Hesi Medical Surgical 1
HESI Medical-Surgical 1 – Practice Questions With Answers
Prepare for your ulosca's HESI Medical-Surgical 1 practice questions—designed for nursing students aiming to pass exams at ease
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Covers fluid & electrolyte imbalances, perioperative care, infection control, and system-specific disorders
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Includes nursing priorities, medication safety, and client education
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Features clinical vignettes and diagnostic reasoning challenges
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Aligned with NCLEX-RN fundamentals and HESI blueprint
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Free Hesi Medical Surgical 1 Questions
A male adolescent arrives at the clinic and reports intense pain in the testicular area that occurred during football practice at high school. The nurse observes the scrotum and identifies significant erythema and swelling. Which action should the nurse take
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Report the findings immediately to the healthcare provider.
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Provide the adolescent with a urinal for urinary hesitancy.
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Obtain a swab of secretions from the penis and urethra.
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Collect a sterile urine sample for culture and sensitivity.
Explanation
Correct Answer A. Report the findings immediately to the healthcare provider.
Why this is the correct answer:
A. Report the findings immediately to the healthcare provider.
Acute scrotal pain with erythema and swelling in an adolescent is a red flag for testicular torsion, a surgical emergency. Testicular torsion compromises blood supply to the testis, and irreversible ischemic damage can occur within 4–6 hours. The nurse’s priority is to immediately notify the healthcare provider so urgent surgical intervention can be initiated. Prompt action is essential to preserve testicular viability and prevent infertility.
Why the other options are incorrect:
B. Provide the adolescent with a urinal for urinary hesitancy.
Urinary hesitancy is not the primary concern in this scenario. The focus should be on the acute scrotal emergency, not bladder function.
C. Obtain a swab of secretions from the penis and urethra.
Swabbing for secretions would be relevant if an infection such as urethritis or sexually transmitted disease were suspected. However, there are no signs of penile discharge, and delaying care for this would waste critical time.
D. Collect a sterile urine sample for culture and sensitivity.
A urine culture may help rule out urinary tract infection or epididymitis, but this is not the priority. The immediate concern is possible torsion, which requires surgical evaluation without delay.
A client with colitis reports to the clinic for a follow up visit. The client is currently taking an antiinflammatory medication daily and reports occasional bloody diarrhea, fatigue, and night sweats. Which assessment is most important for the nurse to obtain
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Body weight.
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Oral temperature.
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Lung sounds.
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Blood pressure.
Explanation
Correct Answer B: Oral temperature.
Explanation of the correct answer:
B. Oral temperature:
The client with colitis who is experiencing symptoms such as bloody diarrhea, fatigue, and night sweats may be showing signs of an active flare or a potential complication, such as an infection or inflammation. An elevated temperature could indicate infection or increased inflammation, both of which require prompt attention in clients with inflammatory bowel disease (IBD). Since the client is already on anti-inflammatory medication, it is important to assess for any signs of infection, as these medications can sometimes suppress symptoms of infection. Monitoring the client's temperature is critical to assess for fever, which may suggest a need for further intervention or adjustment of the treatment plan.
Why the other options are incorrect:
A. Body weight:
While monitoring body weight is important in assessing the nutritional status of a client with colitis, it is not the most immediate concern. The symptoms reported (bloody diarrhea, fatigue, and night sweats) are more indicative of an ongoing inflammatory process or possible infection, and temperature would be the more urgent assessment in this context.
C. Lung sounds:
Lung sounds would be relevant if the client was exhibiting respiratory symptoms, such as shortness of breath or cough. There is no mention of respiratory symptoms in this scenario, so lung sounds are not the most important assessment at this time.
D. Blood pressure:
Blood pressure can be an important assessment, particularly in clients who are at risk for dehydration due to diarrhea or those with other cardiovascular concerns. However, given the symptoms of bloody diarrhea, fatigue, and night sweats, a fever is more concerning as it may indicate infection or an inflammatory flare-up that requires immediate attention. Blood pressure monitoring could be considered later, but it is not the most urgent priority in this situation.
Following a total thyroidectomy, the nurse plans to observe a client for complications. Which finding indicates that the client has developed a complication
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Reports muscle twitching in hands and feet.
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Diaphoretic, but denies any headache.
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Denies muscle spasms in extremities.
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Notes back and joint tenderness and pain.
Explanation
Correct Answer A: Reports muscle twitching in hands and feet.
Explanation of the correct answer:
After a total thyroidectomy, a common complication is hypocalcemia, which occurs due to inadvertent damage to the parathyroid glands. The parathyroid glands regulate calcium levels in the blood, and damage to them can lead to decreased calcium levels. One of the classic signs of hypocalcemia is muscle twitching or spasms, particularly in the hands and feet, as well as tingling sensations (also known as tetany). Therefore, muscle twitching in the hands and feet should be reported as a possible complication after thyroidectomy.
Why the other options are incorrect:
B. Diaphoretic, but denies any headache:
While diaphoresis can be a symptom of a variety of conditions, including thyroid imbalances or stress, it is not specifically indicative of a complication immediately following a thyroidectomy. Since the client denies headache, this finding alone is not sufficient to suggest a complication like hypocalcemia or other common postoperative issues such as hemorrhage or infection.
C. Denies muscle spasms in extremities:
The absence of muscle spasms is not a concern following a thyroidectomy. In fact, it is reassuring to know that the client does not report muscle spasms, as this would suggest that hypocalcemia (which causes spasms) is not present. Therefore, this finding does not indicate a complication.
D. Notes back and joint tenderness and pain:
Back and joint pain can occur due to various reasons, such as positioning during surgery or general discomfort following surgery. However, this type of pain is not specific to thyroidectomy complications and does not raise immediate concern. It is important to assess for more concerning symptoms like tetany or other signs of electrolyte imbalances after a thyroidectomy.
During an assessment, the nurse determines that a client with hypothyroidism has a goiter. An increase in which laboratory test result(s) supports this finding
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Serum triiodothyronine (T3) and thyroxine (T4).
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Thyroid stimulating hormone (TSH).
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lodine.
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Calcium
Explanation
Correct Answer B: Thyroid stimulating hormone (TSH).
Explanation of the correct answer:
In hypothyroidism, the thyroid gland is underactive and produces insufficient amounts of thyroid hormones (T3 and T4). In response to this, the pituitary gland secretes more thyroid-stimulating hormone (TSH) to stimulate the thyroid gland to produce more hormones. However, in hypothyroidism, the thyroid cannot respond adequately, leading to persistently high levels of TSH in the blood. A goiter, which is an enlargement of the thyroid gland, often occurs as a result of the gland's continuous stimulation due to high TSH levels. Therefore, an increase in TSH levels supports the presence of hypothyroidism and the development of a goiter.
Why the other options are incorrect:
A. Serum triiodothyronine (T3) and thyroxine (T4):
In hypothyroidism, the levels of T3 and T4 are typically low, not elevated. Therefore, an increase in these levels would not support the presence of a goiter in a client with hypothyroidism.
C. Iodine:
Iodine deficiency can lead to a goiter, but iodine levels are not typically elevated in hypothyroidism. Instead, iodine deficiency may be a contributing factor to goiter formation, but it is not a direct laboratory result associated with hypothyroidism and goiter in the context of this question.
D. Calcium:
Calcium levels are not directly related to the presence of a goiter in hypothyroidism. Although calcium imbalances can occur with thyroid disorders (e.g., hyperparathyroidism), calcium levels do not provide direct information about the thyroid's function or the presence of a goiter.
Which dietary instruction is most important for the nurse to explain to a client who has had gastric bypass surgery
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Chew slowly and thoroughly.
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Eat small frequent meals.
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Sip fluids with each meal.
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Reduce intake of fatty foods.
Explanation
Correct Answer A: Chew slowly and thoroughly.
Explanation of the correct answer:
A. Chew slowly and thoroughly:
After gastric bypass surgery, the stomach size is significantly reduced, which means that food must be chewed thoroughly to prevent discomfort, such as nausea, vomiting, or a sensation of fullness. Smaller pieces of food are more easily digested in the smaller stomach pouch. Chewing food slowly also helps the body to better absorb nutrients, reducing the risk of digestive issues and helping the client feel more satisfied after meals.
Why the other options are incorrect:
B. Eat small frequent meals:
While eating small, frequent meals is important to prevent overeating after gastric bypass surgery, it is not the most important instruction. This recommendation is typically given as part of a broader dietary plan, but the priority is to ensure that the food is chewed properly, which directly impacts digestion.
C. Sip fluids with each meal:
Sipping fluids with meals is generally discouraged after gastric bypass surgery, as it can cause discomfort by filling the stomach too quickly and reducing the space available for food. Clients are usually advised to drink fluids between meals rather than during them to avoid overfilling the stomach pouch and to prevent stretching of the pouch.
D. Reduce intake of fatty foods:
Although reducing the intake of fatty foods is an important dietary recommendation after gastric bypass surgery to aid weight loss and prevent discomfort, it is not the most critical instruction compared to chewing food slowly. Fatty foods can lead to digestive issues such as diarrhea or nausea, but proper chewing is more immediately important for the safe digestion of food.
The nurse observes that a client with Parkinson's disease (PD) has a mask like face. Which follow up assessment is most important for the nurse to implement
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Determine ability to chew and swallow.
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Observe appearance of oral mucosa.
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Assess patterns of speech.
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Note frequency of drooling.
Explanation
Correct Answer A: Determine ability to chew and swallow.
Why this is the correct answer:
A mask-like face is a common characteristic of Parkinson's disease (PD), due to bradykinesia (slowness of movement) and hypomimia (reduced facial expression). This facial appearance is often associated with dysphagia (difficulty swallowing), a frequent concern in PD. Difficulty in swallowing can lead to aspiration, which increases the risk of pneumonia and other complications. Therefore, the most important follow-up assessment for the nurse to implement is to determine the client’s ability to chew and swallow to ensure safety and prevent aspiration.
Why the other options are incorrect:
B. Observe appearance of oral mucosa.
While it is important to assess the oral mucosa for signs of dryness or infection, this assessment is secondary in this situation. The primary concern should be the client’s ability to swallow, as dysphagia is more likely to result in immediate health risks, such as aspiration.
C. Assess patterns of speech.
Speech patterns, such as soft or monotone voice, are common in Parkinson’s disease. However, assessing speech patterns is not as critical as evaluating swallowing ability when a mask-like face is observed. Dysphagia is more directly linked to the immediate risk of aspiration, which can lead to severe complications.
D. Note frequency of drooling.
Drooling can occur in Parkinson's disease due to reduced swallowing reflex or poor oral motor control. While important, it is not as immediately critical as assessing the client’s ability to swallow safely. The risk of aspiration due to swallowing difficulties should take priority.
A client with a history of heart failure is admitted to the cardiac unit with a serum sodium level of 128 mEq/L (128 mmol/L). The client is instructed to limit fluid intake to 1,500 mL per day, as prescribed, The client's serum sodium level the following day is 122 mEq/L (122 mmol/L). Which action should the nurse implement
Reference Range
Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]:
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Consult with the healthcare provider to increase the client's allowable fluid intake
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Explain that the fluid restriction has restored the client's electrolyte levels.
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Encourage the client to add salt to the foods on each of the hospital meal trays.
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Reteach the client about the need to adhere to the prescribed fluid restrictions.
Explanation
Correct Answer A: Consult with the healthcare provider to increase the client's allowable fluid intake.
Why this is the correct answer:
The client’s serum sodium level has continued to decrease from 128 mEq/L to 122 mEq/L, which indicates worsening hyponatremia (low sodium levels). Fluid restriction is a common management strategy for heart failure, but the continuing decline in sodium levels suggests that the client may not be receiving adequate treatment. In such cases, the nurse should consult with the healthcare provider to reevaluate the fluid restriction and potentially adjust the plan of care. This may involve modifying fluid intake, adjusting medications, or considering other interventions such as sodium replacement or diuretics.
Why the other options are incorrect:
B. Explain that the fluid restriction has restored the client's electrolyte levels.
The client's serum sodium level has decreased, not increased. This response would be incorrect because the fluid restriction has not restored the electrolyte balance as intended. In fact, it appears to have contributed to further electrolyte imbalance, so this explanation is not accurate.
C. Encourage the client to add salt to the foods on each of the hospital meal trays.
Encouraging the client to add salt to their food is not recommended in this situation because the client is experiencing hyponatremia. Increasing sodium intake without proper medical oversight could worsen the condition. In fact, managing hyponatremia typically involves restricting fluid intake and monitoring electrolyte levels, not increasing dietary sodium.
D. Reteach the client about the need to adhere to the prescribed fluid restrictions.
While it is important to ensure the client understands the fluid restriction regimen, the client's sodium levels have continued to decrease despite the restriction, suggesting that the current plan may not be effective. Re-teaching fluid restriction without reassessing the overall treatment plan or consulting the healthcare provider may not address the root cause of the problem.
The nurse observes a mother giving her 11-month-old ferrous sulfate, followed by 2 ounces (60 mL) of orange juice. Which should the nurse do next
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Instruct the mother to feed the infant nothing for 30 minutes after giving the iron drops.
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Tell the mother to follow the iron drops with infant formula instead of orange juice.
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Suggest placing the iron drops in the orange juice and then feeding the infant.
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Give the mother positive feedback about the way she administered the medication.
Explanation
Correct Answer D. Give the mother positive feedback about the way she administered the medication.
Why this is the correct answer:
D. Give the mother positive feedback about the way she administered the medication.
Ferrous sulfate is best absorbed in the presence of vitamin C, and orange juice is an excellent source. Giving the drops with orange juice maximizes absorption and supports effective treatment of iron deficiency anemia. The mother demonstrated correct administration, so the nurse should provide positive reinforcement to encourage continuation of this effective practice.
Why the other options are incorrect:
A. Instruct the mother to feed the infant nothing for 30 minutes after giving the iron drops.
There is no requirement to keep the infant NPO after giving iron. The focus is on administering iron with vitamin C to enhance absorption and avoiding giving it with milk.
B. Tell the mother to follow the iron drops with infant formula instead of orange juice.
Formula (especially cow’s milk–based) inhibits iron absorption due to calcium content. This would decrease the effectiveness of the iron supplement.
C. Suggest placing the iron drops in the orange juice and then feeding the infant.
This may seem reasonable, but mixing the iron in juice can stain the teeth and reduce assurance of a full dose being consumed. Giving the iron directly and then following with juice is the correct method.
An older resident of a skilled nursing facility (SNF) has not had a bowel movement in the last week. After assessing the client's abdomen, which action should the nurse take next
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Increase assisted ambulation.
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Perform a digital examination for fecal impaction.
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Administer an oil retention enema.
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Increase dietary fiber and add prune juice daily.
Explanation
Correct Answer B: Perform a digital examination for fecal impaction.
Explanation of the correct answer:
The client has not had a bowel movement in a week, which suggests potential constipation or fecal impaction. In this scenario, performing a digital examination for fecal impaction is the next appropriate step. Fecal impaction is a common issue in older adults, especially those in skilled nursing facilities, due to factors such as immobility, dehydration, or poor dietary habits. A digital examination is performed to assess for the presence of hardened stool in the rectum that may be obstructing the passage of stool.
Why the other options are incorrect:
A. Increase assisted ambulation:
Increasing ambulation can help with constipation by promoting peristalsis and overall gastrointestinal motility. However, in this case, since the client has not had a bowel movement for a week, the priority action is to assess for fecal impaction first, as this could be causing the constipation. Ambulation can be considered after ruling out impaction, but it is not the immediate intervention.
C. Administer an oil retention enema:
While oil retention enemas are sometimes used to soften stool and promote a bowel movement, it is essential to assess for fecal impaction before administering any laxative or enema. If fecal impaction is present, using an enema could be ineffective or potentially harmful, as it may not relieve the obstruction. A digital examination should be performed first to rule out fecal impaction.
D. Increase dietary fiber and add prune juice daily:
Increasing dietary fiber and adding prune juice are good long-term strategies for managing constipation. However, in the acute setting where the client has not had a bowel movement for a week, it is crucial to assess for fecal impaction first. If fecal impaction is present, dietary changes and juice intake will not be effective until the impaction is cleared.
Following a vaginal delivery, the nurse places the neonate under the radiant warmer, provides naso-oropharyngeal suction, and dries the neonate's skin to elicit spontaneous respirations. The newborn heart rate is 100 beats/minute and remains apneic when the nurse flicks the soles of the feet. Which action should the nurse implement next
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Assist neonatologist with intubation.
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Start IV infusion in a scalp vein.
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Provide positive pressure ventilation.
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Give blow-by oxygen via cannula.
Explanation
Correct Answer C. Provide positive pressure ventilation.
Why this is the correct answer:
C. Provide positive pressure ventilation.
According to neonatal resuscitation guidelines, if a newborn is apneic or has a heart rate below 100 beats/minute after initial stimulation, the next step is to initiate positive pressure ventilation (PPV) with a bag-valve-mask. PPV helps inflate the lungs, establish effective respirations, and improve oxygenation and circulation. This is the critical next action to prevent hypoxia and further deterioration.
Why the other options are incorrect:
A. Assist neonatologist with intubation.
Intubation may be needed if PPV is ineffective or prolonged resuscitation is required, but the immediate next step is to begin PPV with a bag and mask, not proceed directly to intubation.
B. Start IV infusion in a scalp vein.
IV access is used for fluids or emergency medications (e.g., epinephrine), but this is not the immediate priority. Effective ventilation takes precedence over IV access in neonatal resuscitation.
D. Give blow-by oxygen via cannula.
Blow-by oxygen is inadequate for an apneic infant. Oxygen must be delivered under pressure to expand the alveoli and initiate effective respirations.
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1. Introduction
The HESI Medical-Surgical 1 Online Practice Guide equips nursing students with the core clinical knowledge and critical reasoning skills essential for success in med-surg nursing exams. This resource emphasizes clinical prioritization, patient safety, and application of the nursing process in diverse adult health scenarios. All practice content aligns with HESI competency areas and NCLEX-RN standards, supporting safe and effective patient care delivery.
2. Systems-Based Adult Health Management
Medical-surgical nursing involves managing acute and chronic conditions across body systems. This section builds core clinical judgment through evidence-based care approaches and prioritization frameworks.
Key systems covered include:
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Cardiovascular: heart failure, hypertension, MI, arrhythmias
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Respiratory: pneumonia, COPD, asthma, post-op respiratory compromise
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Renal/Genitourinary: acute kidney injury, chronic renal failure, electrolyte imbalance
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Endocrine: diabetes management, thyroid disorders, adrenal crisis
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Musculoskeletal and Neurological: Parkinson's disease, fractures, stroke care
Emphasis is placed on recognizing early signs of deterioration, integrating lab results with symptoms, and responding effectively to dynamic clinical changes.
3. Clinical Prioritization and Patient Safety
Students must master how to prioritize interventions using frameworks such as ABCs (Airway, Breathing, Circulation) and Maslow’s Hierarchy of Needs. This section enhances decision-making under pressure.
Topics include:
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Safety in the immediate post-op period
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Managing sepsis, hypoglycemia, and electrolyte emergencies
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Responding to changes in LOC or new onset symptoms
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Differentiating urgent from non-urgent needs across multiple patients
Scenarios encourage rapid analysis and action to prevent complications and escalate care appropriately.
4. Evidence-Based Nursing Interventions
This section focuses on implementing interventions that align with national guidelines and evidence-based standards.
Core topics:
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Infection prevention and isolation protocols
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Safe medication administration (including insulin timing and IV antibiotics)
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Positioning strategies to prevent complications (e.g., aspiration, pressure ulcers)
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Supporting mobility, nutrition, and respiratory function in compromised patients
Each scenario tests students on clinical outcomes, safety risks, and nursing rationale.
5. Delegation, Communication, and Ethics
Effective communication and delegation are critical in fast-paced med-surg environments.
Covered concepts:
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Delegating tasks to UAPs and LPNs using the Five Rights of Delegation
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Therapeutic communication in client education and emotional support
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Managing ethical issues such as informed consent and confidentiality
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Culturally responsive care planning
Students engage in clinical judgment challenges involving nurse-patient interaction, interdisciplinary collaboration, and managing workplace dilemmas.
Case Study Example
Patient: Mr. Johnson, 67 years old, presents with dyspnea, bilateral crackles, and 2+ pedal edema. History of CHF and diabetes. Medications include furosemide, metformin, and lisinopril.
Scenario: Mr. Johnson has gained 4 pounds in the past 2 days and reports orthopnea and fatigue.
Analysis:
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Assess fluid volume status, recent lab values (BUN/Creatinine, potassium)
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Nursing diagnoses may include “Fluid volume excess” and “Activity intolerance”
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Plan includes medication timing adjustment, fluid restriction education, and daily weights
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Implementation involves administering diuretics, monitoring I&O, and positioning
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Evaluation confirms reduced edema, improved breathing, and weight stabilization
Frequently Asked Question
This guide is perfect for nursing students preparing for the HESI Medical-Surgical 1 exam—and anyone wanting to boost their clinical reasoning and NCLEX readiness.
Yes. Whether you’re new to HESI or looking to retake, this guide is built to simplify complex concepts and sharpen your clinical judgment.
Expect heavy focus on cardiovascular, respiratory, renal, and endocrine systems—plus medication safety, clinical reasoning, lab value interpretation, and emergency response.
Absolutely. All content is aligned with NCLEX-RN guidelines and the latest HESI exam blueprints, focusing on safe, evidence-based adult patient care.
Yes! The questions are designed to reflect HESI exam structure, prioritization formats, and NCLEX-style thinking—giving you the confidence to answer with accuracy under pressure.
You’ll get access to 150+ exam-style questions covering fluid balance, perioperative care, infection control, and system-specific conditions—plus detailed rationales and real-world clinical scenarios.