HESI PN Medical-Surgical NGN Exam Prep
2026–2027 | Version 3 | Practice Questions
with Detailed Answer Explanations |
Practical Nursing Med-Surg Study Guide
HESI PN Medical-Surgical NGN Exam Prep 2026–2027 | Version 3 | Practice
Questions with Detailed Answer Explanations
• This comprehensive study guide contains practice questions designed to prepare
practical nurses for the HESI PN Medical-Surgical NGN exam with detailed
rationales for each correct answer.
• Use this material by reviewing questions in sections, studying the rationales
carefully, and retaking questions until you achieve consistent mastery—focus on
understanding the "why" behind each answer.
QUESTION 1
A 58-year-old male client with chronic hypertension is prescribed lisinopril, an
ACE inhibitor. Which assessment finding would indicate a potentially serious
adverse effect of this medication?
A) Blood pressure decrease of 10 mmHg
B) Mild dizziness upon standing
C) Persistent dry cough
D) Decreased appetite
E) Mild headache
CORRECT ANSWER: C) Persistent dry cough
Rationale: ACE inhibitors like lisinopril cause a persistent dry cough in 10-20% of
patients due to inhibition of ACE (which breaks down bradykinin). While this is not
life-threatening, it is a common and bothersome adverse effect that may require
medication change. Options A, B, D, and E are either expected effects or minor side
effects. A blood pressure decrease of 10 mmHg is therapeutic, dizziness upon
standing may be expected initially but typically resolves, decreased appetite is not
typical of ACE inhibitors, and mild headache is not a characteristic adverse effect.
,The persistent dry cough is the most significant adverse effect to monitor and
report.
QUESTION 2
A 72-year-old female client is admitted with acute coronary syndrome. The
cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
E) Diagonal branch
CORRECT ANSWER: B) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, and aVF) indicates an
inferior wall myocardial infarction, which is most commonly caused by occlusion of
the right coronary artery (RCA), as it typically supplies the inferior wall of the left
ventricle in approximately 80% of the population. The LAD supplies the anterior
and anteroseptal walls (shows changes in leads V1-V4), the left circumflex supplies
the lateral walls (changes in leads I, aVL, V5-V6), and the left main coronary artery
occlusion would present with more extensive ST changes. Understanding coronary
anatomy and ECG changes is critical for rapid identification of MI location and
appropriate interventions.
QUESTION 3
A 45-year-old male client with COPD is receiving oxygen therapy. Which
oxygen delivery method would be most appropriate if the client requires a
precise FiO2 and needs to perform activities of daily living?
A) Nasal cannula
,B) Venturi mask
C) Non-rebreather mask
D) Simple face mask
E) Tent mask
CORRECT ANSWER: B) Venturi mask
Rationale: The Venturi mask delivers a precise and predictable FiO2 (typically 24%-
50%) through the use of specific air-entrainment ports, making it ideal for clients
who require controlled oxygen therapy, particularly those with COPD at risk for CO2
retention. While a nasal cannula allows mobility, it does not deliver a precise FiO2.
Non-rebreather masks deliver high concentrations (80%-95%) but are not precise
and restrict activity. Simple face masks deliver 40%-60% FiO2 but are less precise
than Venturi masks. The Venturi mask is the gold standard when precise FiO2
delivery is necessary and the client needs some mobility.
QUESTION 4
A 68-year-old female client with heart failure is prescribed furosemide 40 mg
daily. The nurse recognizes that this diuretic works primarily in which
location?
A) Glomerulus
B) Proximal convoluted tubule
C) Loop of Henle
D) Distal convoluted tubule
E) Collecting duct
CORRECT ANSWER: C) Loop of Henle
Rationale: Furosemide is a loop diuretic that acts on the thick ascending limb of
the loop of Henle, where it inhibits the Na-K-2Cl co-transporter. This action
prevents reabsorption of sodium, potassium, and chloride, resulting in potent
diuresis. Loop diuretics are the most effective class of diuretics and are often used
, in acute decompensated heart failure. Understanding the site of action of different
diuretics is essential for predicting their potency and potential electrolyte
complications. Thiazides work in the distal convoluted tubule (less potent), and
potassium-sparing diuretics work in the collecting duct.
QUESTION 5
A 55-year-old male client with a history of gastric ulcer disease is admitted
with severe epigastric pain and hematemesis. Which nursing intervention is
the priority?
A) Administer antacids orally
B) Establish two large-bore IV lines
C) Position client upright to facilitate vomiting
D) Obtain detailed dietary history
E) Begin NPO status and monitor vital signs
CORRECT ANSWER: B) Establish two large-bore IV lines
Rationale: In acute GI hemorrhage with hematemesis, establishing two large-bore
IV lines is the priority intervention because it allows for rapid fluid replacement,
medication administration, and blood transfusion if needed. This is a critical step in
managing hemorrhagic shock. While NPO status is important, IV access takes
priority. Oral antacids are contraindicated with active bleeding. Positioning upright
facilitates aspiration, not appropriate care. Dietary history is not a priority in acute
bleeding. The immediate focus must be on hemodynamic stabilization through
rapid IV access and fluid resuscitation.
QUESTION 6
A 42-year-old female client presents with sudden onset dyspnea, chest pain,
and a pulse oximetry reading of 88%. The client states, "I flew back from
2026–2027 | Version 3 | Practice Questions
with Detailed Answer Explanations |
Practical Nursing Med-Surg Study Guide
HESI PN Medical-Surgical NGN Exam Prep 2026–2027 | Version 3 | Practice
Questions with Detailed Answer Explanations
• This comprehensive study guide contains practice questions designed to prepare
practical nurses for the HESI PN Medical-Surgical NGN exam with detailed
rationales for each correct answer.
• Use this material by reviewing questions in sections, studying the rationales
carefully, and retaking questions until you achieve consistent mastery—focus on
understanding the "why" behind each answer.
QUESTION 1
A 58-year-old male client with chronic hypertension is prescribed lisinopril, an
ACE inhibitor. Which assessment finding would indicate a potentially serious
adverse effect of this medication?
A) Blood pressure decrease of 10 mmHg
B) Mild dizziness upon standing
C) Persistent dry cough
D) Decreased appetite
E) Mild headache
CORRECT ANSWER: C) Persistent dry cough
Rationale: ACE inhibitors like lisinopril cause a persistent dry cough in 10-20% of
patients due to inhibition of ACE (which breaks down bradykinin). While this is not
life-threatening, it is a common and bothersome adverse effect that may require
medication change. Options A, B, D, and E are either expected effects or minor side
effects. A blood pressure decrease of 10 mmHg is therapeutic, dizziness upon
standing may be expected initially but typically resolves, decreased appetite is not
typical of ACE inhibitors, and mild headache is not a characteristic adverse effect.
,The persistent dry cough is the most significant adverse effect to monitor and
report.
QUESTION 2
A 72-year-old female client is admitted with acute coronary syndrome. The
cardiac monitor shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
E) Diagonal branch
CORRECT ANSWER: B) Right coronary artery
Rationale: ST-segment elevation in the inferior leads (II, III, and aVF) indicates an
inferior wall myocardial infarction, which is most commonly caused by occlusion of
the right coronary artery (RCA), as it typically supplies the inferior wall of the left
ventricle in approximately 80% of the population. The LAD supplies the anterior
and anteroseptal walls (shows changes in leads V1-V4), the left circumflex supplies
the lateral walls (changes in leads I, aVL, V5-V6), and the left main coronary artery
occlusion would present with more extensive ST changes. Understanding coronary
anatomy and ECG changes is critical for rapid identification of MI location and
appropriate interventions.
QUESTION 3
A 45-year-old male client with COPD is receiving oxygen therapy. Which
oxygen delivery method would be most appropriate if the client requires a
precise FiO2 and needs to perform activities of daily living?
A) Nasal cannula
,B) Venturi mask
C) Non-rebreather mask
D) Simple face mask
E) Tent mask
CORRECT ANSWER: B) Venturi mask
Rationale: The Venturi mask delivers a precise and predictable FiO2 (typically 24%-
50%) through the use of specific air-entrainment ports, making it ideal for clients
who require controlled oxygen therapy, particularly those with COPD at risk for CO2
retention. While a nasal cannula allows mobility, it does not deliver a precise FiO2.
Non-rebreather masks deliver high concentrations (80%-95%) but are not precise
and restrict activity. Simple face masks deliver 40%-60% FiO2 but are less precise
than Venturi masks. The Venturi mask is the gold standard when precise FiO2
delivery is necessary and the client needs some mobility.
QUESTION 4
A 68-year-old female client with heart failure is prescribed furosemide 40 mg
daily. The nurse recognizes that this diuretic works primarily in which
location?
A) Glomerulus
B) Proximal convoluted tubule
C) Loop of Henle
D) Distal convoluted tubule
E) Collecting duct
CORRECT ANSWER: C) Loop of Henle
Rationale: Furosemide is a loop diuretic that acts on the thick ascending limb of
the loop of Henle, where it inhibits the Na-K-2Cl co-transporter. This action
prevents reabsorption of sodium, potassium, and chloride, resulting in potent
diuresis. Loop diuretics are the most effective class of diuretics and are often used
, in acute decompensated heart failure. Understanding the site of action of different
diuretics is essential for predicting their potency and potential electrolyte
complications. Thiazides work in the distal convoluted tubule (less potent), and
potassium-sparing diuretics work in the collecting duct.
QUESTION 5
A 55-year-old male client with a history of gastric ulcer disease is admitted
with severe epigastric pain and hematemesis. Which nursing intervention is
the priority?
A) Administer antacids orally
B) Establish two large-bore IV lines
C) Position client upright to facilitate vomiting
D) Obtain detailed dietary history
E) Begin NPO status and monitor vital signs
CORRECT ANSWER: B) Establish two large-bore IV lines
Rationale: In acute GI hemorrhage with hematemesis, establishing two large-bore
IV lines is the priority intervention because it allows for rapid fluid replacement,
medication administration, and blood transfusion if needed. This is a critical step in
managing hemorrhagic shock. While NPO status is important, IV access takes
priority. Oral antacids are contraindicated with active bleeding. Positioning upright
facilitates aspiration, not appropriate care. Dietary history is not a priority in acute
bleeding. The immediate focus must be on hemodynamic stabilization through
rapid IV access and fluid resuscitation.
QUESTION 6
A 42-year-old female client presents with sudden onset dyspnea, chest pain,
and a pulse oximetry reading of 88%. The client states, "I flew back from
