HEALTH EDUCATION SYSTEMS INCORPORATED (HESI)
HESI Med Surg Exit Exam V1
NGN Format | Real Questions with Verified Answers
Official Practice Exam | 2026/2027 Edition
100 Questions 120 Minutes 80% Passing Score Recertification
TABLE OF CONTENTS
Section 1: Cardiovascular Disorders .......... Q1-Q20 (20 questions)
Section 2: Respiratory Disorders .......... Q21-Q37 (17 questions)
Section 3: Neurological Disorders .......... Q38-Q55 (18 questions)
Section 4: Gastrointestinal and Hepatic Disorders .......... Q56-Q71 (16 questions)
Section 5: Renal and Endocrine Disorders .......... Q72-Q88 (17 questions)
Section 6: Musculoskeletal, Integumentary, and Hematologic Disorders .......... Q89-Q100 (12 questions)
INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question is worth equal
points. You have 120 minutes to complete all 100 questions. A score of 80% or higher (80/100) is required to pass. No
electronic devices are permitted. Mark your answers on the separate answer sheet provided. This exam follows NGN (Next
Generation NCLEX) format.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 1 of
, Section 1: Cardiovascular Disorders -- 2026/2027
Q1 Question 1 of 100
A 68-year-old male arrives in the emergency department with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea that began 90 minutes ago. The 12-lead ECG
shows ST-segment elevation in leads II, III, and aVF. The nurse anticipates immediate preparation for
which intervention?
A. Administration of thrombolytics only without catheterization
B. Emergency coronary artery bypass graft surgery
C. Placement of an intra-aortic balloon pump
D. Percutaneous coronary intervention to restore blood flow to the inferior wall
Correct Answer: B
Rationale:
ST elevation in leads II, III, and aVF indicates an inferior wall STEMI, and the standard of care is immediate
percutaneous coronary intervention (PCI) to restore patency of the occluded artery, typically the right coronary artery.
Thrombolytics are used when PCI is unavailable, CABG is not first-line for acute STEMI, and an IABP is for
cardiogenic shock.
Q2 Question 2 of 100
A 72-year-old female is admitted with heart failure and presents with jugular venous distension,
bilateral crackles in the lung bases, and 3+ pitting edema in both ankles. Her BNP level is 1,200
pg/mL. Which pathophysiologic process best explains her peripheral edema?
A. Decreased oncotic pressure from liver failure allowing fluid to leak from vessels
B. Lymphatic obstruction preventing return of interstitial fluid to the circulation
C. Increased capillary permeability from inflammatory cytokines causing fluid extravasation
D. Increased hydrostatic pressure from volume overload pushing fluid into interstitial spaces
Correct Answer: B
Rationale:
In heart failure, decreased cardiac output activates the renin-angiotensin-aldosterone system, causing sodium and
water retention that increases intravascular volume and hydrostatic pressure, forcing fluid into the interstitial spaces.
Decreased oncotic pressure is seen in liver or kidney disease, lymphatic obstruction in malignancy, and capillary
permeability in sepsis or burns.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 2 of
, Q3 Question 3 of 100
A 55-year-old male with a history of hypertension and hyperlipidemia presents to the clinic for a
routine visit. His blood pressure is 162/98 mmHg, and he reports occasional headaches. The nurse
educates the patient about lifestyle modifications. Which dietary change would most effectively lower
his blood pressure?
A. Increasing potassium supplementation to 4,000 mg daily without dietary changes
B. Eliminating all fat from the diet and increasing protein intake
C. Consuming three servings of red meat weekly for iron and vitamin B12
D. Reducing sodium intake to less than 2,300 mg per day and following the DASH eating plan
Correct Answer: B
Rationale:
The DASH diet combined with sodium restriction has been proven to significantly reduce blood pressure in
hypertensive patients by promoting vasodilation and reducing fluid retention. Potassium supplementation without
dietary changes is less effective, eliminating all fat is unnecessary and potentially harmful, and red meat consumption
does not lower blood pressure.
Q4 Question 4 of 100
A 60-year-old female undergoes mitral valve replacement and is started on warfarin therapy. The
nurse provides discharge teaching about anticoagulation management. The patient should be
instructed to notify the healthcare provider immediately about which symptom?
A. Occasional mild bruising on the arms and legs
B. Slight pink discoloration of the urine once
C. Mild headache that resolves with acetaminophen
D. Black tarry stools indicating possible gastrointestinal bleeding
Correct Answer: B
Rationale:
Black tarry stools (melena) indicate upper gastrointestinal bleeding, a serious and potentially life-threatening
complication of warfarin therapy requiring immediate medical attention. Mild bruising is common with anticoagulants,
slight pink urine may be insignificant, and mild headaches are not typically emergencies.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 3 of
, Q5 Question 5 of 100
A 48-year-old male is admitted with a diagnosis of deep vein thrombosis in the left leg after a
long-haul flight. He is started on a heparin infusion. Six hours after the infusion begins, the nurse
notes that the aPTT is 45 seconds and the control is 35 seconds. Which action should the nurse
take?
A. Increase the heparin infusion rate independently to achieve therapeutic levels
B. Discontinue the heparin infusion immediately due to excessive anticoagulation
C. Document the result as normal and continue the current infusion rate
D. Notify the healthcare provider because the aPTT is subtherapeutic and the dose may need adjustment
Correct Answer: B
Rationale:
The therapeutic aPTT for heparin therapy is typically 1.5 to 2.5 times the control value (52.5 to 87.5 seconds). An aPTT
of 45 seconds is below the therapeutic range, indicating subtherapeutic anticoagulation, so the nurse should notify the
provider for possible dose adjustment. The nurse should not independently adjust the rate, and discontinuing is
inappropriate.
Q6 Question 6 of 100
A 65-year-old male with chronic atrial fibrillation is prescribed dabigatran. The nurse understands that
unlike warfarin, this direct oral anticoagulant has which characteristic?
A. It has a narrow therapeutic index requiring frequent blood tests
B. It works by inhibiting vitamin K-dependent clotting factors
C. It is reversed by administration of vitamin K (phytonadione)
D. It does not require routine INR monitoring for dose adjustment
Correct Answer: B
Rationale:
Dabigatran is a direct thrombin inhibitor that does not require routine INR monitoring because it has a predictable
anticoagulant effect at fixed doses. Warfarin requires INR monitoring and works by inhibiting vitamin K-dependent
factors. The reversal agent for dabigatran is idarucizumab, not vitamin K.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 4 of
HESI Med Surg Exit Exam V1
NGN Format | Real Questions with Verified Answers
Official Practice Exam | 2026/2027 Edition
100 Questions 120 Minutes 80% Passing Score Recertification
TABLE OF CONTENTS
Section 1: Cardiovascular Disorders .......... Q1-Q20 (20 questions)
Section 2: Respiratory Disorders .......... Q21-Q37 (17 questions)
Section 3: Neurological Disorders .......... Q38-Q55 (18 questions)
Section 4: Gastrointestinal and Hepatic Disorders .......... Q56-Q71 (16 questions)
Section 5: Renal and Endocrine Disorders .......... Q72-Q88 (17 questions)
Section 6: Musculoskeletal, Integumentary, and Hematologic Disorders .......... Q89-Q100 (12 questions)
INSTRUCTIONS
Read each question carefully. Select the single best answer from the four options provided. Each question is worth equal
points. You have 120 minutes to complete all 100 questions. A score of 80% or higher (80/100) is required to pass. No
electronic devices are permitted. Mark your answers on the separate answer sheet provided. This exam follows NGN (Next
Generation NCLEX) format.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 1 of
, Section 1: Cardiovascular Disorders -- 2026/2027
Q1 Question 1 of 100
A 68-year-old male arrives in the emergency department with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea that began 90 minutes ago. The 12-lead ECG
shows ST-segment elevation in leads II, III, and aVF. The nurse anticipates immediate preparation for
which intervention?
A. Administration of thrombolytics only without catheterization
B. Emergency coronary artery bypass graft surgery
C. Placement of an intra-aortic balloon pump
D. Percutaneous coronary intervention to restore blood flow to the inferior wall
Correct Answer: B
Rationale:
ST elevation in leads II, III, and aVF indicates an inferior wall STEMI, and the standard of care is immediate
percutaneous coronary intervention (PCI) to restore patency of the occluded artery, typically the right coronary artery.
Thrombolytics are used when PCI is unavailable, CABG is not first-line for acute STEMI, and an IABP is for
cardiogenic shock.
Q2 Question 2 of 100
A 72-year-old female is admitted with heart failure and presents with jugular venous distension,
bilateral crackles in the lung bases, and 3+ pitting edema in both ankles. Her BNP level is 1,200
pg/mL. Which pathophysiologic process best explains her peripheral edema?
A. Decreased oncotic pressure from liver failure allowing fluid to leak from vessels
B. Lymphatic obstruction preventing return of interstitial fluid to the circulation
C. Increased capillary permeability from inflammatory cytokines causing fluid extravasation
D. Increased hydrostatic pressure from volume overload pushing fluid into interstitial spaces
Correct Answer: B
Rationale:
In heart failure, decreased cardiac output activates the renin-angiotensin-aldosterone system, causing sodium and
water retention that increases intravascular volume and hydrostatic pressure, forcing fluid into the interstitial spaces.
Decreased oncotic pressure is seen in liver or kidney disease, lymphatic obstruction in malignancy, and capillary
permeability in sepsis or burns.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 2 of
, Q3 Question 3 of 100
A 55-year-old male with a history of hypertension and hyperlipidemia presents to the clinic for a
routine visit. His blood pressure is 162/98 mmHg, and he reports occasional headaches. The nurse
educates the patient about lifestyle modifications. Which dietary change would most effectively lower
his blood pressure?
A. Increasing potassium supplementation to 4,000 mg daily without dietary changes
B. Eliminating all fat from the diet and increasing protein intake
C. Consuming three servings of red meat weekly for iron and vitamin B12
D. Reducing sodium intake to less than 2,300 mg per day and following the DASH eating plan
Correct Answer: B
Rationale:
The DASH diet combined with sodium restriction has been proven to significantly reduce blood pressure in
hypertensive patients by promoting vasodilation and reducing fluid retention. Potassium supplementation without
dietary changes is less effective, eliminating all fat is unnecessary and potentially harmful, and red meat consumption
does not lower blood pressure.
Q4 Question 4 of 100
A 60-year-old female undergoes mitral valve replacement and is started on warfarin therapy. The
nurse provides discharge teaching about anticoagulation management. The patient should be
instructed to notify the healthcare provider immediately about which symptom?
A. Occasional mild bruising on the arms and legs
B. Slight pink discoloration of the urine once
C. Mild headache that resolves with acetaminophen
D. Black tarry stools indicating possible gastrointestinal bleeding
Correct Answer: B
Rationale:
Black tarry stools (melena) indicate upper gastrointestinal bleeding, a serious and potentially life-threatening
complication of warfarin therapy requiring immediate medical attention. Mild bruising is common with anticoagulants,
slight pink urine may be insignificant, and mild headaches are not typically emergencies.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 3 of
, Q5 Question 5 of 100
A 48-year-old male is admitted with a diagnosis of deep vein thrombosis in the left leg after a
long-haul flight. He is started on a heparin infusion. Six hours after the infusion begins, the nurse
notes that the aPTT is 45 seconds and the control is 35 seconds. Which action should the nurse
take?
A. Increase the heparin infusion rate independently to achieve therapeutic levels
B. Discontinue the heparin infusion immediately due to excessive anticoagulation
C. Document the result as normal and continue the current infusion rate
D. Notify the healthcare provider because the aPTT is subtherapeutic and the dose may need adjustment
Correct Answer: B
Rationale:
The therapeutic aPTT for heparin therapy is typically 1.5 to 2.5 times the control value (52.5 to 87.5 seconds). An aPTT
of 45 seconds is below the therapeutic range, indicating subtherapeutic anticoagulation, so the nurse should notify the
provider for possible dose adjustment. The nurse should not independently adjust the rate, and discontinuing is
inappropriate.
Q6 Question 6 of 100
A 65-year-old male with chronic atrial fibrillation is prescribed dabigatran. The nurse understands that
unlike warfarin, this direct oral anticoagulant has which characteristic?
A. It has a narrow therapeutic index requiring frequent blood tests
B. It works by inhibiting vitamin K-dependent clotting factors
C. It is reversed by administration of vitamin K (phytonadione)
D. It does not require routine INR monitoring for dose adjustment
Correct Answer: B
Rationale:
Dabigatran is a direct thrombin inhibitor that does not require routine INR monitoring because it has a predictable
anticoagulant effect at fixed doses. Warfarin requires INR monitoring and works by inhibiting vitamin K-dependent
factors. The reversal agent for dabigatran is idarucizumab, not vitamin K.
HESI Med Surg Exit V1 -- 2026/2027 | Passing Score: 80% | Page 4 of
