2026 HESI PN Medical-
Surgical Exam Prep Bank |
400 NGN Questions,
Detailed Rationales &
Verified Answers (Graded
A+)
Master your upcoming exam with this
comprehensive study bank featuring 400 highly
optimized, Next-Generation NCLEX (NGN) style
HESI PN Medical-Surgical practice questions. Every
question includes a verified correct answer along
with a detailed, italicized rationale designed to break
down and clarify complex pharmacology,
pathophysiology, and practical nursing concepts.
Perfectly formatted with distinct spacing blocks for
clean readability, this premium study guide is your
ultimate tool for secure comprehension and
achieving a guaranteed top grade.
,Q1. A nurse is caring for a client who is taking lithium and reports persistent
nausea and vomiting for 2 days. Which of the following laboratory values should
the nurse report to the provider?
a) Potassium 4.0 mEq/L
b) Lithium 0.9 mEq/L
c) BUN 12 mg/dL
d) Sodium 132 mEq/L
Answer: d
Rationale: The nurse should identify that a sodium level of 132 mEq/L is not within the
expected reference range of 136 to 145 mEq/L. This finding indicates hyponatremia,
which can lead to lithium accumulation and places the client at risk for lithium toxicity.
The nurse should report this finding to the provider.
Q2. A nurse is collecting data from a client who has a deep-vein thrombosis (DVT)
in the left lower extremity. Which of the following findings should the nurse
expect?
a) Pale, cool skin on the left leg
b) Absent pedal pulses in the left foot
c) Swelling and redness of the left calf
d) Flaccid muscles in the left thigh
Answer: c
Rationale: Expected findings of a DVT include unilateral swelling, localized redness,
warmth, and tenderness over the affected vein. Cool, pale skin and absent pulses are
signs of arterial insufficiency rather than venous thrombosis.
Q3. A nurse is caring for a client who is 4 hours postoperative following a
subtotal thyroidectomy. Which of the following items is the priority for the nurse
to place at the bedside?
a) A suction machine and a tracheostomy tray
b) An incentive spirometer and pillows
c) A blood pressure cuff and a stethoscope
d) An extra intravenous infusion pump
Answer: a
Rationale: Airway obstruction due to edema or laryngeal nerve damage is a life-
threatening complication of a thyroidectomy. Having suction equipment and an
emergency tracheostomy tray at the bedside is the highest priority for client safety.
Q4. A nurse is reinforcing teaching with a client who has iron deficiency anemia
and a new prescription for ferrous sulfate tablets. Which of the following
instructions should the nurse include?
a) Take the medication with an antacid to avoid an upset stomach.
b) Drink a glass of orange juice when taking the tablet.
c) Expect your stools to become light clay-colored.
d) Crush the tablet and mix it into applesauce.
,Answer: b
Rationale: Vitamin C enhances the absorption of iron. Antacids decrease absorption
and should be avoided. Iron supplements typically cause stools to become dark green
or black, which is an expected and harmless finding.
Q5. A nurse is caring for a client who is experiencing an acute asthma attack.
Which of the following medications should the nurse administer first?
a) Fluticasone propionate inhaler
b) Salmeterol dry powder inhaler
c) Albuterol metered-dose inhaler
d) Oral prednisone liquid
Answer: c
Rationale: Albuterol is a short-acting beta-2 agonist that acts as a rapid rescue
bronchodilator to relieve acute bronchospasms. Fluticasone and salmeterol are long-
term maintenance medications, and oral prednisone takes several hours to produce
therapeutic anti-inflammatory effects.
Q6. A nurse is collecting data from a client who has chronic kidney disease
(CKD). Which of the following laboratory values indicates a worsening of the
disease?
a) Decreased blood urea nitrogen (BUN)
b) Increased serum creatinine
c) Increased hemoglobin level
d) Decreased serum potassium
Answer: b
Rationale: Creatinine is a waste product of muscle metabolism excreted entirely by the
kidneys. An increase in serum creatinine directly indicates a decline in glomerular
filtration and worsening renal function. Potassium and BUN levels usually increase in
CKD, while hemoglobin decreases.
Q7. A nurse is monitoring a client who is receiving a unit of packed red blood
cells. Which of the following findings indicates a hemolytic transfusion reaction?
a) Low-back pain and chills
b) Hypertension and bounding pulse
c) Distended neck veins and dyspnea
d) Dry skin and bradycardia
Answer: a
Rationale: Signs of an acute hemolytic transfusion reaction include low-back pain, chills,
fever, tachycardia, and hypotension. Fluid overload causes distended neck veins and
hypertension, which requires a different clinical response.
Q8. A nurse is caring for a client who has a newly placed ileostomy. Which of the
following characteristics should the nurse expect when evaluating the stoma
output during the initial postoperative days?
a) Formed, dark brown stool
b) Semiformed green stool
, c) Loose, dark red blood clots
d) Liquid, greenish-yellow drainage
Answer: d
Rationale: Initial drainage from a new ileostomy is liquid and greenish-yellow because it
bypasses the large intestine where water absorption occurs. Over time, the output will
thicken slightly to a paste-like consistency, but it will never become fully formed.
Q9. A nurse is reinforcing teaching about foot care with a client who has diabetes
mellitus. Which of the following statements by the client indicates an
understanding of the instructions?
a) "I will soak my feet in warm water for 20 minutes every night."
b) "I should apply moisturizing lotion between my toes after washing."
c) "I will inspect the bottoms of my feet daily using a hand mirror."
d) "I can walk barefoot as long as I am indoors on clean carpets."
Answer: c
Rationale: Daily inspection of the feet using a mirror helps identify minor injuries,
blisters, or redness early to prevent diabetic ulcers. Soaking feet promotes skin
breakdown, lotion between the toes fosters fungal growth, and walking barefoot
increases the risk of undetected trauma.
Q10. A nurse is caring for a client who has peripheral arterial disease (PAD).
Which of the following actions should the nurse take to promote arterial blood
flow?
a) Elevate the client's legs above the level of the heart.
b) Position the client's legs in a dependent position.
c) Apply ice packs to the client's calves twice daily.
d) Instruct the client to cross their legs at the knees.
Answer: b
Rationale: Placing the legs in a dependent position allows gravity to assist arterial blood
flow to the lower extremities. Elevating the legs or crossing them restricts arterial flow,
and ice packs cause vasoconstriction, which worsens the ischemia.
Q11. A nurse is collecting data from a client who has a skeletal traction pin for a
fractured femur. Which of the following findings indicates a localized infection at
the pin site?
a) Serosanguineous drainage on the dressing
b) Mild erythema extending 1 mm around the pin
c) Purulent drainage and localized warmth
d) Client report of a dull ache in the thigh
Answer: c
Rationale: Purulent (pus-like) drainage, foul odor, worsening localized warmth, and
severe tenderness are classic signs of a pin site infection. Small amounts of
serosanguineous drainage and minimal redness are normal healing responses during
the initial days.
Surgical Exam Prep Bank |
400 NGN Questions,
Detailed Rationales &
Verified Answers (Graded
A+)
Master your upcoming exam with this
comprehensive study bank featuring 400 highly
optimized, Next-Generation NCLEX (NGN) style
HESI PN Medical-Surgical practice questions. Every
question includes a verified correct answer along
with a detailed, italicized rationale designed to break
down and clarify complex pharmacology,
pathophysiology, and practical nursing concepts.
Perfectly formatted with distinct spacing blocks for
clean readability, this premium study guide is your
ultimate tool for secure comprehension and
achieving a guaranteed top grade.
,Q1. A nurse is caring for a client who is taking lithium and reports persistent
nausea and vomiting for 2 days. Which of the following laboratory values should
the nurse report to the provider?
a) Potassium 4.0 mEq/L
b) Lithium 0.9 mEq/L
c) BUN 12 mg/dL
d) Sodium 132 mEq/L
Answer: d
Rationale: The nurse should identify that a sodium level of 132 mEq/L is not within the
expected reference range of 136 to 145 mEq/L. This finding indicates hyponatremia,
which can lead to lithium accumulation and places the client at risk for lithium toxicity.
The nurse should report this finding to the provider.
Q2. A nurse is collecting data from a client who has a deep-vein thrombosis (DVT)
in the left lower extremity. Which of the following findings should the nurse
expect?
a) Pale, cool skin on the left leg
b) Absent pedal pulses in the left foot
c) Swelling and redness of the left calf
d) Flaccid muscles in the left thigh
Answer: c
Rationale: Expected findings of a DVT include unilateral swelling, localized redness,
warmth, and tenderness over the affected vein. Cool, pale skin and absent pulses are
signs of arterial insufficiency rather than venous thrombosis.
Q3. A nurse is caring for a client who is 4 hours postoperative following a
subtotal thyroidectomy. Which of the following items is the priority for the nurse
to place at the bedside?
a) A suction machine and a tracheostomy tray
b) An incentive spirometer and pillows
c) A blood pressure cuff and a stethoscope
d) An extra intravenous infusion pump
Answer: a
Rationale: Airway obstruction due to edema or laryngeal nerve damage is a life-
threatening complication of a thyroidectomy. Having suction equipment and an
emergency tracheostomy tray at the bedside is the highest priority for client safety.
Q4. A nurse is reinforcing teaching with a client who has iron deficiency anemia
and a new prescription for ferrous sulfate tablets. Which of the following
instructions should the nurse include?
a) Take the medication with an antacid to avoid an upset stomach.
b) Drink a glass of orange juice when taking the tablet.
c) Expect your stools to become light clay-colored.
d) Crush the tablet and mix it into applesauce.
,Answer: b
Rationale: Vitamin C enhances the absorption of iron. Antacids decrease absorption
and should be avoided. Iron supplements typically cause stools to become dark green
or black, which is an expected and harmless finding.
Q5. A nurse is caring for a client who is experiencing an acute asthma attack.
Which of the following medications should the nurse administer first?
a) Fluticasone propionate inhaler
b) Salmeterol dry powder inhaler
c) Albuterol metered-dose inhaler
d) Oral prednisone liquid
Answer: c
Rationale: Albuterol is a short-acting beta-2 agonist that acts as a rapid rescue
bronchodilator to relieve acute bronchospasms. Fluticasone and salmeterol are long-
term maintenance medications, and oral prednisone takes several hours to produce
therapeutic anti-inflammatory effects.
Q6. A nurse is collecting data from a client who has chronic kidney disease
(CKD). Which of the following laboratory values indicates a worsening of the
disease?
a) Decreased blood urea nitrogen (BUN)
b) Increased serum creatinine
c) Increased hemoglobin level
d) Decreased serum potassium
Answer: b
Rationale: Creatinine is a waste product of muscle metabolism excreted entirely by the
kidneys. An increase in serum creatinine directly indicates a decline in glomerular
filtration and worsening renal function. Potassium and BUN levels usually increase in
CKD, while hemoglobin decreases.
Q7. A nurse is monitoring a client who is receiving a unit of packed red blood
cells. Which of the following findings indicates a hemolytic transfusion reaction?
a) Low-back pain and chills
b) Hypertension and bounding pulse
c) Distended neck veins and dyspnea
d) Dry skin and bradycardia
Answer: a
Rationale: Signs of an acute hemolytic transfusion reaction include low-back pain, chills,
fever, tachycardia, and hypotension. Fluid overload causes distended neck veins and
hypertension, which requires a different clinical response.
Q8. A nurse is caring for a client who has a newly placed ileostomy. Which of the
following characteristics should the nurse expect when evaluating the stoma
output during the initial postoperative days?
a) Formed, dark brown stool
b) Semiformed green stool
, c) Loose, dark red blood clots
d) Liquid, greenish-yellow drainage
Answer: d
Rationale: Initial drainage from a new ileostomy is liquid and greenish-yellow because it
bypasses the large intestine where water absorption occurs. Over time, the output will
thicken slightly to a paste-like consistency, but it will never become fully formed.
Q9. A nurse is reinforcing teaching about foot care with a client who has diabetes
mellitus. Which of the following statements by the client indicates an
understanding of the instructions?
a) "I will soak my feet in warm water for 20 minutes every night."
b) "I should apply moisturizing lotion between my toes after washing."
c) "I will inspect the bottoms of my feet daily using a hand mirror."
d) "I can walk barefoot as long as I am indoors on clean carpets."
Answer: c
Rationale: Daily inspection of the feet using a mirror helps identify minor injuries,
blisters, or redness early to prevent diabetic ulcers. Soaking feet promotes skin
breakdown, lotion between the toes fosters fungal growth, and walking barefoot
increases the risk of undetected trauma.
Q10. A nurse is caring for a client who has peripheral arterial disease (PAD).
Which of the following actions should the nurse take to promote arterial blood
flow?
a) Elevate the client's legs above the level of the heart.
b) Position the client's legs in a dependent position.
c) Apply ice packs to the client's calves twice daily.
d) Instruct the client to cross their legs at the knees.
Answer: b
Rationale: Placing the legs in a dependent position allows gravity to assist arterial blood
flow to the lower extremities. Elevating the legs or crossing them restricts arterial flow,
and ice packs cause vasoconstriction, which worsens the ischemia.
Q11. A nurse is collecting data from a client who has a skeletal traction pin for a
fractured femur. Which of the following findings indicates a localized infection at
the pin site?
a) Serosanguineous drainage on the dressing
b) Mild erythema extending 1 mm around the pin
c) Purulent drainage and localized warmth
d) Client report of a dull ache in the thigh
Answer: c
Rationale: Purulent (pus-like) drainage, foul odor, worsening localized warmth, and
severe tenderness are classic signs of a pin site infection. Small amounts of
serosanguineous drainage and minimal redness are normal healing responses during
the initial days.
