the physician
C. Administer 15g of glucose orally
D. Start an IV insulin drip
Correct Answer: C
Rationale: These are signs of hypoglycemia. The immediate nursing action
is to administer 15g of fast-acting glucose, such as juice or glucose tabs. IV
HESI Med-Surg Test Bank 2025–2026 | 110+
NCLEX-Style Questions & Rationales |
Systems-Based A+ Nursing Review
1. Neuro System
A nurse is caring for a 67-year-old male patient admitted with a stroke
affecting the left hemisphere of the brain. The patient has right-sided
hemiplegia and expressive aphasia. Which nursing intervention is the most
appropriate when communicating with this patient?
A. Speak loudly and repeat questions until he responds
B. Provide visual aids and ask open-ended questions
C. Use short, simple sentences and allow time for response
D. Complete all care without verbal interaction to reduce frustration
, 2
Correct Answer: C
Rationale: Expressive aphasia is common in left-sided stroke and affects
speech production. The nurse should use short, simple sentences, provide
time for processing, and encourage alternative forms of communication.
Loudness will not improve comprehension, and avoiding communication
increases isolation.
Reference: Lewis et al., Medical-Surgical Nursing, 11th ed.
2. Cardiac System
A patient with congestive heart failure (CHF) is prescribed furosemide 40
mg IV twice daily. On assessment, the nurse notes muscle weakness, leg
cramps, and an irregular pulse. Which lab value is the nurse most concerned
about?
A. Potassium 2.8 mEq/L
B. Sodium 135 mEq/L
C. Hemoglobin 13.5 g/dL
D. Calcium 9.0 mg/dL
Correct Answer: A
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. A level of 2.8 mEq/L is critically low and may cause cardiac
dysrhythmias, muscle cramps, and weakness.
Reference: Ignatavicius & Workman, Med-Surg Nursing, 9th ed.
3. Respiratory System
A nurse is caring for a patient with COPD who is receiving 2 L/min of
, 3
oxygen via nasal cannula. The patient reports increasing shortness of breath.
What is the nurse's priority action?
A. Increase oxygen to 4 L/min
B. Notify the healthcare provider immediately
C. Encourage pursed-lip breathing and reassess
D. Place the patient in supine position to rest
Correct Answer: C
Rationale: Pursed-lip breathing improves oxygenation and decreases CO₂
retention. COPD patients depend on hypoxic drive, and increasing oxygen
without order may suppress respiratory drive. Positioning upright, not
supine, improves breathing.
Reference: Potter & Perry, Fundamentals of Nursing, 10th ed.
4. GI System
A patient is post-op day 1 following a bowel resection. The nurse notes
abdominal distension and absence of bowel sounds. What should the nurse
do first?
A. Call the surgeon
B. Document the findings
C. Reposition the patient and encourage ambulation
D. Administer a laxative as prescribed
Correct Answer: C
Rationale: Post-op ileus is common after abdominal surgery. Early
ambulation and repositioning help stimulate peristalsis. There is no need to
call the surgeon unless obstruction is suspected or symptoms worsen.
Reference: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing
, 4
5. Renal System
A 70-year-old patient with chronic kidney disease has a serum creatinine of
3.4 mg/dL and BUN of 45 mg/dL. Which dietary instruction is most
appropriate?
A. Increase protein intake to promote healing
B. Avoid foods high in potassium and phosphorus
C. Drink more than 3 liters of fluid daily
D. Use salt substitutes to flavor food
Correct Answer: B
Rationale: Patients with CKD must restrict potassium and phosphorus to
prevent cardiac and bone complications. High-protein diets worsen kidney
workload. Salt substitutes often contain potassium and should be avoided.
Reference: ATI Nutrition for Nursing, 7th ed.
6. Endocrine System
A nurse is caring for a patient newly diagnosed with type 1 diabetes. The
patient becomes confused and diaphoretic during the morning assessment.
What is the nurse’s next best action?
A. Recheck blood glucose in 15 minutes
B. Notify the physician
C. Administer 15g of glucose orally
D. Start an IV insulin drip
Correct Answer: C
Rationale: These are signs of hypoglycemia. The immediate nursing action
is to administer 15g of fast-acting glucose, such as juice or glucose tabs. IV
