HESI RN Medical-Surgical (Med-Surg) Exam
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Free HESI RN Medical-Surgical (Med-Surg) Exam Questions
A nurse is reviewing the client’s assessment findings after a fall. Based on the clinical presentation, which findings are MOST consistent with a humeral fracture rather than a rotator cuff injury? (Select all that apply.)
- Reduced pulse distal to the injury
- 1+ strength in the left upper extremity
- Decreased range of motion
- Coolness of the skin
- Pain with movement
Explanation
A. Reduced pulse distal to the injury
A diminished pulse (left radial 1+ compared to 2+ on the right) suggests vascular compromise, which is far more characteristic of a humeral fracture than a rotator cuff tear. Fractures can compress or injure nearby vessels, making this a concerning, fracture-specific finding requiring urgent evaluation.
B. 1+ strength in the left upper extremity
Severely reduced arm strength after trauma may occur in both conditions but is more severe in fractures where pain, structural instability, and possible nerve involvement decrease motor ability. In this case, the client cannot move the left arm and is guarding, consistent with a possible humeral fracture.
D. Coolness of the skin
A cool extremity indicates compromised perfusion, a complication associated with fractures where swelling or displacement may impair circulation. This is not typical of isolated rotator cuff injuries, making this finding strongly indicative of humeral fracture.
Correct Answer Is:
A, B, DThe nurse is caring for a client who tests positive for the sexually transmitted infection (STI) gonorrhea. The client reports having sex with someone who has many partners. Which response should the nurse provide?
- A Teach importance of medication regimen and follow up protocol.
- B Emphasize that using safe sex practices removes the risk of STIs.
- C Discuss that partners without similar symptoms may not be infected.
- D Clarify that all STIs are transmitted through sexual intercourse.
Explanation
When a client is diagnosed with gonorrhea, the immediate priority is ensuring they understand the prescribed treatment plan, the importance of completing all antibiotics, and the need for follow-up testing to confirm cure. The nurse should also emphasize partner notification and treatment to prevent reinfection. This response directly addresses safety, reduces transmission risk, and aligns with evidence-based STI management guidelines.
Correct Answer Is:
A
A client with Cushing's syndrome is recovering from an elective laparoscopic procedure. Which assessment finding warrants immediate intervention by the nurse?
- A Pitting ankle edema.
- B Purple marks on skin of the abdomen.
- C Irregular apical heart rate.
- D Quarter-size blood spot on dressing.
Explanation
An irregular apical heart rate is the most urgent finding because clients with Cushing’s syndrome are at increased risk for cardiac dysrhythmias, electrolyte imbalances (especially hypokalemia), hypertension, and fluid overload. An irregular heart rhythm can indicate life-threatening dysrhythmias, requiring immediate assessment, cardiac monitoring, and electrolyte evaluation.
The other findings—edema, purple abdominal striae, and minimal surgical drainage—are expected with Cushing’s syndrome or postoperative recovery and do not indicate acute deterioration.
Correct Answer Is:
C
The nurse observes that a newly admitted client with Parkinson's disease exhibits a mask-like facial appearance. Which additional nursing assessment takes priority in response to this finding?
- A Respiratory rate.
- B Swallowing ability.
- C Neck flexion.
- D Speech patterns.
Explanation
A mask-like facial expression in Parkinson’s disease occurs due to rigidity and decreased facial muscle movement. This same rigidity can significantly impair swallowing, placing the client at high risk for aspiration, choking, and inadequate nutrition. Because airway protection is a priority, assessing swallowing ability becomes essential. Early identification allows prompt interventions such as modified diets, swallowing precautions, or speech-language pathology referral to reduce aspiration risk and support safe intake.
Correct Answer Is:
B
Patient Data
History and Physical
54-year-old female is brought to the emergency department (ED) by private vehicle. She reports difficulty breathing which has significantly worsened in the past two days, and a moist cough producing thick, yellow sputum. Client reports home oxygen use of 1 liter/minute via nasal cannula; however, she has increased her use to 2 liters/minute due to difficulty
breathing. She has a medical history of heart failure (HF), hypertension, stage 2 kidney disease, and chronic obstructive pulmonary disease (COPD) with multiple exacerbations. Two weeks ago, client had a viral upper respiratory infection for which she was started on stress dose steroids. She has no known allergies.
Nurses' Notes
2005
Healthcare assessment completed by healthcare provider (HCP).
Assessment
. General observation: Is leaning forward, resting her arms in front of her on the pillows. Hair is unkempt, poor oral hygiene, and body odor are noted.
· Neurological: Alert and oriented x 3.
· Cardiovascular: Heart sounds of S1, S2, S3, S4, and a systolic murmur. Jugular vein distention.
. Respiratory: Shallow respirations. Expiratory wheezing and crackles in bilateral upper lobes and diminished bilateral bases. Intercostal retractions.
· Musculoskeletal: Generalized weakness and easily fatigued.
· Gastrointestinal and genitourinary: Increased thirst. Last bowel movement 2 days ago. Increased urinary frequency.
. Integumentary: Skin is warm and diaphoretic. Bilateral finger clubbing. Dry mucous membranes. Poor skin turgor.
Flow Sheet
2005
Vital signs
· Temperature: 100.2° F (37.9° C) Axillary
. Heart rate: 124 beats/minute
. Respiration: 38 breaths/minute
· Blood pressure: 164/94 mm Hg
. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
. Height: 5 feet, 11 inches (180.3 cm)
· Weight: 155 pounds (70.3 kg)
. Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
For each of the findings listed, click to indicate which are consistent with the disease process of chronic obstructive pulmonary disease (COPD), heart failure (HF), or urinary tract infection (UTI). Each column must have at least one response option selected.
For each finding listed below, which findings are consistent with the disease process of urinary tract infection (UTI)? (Select all that apply.)
- A Pain: heaviness in the chest, rated 6 out of 10
- B Temperature: 100.2° F (37.9° C)
- C Oxygen saturation: 87% on 2 liters/minute via nasal cannula
- D Heart sounds of S1, S2, S3, S4
- E Respiration: 38 breaths/minute
- F Jugular vein distention
- G Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Explanation
B. Temperature: 100.2° F (37.9° C)
While the fever may also be related to COPD or HF complications, low-grade fever is commonly seen in UTIs, especially in older adults. Increased urinary frequency mentioned in the case also supports the possibility of UTI as a comorbidity.
Correct Answer Is:
B
When assessing a client for a potential diagnosis of lung cancer, the nurse should review the history for which condition?
- A Night sweats.
- B Hemoptysis.
- C Productive cough.
- D Dyspnea.
Explanation
Hemoptysis—coughing up blood—is a classic and highly significant symptom associated with lung cancer. Tumors within the airway can erode or irritate bronchial blood vessels, leading to bleeding that appears as blood-streaked sputum or frank bloody mucus. This finding warrants prompt evaluation because it often signals advanced or centrally located lesions. While other respiratory symptoms may occur with many lung conditions, hemoptysis is particularly concerning for malignancy and is therefore a key historical cue the nurse should assess when lung cancer is suspected.
Correct Answer Is:
B
Patient Data
History and Physical
54-year-old female is brought to the emergency department (ED) by private vehicle. She reports difficulty breathing which has significantly worsened in the past two days, and a moist cough producing thick, yellow sputum. Client reports home oxygen use of 1 liter/minute via nasal cannula; however, she has increased her use to 2 liters/minute due to difficulty
breathing. She has a medical history of heart failure (HF), hypertension, stage 2 kidney disease, and chronic obstructive pulmonary disease (COPD) with multiple exacerbations. Two weeks ago, client had a viral upper respiratory infection for which she was started on stress dose steroids. She has no known allergies.
Nurses' Notes
2005
Healthcare assessment completed by healthcare provider (HCP).
Assessment
. General observation: Is leaning forward, resting her arms in front of her on the pillows. Hair is unkempt, poor oral hygiene, and body odor are noted.
· Neurological: Alert and oriented x 3.
· Cardiovascular: Heart sounds of S1, S2, S3, S4, and a systolic murmur. Jugular vein distention.
. Respiratory: Shallow respirations. Expiratory wheezing and crackles in bilateral upper lobes and diminished bilateral bases. Intercostal retractions.
· Musculoskeletal: Generalized weakness and easily fatigued.
· Gastrointestinal and genitourinary: Increased thirst. Last bowel movement 2 days ago. Increased urinary frequency.
. Integumentary: Skin is warm and diaphoretic. Bilateral finger clubbing. Dry mucous membranes. Poor skin turgor.
Flow Sheet
2005
Vital signs
· Temperature: 100.2° F (37.9° C) Axillary
. Heart rate: 124 beats/minute
. Respiration: 38 breaths/minute
· Blood pressure: 164/94 mm Hg
. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
. Height: 5 feet, 11 inches (180.3 cm)
· Weight: 155 pounds (70.3 kg)
. Pain: rated 6 on a 0 to 10 scale, heaviness in the chest
For each of the findings listed, click to indicate which are consistent with the disease process of chronic obstructive pulmonary disease (COPD), heart failure (HF), or urinary tract infection (UTI). Each column must have at least one response option selected.
For each finding listed below, which findings are consistent with the disease process of chronic obstructive pulmonary disease (COPD)? (Select all that apply.)
- A Pain: heaviness in the chest, rated 6 out of 10
- B Temperature: 100.2° F (37.9° C)
- C Oxygen saturation: 87% on 2 liters/minute via nasal cannula
- D Heart sounds of S1, S2, S3, S4
- E Respiration: 38 breaths/minute
- F Jugular vein distention
- G Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Explanation
C. Oxygen saturation: 87% on 2 liters/minute via nasal cannula
Severe hypoxemia is a hallmark of COPD exacerbation. This client’s oxygen requirement has increased from 1 L/min to 2 L/min at home and still remains low at 87%, indicating poor gas exchange due to airflow obstruction or infection.
E. Respiration: 38 breaths/minute
Tachypnea occurs during COPD exacerbations due to increased work of breathing, air trapping, and impaired ventilation. A respiratory rate of 38 is critically high and consistent with acute COPD distress.
G. Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bases
Wheezing indicates airway narrowing and inflammation, while diminished breath sounds reflect air trapping or hyperinflation. Crackles may appear when a COPD patient also has an acute infection such as pneumonia.
Correct Answer Is:
C, E, G
A client has an absolute neutrophil count (ANC) of 500/mm³ (0.5 × 10⁹/L) after completing chemotherapy. Which intervention is most important for the nurse to implement?
Reference Range: Neutrophils (ANC): 2,500–5,800/mm³ (2.5–5.8 × 10⁹/L)
- A Place the client in protective isolation.
- B Assess vital signs every 4 hours.
- C Implement bleeding precautions.
- D Review need for pneumococcal vaccine.
Explanation
An ANC of 500/mm³ indicates severe neutropenia, placing the client at extremely high risk for life-threatening infection because the immune system cannot mount an adequate response. Protective (reverse) isolation is the most important priority intervention to reduce exposure to pathogens. This includes a private room, strict hand hygiene, limiting visitors, and avoiding fresh flowers or raw foods. Infection prevention becomes the nurse’s highest priority until neutrophil counts recover.
Correct Answer Is:
A
For each finding listed below, which findings are consistent with the disease process of urinary tract infection (UTI)? (Select all that apply.)
- A Pain: heaviness in the chest, rated 6 out of 10
- B Temperature: 100.2° F (37.9° C)
- C Oxygen saturation: 87% on 2 liters/minute via nasal cannula
- D Heart sounds of S1, S2, S3, S4
- E Respiration: 38 breaths/minute
- F Jugular vein distention
- G Expiratory wheezing and crackles heard in bilateral upper lobes and diminished bilateral bases
Explanation
B. Temperature: 100.2° F (37.9° C)
While the fever may also be related to COPD or HF complications, low-grade fever is commonly seen in UTIs, especially in older adults. Increased urinary frequency mentioned in the case also supports the possibility of UTI as a comorbidity.
Correct Answer Is:
BThe nurse determines that a client who arrives in the preoperative holding area before surgery is allergic to bananas. Which action should the nurse implement prior to taking the client into the operative area?
- A Avoid using skin preparation solutions that contain povidone iodine.
- B Attach an identification band on the client for allergy to penicillin antibiotics.
- C Notify the surgeon and radiology to avoid the use of radiographic dyes.
- D Replace latex containing devices in the operating room (OR) with alternate synthetic materials.
Explanation
A banana allergy is strongly associated with latex allergy due to cross-reactivity between latex proteins and proteins found in certain fruits such as bananas, kiwis, and avocados. Clients with these allergies are at higher risk for life-threatening anaphylactic reactions if exposed to latex during surgery. Therefore, the nurse must ensure a latex-free environment by replacing all latex-containing materials with synthetic alternatives before the client enters the OR. This prevents inadvertent exposure and significantly reduces perioperative risk.
Correct Answer Is:
D
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