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HESI RN MED-SURG VERSION B 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 B Exam is the second 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. This is an alternate version with different case
scenarios and clinical presentations.
QUESTION 1
A client with acute myocardial infarction is receiving thrombolytic therapy. Which assessment finding
requires immediate intervention?
A) Chest pain rated 3 on a scale of 0-10
B) Blood pressure of 142/88 mmHg
C) Bleeding from the IV site
D) Heart rate of 92 bpm
Correct Answer: C
Rationale: Thrombolytic therapy increases the risk of bleeding. Bleeding from the IV site or any other site
requires immediate intervention, including stopping the infusion and notifying the provider. Chest pain (A),
elevated BP (B), and tachycardia (D) are expected in MI.
QUESTION 2
A client with chronic heart failure is prescribed sacubitril/valsartan (Entresto). Which finding would the nurse
report to the healthcare provider before administering this medication?
A) Serum potassium of 4.8 mEq/L
B) Blood pressure of 102/68 mmHg
C) Serum creatinine of 1.8 mg/dL
D) Weight gain of 1 pound in 24 hours
,2
Correct Answer: B
Rationale: Sacubitril/valsartan can cause significant hypotension. A blood pressure of 102/68 mmHg is
relatively low and should be reported before administration. The medication is contraindicated in clients with
hypotension (systolic <100 mmHg).
QUESTION 3
A client with COPD is prescribed tiotropium (Spiriva) via inhaler. Which teaching should the nurse provide?
A) "Take this medication for acute exacerbations."
B) "This medication should be taken once daily."
C) "This medication works immediately to relieve shortness of breath."
D) "This medication can be used with a spacer."
Correct Answer: B
Rationale: Tiotropium is a long-acting anticholinergic (LAMA) used for maintenance therapy in COPD. It
should be taken once daily. It is not for acute exacerbations (A) or immediate relief (C).
QUESTION 4
A client is admitted with a diagnosis of acute pancreatitis. Which assessment finding indicates a complication?
A) Epigastric pain radiating to the back
B) Nausea and vomiting
C) Cullen's sign
D) Fever and tachycardia
Correct Answer: C
Rationale: Cullen's sign (ecchymosis around the umbilicus) indicates retroperitoneal bleeding and is a sign of
severe pancreatitis with complications. Epigastric pain radiating to the back (A) is a classic symptom. Nausea
and vomiting (B) are expected findings.
QUESTION 5
A client with peripheral artery disease (PAD) is prescribed cilostazol (Pletal). Which teaching should the
nurse include?
,3
A) "This medication will prevent blood clots."
B) "This medication should be taken on an empty stomach."
C) "This medication may take several weeks to be effective."
D) "This medication should be taken with grapefruit juice."
Correct Answer: C
Rationale: Cilostazol is a phosphodiesterase inhibitor that improves symptoms of PAD by increasing blood
flow. It may take several weeks to achieve full effectiveness. It does not prevent blood clots (A). It should be
taken with food (B).
QUESTION 6
A client is receiving IV heparin for a pulmonary embolism. Which laboratory value indicates the therapy is
therapeutic?
A) aPTT of 45 seconds
B) aPTT of 65 seconds
C) aPTT of 35 seconds
D) INR of 3.0
Correct Answer: B
Rationale: The therapeutic aPTT for heparin is 1.5-2.5 times the normal control value (typically 60-90
seconds). An aPTT of 45 seconds (A) is below therapeutic range. INR (D) is used for warfarin, not heparin.
QUESTION 7
A client with heart failure is prescribed spironolactone (Aldactone). Which teaching is most important?
A) "Monitor for signs of hyperkalemia."
B) "Monitor for signs of hypokalemia."
C) "Take this medication with a potassium supplement."
D) "This medication will increase your urine output immediately."
Correct Answer: A
, 4
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Clients should be
taught to monitor for signs of hyperkalemia (muscle weakness, palpitations). Potassium supplements (C)
should not be taken with this medication.
QUESTION 8
A client with a colostomy is being discharged. Which statement indicates the client understands stoma care?
A) "I should change the pouch every day."
B) "I should clean the stoma with soap and water."
C) "I should report any bleeding from the stoma."
D) "I should avoid eating foods that produce gas."
Correct Answer: B
Rationale: The stoma should be cleaned with soap and water and patted dry. The pouch should be changed
every 3-7 days (A), not daily. A small amount of bleeding is normal (C). Gas-producing foods may be avoided
as needed.
QUESTION 9
A client with chronic kidney disease (CKD) is experiencing hyperphosphatemia. Which medication is most
likely prescribed?
A) Calcitriol
B) Sevelamer
C) Erythropoietin
D) Ferrous sulfate
Correct Answer: B
Rationale: Sevelamer is a phosphate binder that binds dietary phosphorus in the GI tract, preventing its
absorption. Calcitriol (A) treats hypocalcemia. Erythropoietin (C) treats anemia. Ferrous sulfate (D) treats
iron deficiency anemia.
QUESTION 10
A client with diabetes is receiving an insulin infusion. Which finding indicates the client is experiencing
hypoglycemia?
HESI RN MED-SURG VERSION B 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 B Exam is the second 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. This is an alternate version with different case
scenarios and clinical presentations.
QUESTION 1
A client with acute myocardial infarction is receiving thrombolytic therapy. Which assessment finding
requires immediate intervention?
A) Chest pain rated 3 on a scale of 0-10
B) Blood pressure of 142/88 mmHg
C) Bleeding from the IV site
D) Heart rate of 92 bpm
Correct Answer: C
Rationale: Thrombolytic therapy increases the risk of bleeding. Bleeding from the IV site or any other site
requires immediate intervention, including stopping the infusion and notifying the provider. Chest pain (A),
elevated BP (B), and tachycardia (D) are expected in MI.
QUESTION 2
A client with chronic heart failure is prescribed sacubitril/valsartan (Entresto). Which finding would the nurse
report to the healthcare provider before administering this medication?
A) Serum potassium of 4.8 mEq/L
B) Blood pressure of 102/68 mmHg
C) Serum creatinine of 1.8 mg/dL
D) Weight gain of 1 pound in 24 hours
,2
Correct Answer: B
Rationale: Sacubitril/valsartan can cause significant hypotension. A blood pressure of 102/68 mmHg is
relatively low and should be reported before administration. The medication is contraindicated in clients with
hypotension (systolic <100 mmHg).
QUESTION 3
A client with COPD is prescribed tiotropium (Spiriva) via inhaler. Which teaching should the nurse provide?
A) "Take this medication for acute exacerbations."
B) "This medication should be taken once daily."
C) "This medication works immediately to relieve shortness of breath."
D) "This medication can be used with a spacer."
Correct Answer: B
Rationale: Tiotropium is a long-acting anticholinergic (LAMA) used for maintenance therapy in COPD. It
should be taken once daily. It is not for acute exacerbations (A) or immediate relief (C).
QUESTION 4
A client is admitted with a diagnosis of acute pancreatitis. Which assessment finding indicates a complication?
A) Epigastric pain radiating to the back
B) Nausea and vomiting
C) Cullen's sign
D) Fever and tachycardia
Correct Answer: C
Rationale: Cullen's sign (ecchymosis around the umbilicus) indicates retroperitoneal bleeding and is a sign of
severe pancreatitis with complications. Epigastric pain radiating to the back (A) is a classic symptom. Nausea
and vomiting (B) are expected findings.
QUESTION 5
A client with peripheral artery disease (PAD) is prescribed cilostazol (Pletal). Which teaching should the
nurse include?
,3
A) "This medication will prevent blood clots."
B) "This medication should be taken on an empty stomach."
C) "This medication may take several weeks to be effective."
D) "This medication should be taken with grapefruit juice."
Correct Answer: C
Rationale: Cilostazol is a phosphodiesterase inhibitor that improves symptoms of PAD by increasing blood
flow. It may take several weeks to achieve full effectiveness. It does not prevent blood clots (A). It should be
taken with food (B).
QUESTION 6
A client is receiving IV heparin for a pulmonary embolism. Which laboratory value indicates the therapy is
therapeutic?
A) aPTT of 45 seconds
B) aPTT of 65 seconds
C) aPTT of 35 seconds
D) INR of 3.0
Correct Answer: B
Rationale: The therapeutic aPTT for heparin is 1.5-2.5 times the normal control value (typically 60-90
seconds). An aPTT of 45 seconds (A) is below therapeutic range. INR (D) is used for warfarin, not heparin.
QUESTION 7
A client with heart failure is prescribed spironolactone (Aldactone). Which teaching is most important?
A) "Monitor for signs of hyperkalemia."
B) "Monitor for signs of hypokalemia."
C) "Take this medication with a potassium supplement."
D) "This medication will increase your urine output immediately."
Correct Answer: A
, 4
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Clients should be
taught to monitor for signs of hyperkalemia (muscle weakness, palpitations). Potassium supplements (C)
should not be taken with this medication.
QUESTION 8
A client with a colostomy is being discharged. Which statement indicates the client understands stoma care?
A) "I should change the pouch every day."
B) "I should clean the stoma with soap and water."
C) "I should report any bleeding from the stoma."
D) "I should avoid eating foods that produce gas."
Correct Answer: B
Rationale: The stoma should be cleaned with soap and water and patted dry. The pouch should be changed
every 3-7 days (A), not daily. A small amount of bleeding is normal (C). Gas-producing foods may be avoided
as needed.
QUESTION 9
A client with chronic kidney disease (CKD) is experiencing hyperphosphatemia. Which medication is most
likely prescribed?
A) Calcitriol
B) Sevelamer
C) Erythropoietin
D) Ferrous sulfate
Correct Answer: B
Rationale: Sevelamer is a phosphate binder that binds dietary phosphorus in the GI tract, preventing its
absorption. Calcitriol (A) treats hypocalcemia. Erythropoietin (C) treats anemia. Ferrous sulfate (D) treats
iron deficiency anemia.
QUESTION 10
A client with diabetes is receiving an insulin infusion. Which finding indicates the client is experiencing
hypoglycemia?
