1|Page
EVOLVE Elsevier HESI Medical-Surgical Exit Exam
Version 1 Study Guide 2025 | HESI Med-Surg Practice
Questions, Answers, and NCLEX Review
Prepare for the HESI Medical-Surgical Exit Exam Version 1 (2025) with this comprehensive
Elsevier-based review. Covers adult health, pathophysiology, pharmacology, nursing
interventions, and NCLEX-style critical thinking questions. Includes rationales, scoring
strategies, and updated HESI practice test content aligned with the latest NCLEX blueprint.
• HESI Medical Surgical Exit Exam Version 1
• HESI Med-Surg Exit Exam 2025
• • HESI Exit Exam Med Surg answers
• • HESI Med Surg practice questions
• • HESI Med Surg review PDF
• • HESI Exit Exam Version 1 study guide
•
A client with alcohol-related liver disease is admitted to the unit. Which prescription should the nurse
call the health care provider about for reverification for this client?
A.Vitamin K1, 5 mg IM daily
B.High-calorie, low-sodium diet
C.Fluid restriction to 1500 mL/day
D.Nembutal sodium at bedtime for rest - ANSWER-Answer: D
Rationale→Sedatives such as pentobarbital are contraindicated for clients with liver damage and can
have dangerous consequences. Option A is often prescribed because the normal clotting mechanism is
damaged. Option B is needed to help restore energy to the debilitated client. Sodium is often restricted
because of edema. Fluids are restricted to decrease ascites, which often accompanies cirrhosis,
particularly in the later stages of the disease.
,2|Page
What is the most important nursing priority for a client who has been admitted for a possible kidney
stone?
A.Reducing dairy products in the diet
B.Straining all urine
C.Measuring intake and output
D.Increasing fluid intake - ANSWER-Answer: B
Rationale→Straining all urine is the most important nursing action to take in this case. Encouraging fluid
intake is important for any client who may have a kidney stone, but it is even more important to strain all
urine. Straining urine will enable the nurse to determine when the kidney stone has been passed and
may prevent the need for surgery. Option C is not the highest priority action. Option A is usually not
recommended until the stone is obtained and the content of the stone is determined. Even then, dietary
restrictions are controversial.
The nurse notes that a client who is scheduled for surgery the next morning has an elevated blood urea
nitrogen (BUN) level. Which condition is most likely to have contributed to this finding?
A.Myocardial infarction 2 months ago
B.Anorexia and vomiting for the past 2 days
C.Recently diagnosed type 2 diabetes mellitus
D.Skeletal traction for a right hip fracture - ANSWER-Answer: B
Rationale→The blood urea nitrogen (BUN) level indicates the effectiveness of the kidneys in filtering
waste from the blood. Dehydration, which could be caused by vomiting, would cause an increased BUN
level. Option A would affect serum enzyme levels, not the BUN level. Option C would primarily affect the
blood glucose level; renal failure that could increase the BUN level would be unlikely in a client newly
diagnosed with type 2 diabetes. Effects of option D might affect the complete blood count (CBC) but
would not directly increase the BUN level.
The nurse on a medical-surgical unit is receiving a client from the postanesthesia care unit (PACU) with a
Penrose drain. Before choosing a room for this client, which information is most important for the nurse
to obtain?
A. If suctioning will be needed for drainage of the wound
B. If the family would prefer a private or semi private room
C. If the client also has a Hemovac in place
,3|Page
D. If the client's wound is infected - ANSWER-Answer: D
Rationale→The fact that the client has a Penrose drain should alert the nurse to the possibility that the
surgical wound is infected. Penrose drains provide a sinus tract or opening and are often used to provide
drainage of an abscess. To avoid contamination of another postoperative client, it is most important to
place any client with an infected wound in a private room. A Penrose drain does not require option A.
Although option B is helpful information, it does not have the priority of option D. A Hemovac is used to
drain fluid from a dead space and is not a determinant for the room assignment.
The nurse is giving preoperative instructions to a 14-year-old client scheduled for surgery to correct a
spinal curvature. Which statement by the client best demonstrates that learning has taken place?
A."I will read all the teaching booklets you gave me before surgery."
B."I have had surgery before, so I know what to expect afterward."
C."All the things people have told me will help me take care of my back."
D."Let me show you the method of turning I will use after surgery." - ANSWER-Answer: D
Rationale→The outcome of learning is best demonstrated when the client not only verbalizes an
understanding but also provides a return demonstration. A 14-year-old client may or may not follow
through with option A, and there is no measurement of learning. Option B may help the client
understand the surgical process, but the type of surgery may have been very different, with differing
postoperative care. In option C, the client may be saying what the nurse wants to hear without
expressing any real understanding of what to do after surgery.
A hospitalized client is receiving nasogastric tube feedings via a small-bore tube and a continuous pump
infusion. The client begins to cough and produces a moderate amount of white sputum. Which action
should the nurse take first?
A.Auscultate the client's breath sounds.
B.Turn off the continuous feeding pump
C.Check placement of the nasogastric tube
D.Measure the amount of residual feeding - ANSWER-Answer: B
Rationale→A productive cough may indicate that the feeding has been aspirated. The nurse should first
stop the feeding to prevent further aspiration. Options A, C, and D should all be performed before
restarting the tube feeding if no evidence of aspiration is present and the tube is in place.
A 63-year-old client with type 2 diabetes mellitus is admitted for treatment of an ulcer on the heel of the
left foot that has not healed with wound care. The nurse observes that the entire left foot is darker in
color than the right foot. Which additional symptom should the nurse expect to find?
, 4|Page
A.Pedal pulses will be weak or absent in the left foot.
B.The client will state that the left foot is usually warm.
C.Flexion and extension of the left foot will be limited.
D.Capillary refill of the client's left toes will be brisk. - ANSWER-Answer: A
Rationale→Symptoms associated with decreased blood supply are weak or absent pedal and tibial
pulses. The client with diabetes experiences vascular scarring as a result of atherosclerotic changes in
the peripheral vessels. This results in compromised perfusion to the dependent extremities, which
further delays wound healing in the affected foot. Although flexion and extension may be limited,
depending on the degree of damage, this is not always the case. Options B and D are signs of adequate
perfusion of the foot, which would not be expected in this client.
A 55-year-old male client has been admitted to the hospital with a medical diagnosis of chronic
obstructive pulmonary disease (COPD). Which risk factor is the most significant in the development of
this client's COPD?
A.The client's father was diagnosed with COPD in his 50s
B.A close family member contracted tuberculosis last year.
C.The client smokes one to two packs of cigarettes per day.
D.The client has been 40 pounds overweight for 15 years - ANSWER-Answer: C
Rationale→Smoking, considered to be a modifiable risk factor, is the most significant risk factor for the
development of COPD. The exact mechanism of genetic and hereditary implications for the development
of COPD is still under investigation, although exposure to similar predisposing factors (e.g., smoking or
inhaling secondhand smoke) may increase the likelihood of COPD incidence among family members.
Options B and D do not exceed the risks associated with cigarette smoking in the development of COPD.
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day.
The nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the
best immediate action for the charge nurse to take
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
D.Inform the nurse that her behavior is disruptive to the rest of the staff. - ANSWER-Answer: A
Rationale→Continuing with the shift report is the best immediate action because it allows the nurse who
was floated some cooling off time. At a later time (after the nurse has cooled off) the charge nurse
should discuss the conduct of the nurse in private. Option B encourages the nurse to shirk the float
EVOLVE Elsevier HESI Medical-Surgical Exit Exam
Version 1 Study Guide 2025 | HESI Med-Surg Practice
Questions, Answers, and NCLEX Review
Prepare for the HESI Medical-Surgical Exit Exam Version 1 (2025) with this comprehensive
Elsevier-based review. Covers adult health, pathophysiology, pharmacology, nursing
interventions, and NCLEX-style critical thinking questions. Includes rationales, scoring
strategies, and updated HESI practice test content aligned with the latest NCLEX blueprint.
• HESI Medical Surgical Exit Exam Version 1
• HESI Med-Surg Exit Exam 2025
• • HESI Exit Exam Med Surg answers
• • HESI Med Surg practice questions
• • HESI Med Surg review PDF
• • HESI Exit Exam Version 1 study guide
•
A client with alcohol-related liver disease is admitted to the unit. Which prescription should the nurse
call the health care provider about for reverification for this client?
A.Vitamin K1, 5 mg IM daily
B.High-calorie, low-sodium diet
C.Fluid restriction to 1500 mL/day
D.Nembutal sodium at bedtime for rest - ANSWER-Answer: D
Rationale→Sedatives such as pentobarbital are contraindicated for clients with liver damage and can
have dangerous consequences. Option A is often prescribed because the normal clotting mechanism is
damaged. Option B is needed to help restore energy to the debilitated client. Sodium is often restricted
because of edema. Fluids are restricted to decrease ascites, which often accompanies cirrhosis,
particularly in the later stages of the disease.
,2|Page
What is the most important nursing priority for a client who has been admitted for a possible kidney
stone?
A.Reducing dairy products in the diet
B.Straining all urine
C.Measuring intake and output
D.Increasing fluid intake - ANSWER-Answer: B
Rationale→Straining all urine is the most important nursing action to take in this case. Encouraging fluid
intake is important for any client who may have a kidney stone, but it is even more important to strain all
urine. Straining urine will enable the nurse to determine when the kidney stone has been passed and
may prevent the need for surgery. Option C is not the highest priority action. Option A is usually not
recommended until the stone is obtained and the content of the stone is determined. Even then, dietary
restrictions are controversial.
The nurse notes that a client who is scheduled for surgery the next morning has an elevated blood urea
nitrogen (BUN) level. Which condition is most likely to have contributed to this finding?
A.Myocardial infarction 2 months ago
B.Anorexia and vomiting for the past 2 days
C.Recently diagnosed type 2 diabetes mellitus
D.Skeletal traction for a right hip fracture - ANSWER-Answer: B
Rationale→The blood urea nitrogen (BUN) level indicates the effectiveness of the kidneys in filtering
waste from the blood. Dehydration, which could be caused by vomiting, would cause an increased BUN
level. Option A would affect serum enzyme levels, not the BUN level. Option C would primarily affect the
blood glucose level; renal failure that could increase the BUN level would be unlikely in a client newly
diagnosed with type 2 diabetes. Effects of option D might affect the complete blood count (CBC) but
would not directly increase the BUN level.
The nurse on a medical-surgical unit is receiving a client from the postanesthesia care unit (PACU) with a
Penrose drain. Before choosing a room for this client, which information is most important for the nurse
to obtain?
A. If suctioning will be needed for drainage of the wound
B. If the family would prefer a private or semi private room
C. If the client also has a Hemovac in place
,3|Page
D. If the client's wound is infected - ANSWER-Answer: D
Rationale→The fact that the client has a Penrose drain should alert the nurse to the possibility that the
surgical wound is infected. Penrose drains provide a sinus tract or opening and are often used to provide
drainage of an abscess. To avoid contamination of another postoperative client, it is most important to
place any client with an infected wound in a private room. A Penrose drain does not require option A.
Although option B is helpful information, it does not have the priority of option D. A Hemovac is used to
drain fluid from a dead space and is not a determinant for the room assignment.
The nurse is giving preoperative instructions to a 14-year-old client scheduled for surgery to correct a
spinal curvature. Which statement by the client best demonstrates that learning has taken place?
A."I will read all the teaching booklets you gave me before surgery."
B."I have had surgery before, so I know what to expect afterward."
C."All the things people have told me will help me take care of my back."
D."Let me show you the method of turning I will use after surgery." - ANSWER-Answer: D
Rationale→The outcome of learning is best demonstrated when the client not only verbalizes an
understanding but also provides a return demonstration. A 14-year-old client may or may not follow
through with option A, and there is no measurement of learning. Option B may help the client
understand the surgical process, but the type of surgery may have been very different, with differing
postoperative care. In option C, the client may be saying what the nurse wants to hear without
expressing any real understanding of what to do after surgery.
A hospitalized client is receiving nasogastric tube feedings via a small-bore tube and a continuous pump
infusion. The client begins to cough and produces a moderate amount of white sputum. Which action
should the nurse take first?
A.Auscultate the client's breath sounds.
B.Turn off the continuous feeding pump
C.Check placement of the nasogastric tube
D.Measure the amount of residual feeding - ANSWER-Answer: B
Rationale→A productive cough may indicate that the feeding has been aspirated. The nurse should first
stop the feeding to prevent further aspiration. Options A, C, and D should all be performed before
restarting the tube feeding if no evidence of aspiration is present and the tube is in place.
A 63-year-old client with type 2 diabetes mellitus is admitted for treatment of an ulcer on the heel of the
left foot that has not healed with wound care. The nurse observes that the entire left foot is darker in
color than the right foot. Which additional symptom should the nurse expect to find?
, 4|Page
A.Pedal pulses will be weak or absent in the left foot.
B.The client will state that the left foot is usually warm.
C.Flexion and extension of the left foot will be limited.
D.Capillary refill of the client's left toes will be brisk. - ANSWER-Answer: A
Rationale→Symptoms associated with decreased blood supply are weak or absent pedal and tibial
pulses. The client with diabetes experiences vascular scarring as a result of atherosclerotic changes in
the peripheral vessels. This results in compromised perfusion to the dependent extremities, which
further delays wound healing in the affected foot. Although flexion and extension may be limited,
depending on the degree of damage, this is not always the case. Options B and D are signs of adequate
perfusion of the foot, which would not be expected in this client.
A 55-year-old male client has been admitted to the hospital with a medical diagnosis of chronic
obstructive pulmonary disease (COPD). Which risk factor is the most significant in the development of
this client's COPD?
A.The client's father was diagnosed with COPD in his 50s
B.A close family member contracted tuberculosis last year.
C.The client smokes one to two packs of cigarettes per day.
D.The client has been 40 pounds overweight for 15 years - ANSWER-Answer: C
Rationale→Smoking, considered to be a modifiable risk factor, is the most significant risk factor for the
development of COPD. The exact mechanism of genetic and hereditary implications for the development
of COPD is still under investigation, although exposure to similar predisposing factors (e.g., smoking or
inhaling secondhand smoke) may increase the likelihood of COPD incidence among family members.
Options B and D do not exceed the risks associated with cigarette smoking in the development of COPD.
During the shift report, the charge nurse informs a nurse of a reassignment to another unit for the day.
The nurse begins to sigh deeply and tosses about her belongings when preparing to leave. What is the
best immediate action for the charge nurse to take
A.Continue with the shift report and talk to the nurse about the incident at a later time.
B.Ask the nurse to call the house supervisor to see if she must be reassigned.
C.Stop the shift report and remind the nurse that all staff are floated equally.
D.Inform the nurse that her behavior is disruptive to the rest of the staff. - ANSWER-Answer: A
Rationale→Continuing with the shift report is the best immediate action because it allows the nurse who
was floated some cooling off time. At a later time (after the nurse has cooled off) the charge nurse
should discuss the conduct of the nurse in private. Option B encourages the nurse to shirk the float
