HESI PN MEDICAL-SURGICAL NGN STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | COMPREHENSIVE PRACTICE EXAM | ADVANCED
REVIEW | EXAM PREPARATION | LATEST UPDATE 2026/2027
Examiner:
HESI (Health Education Systems, Inc.) – Practical Nursing (PN) Medical-Surgical
Assessment
TABLE OF CONTENTS
1. Foundations of Adult Medical-Surgical Nursing
2. Cardiovascular Disorders
3. Respiratory Disorders
4. Neurological Disorders
5. Endocrine Disorders
6. Gastrointestinal Disorders
7. Renal and Genitourinary Disorders
8. Musculoskeletal Disorders
9. Hematologic and Immune Disorders
10. Integumentary Disorders
11. Oncology
12. Infectious Diseases
13. Fluid, Electrolyte, and Acid-Base Balance
14. Perioperative Nursing
15. Pharmacology in Medical-Surgical Nursing
16. Prioritization and Clinical Judgment (NGN)
17. Patient Safety and Quality Improvement
18. Delegation and Care Coordination
19. Documentation and Professional Practice
20. Comprehensive Clinical Application
DIAGNOSTIC REASONING || CLINICAL JUDGMENT || PRIORITIZATION || SAFETY ||
PHARMACOLOGY || FLUID BALANCE || ELECTROLYTES || CARDIOVASCULAR ||
,RESPIRATORY || NEUROLOGICAL || ENDOCRINE || RENAL || GASTROINTESTINAL ||
INFECTION CONTROL || PERIOPERATIVE CARE || PATIENT EDUCATION ||
DELEGATION || QUALITY IMPROVEMENT || EVIDENCE-BASED PRACTICE ||
COMPREHENSIVE REVIEW
QUESTION 1.
A client with acute decompensated heart failure develops increasing dyspnea,
bilateral crackles, jugular venous distention, and an oxygen saturation of 86% despite
receiving oxygen by nasal cannula. Which nursing action has the highest priority?
A. Place the client in high Fowler's position and notify the provider while preparing
for additional respiratory support.
B. Encourage oral fluid intake to improve renal perfusion.
C. Administer the scheduled stool softener.
D. Ambulate the client to improve circulation.
🔴 Correct Answer: A. Place the client in high Fowler's position and notify the
provider while preparing for additional respiratory support.
🔵 Explanation: Acute pulmonary congestion requires immediate interventions that
improve oxygenation and reduce the work of breathing. Positioning the client upright
promotes lung expansion while escalation of respiratory support may be necessary.
Increasing fluids could worsen pulmonary edema, and the remaining options do not
address the immediate threat to life.
QUESTION 2.
A client with diabetic ketoacidosis has received several hours of treatment. Which
assessment finding indicates that therapy is progressing appropriately?
A. Serum glucose remains elevated while mental status declines.
B. Serum bicarbonate increases and the anion gap narrows.
C. Urine ketones remain strongly positive with worsening acidosis.
D. Respiratory rate continues to increase with deeper respirations.
,🔴 Correct Answer: B. Serum bicarbonate increases and the anion gap narrows.
🔵 Explanation: Resolution of diabetic ketoacidosis is demonstrated by correction of
metabolic acidosis, reflected by increasing bicarbonate levels and closure of the anion
gap. Persistent acidosis, worsening neurologic status, or increasing Kussmaul
respirations suggest inadequate improvement.
QUESTION 3.
A postoperative client suddenly develops chest pain, tachycardia, and shortness of
breath. Which finding most strongly supports the nurse's suspicion of a pulmonary
embolism?
A. Bradycardia with hypertension.
B. Productive cough with thick yellow sputum.
C. Sudden pleuritic chest pain accompanied by unexplained hypoxemia.
D. Gradual onset of peripheral edema.
🔴 Correct Answer: C. Sudden pleuritic chest pain accompanied by unexplained
hypoxemia.
🔵 Explanation: Pulmonary embolism commonly presents with abrupt pleuritic chest
pain, dyspnea, tachycardia, and hypoxemia. The other findings are more consistent
with different clinical conditions and are not the classic presentation of an acute
embolic event.
QUESTION 4.
A client with chronic kidney disease has a serum potassium level of 6.7 mEq/L and
develops peaked T waves on the cardiac monitor. Which provider prescription should
the nurse anticipate implementing first?
A. Administer oral sodium bicarbonate the next morning.
B. Restrict dietary sodium.
C. Schedule hemodialysis for the following week.
D. Administer intravenous calcium gluconate as prescribed.
, 🔴 Correct Answer: D. Administer intravenous calcium gluconate as prescribed.
🔵 Explanation: Severe hyperkalemia with electrocardiographic changes places the
client at immediate risk for lethal dysrhythmias. Calcium gluconate stabilizes the
cardiac membrane while additional therapies lower serum potassium. Delayed
interventions do not adequately address the immediate cardiac risk.
QUESTION 5.
A nurse is caring for four clients. Which client should be assessed first?
A. A client with pneumonia whose oxygen saturation has decreased from 95% to 88%
on prescribed oxygen.
B. A client awaiting discharge who requests medication teaching.
C. A client with osteoarthritis requesting pain medication.
D. A client with stable heart failure awaiting breakfast.
🔴 Correct Answer: A. A client with pneumonia whose oxygen saturation has
decreased from 95% to 88% on prescribed oxygen.
🔵 Explanation: A declining oxygen saturation despite oxygen therapy suggests
worsening respiratory compromise and requires immediate assessment. The remaining
clients have needs that are important but not immediately life threatening.
QUESTION 6.
A client receiving continuous unfractionated heparin develops hematuria and
bleeding from the IV insertion site. Which laboratory result is most important for the
nurse to review?
A. Hemoglobin A1C.
B. Activated partial thromboplastin time (aPTT).
C. Serum magnesium.
D. Total cholesterol.
🔴 Correct Answer: B. Activated partial thromboplastin time (aPTT).
QUESTIONS & ANSWERS | COMPREHENSIVE PRACTICE EXAM | ADVANCED
REVIEW | EXAM PREPARATION | LATEST UPDATE 2026/2027
Examiner:
HESI (Health Education Systems, Inc.) – Practical Nursing (PN) Medical-Surgical
Assessment
TABLE OF CONTENTS
1. Foundations of Adult Medical-Surgical Nursing
2. Cardiovascular Disorders
3. Respiratory Disorders
4. Neurological Disorders
5. Endocrine Disorders
6. Gastrointestinal Disorders
7. Renal and Genitourinary Disorders
8. Musculoskeletal Disorders
9. Hematologic and Immune Disorders
10. Integumentary Disorders
11. Oncology
12. Infectious Diseases
13. Fluid, Electrolyte, and Acid-Base Balance
14. Perioperative Nursing
15. Pharmacology in Medical-Surgical Nursing
16. Prioritization and Clinical Judgment (NGN)
17. Patient Safety and Quality Improvement
18. Delegation and Care Coordination
19. Documentation and Professional Practice
20. Comprehensive Clinical Application
DIAGNOSTIC REASONING || CLINICAL JUDGMENT || PRIORITIZATION || SAFETY ||
PHARMACOLOGY || FLUID BALANCE || ELECTROLYTES || CARDIOVASCULAR ||
,RESPIRATORY || NEUROLOGICAL || ENDOCRINE || RENAL || GASTROINTESTINAL ||
INFECTION CONTROL || PERIOPERATIVE CARE || PATIENT EDUCATION ||
DELEGATION || QUALITY IMPROVEMENT || EVIDENCE-BASED PRACTICE ||
COMPREHENSIVE REVIEW
QUESTION 1.
A client with acute decompensated heart failure develops increasing dyspnea,
bilateral crackles, jugular venous distention, and an oxygen saturation of 86% despite
receiving oxygen by nasal cannula. Which nursing action has the highest priority?
A. Place the client in high Fowler's position and notify the provider while preparing
for additional respiratory support.
B. Encourage oral fluid intake to improve renal perfusion.
C. Administer the scheduled stool softener.
D. Ambulate the client to improve circulation.
🔴 Correct Answer: A. Place the client in high Fowler's position and notify the
provider while preparing for additional respiratory support.
🔵 Explanation: Acute pulmonary congestion requires immediate interventions that
improve oxygenation and reduce the work of breathing. Positioning the client upright
promotes lung expansion while escalation of respiratory support may be necessary.
Increasing fluids could worsen pulmonary edema, and the remaining options do not
address the immediate threat to life.
QUESTION 2.
A client with diabetic ketoacidosis has received several hours of treatment. Which
assessment finding indicates that therapy is progressing appropriately?
A. Serum glucose remains elevated while mental status declines.
B. Serum bicarbonate increases and the anion gap narrows.
C. Urine ketones remain strongly positive with worsening acidosis.
D. Respiratory rate continues to increase with deeper respirations.
,🔴 Correct Answer: B. Serum bicarbonate increases and the anion gap narrows.
🔵 Explanation: Resolution of diabetic ketoacidosis is demonstrated by correction of
metabolic acidosis, reflected by increasing bicarbonate levels and closure of the anion
gap. Persistent acidosis, worsening neurologic status, or increasing Kussmaul
respirations suggest inadequate improvement.
QUESTION 3.
A postoperative client suddenly develops chest pain, tachycardia, and shortness of
breath. Which finding most strongly supports the nurse's suspicion of a pulmonary
embolism?
A. Bradycardia with hypertension.
B. Productive cough with thick yellow sputum.
C. Sudden pleuritic chest pain accompanied by unexplained hypoxemia.
D. Gradual onset of peripheral edema.
🔴 Correct Answer: C. Sudden pleuritic chest pain accompanied by unexplained
hypoxemia.
🔵 Explanation: Pulmonary embolism commonly presents with abrupt pleuritic chest
pain, dyspnea, tachycardia, and hypoxemia. The other findings are more consistent
with different clinical conditions and are not the classic presentation of an acute
embolic event.
QUESTION 4.
A client with chronic kidney disease has a serum potassium level of 6.7 mEq/L and
develops peaked T waves on the cardiac monitor. Which provider prescription should
the nurse anticipate implementing first?
A. Administer oral sodium bicarbonate the next morning.
B. Restrict dietary sodium.
C. Schedule hemodialysis for the following week.
D. Administer intravenous calcium gluconate as prescribed.
, 🔴 Correct Answer: D. Administer intravenous calcium gluconate as prescribed.
🔵 Explanation: Severe hyperkalemia with electrocardiographic changes places the
client at immediate risk for lethal dysrhythmias. Calcium gluconate stabilizes the
cardiac membrane while additional therapies lower serum potassium. Delayed
interventions do not adequately address the immediate cardiac risk.
QUESTION 5.
A nurse is caring for four clients. Which client should be assessed first?
A. A client with pneumonia whose oxygen saturation has decreased from 95% to 88%
on prescribed oxygen.
B. A client awaiting discharge who requests medication teaching.
C. A client with osteoarthritis requesting pain medication.
D. A client with stable heart failure awaiting breakfast.
🔴 Correct Answer: A. A client with pneumonia whose oxygen saturation has
decreased from 95% to 88% on prescribed oxygen.
🔵 Explanation: A declining oxygen saturation despite oxygen therapy suggests
worsening respiratory compromise and requires immediate assessment. The remaining
clients have needs that are important but not immediately life threatening.
QUESTION 6.
A client receiving continuous unfractionated heparin develops hematuria and
bleeding from the IV insertion site. Which laboratory result is most important for the
nurse to review?
A. Hemoglobin A1C.
B. Activated partial thromboplastin time (aPTT).
C. Serum magnesium.
D. Total cholesterol.
🔴 Correct Answer: B. Activated partial thromboplastin time (aPTT).
