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HESI NUR 209 MEDICAL SURGICAL NURSING I
ACTUAL EXAM PREP 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
SECTION 1: QUESTIONS 1–50
1. A patient post-operative day 1 from an open appendectomy reports pain of 7/10.
The nurse administers morphine 4 mg IV. Thirty minutes later, the patient reports
pain 6/10 and is drowsy but arousable. Respiratory rate is 10 breaths/min. What is
the priority nursing action?
A) Administer naloxone per protocol
B) Apply oxygen and stimulate the patient to breathe deeply
C) Document the findings as expected
D) Administer another dose of morphine
*Rationale: Respiratory rate of 10 is below normal but not yet critical (below 8
requires naloxone). Stimulation and oxygen support are first-line; naloxone is
reserved for severe respiratory depression.*
2. A patient with heart failure has daily weights ordered. The patient’s weight
increased by 2.2 kg (4.8 lb) in 24 hours. What is the most appropriate nursing
action?
A) Encourage increased oral fluid intake
B) Notify the healthcare provider immediately
C) Restrict sodium intake to 1 g/day
D) Repeat the weight in the morning
Rationale: A 2.2 kg weight gain in 24 hours indicates significant fluid retention,
likely worsening heart failure. Immediate provider notification is required for
diuretic adjustment.
3. The nurse is caring for a patient with a nasogastric (NG) tube set to low
intermittent suction. Which electrolyte imbalance is the patient at highest risk for?
A) Hyperkalemia
B) Hypokalemia
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C) Hypernatremia
D) Hypercalcemia
Rationale: NG suction removes gastric fluid rich in potassium, hydrogen, and
chloride, leading to hypokalemic, hypochloremic metabolic alkalosis.
4. A patient with type 2 diabetes mellitus is prescribed metformin 500 mg twice
daily. Which laboratory value requires the nurse to hold the medication and contact
the provider?
A) Hemoglobin A1c 7.2%
B) Fasting blood glucose 130 mg/dL
C) Serum creatinine 1.9 mg/dL
D) ALT 40 units/L
*Rationale: Metformin is contraindicated with elevated serum creatinine (≥1.5
mg/dL in males, ≥1.4 in females) due to risk of lactic acidosis.*
5. The nurse is assessing a patient 4 hours after a total knee replacement. The
patient reports sudden, severe shortness of breath and chest pain. The pulse
oximeter reads 88% on room air. What is the priority intervention?
A) Administer oxygen at 2 L/min via nasal cannula
B) Apply high-flow oxygen and prepare for possible pulmonary embolism
C) Elevate the head of the bed to 90 degrees
D) Auscultate breath sounds and reassess
Rationale: Sudden dyspnea, chest pain, and hypoxia post-orthopedic surgery are
classic signs of pulmonary embolism. High-flow oxygen and immediate medical
evaluation are priorities.
6. A patient with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on 2 L/min via nasal cannula. The nurse increases the oxygen to
4 L/min. Thirty minutes later, the patient is lethargic with a respiratory rate of 8
breaths/min. What is the most likely cause?
A) Oxygen-induced hypercapnia with loss of hypoxic drive
B) Decreased hypoxic respiratory drive due to high oxygen
C) Carbon dioxide narcosis from retained CO2
D) Pulmonary embolism
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive.
Excessive oxygen can reduce respiratory drive, worsening hypercapnia and
causing lethargy.
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7. A patient is receiving a blood transfusion of packed red blood cells. Fifteen
minutes after the start, the patient reports chills, low back pain, and feels
“feverish.” Temperature is 38.5°C (101.3°F). What is the priority nursing action?
A) Slow the transfusion rate to 50 mL/hr
B) Administer acetaminophen per order
C) Stop the transfusion and maintain IV line with normal saline
D) Notify the healthcare provider after stopping
Rationale: These symptoms suggest an acute hemolytic or febrile reaction. Stop
transfusion immediately, keep line open with saline, then notify provider.
8. The nurse is teaching a patient with newly diagnosed hypertension about dietary
changes. Which patient statement indicates correct understanding?
A) “I should avoid all canned vegetables.”
B) “I will check food labels for sodium content and aim for less than 2,300 mg
per day.”
C) “I can use sea salt instead of table salt because it has less sodium.”
D) “I need to eliminate all carbohydrates from my diet.”
*Rationale: DASH diet recommends <2,300 mg sodium/day (or <1,500 mg for
higher risk). Sea salt has similar sodium content as table salt.*
9. A patient with cirrhosis develops asterixis (liver flap). What is the priority
nursing assessment?
A) Blood glucose level
B) Serum ammonia level
C) Prothrombin time
D) Serum albumin
Rationale: Asterixis is a sign of hepatic encephalopathy, which is associated with
elevated ammonia levels. This requires prompt intervention.
10. The nurse is caring for a patient with a chest tube to water seal drainage for a
pneumothorax. The nurse notes continuous bubbling in the water seal chamber.
What is the most appropriate action?
A) Clamp the chest tube immediately
B) Assess for an air leak in the system
C) Increase suction pressure
D) Document as normal finding
Rationale: Intermittent bubbling with coughing is normal; continuous bubbling
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indicates an air leak. Clamping is dangerous; assess the system and notify
provider.
11. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. The nurse expects to administer which medication?
A) Furosemide 40 mg IV push
B) Calcium gluconate IV
C) Spironolactone 25 mg orally
D) Potassium chloride 20 mEq orally
Rationale: Calcium gluconate is given emergently to stabilize cardiac
membranes in severe hyperkalemia. Other treatments include insulin/glucose,
albuterol, and sodium polystyrene sulfonate.
12. The nurse is preparing a patient for a colonoscopy. The patient takes warfarin
daily for atrial fibrillation. What instruction should the nurse provide?
A) Continue warfarin as usual
B) Hold warfarin 5 days before the procedure per provider order
C) Double the dose the day before the procedure
D) Take warfarin with a small sip of water the morning of the procedure
Rationale: Warfarin is typically held 5 days before invasive procedures to reduce
bleeding risk. Bridging therapy may be ordered. Never instruct patient
independently without provider order.
13. A patient with a traumatic brain injury has an intracranial pressure (ICP)
monitor in place. The ICP reading is 22 mm Hg. Which nursing intervention is
most appropriate?
A) Elevate the head of the bed to 90 degrees
B) Maintain head of bed at 30 degrees and keep neck midline
C) Encourage the patient to cough and deep breathe
D) Cluster all care activities to minimize disturbances
*Rationale: Normal ICP is 5-15 mm Hg; 22 is elevated. HOB 30 degrees, neck
midline, avoid clustering care, and minimize suctioning. HOB 90 degrees may
lower cerebral perfusion.*
14. The nurse assesses a patient 2 hours after a thyroidectomy. The patient reports
tingling around the mouth and fingers. The nurse notes Chvostek’s sign positive.
What is the priority action?
A) Administer oral calcium carbonate
B) Check serum calcium level and notify provider
HESI NUR 209 MEDICAL SURGICAL NURSING I
ACTUAL EXAM PREP 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
SECTION 1: QUESTIONS 1–50
1. A patient post-operative day 1 from an open appendectomy reports pain of 7/10.
The nurse administers morphine 4 mg IV. Thirty minutes later, the patient reports
pain 6/10 and is drowsy but arousable. Respiratory rate is 10 breaths/min. What is
the priority nursing action?
A) Administer naloxone per protocol
B) Apply oxygen and stimulate the patient to breathe deeply
C) Document the findings as expected
D) Administer another dose of morphine
*Rationale: Respiratory rate of 10 is below normal but not yet critical (below 8
requires naloxone). Stimulation and oxygen support are first-line; naloxone is
reserved for severe respiratory depression.*
2. A patient with heart failure has daily weights ordered. The patient’s weight
increased by 2.2 kg (4.8 lb) in 24 hours. What is the most appropriate nursing
action?
A) Encourage increased oral fluid intake
B) Notify the healthcare provider immediately
C) Restrict sodium intake to 1 g/day
D) Repeat the weight in the morning
Rationale: A 2.2 kg weight gain in 24 hours indicates significant fluid retention,
likely worsening heart failure. Immediate provider notification is required for
diuretic adjustment.
3. The nurse is caring for a patient with a nasogastric (NG) tube set to low
intermittent suction. Which electrolyte imbalance is the patient at highest risk for?
A) Hyperkalemia
B) Hypokalemia
,2|Page
C) Hypernatremia
D) Hypercalcemia
Rationale: NG suction removes gastric fluid rich in potassium, hydrogen, and
chloride, leading to hypokalemic, hypochloremic metabolic alkalosis.
4. A patient with type 2 diabetes mellitus is prescribed metformin 500 mg twice
daily. Which laboratory value requires the nurse to hold the medication and contact
the provider?
A) Hemoglobin A1c 7.2%
B) Fasting blood glucose 130 mg/dL
C) Serum creatinine 1.9 mg/dL
D) ALT 40 units/L
*Rationale: Metformin is contraindicated with elevated serum creatinine (≥1.5
mg/dL in males, ≥1.4 in females) due to risk of lactic acidosis.*
5. The nurse is assessing a patient 4 hours after a total knee replacement. The
patient reports sudden, severe shortness of breath and chest pain. The pulse
oximeter reads 88% on room air. What is the priority intervention?
A) Administer oxygen at 2 L/min via nasal cannula
B) Apply high-flow oxygen and prepare for possible pulmonary embolism
C) Elevate the head of the bed to 90 degrees
D) Auscultate breath sounds and reassess
Rationale: Sudden dyspnea, chest pain, and hypoxia post-orthopedic surgery are
classic signs of pulmonary embolism. High-flow oxygen and immediate medical
evaluation are priorities.
6. A patient with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on 2 L/min via nasal cannula. The nurse increases the oxygen to
4 L/min. Thirty minutes later, the patient is lethargic with a respiratory rate of 8
breaths/min. What is the most likely cause?
A) Oxygen-induced hypercapnia with loss of hypoxic drive
B) Decreased hypoxic respiratory drive due to high oxygen
C) Carbon dioxide narcosis from retained CO2
D) Pulmonary embolism
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive.
Excessive oxygen can reduce respiratory drive, worsening hypercapnia and
causing lethargy.
,3|Page
7. A patient is receiving a blood transfusion of packed red blood cells. Fifteen
minutes after the start, the patient reports chills, low back pain, and feels
“feverish.” Temperature is 38.5°C (101.3°F). What is the priority nursing action?
A) Slow the transfusion rate to 50 mL/hr
B) Administer acetaminophen per order
C) Stop the transfusion and maintain IV line with normal saline
D) Notify the healthcare provider after stopping
Rationale: These symptoms suggest an acute hemolytic or febrile reaction. Stop
transfusion immediately, keep line open with saline, then notify provider.
8. The nurse is teaching a patient with newly diagnosed hypertension about dietary
changes. Which patient statement indicates correct understanding?
A) “I should avoid all canned vegetables.”
B) “I will check food labels for sodium content and aim for less than 2,300 mg
per day.”
C) “I can use sea salt instead of table salt because it has less sodium.”
D) “I need to eliminate all carbohydrates from my diet.”
*Rationale: DASH diet recommends <2,300 mg sodium/day (or <1,500 mg for
higher risk). Sea salt has similar sodium content as table salt.*
9. A patient with cirrhosis develops asterixis (liver flap). What is the priority
nursing assessment?
A) Blood glucose level
B) Serum ammonia level
C) Prothrombin time
D) Serum albumin
Rationale: Asterixis is a sign of hepatic encephalopathy, which is associated with
elevated ammonia levels. This requires prompt intervention.
10. The nurse is caring for a patient with a chest tube to water seal drainage for a
pneumothorax. The nurse notes continuous bubbling in the water seal chamber.
What is the most appropriate action?
A) Clamp the chest tube immediately
B) Assess for an air leak in the system
C) Increase suction pressure
D) Document as normal finding
Rationale: Intermittent bubbling with coughing is normal; continuous bubbling
, 4|Page
indicates an air leak. Clamping is dangerous; assess the system and notify
provider.
11. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. The nurse expects to administer which medication?
A) Furosemide 40 mg IV push
B) Calcium gluconate IV
C) Spironolactone 25 mg orally
D) Potassium chloride 20 mEq orally
Rationale: Calcium gluconate is given emergently to stabilize cardiac
membranes in severe hyperkalemia. Other treatments include insulin/glucose,
albuterol, and sodium polystyrene sulfonate.
12. The nurse is preparing a patient for a colonoscopy. The patient takes warfarin
daily for atrial fibrillation. What instruction should the nurse provide?
A) Continue warfarin as usual
B) Hold warfarin 5 days before the procedure per provider order
C) Double the dose the day before the procedure
D) Take warfarin with a small sip of water the morning of the procedure
Rationale: Warfarin is typically held 5 days before invasive procedures to reduce
bleeding risk. Bridging therapy may be ordered. Never instruct patient
independently without provider order.
13. A patient with a traumatic brain injury has an intracranial pressure (ICP)
monitor in place. The ICP reading is 22 mm Hg. Which nursing intervention is
most appropriate?
A) Elevate the head of the bed to 90 degrees
B) Maintain head of bed at 30 degrees and keep neck midline
C) Encourage the patient to cough and deep breathe
D) Cluster all care activities to minimize disturbances
*Rationale: Normal ICP is 5-15 mm Hg; 22 is elevated. HOB 30 degrees, neck
midline, avoid clustering care, and minimize suctioning. HOB 90 degrees may
lower cerebral perfusion.*
14. The nurse assesses a patient 2 hours after a thyroidectomy. The patient reports
tingling around the mouth and fingers. The nurse notes Chvostek’s sign positive.
What is the priority action?
A) Administer oral calcium carbonate
B) Check serum calcium level and notify provider
