2026/2027 HESI MED-SURG RN CUSTOM EXAM 300
ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST UPDATE ALREADY
GRADED A+
The 2026/2027 HESI Med-Surg RN Custom Exam is a comprehensive,
scenario-based assessment designed to evaluate clinical judgment and
prioritization skills in adult medical-surgical nursing. It emphasizes safe,
patient-centered care across diverse conditions, including cardiovascular,
respiratory, endocrine, gastrointestinal, renal, and neurological disorders.
Questions integrate pathophysiology, pharmacology, fluid/electrolyte balance,
perioperative care, and emergency interventions. The exam focuses on
identifying subtle clinical changes, implementing evidence-based nursing
actions, and recognizing complications early. Success requires critical
thinking, time management, and the ability to apply the nursing process—
from assessment and analysis to planning and evaluation—in complex, real-
world healthcare situations.
Question 1
A client with heart failure suddenly develops pink-tinged frothy sputum, severe
dyspnea, and anxiety. Which action should the nurse take first?
A) Increase IV fluids
B) Place the client in high Fowler's position
C) Obtain a sputum sample
D) Administer PRN antianxiety medication
Correct Answer: B
Rationale: These symptoms indicate acute pulmonary edema. High-Fowler's
position improves oxygenation by decreasing venous return to the heart and
reducing pulmonary congestion. IV fluids would worsen fluid overload. Obtaining
a sputum sample and administering antianxiety medication are not the priority
actions.
Question 2
A client receiving chemotherapy asks the nurse, Why is so much of my hair falling
out each day? Which response by the nurse best explains the reason for alopecia?
,A) Chemotherapy affects the cells of the body that grow rapidly, both normal and
malignant
B) Alopecia is a common side effect you will experience during long-term steroid
therapy
C) Your hair will grow back completely after your course of chemotherapy is
completed
D) The chemotherapy causes permanent alterations in your hair follicles that lead
to hair loss
Correct Answer: A
Rationale: The common adverse effects of chemotherapy (nausea, vomiting,
alopecia, bone marrow depression) are due to chemotherapy's effect on the rapidly
reproducing cells, both normal and malignant. Hair loss is not permanent in most
cases and is not caused by steroids.
Question 3
After checking the urinary drainage system for kinks in the tubing, the nurse
determines that a client who has returned from the post-anesthesia care unit has a
urinary output of 20 mL over 2 hours. What action should the nurse implement
first?
A) Increase the IV fluid rate
B) Notify the healthcare provider
C) Assess the client's vital signs
D) Document the finding
Correct Answer: C
Rationale: Urinary output of less than 30 mL/hour may indicate hypovolemia or
renal impairment. The nurse should first assess the client's vital signs, especially
blood pressure and heart rate, to evaluate for signs of hypovolemia or shock before
implementing other interventions.
Question 4
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg.
Which action should the nurse implement?
A) Position the head of the bed flat
B) Withhold intravenous fluids
C) Administer a bolus of IV fluids
D) Give an antihypertensive medication
Correct Answer: D
Rationale: Completed strokes usually produce neurologic deficits within an hour,
and the client's current elevated blood pressure requires antihypertensive
,medication. Positioning the head flat could increase intracranial pressure.
Withholding fluids or giving a bolus are not appropriate actions.
Question 5
The nurse is assisting a client out of bed for the first time after surgery. What
action should the nurse do first?
A) Allow the client to sit with the bed in a high Fowler's position
B) Place a gait belt around the client's waist
C) Have the client dangle legs at the bedside
D) Assess the client's blood pressure
Correct Answer: A
Rationale: The first step is to raise the head of the bed to a high Fowler's position,
which allows venous return to compensate from lying flat and the vasodilation
effects of perioperative drugs. This helps prevent the client from becoming light-
headed and decreases the chance of a client fall.
Question 6
A client with cirrhosis has abdominal distention and difficulty breathing. Which
intervention is expected?
A) Insert NG tube
B) Prepare for paracentesis
C) Provide high-protein diet
D) Administer opioid analgesics
Correct Answer: B
Rationale: Ascites impairs breathing; paracentesis removes excess fluid, improving
comfort and ventilation. An NG tube is not indicated for ascites. A high-protein
diet may worsen hepatic encephalopathy. Opioids can worsen respiratory
depression.
Question 7
A client with cancer is receiving chemotherapy with a known vesicant. The client's
IV has been in place for 72 hours. The nurse determines that a new IV site cannot
be obtained, and leaves the present IV in place. What is the greatest clinical risk
related to this situation?
A) Impaired skin integrity
B) Infection
C) Extravasation
D) Phlebitis
Correct Answer: A
, Rationale: Vesicant chemotherapy can cause severe tissue damage if extravasation
occurs. Leaving an older IV in place increases the risk of infiltration and
extravasation, leading to impaired skin integrity and tissue necrosis.
Question 8
A client with a suspected stroke suddenly cannot speak but can follow commands.
Which stroke type is suspected?
A) Hemorrhagic
B) Expressive aphasia
C) Right-sided stroke
D) Receptive aphasia
Correct Answer: B
Rationale: Inability to verbalize with preserved comprehension indicates Broca's
area involvement (expressive aphasia). This is typically associated with left
hemisphere stroke. Hemorrhagic stroke does not specify the type of aphasia. Right-
sided stroke would cause left-sided motor deficits.
Question 9
A postoperative client reports incisional pain. The client has two prescriptions for
PRN analgesia that accompanied the client from the post-anesthesia unit. Before
selecting which medication to administer, which action should the nurse
implement?
A) Compare the client's pain scale rating with the prescribed dosing
B) Assess the client's respiratory rate
C) Check the client's last medication administration time
D) Review the client's allergy history
Correct Answer: A
Rationale: The nurse should compare the client's pain scale rating with the
prescribed dosing for each PRN medication to determine which medication is most
appropriate based on the severity of pain. Respiratory rate, last administration time,
and allergies are also important but the pain rating guides the selection.
Question 10
A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A) Administer lidocaine, 75 mg intravenous push
B) Perform synchronized cardioversion
C) Defibrillate the client as soon as possible
D) Administer atropine, 0.4 mg intravenous push
ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST UPDATE ALREADY
GRADED A+
The 2026/2027 HESI Med-Surg RN Custom Exam is a comprehensive,
scenario-based assessment designed to evaluate clinical judgment and
prioritization skills in adult medical-surgical nursing. It emphasizes safe,
patient-centered care across diverse conditions, including cardiovascular,
respiratory, endocrine, gastrointestinal, renal, and neurological disorders.
Questions integrate pathophysiology, pharmacology, fluid/electrolyte balance,
perioperative care, and emergency interventions. The exam focuses on
identifying subtle clinical changes, implementing evidence-based nursing
actions, and recognizing complications early. Success requires critical
thinking, time management, and the ability to apply the nursing process—
from assessment and analysis to planning and evaluation—in complex, real-
world healthcare situations.
Question 1
A client with heart failure suddenly develops pink-tinged frothy sputum, severe
dyspnea, and anxiety. Which action should the nurse take first?
A) Increase IV fluids
B) Place the client in high Fowler's position
C) Obtain a sputum sample
D) Administer PRN antianxiety medication
Correct Answer: B
Rationale: These symptoms indicate acute pulmonary edema. High-Fowler's
position improves oxygenation by decreasing venous return to the heart and
reducing pulmonary congestion. IV fluids would worsen fluid overload. Obtaining
a sputum sample and administering antianxiety medication are not the priority
actions.
Question 2
A client receiving chemotherapy asks the nurse, Why is so much of my hair falling
out each day? Which response by the nurse best explains the reason for alopecia?
,A) Chemotherapy affects the cells of the body that grow rapidly, both normal and
malignant
B) Alopecia is a common side effect you will experience during long-term steroid
therapy
C) Your hair will grow back completely after your course of chemotherapy is
completed
D) The chemotherapy causes permanent alterations in your hair follicles that lead
to hair loss
Correct Answer: A
Rationale: The common adverse effects of chemotherapy (nausea, vomiting,
alopecia, bone marrow depression) are due to chemotherapy's effect on the rapidly
reproducing cells, both normal and malignant. Hair loss is not permanent in most
cases and is not caused by steroids.
Question 3
After checking the urinary drainage system for kinks in the tubing, the nurse
determines that a client who has returned from the post-anesthesia care unit has a
urinary output of 20 mL over 2 hours. What action should the nurse implement
first?
A) Increase the IV fluid rate
B) Notify the healthcare provider
C) Assess the client's vital signs
D) Document the finding
Correct Answer: C
Rationale: Urinary output of less than 30 mL/hour may indicate hypovolemia or
renal impairment. The nurse should first assess the client's vital signs, especially
blood pressure and heart rate, to evaluate for signs of hypovolemia or shock before
implementing other interventions.
Question 4
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg.
Which action should the nurse implement?
A) Position the head of the bed flat
B) Withhold intravenous fluids
C) Administer a bolus of IV fluids
D) Give an antihypertensive medication
Correct Answer: D
Rationale: Completed strokes usually produce neurologic deficits within an hour,
and the client's current elevated blood pressure requires antihypertensive
,medication. Positioning the head flat could increase intracranial pressure.
Withholding fluids or giving a bolus are not appropriate actions.
Question 5
The nurse is assisting a client out of bed for the first time after surgery. What
action should the nurse do first?
A) Allow the client to sit with the bed in a high Fowler's position
B) Place a gait belt around the client's waist
C) Have the client dangle legs at the bedside
D) Assess the client's blood pressure
Correct Answer: A
Rationale: The first step is to raise the head of the bed to a high Fowler's position,
which allows venous return to compensate from lying flat and the vasodilation
effects of perioperative drugs. This helps prevent the client from becoming light-
headed and decreases the chance of a client fall.
Question 6
A client with cirrhosis has abdominal distention and difficulty breathing. Which
intervention is expected?
A) Insert NG tube
B) Prepare for paracentesis
C) Provide high-protein diet
D) Administer opioid analgesics
Correct Answer: B
Rationale: Ascites impairs breathing; paracentesis removes excess fluid, improving
comfort and ventilation. An NG tube is not indicated for ascites. A high-protein
diet may worsen hepatic encephalopathy. Opioids can worsen respiratory
depression.
Question 7
A client with cancer is receiving chemotherapy with a known vesicant. The client's
IV has been in place for 72 hours. The nurse determines that a new IV site cannot
be obtained, and leaves the present IV in place. What is the greatest clinical risk
related to this situation?
A) Impaired skin integrity
B) Infection
C) Extravasation
D) Phlebitis
Correct Answer: A
, Rationale: Vesicant chemotherapy can cause severe tissue damage if extravasation
occurs. Leaving an older IV in place increases the risk of infiltration and
extravasation, leading to impaired skin integrity and tissue necrosis.
Question 8
A client with a suspected stroke suddenly cannot speak but can follow commands.
Which stroke type is suspected?
A) Hemorrhagic
B) Expressive aphasia
C) Right-sided stroke
D) Receptive aphasia
Correct Answer: B
Rationale: Inability to verbalize with preserved comprehension indicates Broca's
area involvement (expressive aphasia). This is typically associated with left
hemisphere stroke. Hemorrhagic stroke does not specify the type of aphasia. Right-
sided stroke would cause left-sided motor deficits.
Question 9
A postoperative client reports incisional pain. The client has two prescriptions for
PRN analgesia that accompanied the client from the post-anesthesia unit. Before
selecting which medication to administer, which action should the nurse
implement?
A) Compare the client's pain scale rating with the prescribed dosing
B) Assess the client's respiratory rate
C) Check the client's last medication administration time
D) Review the client's allergy history
Correct Answer: A
Rationale: The nurse should compare the client's pain scale rating with the
prescribed dosing for each PRN medication to determine which medication is most
appropriate based on the severity of pain. Respiratory rate, last administration time,
and allergies are also important but the pain rating guides the selection.
Question 10
A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A) Administer lidocaine, 75 mg intravenous push
B) Perform synchronized cardioversion
C) Defibrillate the client as soon as possible
D) Administer atropine, 0.4 mg intravenous push
