Hesi Medical Surgical 1
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Free Hesi Medical Surgical 1 Questions
A female reports to the nurse that she has uncontrollable urine loss when coughing or sneezing. Which action should the nurse recommend
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Drink non-caffeinated colas only.
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Urinate every two to three hours.
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Reduce intake of processed foods.
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Limit the daily intake of water.
Explanation
Correct Answer B: Urinate every two to three hours.
Why this is the correct answer:
The client is reporting stress incontinence, which is a type of urinary incontinence that often occurs with physical activities that increase intra-abdominal pressure, such as coughing or sneezing. One of the primary recommendations for managing stress incontinence is to urinate every two to three hours to avoid a full bladder, which can increase the likelihood of involuntary leakage. This routine helps to ensure that the bladder is not overfilled, reducing the risk of incontinence episodes. It is also part of a broader strategy of bladder training to improve control over urination.
Why the other options are incorrect:
A. Drink non-caffeinated colas only.
While caffeine can sometimes irritate the bladder and increase the frequency of urination, drinking non-caffeinated colas is not a specific intervention for managing stress incontinence. It is more important to focus on a balanced fluid intake rather than restricting fluids to specific types of beverages. In fact, excessive fluid restriction can lead to concentrated urine and increased irritation of the bladder.
C. Reduce intake of processed foods.
While reducing the intake of processed foods is generally good for overall health, it is not a specific intervention for managing stress incontinence. Processed foods may contribute to weight gain or other issues, but they do not directly address the cause of stress incontinence, which is usually related to pelvic floor weakness or pressure changes, not dietary habits alone.
D. Limit the daily intake of water.
Limiting water intake is not recommended for managing incontinence. Dehydration can actually worsen urinary tract issues and lead to more concentrated urine, which can irritate the bladder and increase the frequency of incontinence episodes. It is important to maintain adequate fluid intake to ensure proper hydration, while also using bladder training techniques to prevent overfilling and incontinence.
A child receives a prescription for diphenhydramine 12.5 mg by mouth every 4 hours as needed for pruritus. The bottle is labeled "Diphenhydramine for Oral Solution, USP 12.5 mg per 5 mL." How many teaspoon(s) should the nurse instruct the parent to administer with each dose
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½ teaspoon
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1 teaspoon
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1½ teaspoons
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2 teaspoons
Explanation
Correct Answer B. 1 teaspoon
Why this is the correct answer:
B. 1 teaspoon.
The ordered dose is 12.5 mg, and the solution is labeled 12.5 mg per 5 mL. This means the child requires 5 mL for each dose. Since 5 mL equals exactly 1 teaspoon, the correct amount for the parent to give is 1 teaspoon per dose. This matches the prescribed dose precisely and ensures safe, accurate administration.
Why the other options are incorrect:
A. ½ teaspoon.
Half a teaspoon is 2.5 mL, which equals only 6.25 mg of diphenhydramine. This underdoses the child, failing to meet the prescribed 12.5 mg requirement.
C. 1½ teaspoons.
One and a half teaspoons equals 7.5 mL, which delivers 18.75 mg of diphenhydramine. This exceeds the prescribed 12.5 mg dose and risks overmedication.
D. 2 teaspoons.
Two teaspoons equal 10 mL, which contains 25 mg of diphenhydramine—double the ordered dose. This would place the child at risk for serious adverse effects such as sedation, confusion, or toxicity.
A client is admitted with a ruptured diverticulum and peritonitis. The client's vital signs are temperature 103.2° F (39.6°C) orally, heart rate 126 beats/minute, respirations 32 breaths/minute, and blood pressure 70/40 mm Hg. The client's urine output is 25 mL/hour. Which action should the nurse implement
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Give antipyretics every 4 hours for fever.
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Infuse IV antibiotics and crystalloids fluids.
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Review complete blood cell counts.
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Place the client in Trendelenburg position.
Explanation
Correct Answer B: Infuse IV antibiotics and crystalloids fluids.
Why this is the correct answer:
The client presents with ruptured diverticulum and peritonitis, accompanied by severe systemic signs: high fever (103.2°F), tachycardia (126 bpm), tachypnea (32 breaths/min), hypotension (70/40 mm Hg), and decreased urine output (25 mL/hr). These findings are consistent with septic shock resulting from peritoneal infection.
The priority intervention in septic shock is rapid administration of IV fluids (crystalloids) to restore intravascular volume and perfusion, followed by prompt initiation of broad-spectrum IV antibiotics to control the source of infection. These measures are part of the Surviving Sepsis Campaign's early goal-directed therapy, which is critical for reducing mortality in sepsis.
Why the other options are incorrect:
A. Give antipyretics every 4 hours for fever.
While fever management can improve comfort, it is not a priority in life-threatening shock. Antipyretics do not address the underlying infection or hemodynamic instability, and fever may actually be beneficial in fighting infection. Fever control should not delay urgent fluid resuscitation and antibiotics.
C. Review complete blood cell counts.
A CBC may provide useful information (e.g., leukocytosis, hemoconcentration), but reviewing labs is a diagnostic step, not an immediate life-saving intervention. In septic shock, delaying treatment to wait for labs can worsen the patient’s outcome.
D. Place the client in Trendelenburg position.
Trendelenburg is not recommended for hypotension or shock. It does not improve perfusion and may compromise respiratory function by increasing abdominal pressure, especially in peritonitis. It is an outdated and ineffective method of managing hypotension.
A client's laboratory findings indicate elevations in triiodothyronine (T3) and thyroxine (T4) hormones. The nurse suspects that the client may have hyperthyroidism. Which assessment finding is most often associated with hyperthyroidism
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Increased heart rate.
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Atrophied thyroid gland.
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Diarrhea stools.
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Periorbital edema.
Explanation
Correct Answer A: Increased heart rate.
Why this is the correct answer:
Hyperthyroidism is a condition where there is an excessive production of thyroid hormones (T3 and T4), which accelerates the body's metabolism. One of the most common and early symptoms of hyperthyroidism is an increased heart rate (tachycardia), which occurs due to the stimulating effect of excess thyroid hormones on the cardiovascular system. The elevated thyroid hormones cause the heart to pump faster, leading to tachycardia. This is the most common and frequent finding associated with hyperthyroidism.
Why the other options are incorrect:
B. Atrophied thyroid gland.
An atrophied thyroid gland is more likely to be seen in hypothyroidism rather than hyperthyroidism. In hyperthyroidism, the thyroid gland is often enlarged (goiter) due to the overproduction of hormones. Atrophy of the thyroid gland can occur in conditions like Hashimoto’s thyroiditis, which leads to hypothyroidism, not in hyperthyroidism.
C. Diarrhea stools.
Although diarrhea can occur in some cases of hyperthyroidism due to the increased metabolic rate and gastrointestinal motility, it is not as commonly observed as tachycardia. Increased bowel movements or diarrhea may be present, but they are secondary to the more prominent symptoms of hyperthyroidism, such as tachycardia, weight loss, and nervousness.
D. Periorbital edema.
Periorbital edema (swelling around the eyes) is more commonly seen in hypothyroidism, particularly in myxedema. In hyperthyroidism, you are more likely to observe symptoms such as exophthalmos (bulging eyes) in Graves' disease, which is a common cause of hyperthyroidism, rather than periorbital edema.
A client recently diagnosed with Crohn's disease calls the clinic about several concerns. Which client comment should the nurse report to the healthcare provider
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Constipation for 2 days after eating cheese.
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Request to schedule another colonoscopy.
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Bloody diarrhea after eating grilled beef.
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Abdominal pain relieved by defecation.
Explanation
Correct Answer C: Bloody diarrhea after eating grilled beef.
Why this is the correct answer:
Bloody diarrhea is a significant symptom that requires immediate attention in a client with Crohn’s disease. It may indicate active disease flare-up, severe inflammation, or intestinal bleeding, which can lead to serious complications such as anemia or perforation. Any instance of bloody diarrhea should be promptly reported to the healthcare provider as it may necessitate further diagnostic evaluation, adjustments in treatment, or intervention to manage complications. While Crohn’s disease can cause gastrointestinal symptoms, the presence of blood in the stool warrants careful evaluation to rule out complications like ulceration, fistulas, or infection.
Why the other options are incorrect:
A. Constipation for 2 days after eating cheese.
Constipation is a common issue for individuals with Crohn’s disease, and some clients may experience it after eating certain foods, such as cheese, due to lactose intolerance or changes in the gastrointestinal motility associated with Crohn’s disease. However, this symptom alone does not necessarily require urgent attention unless it is part of a broader pattern of changes in bowel habits. It is not an immediate concern unless it becomes severe or chronic.
B. Request to schedule another colonoscopy.
While colonoscopy is important for monitoring the progression of Crohn’s disease, a request for another colonoscopy does not require immediate reporting to the healthcare provider unless there are specific indications that more frequent evaluations are necessary, such as a flare-up of symptoms or unexplained changes in the disease course. This comment alone does not indicate a medical emergency or require urgent action.
D. Abdominal pain relieved by defecation.
Abdominal pain that is relieved by defecation can be a symptom associated with Crohn's disease, especially in the case of intestinal inflammation or obstructions. It is not uncommon for individuals with Crohn's disease to experience such pain, and while it may be discomforting, it does not require urgent action unless it is accompanied by other concerning symptoms such as severe pain, fever, or bleeding. This is more of a discomfort issue than an urgent medical concern.
The nurse is caring for an older adult client who is admitted due to a change in mental status after two days of nausea and vomiting. The client's home medications include SUBQ insulin, a daily antihypertensive, and a daily diuretic. Which intervention should the nurse implement first
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Obtain a capillary blood glucose level.
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Establish a mental status baseline.
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Check accuracy of medication list.
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Insert an indwelling urinary catheter.
Explanation
Correct Answer A: Obtain a capillary blood glucose level.
Why this is the correct answer:
The client is presenting with altered mental status after two days of nausea and vomiting. This raises immediate concern for metabolic disturbances such as hypoglycemia or electrolyte imbalances, both of which can be life-threatening and must be evaluated urgently. Given the client is on subcutaneous insulin and has been vomiting (likely reducing oral intake), hypoglycemia is a critical concern. A capillary blood glucose (CBG) can be obtained quickly and non-invasively at the bedside and provides immediate data that can guide urgent treatment. If the client is hypoglycemic, this needs to be corrected immediately to prevent irreversible brain injury.
Why the other options are incorrect:
B. Establish a mental status baseline.
While important for ongoing assessment, establishing a baseline is not the priority when the cause of the altered mental status is potentially life-threatening and reversible, such as hypoglycemia. Mental status evaluation will be more accurate and meaningful after urgent metabolic causes are ruled out or treated.
C. Check accuracy of medication list.
Medication reconciliation is critical during admission but is a secondary priority when the client is acutely ill and symptomatic. Reviewing the medication list will help determine possible contributors (e.g., insulin, diuretic), but does not provide immediate diagnostic or therapeutic benefit.
D. Insert an indwelling urinary catheter.
This may become necessary for monitoring urine output and assessing hydration status or renal perfusion, but it is not the first priority. It does not address the acute risk of hypoglycemia or correct the altered mental status
When caring for a client who had general anesthesia, which nursing protocol has priority during the immediate postoperative period
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Evaluate temperature every 15 minutes.
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Record blood pressure every 15 minutes.
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Determine respiratory rate every 10 minutes.
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Assess level of consciousness every 5 minutes.
Explanation
Correct Answer C: Determine respiratory rate every 10 minutes.
Why this is the correct answer:
The most critical priority in the immediate postoperative period is monitoring for airway and respiratory compromise, especially after general anesthesia, which can depress respiratory function. Respiratory assessment, including rate, depth, and effort, must be done frequently to identify early signs of hypoventilation, airway obstruction, or hypoxia. Determining the respiratory rate every 10 minutes allows the nurse to promptly detect and intervene if respiratory compromise occurs, which is essential for patient safety and aligns with the ABCs (Airway, Breathing, Circulation) of nursing priorities.
Why the other options are incorrect:
A. Evaluate temperature every 15 minutes.
While monitoring temperature is important postoperatively to detect hypothermia or malignant hyperthermia, it is not the immediate priority. Temperature changes usually occur gradually, and they do not pose as immediate a threat to life as respiratory compromise does.
B. Record blood pressure every 15 minutes.
Blood pressure monitoring is essential to assess for hemodynamic stability, bleeding, or shock. However, while it is a critical component of postoperative care, it comes after ensuring a patent airway and adequate ventilation. Respiratory compromise can lead to cardiac arrest more rapidly than changes in blood pressure.
D. Assess level of consciousness every 5 minutes.
Assessing the level of consciousness is important, especially to monitor recovery from anesthesia. However, changes in consciousness can be a later sign of hypoxia. It is more effective to prevent hypoxia in the first place by prioritizing respiratory assessment.
Summary:
In the immediate postoperative period after general anesthesia, the priority is to monitor for complications related to airway and breathing. Respiratory rate should be checked frequently, as respiratory compromise is the most immediate life-threatening condition. While vital signs, temperature, and consciousness levels are all important, they follow airway and breathing in priority. Therefore, C. Determine respiratory rate every 10 minutes is the correct answer.
A toddler is hospitalized with Kawasaki's disease. Pharmacological management includes aspirin therapy. Which is the primary benefit of the aspirin
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Reduce joint swelling.
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Manage irritability.
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Minimize vascular inflammation.
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Control high fever.
Explanation
Correct Answer C. Minimize vascular inflammation.
Why this is the correct answer:
C. Minimize vascular inflammation.
Kawasaki’s disease is an acute, systemic vasculitis that primarily affects children under 5. The most serious complication is the development of coronary artery aneurysms. Aspirin is prescribed not only for its antipyretic and analgesic properties but primarily for its anti-inflammatory and antiplatelet effects, which help reduce vascular inflammation and lower the risk of clot formation and coronary artery damage. This is the main therapeutic purpose of aspirin in Kawasaki’s disease.
Why the other options are incorrect:
A. Reduce joint swelling.
While aspirin can relieve inflammation and discomfort, the major concern in Kawasaki’s disease is coronary and systemic vascular inflammation, not just joint swelling.
B. Manage irritability.
Irritability is a common symptom due to prolonged fever, but aspirin is not given primarily for this. Comfort measures and fever reduction address irritability, but the vascular protection is the true priority.
D. Control high fever.
Although aspirin helps reduce fever, acetaminophen or ibuprofen could also serve that role. In Kawasaki’s disease, aspirin’s critical role is in reducing vascular inflammation and preventing cardiac complications, not just fever control.
A one-month-old infant admitted to the hospital with dehydration and failure to thrive receives a prescription for enteral feedings. To maintain normal growth and development of the infant, which action should the nurse include in the plan of care
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Use sterile technique during feedings.
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Ensure placement of the nasogastric tube with an abdominal x-ray.
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Speak to the healthcare provider about instituting physical therapy.
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Offer a pacifier for non nutritive sucking.
Explanation
Correct Answer D. Offer a pacifier for non nutritive sucking.
Why this is the correct answer:
D. Offer a pacifier for non nutritive sucking.
Infants receiving enteral tube feedings miss out on normal sucking experiences, which are crucial for oral motor development, soothing, and parent-infant bonding. Offering a pacifier provides non-nutritive sucking, which supports normal growth and developmental needs. It helps prevent future feeding difficulties, promotes self-soothing, and ensures the infant continues to develop oral coordination even when nutrition is provided through a tube.
Why the other options are incorrect:
A. Use sterile technique during feedings.
Sterile technique is not required for enteral feedings; clean technique is sufficient. Overly strict sterile procedures are unnecessary and not the developmental priority in this case.
B. Ensure placement of the nasogastric tube with an abdominal x-ray.
An abdominal x-ray is typically used for initial confirmation of tube placement. Once confirmed, ongoing verification can be done by aspirating gastric contents and checking pH. This step is about safety, not growth and development.
C. Speak to the healthcare provider about instituting physical therapy.
Physical therapy is not indicated at this point unless there are neuromuscular issues. The immediate developmental concern is ensuring the infant maintains normal oral motor patterns through non-nutritive sucking.
An older adult resident of a long-term care facility was admitted to the hospital with a fractured right hip following a fall. Three days after admission the client develops confusion. Which finding warrants immediate intervention by the nurse
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Concentrated urine output.
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Complains of head pain.
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Serum glucose level 160mg/dL (8.88 mmol/L).
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Bruising on both arms.
Explanation
Correct Answer B: Complains of head pain.
Explanation of the correct answer:
Confusion in an older adult, especially after a fall and hip fracture, can be indicative of a serious complication such as a head injury, which may have occurred during the fall or from subsequent trauma. The complaint of head pain could suggest a concussion, subdural hematoma, or another intracranial injury that requires immediate attention. Head pain, particularly after a fall, warrants urgent evaluation to rule out potentially life-threatening conditions such as intracranial bleeding or increased intracranial pressure.
Why the other options are incorrect:
A. Concentrated urine output:
Concentrated urine output may suggest dehydration, especially in older adults, but it does not indicate a life-threatening situation that requires immediate intervention. While dehydration should be addressed, it is not as urgent as potential head trauma, which can have more severe and immediate consequences.
C. Serum glucose level 160 mg/dL (8.88 mmol/L):
A serum glucose level of 160 mg/dL is elevated, but it is not dangerously high and may not require immediate intervention unless the client has diabetes and is at risk for diabetic ketoacidosis or hyperosmolar hyperglycemic state. A blood glucose level of 160 mg/dL is not life-threatening on its own, and interventions such as adjusting insulin or diet can be addressed as part of routine care, rather than requiring immediate action.
D. Bruising on both arms:
Bruising on both arms, especially in the context of a recent fall and hip fracture, may be due to the injury itself or from the physical handling of the client. However, bruising alone is not immediately life-threatening and does not require urgent intervention unless accompanied by other signs of significant internal injury, such as swelling or severe pain. The priority here is to address the confusion and the possible head injury.
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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.