HESI 2.0 MEDICAL-SURGICAL NURSING (MED-
SURG) EXAMINATION (2025/2026)
HIGH-YIELD STRUCTURED EXAMINATION DESIGNED TO
EVALUATE CLINICAL JUDGMENT, CRITICAL THINKING, AND
SAFE NURSING PRACTICE IN MEDICAL-SURGICAL
SPRING SEMESTER EXAM [2025/2026]
The nurse is assessing a client's laboratory values following administration of chemotherapy.
Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome
(TLS)?
a. Serum PTT of 10 seconds.
b. Serum calcium of 5 mg/dL.
c. Oxygen saturation of 90%.
d. Hemoglobin of 10 g/dL
B - Tumor lysis syndrome (TLS) results in hyperkalemia, hypocalcemia, hyperuricemia, and
hyperphosphatemia. A serum calcium level of 5, which is low, is an indicator of possible tumor
lysis syndrome.
Which description of symptoms is characteristic of a client diagnosed with trigeminal neuralgia
(tic douloureux)?
a. Tinnitus, vertigo, and hearing difficulties.
b. Sudden, stabbing, severe pain over the lip and chin.
1|Page
,c. Facial weakness and paralysis.
d. Difficulty in chewing, talking, and swallowing.
B - Trigeminal neuralgia is characterized by paroxysms of pain, similar to an electric shock, in the
area innervated by one or more branches of the trigeminal nerve (5th cranial). Women are
more often afflicted with this condition and generally occurs in clients over the age of 50 years
old.
Which discharge instruction is most important for a client after a kidney transplant?
a. Weigh weekly.
b. Report symptoms of secondary Candidiasis.
c. Use daily reminders to take immunosuppressants.
d. Stop cigarette smoking.
C - After a renal transplantation, acute rejection is a high risk for several months. The organ
recipient will have to take immunosuppressive therapy for the rest of their lives, such as
corticosteroids and azathioprine, to prevent organ transplant rejection. Discharge instructions
include measures such as daily reminders to ensure the client takes these medications regularly
to prevent organ rejection from occurring.
The nurse is providing dietary instructions to a 68-year-old client who is at high risk for
development of coronary heart disease (CHD). Which information should the nurse include?
a. Limit dietary selection of cholesterol to 300 mg per day.
b. Increase intake of soluble fiber to 10 to 25 grams per day.
c. Decrease plant stanols and sterols to less than 2 grams/day.
d. Ensure saturated fat is less than 30% of total caloric intake.
B - To reduce risk factors associated with coronary heart disease, the daily intake of soluble fiber
should be increased to between 10 and 25 grams per day. According to the American Heart
Association, soluble fibers helps reduce LDL cholesterol levels.
2|Page
,Two days postoperative, a male client reports aching pain in his left leg. The nurse assesses
redness and warmth on the lower left calf. Which intervention would be most helpful to this
client?
a. Apply sequential compression devices (SCDs) bilaterally.
b. Assess for a positive Homan's sign in each leg.
c. Pad all bony prominences on the affected leg.
d. Advise the client to remain in bed with the leg elevated.
D - For a client exhibiting symptoms of deep vein thrombosis (DVT), a complication of
immobility, the initial care includes bedrest and elevation of the extremity.
A middle-aged male client with diabetes continues to eat an abundance of foods that are high in
sugar and fat. According to the Health Belief Model, which event is most likely to increase the
client's willingness to become compliant with the prescribed diet?
a. He visits his diabetic brother who just had surgery to amputate an infected foot.
b. He is provided with the most current information about the dangers of untreated diabetes.
c. He comments on the community service announcements about preventing complications
associated with diabetes.
d. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet.
A - The loss of a limb due to diabetes by a family member should be the strongest event or "cue
to action" and is most likely to increase the client's perceived seriousness of the disease.
A 58-year-old client who has been post-menopausal for five years is concerned about the risk
for osteoporosis because her mother has the condition. Which information should the nurse
offer?
a. Osteoporosis is a progressive genetic disease with no effective treatment.
3|Page
, b. Calcium loss from bones can be slowed by increasing calcium intake and exercise.
c. Estrogen replacement therapy should be started to prevent the progression osteoporosis.
d. Low-dose corticosteroid treatment effectively halts the course of osteoporosis.
B - Post-menopausal females are at risk for osteoporosis due to the cessation of estrogen
secretion, but a regimen including calcium, vitamin D, and weight-bearing exercise can help
prevent further bone loss.
The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two
hours is dated two years ago. The client reports that he has a history of "heart trouble," but has
no problems at present. Hospital protocol requires that those over 50 years of age have a recent
ECG prior to surgery. Which nursing action is best for the nurse to implement?
a. Ask the client what he means by "heart trouble."
b. Call for an ECG to be performed immediately.
c. Notify surgery that the ECG is over two years old.
d. Notify the client's surgeon immediately.
B
Which information about mammograms is most important to provide a post-menopausal
female client?
a. Breast self-examinations are not needed if annual mammograms are obtained.
b. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron.
c. Yearly mammograms should be done regardless of previous normal x-rays.
d. Women at high risk should have annual routine and ultrasound mammograms
C - There are different recommendations from different agnecies. For a client with no risk
factors, the earliest breast screening recommendation is a yearly mammogram at the age 40
and till the age of 54. After that every two years. The American College of OB/GYN still
recommend starting mammograms starting at the age of 40 and yearly screeenings. The
4|Page
SURG) EXAMINATION (2025/2026)
HIGH-YIELD STRUCTURED EXAMINATION DESIGNED TO
EVALUATE CLINICAL JUDGMENT, CRITICAL THINKING, AND
SAFE NURSING PRACTICE IN MEDICAL-SURGICAL
SPRING SEMESTER EXAM [2025/2026]
The nurse is assessing a client's laboratory values following administration of chemotherapy.
Which lab value leads the nurse to suspect that the client is experiencing tumor lysis syndrome
(TLS)?
a. Serum PTT of 10 seconds.
b. Serum calcium of 5 mg/dL.
c. Oxygen saturation of 90%.
d. Hemoglobin of 10 g/dL
B - Tumor lysis syndrome (TLS) results in hyperkalemia, hypocalcemia, hyperuricemia, and
hyperphosphatemia. A serum calcium level of 5, which is low, is an indicator of possible tumor
lysis syndrome.
Which description of symptoms is characteristic of a client diagnosed with trigeminal neuralgia
(tic douloureux)?
a. Tinnitus, vertigo, and hearing difficulties.
b. Sudden, stabbing, severe pain over the lip and chin.
1|Page
,c. Facial weakness and paralysis.
d. Difficulty in chewing, talking, and swallowing.
B - Trigeminal neuralgia is characterized by paroxysms of pain, similar to an electric shock, in the
area innervated by one or more branches of the trigeminal nerve (5th cranial). Women are
more often afflicted with this condition and generally occurs in clients over the age of 50 years
old.
Which discharge instruction is most important for a client after a kidney transplant?
a. Weigh weekly.
b. Report symptoms of secondary Candidiasis.
c. Use daily reminders to take immunosuppressants.
d. Stop cigarette smoking.
C - After a renal transplantation, acute rejection is a high risk for several months. The organ
recipient will have to take immunosuppressive therapy for the rest of their lives, such as
corticosteroids and azathioprine, to prevent organ transplant rejection. Discharge instructions
include measures such as daily reminders to ensure the client takes these medications regularly
to prevent organ rejection from occurring.
The nurse is providing dietary instructions to a 68-year-old client who is at high risk for
development of coronary heart disease (CHD). Which information should the nurse include?
a. Limit dietary selection of cholesterol to 300 mg per day.
b. Increase intake of soluble fiber to 10 to 25 grams per day.
c. Decrease plant stanols and sterols to less than 2 grams/day.
d. Ensure saturated fat is less than 30% of total caloric intake.
B - To reduce risk factors associated with coronary heart disease, the daily intake of soluble fiber
should be increased to between 10 and 25 grams per day. According to the American Heart
Association, soluble fibers helps reduce LDL cholesterol levels.
2|Page
,Two days postoperative, a male client reports aching pain in his left leg. The nurse assesses
redness and warmth on the lower left calf. Which intervention would be most helpful to this
client?
a. Apply sequential compression devices (SCDs) bilaterally.
b. Assess for a positive Homan's sign in each leg.
c. Pad all bony prominences on the affected leg.
d. Advise the client to remain in bed with the leg elevated.
D - For a client exhibiting symptoms of deep vein thrombosis (DVT), a complication of
immobility, the initial care includes bedrest and elevation of the extremity.
A middle-aged male client with diabetes continues to eat an abundance of foods that are high in
sugar and fat. According to the Health Belief Model, which event is most likely to increase the
client's willingness to become compliant with the prescribed diet?
a. He visits his diabetic brother who just had surgery to amputate an infected foot.
b. He is provided with the most current information about the dangers of untreated diabetes.
c. He comments on the community service announcements about preventing complications
associated with diabetes.
d. His wife expresses a sincere willingness to prepare meals that are within his prescribed diet.
A - The loss of a limb due to diabetes by a family member should be the strongest event or "cue
to action" and is most likely to increase the client's perceived seriousness of the disease.
A 58-year-old client who has been post-menopausal for five years is concerned about the risk
for osteoporosis because her mother has the condition. Which information should the nurse
offer?
a. Osteoporosis is a progressive genetic disease with no effective treatment.
3|Page
, b. Calcium loss from bones can be slowed by increasing calcium intake and exercise.
c. Estrogen replacement therapy should be started to prevent the progression osteoporosis.
d. Low-dose corticosteroid treatment effectively halts the course of osteoporosis.
B - Post-menopausal females are at risk for osteoporosis due to the cessation of estrogen
secretion, but a regimen including calcium, vitamin D, and weight-bearing exercise can help
prevent further bone loss.
The nurse notes that the only ECG for a 55-year-old male client scheduled for surgery in two
hours is dated two years ago. The client reports that he has a history of "heart trouble," but has
no problems at present. Hospital protocol requires that those over 50 years of age have a recent
ECG prior to surgery. Which nursing action is best for the nurse to implement?
a. Ask the client what he means by "heart trouble."
b. Call for an ECG to be performed immediately.
c. Notify surgery that the ECG is over two years old.
d. Notify the client's surgeon immediately.
B
Which information about mammograms is most important to provide a post-menopausal
female client?
a. Breast self-examinations are not needed if annual mammograms are obtained.
b. Radiation exposure is minimized by shielding the abdomen with a lead-lined apron.
c. Yearly mammograms should be done regardless of previous normal x-rays.
d. Women at high risk should have annual routine and ultrasound mammograms
C - There are different recommendations from different agnecies. For a client with no risk
factors, the earliest breast screening recommendation is a yearly mammogram at the age 40
and till the age of 54. After that every two years. The American College of OB/GYN still
recommend starting mammograms starting at the age of 40 and yearly screeenings. The
4|Page
