1
HESI RN MED-SURG VERSION A EXAM - ACTUAL EXAM
2026/2027 | EXPERT VERIFIED | NGN-STYLE | MULTIPLE-
CHOICE | 125 VERIFIED Q&A | COMPLETE RATIONALES |
PASS GUARANTEED - A+ GRADED
EXAM OVERVIEW
This HESI RN Med-Surg Version A Exam is the first of two "actual exam" format assessments. It features 125
questions structured to match the official HESI testing format, with an emphasis on clinical judgment,
pharmacology prioritization, and system-specific disorders across cardiovascular, respiratory, neurological,
endocrine, gastrointestinal, and renal systems.
QUESTION 1
A nurse is caring for a client with heart failure who is receiving furosemide (Lasix) IV push. Which assessment
finding is most important to report to the healthcare provider?
A) Serum potassium level of 3.2 mEq/L
B) Urine output of 40 mL per hour
C) Blood pressure of 138/86 mmHg
D) Weight loss of 1 kg in 24 hours
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia. A potassium level
of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and increases the risk of cardiac arrhythmias,
especially in clients taking digoxin. This finding should be reported immediately.
QUESTION 2
A client with chronic obstructive pulmonary disease (COPD) has a prescription for home oxygen therapy.
Which statement by the client indicates a need for further teaching?
A) "I should use oxygen at 2 L/min via nasal cannula."
B) "I should not smoke while using oxygen."
C) "I should adjust the oxygen flow rate based on how I feel."
D) "I should place the oxygen tubing under my clothing."
,2
Correct Answer: C
Rationale: Clients with COPD should not adjust oxygen flow rates based on how they feel. Oxygen therapy
should be used as prescribed, typically at 1-2 L/min via nasal cannula to maintain SpO2 ≥-90%.
88 Adjusting
the flow rate without prescription can suppress the hypoxic drive.
QUESTION 3
A client is admitted with acute pancreatitis. Which laboratory finding is most indicative of this diagnosis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum bilirubin
D) Elevated serum alkaline phosphatase
Correct Answer: B
Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than serum amylase. Lipase levels
rise within 4-8 hours and remain elevated longer (up to 7-14 days), whereas amylase returns to normal more
quickly. Lipase is considered the gold standard for diagnosis.
QUESTION 4
A client with cirrhosis develops hematemesis. Which action should the nurse take first?
A) Position the client supine and assess vital signs
B) Prepare the client for an upper endoscopy
C) Administer an antiemetic medication
D) Document the episode and continue routine monitoring
Correct Answer: A
Rationale: Hematemesis in a client with cirrhosis suggests possible esophageal variceal bleeding; the priority is
to assess hemodynamic stability and prevent aspiration by positioning appropriately. Endoscopy is important
but follows initial stabilization.
QUESTION 5
A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which position should the
nurse encourage to help relieve discomfort?
,3
A) Supine with legs extended
B) Side-lying with knees drawn to the chest
C) High Fowler's with legs extended
D) Trendelenburg position
Correct Answer: B
Rationale: A side-lying, fetal position with knees drawn to the chest reduces tension on the abdominal
muscles and pancreatic stimulation, helping relieve pain in acute pancreatitis. Lying flat or supine often
worsens pain.
QUESTION 6
A client's laboratory results reveal a hemoglobin of 9.2 g/dL, low ferritin, and microcytic, hypochromic red
blood cells. Which type of anemia does the nurse suspect?
A) Pernicious anemia
B) Iron-deficiency anemia
C) Aplastic anemia
D) Sickle cell anemia
Correct Answer: B
Rationale: Microcytic, hypochromic red blood cells with low ferritin are characteristic of iron-deficiency
anemia, reflecting inadequate iron stores for hemoglobin synthesis.
QUESTION 7
A nurse is caring for a client on the first postoperative day after abdominal surgery. Which intervention is
most effective in preventing atelectasis?
A) Encouraging the client to remain in bed and rest
B) Administering opioids on a strict schedule without reassessment
C) Encouraging incentive spirometry use every 1–2 hours while awake
D) Limiting oral fluid intake
Correct Answer: C
, 4
Rationale: Incentive spirometry promotes deep breathing and lung expansion, which helps prevent atelectasis
and pneumonia after surgery. Prolonged bed rest without lung expansion exercises increases atelectasis risk.
QUESTION 8
A client with unstable angina is prescribed sublingual nitroglycerin. The client reports chest pain after one
tablet. Which action should the nurse take next?
A) Administer a second tablet after 5 minutes if pain persists
B) Wait 30 minutes before giving another dose
C) Instruct the client to swallow the next tablet instead
D) Withhold further doses and reassess in 1 hour
Correct Answer: A
Rationale: If chest pain is unrelieved after the first sublingual nitroglycerin tablet, a second dose may be given
after 5 minutes, up to three doses total, while monitoring blood pressure.
QUESTION 9
A client with atrial fibrillation is started on warfarin therapy. Which statement by the client indicates
understanding of dietary teaching?
A) "I should eat more green leafy vegetables every day."
B) "I need to maintain a consistent intake of vitamin K-containing foods."
C) "I should avoid all vegetables while taking this medication."
D) "I can eat as much spinach and kale as I want without concern."
Correct Answer: B
Rationale: Vitamin K antagonizes warfarin's anticoagulant effect, so clients are taught to maintain a consistent
intake rather than eliminate or drastically increase vitamin K-rich foods, which would cause unpredictable
INR fluctuations.
QUESTION 10
A client in cardiogenic shock has cool, clammy skin, a blood pressure of 78/50 mmHg, and crackles in the
lung bases. Which finding reflects the underlying pathophysiology?
HESI RN MED-SURG VERSION A EXAM - ACTUAL EXAM
2026/2027 | EXPERT VERIFIED | NGN-STYLE | MULTIPLE-
CHOICE | 125 VERIFIED Q&A | COMPLETE RATIONALES |
PASS GUARANTEED - A+ GRADED
EXAM OVERVIEW
This HESI RN Med-Surg Version A Exam is the first of two "actual exam" format assessments. It features 125
questions structured to match the official HESI testing format, with an emphasis on clinical judgment,
pharmacology prioritization, and system-specific disorders across cardiovascular, respiratory, neurological,
endocrine, gastrointestinal, and renal systems.
QUESTION 1
A nurse is caring for a client with heart failure who is receiving furosemide (Lasix) IV push. Which assessment
finding is most important to report to the healthcare provider?
A) Serum potassium level of 3.2 mEq/L
B) Urine output of 40 mL per hour
C) Blood pressure of 138/86 mmHg
D) Weight loss of 1 kg in 24 hours
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia. A potassium level
of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and increases the risk of cardiac arrhythmias,
especially in clients taking digoxin. This finding should be reported immediately.
QUESTION 2
A client with chronic obstructive pulmonary disease (COPD) has a prescription for home oxygen therapy.
Which statement by the client indicates a need for further teaching?
A) "I should use oxygen at 2 L/min via nasal cannula."
B) "I should not smoke while using oxygen."
C) "I should adjust the oxygen flow rate based on how I feel."
D) "I should place the oxygen tubing under my clothing."
,2
Correct Answer: C
Rationale: Clients with COPD should not adjust oxygen flow rates based on how they feel. Oxygen therapy
should be used as prescribed, typically at 1-2 L/min via nasal cannula to maintain SpO2 ≥-90%.
88 Adjusting
the flow rate without prescription can suppress the hypoxic drive.
QUESTION 3
A client is admitted with acute pancreatitis. Which laboratory finding is most indicative of this diagnosis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum bilirubin
D) Elevated serum alkaline phosphatase
Correct Answer: B
Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than serum amylase. Lipase levels
rise within 4-8 hours and remain elevated longer (up to 7-14 days), whereas amylase returns to normal more
quickly. Lipase is considered the gold standard for diagnosis.
QUESTION 4
A client with cirrhosis develops hematemesis. Which action should the nurse take first?
A) Position the client supine and assess vital signs
B) Prepare the client for an upper endoscopy
C) Administer an antiemetic medication
D) Document the episode and continue routine monitoring
Correct Answer: A
Rationale: Hematemesis in a client with cirrhosis suggests possible esophageal variceal bleeding; the priority is
to assess hemodynamic stability and prevent aspiration by positioning appropriately. Endoscopy is important
but follows initial stabilization.
QUESTION 5
A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which position should the
nurse encourage to help relieve discomfort?
,3
A) Supine with legs extended
B) Side-lying with knees drawn to the chest
C) High Fowler's with legs extended
D) Trendelenburg position
Correct Answer: B
Rationale: A side-lying, fetal position with knees drawn to the chest reduces tension on the abdominal
muscles and pancreatic stimulation, helping relieve pain in acute pancreatitis. Lying flat or supine often
worsens pain.
QUESTION 6
A client's laboratory results reveal a hemoglobin of 9.2 g/dL, low ferritin, and microcytic, hypochromic red
blood cells. Which type of anemia does the nurse suspect?
A) Pernicious anemia
B) Iron-deficiency anemia
C) Aplastic anemia
D) Sickle cell anemia
Correct Answer: B
Rationale: Microcytic, hypochromic red blood cells with low ferritin are characteristic of iron-deficiency
anemia, reflecting inadequate iron stores for hemoglobin synthesis.
QUESTION 7
A nurse is caring for a client on the first postoperative day after abdominal surgery. Which intervention is
most effective in preventing atelectasis?
A) Encouraging the client to remain in bed and rest
B) Administering opioids on a strict schedule without reassessment
C) Encouraging incentive spirometry use every 1–2 hours while awake
D) Limiting oral fluid intake
Correct Answer: C
, 4
Rationale: Incentive spirometry promotes deep breathing and lung expansion, which helps prevent atelectasis
and pneumonia after surgery. Prolonged bed rest without lung expansion exercises increases atelectasis risk.
QUESTION 8
A client with unstable angina is prescribed sublingual nitroglycerin. The client reports chest pain after one
tablet. Which action should the nurse take next?
A) Administer a second tablet after 5 minutes if pain persists
B) Wait 30 minutes before giving another dose
C) Instruct the client to swallow the next tablet instead
D) Withhold further doses and reassess in 1 hour
Correct Answer: A
Rationale: If chest pain is unrelieved after the first sublingual nitroglycerin tablet, a second dose may be given
after 5 minutes, up to three doses total, while monitoring blood pressure.
QUESTION 9
A client with atrial fibrillation is started on warfarin therapy. Which statement by the client indicates
understanding of dietary teaching?
A) "I should eat more green leafy vegetables every day."
B) "I need to maintain a consistent intake of vitamin K-containing foods."
C) "I should avoid all vegetables while taking this medication."
D) "I can eat as much spinach and kale as I want without concern."
Correct Answer: B
Rationale: Vitamin K antagonizes warfarin's anticoagulant effect, so clients are taught to maintain a consistent
intake rather than eliminate or drastically increase vitamin K-rich foods, which would cause unpredictable
INR fluctuations.
QUESTION 10
A client in cardiogenic shock has cool, clammy skin, a blood pressure of 78/50 mmHg, and crackles in the
lung bases. Which finding reflects the underlying pathophysiology?
