HESI PN Medical-Surgical NGN Exam
2026/2027 Study Guide | Verified Questions
& Correct Answers with Detailed Rationales
| Comprehensive LPN/LVN Exam Prep
HESI PN MEDICAL-SURGICAL NGN EXAM 2026/2027 STUDY GUIDE
Verified Questions & Correct Answers with Detailed Rationales
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 verified multiple-choice questions
organized by major medical-surgical nursing topics, designed to simulate the actual
HESI PN exam format with detailed rationales for every answer to strengthen your
understanding of critical concepts.
• Study this material by reviewing questions systematically, focusing on the
rationales to understand the "why" behind correct answers, and identifying your
weak areas for targeted review before exam day.
SECTION 1: CARDIOVASCULAR DISORDERS
1. A 68-year-old patient with a history of hypertension is admitted with chest
pain. Which finding would be most consistent with acute myocardial
infarction?
A) Troponin level of 0.02 ng/mL
B) ST segment elevation on ECG
C) Blood pressure of 145/90 mmHg
D) Heart rate of 88 beats per minute
E) Hemoglobin of 14.5 g/dL
Correct Answer: B) ST segment elevation on ECG
,Rationale: ST segment elevation is a hallmark finding in acute myocardial infarction
(MI) indicating transmural ischemia. The troponin level given is normal (normal is
<0.04 ng/mL), blood pressure and heart rate are relatively normal, and hemoglobin
is normal. ST elevation specifically indicates acute tissue damage from MI and is
one of the most specific diagnostic findings for this condition.
2. A patient taking digoxin for heart failure reports nausea, visual
disturbances, and irregular heartbeat. What should the nurse do first?
A) Increase the patient's potassium intake
B) Obtain a serum digoxin level and notify the physician
C) Discontinue the medication immediately
D) Administer an antiemetic medication
E) Increase fluid intake to dilute the medication
Correct Answer: B) Obtain a serum digoxin level and notify the physician
Rationale: These symptoms are classic signs of digoxin toxicity. The nurse must
obtain a serum digoxin level to confirm toxicity, as digoxin has a narrow therapeutic
range (0.5-2.0 ng/mL). The physician must be notified for potential dose adjustment
or discontinuation. Discontinuing without physician order is inappropriate, and the
other options do not address the underlying toxicity.
3. Which assessment finding in a patient with congestive heart failure
indicates the most severe pulmonary congestion?
A) Mild dyspnea on exertion
B) Orthopnea and paroxysmal nocturnal dyspnea
C) Crackles heard in lower lung bases
D) Elevated jugular venous pressure
E) Peripheral edema in lower extremities
, Correct Answer: B) Orthopnea and paroxysmal nocturnal dyspnea
Rationale: Orthopnea (difficulty breathing when lying flat) and paroxysmal
nocturnal dyspnea (sudden breathing difficulty at night) indicate severe pulmonary
edema. These symptoms reflect significant fluid accumulation in the lungs and
indicate more advanced heart failure than the other options. Mild dyspnea on
exertion is less severe, crackles indicate some pulmonary congestion but not as
severe as orthopnea, and peripheral edema and JVD indicate systemic congestion
but not necessarily severe pulmonary edema.
4. A patient is prescribed an ACE inhibitor for hypertension. Which side effect
should the nurse anticipate and monitor for?
A) Hypokalemia and muscle weakness
B) Persistent dry cough
C) Hypercalcemia
D) Hyperglycemia
E) Increased urinary output without electrolyte loss
Correct Answer: B) Persistent dry cough
Rationale: ACE inhibitors commonly cause a dry, persistent cough in 10-20% of
patients due to inhibition of bradykinin breakdown in the lungs. Hypokalemia is not
expected; instead, hyperkalemia may occur. Hypercalcemia and hyperglycemia are
not typical side effects. The cough is the most common and characteristic side
effect requiring patient education.
5. A 55-year-old patient has atrial fibrillation and is started on warfarin
therapy. What is the primary goal of anticoagulation in this patient?
A) To dissolve existing blood clots
B) To prevent stroke from thromboembolic events
C) To slow the heart rate
, D) To restore normal sinus rhythm
E) To reduce blood pressure
Correct Answer: B) To prevent stroke from thromboembolic events
Rationale: Anticoagulation in atrial fibrillation prevents stroke by preventing
thrombus formation in the irregularly contracting atrial chambers. Warfarin
prevents new clot formation but does not dissolve existing clots (that requires
thrombolytics). It does not slow the heart rate, restore sinus rhythm, or directly
reduce blood pressure. Stroke prevention is the critical goal in atrial fibrillation
management.
6. A patient recovering from myocardial infarction exhibits signs of
cardiogenic shock. Which intervention should the nurse prioritize?
A) Increasing intravenous fluid administration
B) Maintaining adequate oxygenation and tissue perfusion
C) Administering diuretics to reduce preload
D) Encouraging ambulation to improve circulation
E) Increasing sodium intake to maintain blood pressure
Correct Answer: B) Maintaining adequate oxygenation and tissue
perfusion
Rationale: In cardiogenic shock, the heart cannot pump effectively, causing
inadequate tissue perfusion. The priority is maintaining oxygenation (may require
supplemental O2 or mechanical ventilation) and ensuring vital organ perfusion. IV
fluids are contraindicated as they increase preload and worsen pulmonary edema.
Diuretics may further compromise perfusion. Activity is restricted. The focus must
be on stabilizing perfusion through oxygen and medications like inotropes.
7. A patient with hypertension is prescribed an alpha-blocker. The nurse
should monitor for which adverse effect?
2026/2027 Study Guide | Verified Questions
& Correct Answers with Detailed Rationales
| Comprehensive LPN/LVN Exam Prep
HESI PN MEDICAL-SURGICAL NGN EXAM 2026/2027 STUDY GUIDE
Verified Questions & Correct Answers with Detailed Rationales
DOCUMENT OVERVIEW
• This comprehensive study guide contains 200 verified multiple-choice questions
organized by major medical-surgical nursing topics, designed to simulate the actual
HESI PN exam format with detailed rationales for every answer to strengthen your
understanding of critical concepts.
• Study this material by reviewing questions systematically, focusing on the
rationales to understand the "why" behind correct answers, and identifying your
weak areas for targeted review before exam day.
SECTION 1: CARDIOVASCULAR DISORDERS
1. A 68-year-old patient with a history of hypertension is admitted with chest
pain. Which finding would be most consistent with acute myocardial
infarction?
A) Troponin level of 0.02 ng/mL
B) ST segment elevation on ECG
C) Blood pressure of 145/90 mmHg
D) Heart rate of 88 beats per minute
E) Hemoglobin of 14.5 g/dL
Correct Answer: B) ST segment elevation on ECG
,Rationale: ST segment elevation is a hallmark finding in acute myocardial infarction
(MI) indicating transmural ischemia. The troponin level given is normal (normal is
<0.04 ng/mL), blood pressure and heart rate are relatively normal, and hemoglobin
is normal. ST elevation specifically indicates acute tissue damage from MI and is
one of the most specific diagnostic findings for this condition.
2. A patient taking digoxin for heart failure reports nausea, visual
disturbances, and irregular heartbeat. What should the nurse do first?
A) Increase the patient's potassium intake
B) Obtain a serum digoxin level and notify the physician
C) Discontinue the medication immediately
D) Administer an antiemetic medication
E) Increase fluid intake to dilute the medication
Correct Answer: B) Obtain a serum digoxin level and notify the physician
Rationale: These symptoms are classic signs of digoxin toxicity. The nurse must
obtain a serum digoxin level to confirm toxicity, as digoxin has a narrow therapeutic
range (0.5-2.0 ng/mL). The physician must be notified for potential dose adjustment
or discontinuation. Discontinuing without physician order is inappropriate, and the
other options do not address the underlying toxicity.
3. Which assessment finding in a patient with congestive heart failure
indicates the most severe pulmonary congestion?
A) Mild dyspnea on exertion
B) Orthopnea and paroxysmal nocturnal dyspnea
C) Crackles heard in lower lung bases
D) Elevated jugular venous pressure
E) Peripheral edema in lower extremities
, Correct Answer: B) Orthopnea and paroxysmal nocturnal dyspnea
Rationale: Orthopnea (difficulty breathing when lying flat) and paroxysmal
nocturnal dyspnea (sudden breathing difficulty at night) indicate severe pulmonary
edema. These symptoms reflect significant fluid accumulation in the lungs and
indicate more advanced heart failure than the other options. Mild dyspnea on
exertion is less severe, crackles indicate some pulmonary congestion but not as
severe as orthopnea, and peripheral edema and JVD indicate systemic congestion
but not necessarily severe pulmonary edema.
4. A patient is prescribed an ACE inhibitor for hypertension. Which side effect
should the nurse anticipate and monitor for?
A) Hypokalemia and muscle weakness
B) Persistent dry cough
C) Hypercalcemia
D) Hyperglycemia
E) Increased urinary output without electrolyte loss
Correct Answer: B) Persistent dry cough
Rationale: ACE inhibitors commonly cause a dry, persistent cough in 10-20% of
patients due to inhibition of bradykinin breakdown in the lungs. Hypokalemia is not
expected; instead, hyperkalemia may occur. Hypercalcemia and hyperglycemia are
not typical side effects. The cough is the most common and characteristic side
effect requiring patient education.
5. A 55-year-old patient has atrial fibrillation and is started on warfarin
therapy. What is the primary goal of anticoagulation in this patient?
A) To dissolve existing blood clots
B) To prevent stroke from thromboembolic events
C) To slow the heart rate
, D) To restore normal sinus rhythm
E) To reduce blood pressure
Correct Answer: B) To prevent stroke from thromboembolic events
Rationale: Anticoagulation in atrial fibrillation prevents stroke by preventing
thrombus formation in the irregularly contracting atrial chambers. Warfarin
prevents new clot formation but does not dissolve existing clots (that requires
thrombolytics). It does not slow the heart rate, restore sinus rhythm, or directly
reduce blood pressure. Stroke prevention is the critical goal in atrial fibrillation
management.
6. A patient recovering from myocardial infarction exhibits signs of
cardiogenic shock. Which intervention should the nurse prioritize?
A) Increasing intravenous fluid administration
B) Maintaining adequate oxygenation and tissue perfusion
C) Administering diuretics to reduce preload
D) Encouraging ambulation to improve circulation
E) Increasing sodium intake to maintain blood pressure
Correct Answer: B) Maintaining adequate oxygenation and tissue
perfusion
Rationale: In cardiogenic shock, the heart cannot pump effectively, causing
inadequate tissue perfusion. The priority is maintaining oxygenation (may require
supplemental O2 or mechanical ventilation) and ensuring vital organ perfusion. IV
fluids are contraindicated as they increase preload and worsen pulmonary edema.
Diuretics may further compromise perfusion. Activity is restricted. The focus must
be on stabilizing perfusion through oxygen and medications like inotropes.
7. A patient with hypertension is prescribed an alpha-blocker. The nurse
should monitor for which adverse effect?
