MED SURGE HESI REAL EXAM 1 & 2 (2 VERSIONS) 2026/2027
OBJECTIVE ASSESSMENT - EXAM
MED SURGE HESI REAL EXAM 1 & 2 (2 VERSIONS)
2026/2027 WITH ALL 200 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
MEDICAL SURGICAL HESI EXAM TEST BANK 2026/2027
RN Medical-Surgical Nursing | Clinical Decision-Making
A+ Verified Passing Score Marks
2026/2027 Edition 75% 1 per question
COVER PAGE - 1
, SECTIONS COVERED
Section 1: Cardiovascular Nursing (Q1-35)
Section 2: Respiratory Nursing (Q36-65)
Section 3: Gastrointestinal and Endocrine Nursing (Q66-100)
Section 4: Neurological and Musculoskeletal Nursing (Q101-130)
Section 5: Renal, Urinary, and Reproductive Nursing (Q131-160)
Section 6: Hematology, Oncology, Immunology, and Clinical Decision-Making (Q161-200)
MED SURGE HESI REAL EXAM 1 & 2 (2 VERSIONS) 2026/2027
This examination assesses application and analysis of medical-surgical nursing principles across cardiovascular, respiratory, gastrointestinal,
endocrine, neurological, musculoskeletal, renal, hematologic, and oncologic conditions. Each question is worth 1 mark. Passing score is 75%.
SECTION 1: Cardiovascular Nursing
Q1.
A 68-year-old client with heart failure is admitted with dyspnea and 3+ pitting edema. The nurse notes JVD and crackles. Furosemide 40 mg IV is
given. Which finding indicates effectiveness?
A. Weight decrease of 1.5 kg in 24 hours and improved lung sounds.
B. Blood pressure rise from 110/70 to 140/90 mm Hg.
C. Urine output of 30 mL/hour for 4 hours.
D. Serum potassium rising from 3.8 to 4.9 mEq/L.
Correct Answer: A
Rationale:
Effective diuresis reduces fluid overload shown by weight loss and clearer lungs. Rising BP or oliguria suggests inadequate response.
Q2.
A client with atrial fibrillation on warfarin has an INR of 4.8 and mild gum bleeding. Which action should the nurse take first?
A. Hold the next warfarin dose and notify the provider.
B. Administer the scheduled dose and recheck INR in 24 hours.
C. Encourage soft-bristled toothbrush only.
D. Prepare to give vitamin K IM immediately.
Correct Answer: A
Rationale:
INR 4.8 is supra-therapeutic; holding the dose and notifying the provider is priority. Vitamin K is for significant bleeding.
Q3.
A post-MI client has a self-terminating 8-second run of VT. The client is asymptomatic with BP 118/72. What is the priority action?
A. Document the event and continue close monitoring.
B. Prepare for immediate synchronized cardioversion.
C. Administer lidocaine bolus as standing order.
D. Call a code and begin compressions.
Correct Answer: A
Rationale:
Self-terminating asymptomatic short VT is managed with monitoring and electrolyte/ischemia evaluation.
Q4.
A client with chronic stable angina has chest pain while walking that is unrelieved after 3 minutes of rest. Nitroglycerin 0.4 mg SL is prescribed. Which
instruction is correct?
A. Take one tablet; if pain persists after 5 minutes call EMS and take a second tablet.
B. Take three tablets at once for maximum effect.
C. Swallow the tablet with water.
D. Wait another 10 minutes before any nitroglycerin.
Correct Answer: A
Rationale:
Guidelines: one SL NTG, call EMS if unrelieved after 5 minutes, then second dose.
,Q5.
After femoral cardiac catheterization the nurse notes a growing hematoma and BP drop from 132/78 to 98/54. Priority action?
A. Apply firm pressure above the site and notify the provider immediately.
B. Elevate the head of bed to 45 degrees.
C. Encourage right-hip flexion.
D. Give 500 mL saline bolus without order.
Correct Answer: A
Rationale:
Expanding hematoma with hypotension signals arterial bleeding requiring pressure and urgent notification.
Q6.
A client on digoxin 0.125 mg daily has K 3.1 mEq/L, digoxin level 1.8 ng/mL, creatinine 1.9 mg/dL. Greatest concern?
A. Hypokalemia increasing digoxin toxicity risk.
B. Digoxin level within 0.5-2.0 ng/mL range.
C. Elevated creatinine needing only dose reduction.
D. All values acceptable.
Correct Answer: A
Rationale:
Hypokalemia potentiates digoxin toxicity even with therapeutic levels.
Q7.
Sudden tearing chest pain radiating to the back, BP 178/98 right arm and 142/80 left arm. Suspected aortic dissection. Priority?
A. Continuous BP monitoring and prepare for emergency imaging and surgical consult.
B. Fluid challenge of 1 L saline.
C. Sit the client upright.
D. Apply SCDs.
Correct Answer: A
Rationale:
Aortic dissection needs rapid BP control, imaging, and surgical evaluation; fluid challenge is contraindicated.
Q8.
Client with PAD reports intermittent claudication after two blocks. Best teaching?
A. Walk to the point of pain, rest, then continue to promote collateral circulation.
B. Avoid all walking.
C. Keep legs elevated above heart level.
D. Apply heating pads to calves.
Correct Answer: A
Rationale:
Supervised walking programs improve collateral circulation in PAD.
Q9.
Client on heparin infusion has aPTT 95 s (therapeutic 60-80). Action?
A. Notify provider and anticipate decrease in heparin rate.
B. Continue current rate.
C. Stop infusion and give protamine immediately.
D. Increase rate by 200 units/hour.
Correct Answer: A
Rationale:
aPTT above therapeutic range increases bleeding risk; reduce rate per protocol.
Q10.
After first dose of lisinopril the client develops lip and tongue swelling with dyspnea. First action?
A. Call rapid response and prepare epinephrine as ordered.
B. Reassure that mild swelling is expected.
C. Give next dose with food.
D. Document and reassess in 30 minutes.
Correct Answer: A
Rationale:
Angioedema is life-threatening; airway support and epinephrine are required.
, Q11.
Four hours post-CABG chest-tube drainage suddenly rises from 40 mL/h to 180 mL in one hour; BP 88/50. Priority?
A. Notify surgeon of possible postoperative hemorrhage.
B. Strip the chest tube vigorously.
C. Raise HOB to high Fowler.
D. Give fluid bolus and reassess in 15 min.
Correct Answer: A
Rationale:
Sudden high output with hypotension suggests surgical bleeding requiring prompt intervention.
Q12.
Client on spironolactone has K 5.6 mEq/L, creatinine 1.4. Action?
A. Hold spironolactone and notify provider of elevated potassium.
B. Give dose as ordered.
C. Encourage bananas and orange juice.
D. Increase the dose.
Correct Answer: A
Rationale:
Spironolactone is potassium-sparing; K 5.6 warrants holding the dose.
Q13.
Client with acute decompensated HF on CPAP. Finding indicating effectiveness?
A. Decreased respiratory rate and improved oxygen saturation.
B. Increased JVP and worsening edema.
C. BP rising to 180/110.
D. Increased anxiety only.
Correct Answer: A
Rationale:
CPAP reduces preload/afterload; lower work of breathing and higher SpO2 confirm benefit.
Q14.
Client with permanent pacemaker has HR 48 and failure to capture; dizzy. Priority?
A. Prepare temporary transcutaneous pacing and notify cardiologist.
B. Instruct Valsalva maneuver.
C. Give atropine 1 mg IV only.
D. Increase lower rate limit without orders.
Correct Answer: A
Rationale:
Failure to capture with symptomatic bradycardia requires temporary pacing support.
Q15.
IV nitroglycerin infusion; BP drops from 140/82 to 86/50. First action?
A. Stop or reduce the infusion per protocol and notify provider.
B. Place in Trendelenburg and continue rate.
C. Give 1 L fluid bolus without order.
D. Increase infusion rate.
Correct Answer: A
Rationale:
Significant hypotension from nitroglycerin requires immediate reduction or cessation.
Q16.
Client with infective endocarditis has new murmur, left-flank pain, and hematuria. Suspect?
A. Septic embolization to the kidney.
B. Acute MI from coronary embolism.
C. Pulmonary embolism from right-sided vegetation.
D. Hepatic abscess only.
Correct Answer: A
Rationale:
Left-sided vegetations embolize systemically; flank pain + hematuria suggest renal embolus.
OBJECTIVE ASSESSMENT - EXAM
MED SURGE HESI REAL EXAM 1 & 2 (2 VERSIONS)
2026/2027 WITH ALL 200 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
MEDICAL SURGICAL HESI EXAM TEST BANK 2026/2027
RN Medical-Surgical Nursing | Clinical Decision-Making
A+ Verified Passing Score Marks
2026/2027 Edition 75% 1 per question
COVER PAGE - 1
, SECTIONS COVERED
Section 1: Cardiovascular Nursing (Q1-35)
Section 2: Respiratory Nursing (Q36-65)
Section 3: Gastrointestinal and Endocrine Nursing (Q66-100)
Section 4: Neurological and Musculoskeletal Nursing (Q101-130)
Section 5: Renal, Urinary, and Reproductive Nursing (Q131-160)
Section 6: Hematology, Oncology, Immunology, and Clinical Decision-Making (Q161-200)
MED SURGE HESI REAL EXAM 1 & 2 (2 VERSIONS) 2026/2027
This examination assesses application and analysis of medical-surgical nursing principles across cardiovascular, respiratory, gastrointestinal,
endocrine, neurological, musculoskeletal, renal, hematologic, and oncologic conditions. Each question is worth 1 mark. Passing score is 75%.
SECTION 1: Cardiovascular Nursing
Q1.
A 68-year-old client with heart failure is admitted with dyspnea and 3+ pitting edema. The nurse notes JVD and crackles. Furosemide 40 mg IV is
given. Which finding indicates effectiveness?
A. Weight decrease of 1.5 kg in 24 hours and improved lung sounds.
B. Blood pressure rise from 110/70 to 140/90 mm Hg.
C. Urine output of 30 mL/hour for 4 hours.
D. Serum potassium rising from 3.8 to 4.9 mEq/L.
Correct Answer: A
Rationale:
Effective diuresis reduces fluid overload shown by weight loss and clearer lungs. Rising BP or oliguria suggests inadequate response.
Q2.
A client with atrial fibrillation on warfarin has an INR of 4.8 and mild gum bleeding. Which action should the nurse take first?
A. Hold the next warfarin dose and notify the provider.
B. Administer the scheduled dose and recheck INR in 24 hours.
C. Encourage soft-bristled toothbrush only.
D. Prepare to give vitamin K IM immediately.
Correct Answer: A
Rationale:
INR 4.8 is supra-therapeutic; holding the dose and notifying the provider is priority. Vitamin K is for significant bleeding.
Q3.
A post-MI client has a self-terminating 8-second run of VT. The client is asymptomatic with BP 118/72. What is the priority action?
A. Document the event and continue close monitoring.
B. Prepare for immediate synchronized cardioversion.
C. Administer lidocaine bolus as standing order.
D. Call a code and begin compressions.
Correct Answer: A
Rationale:
Self-terminating asymptomatic short VT is managed with monitoring and electrolyte/ischemia evaluation.
Q4.
A client with chronic stable angina has chest pain while walking that is unrelieved after 3 minutes of rest. Nitroglycerin 0.4 mg SL is prescribed. Which
instruction is correct?
A. Take one tablet; if pain persists after 5 minutes call EMS and take a second tablet.
B. Take three tablets at once for maximum effect.
C. Swallow the tablet with water.
D. Wait another 10 minutes before any nitroglycerin.
Correct Answer: A
Rationale:
Guidelines: one SL NTG, call EMS if unrelieved after 5 minutes, then second dose.
,Q5.
After femoral cardiac catheterization the nurse notes a growing hematoma and BP drop from 132/78 to 98/54. Priority action?
A. Apply firm pressure above the site and notify the provider immediately.
B. Elevate the head of bed to 45 degrees.
C. Encourage right-hip flexion.
D. Give 500 mL saline bolus without order.
Correct Answer: A
Rationale:
Expanding hematoma with hypotension signals arterial bleeding requiring pressure and urgent notification.
Q6.
A client on digoxin 0.125 mg daily has K 3.1 mEq/L, digoxin level 1.8 ng/mL, creatinine 1.9 mg/dL. Greatest concern?
A. Hypokalemia increasing digoxin toxicity risk.
B. Digoxin level within 0.5-2.0 ng/mL range.
C. Elevated creatinine needing only dose reduction.
D. All values acceptable.
Correct Answer: A
Rationale:
Hypokalemia potentiates digoxin toxicity even with therapeutic levels.
Q7.
Sudden tearing chest pain radiating to the back, BP 178/98 right arm and 142/80 left arm. Suspected aortic dissection. Priority?
A. Continuous BP monitoring and prepare for emergency imaging and surgical consult.
B. Fluid challenge of 1 L saline.
C. Sit the client upright.
D. Apply SCDs.
Correct Answer: A
Rationale:
Aortic dissection needs rapid BP control, imaging, and surgical evaluation; fluid challenge is contraindicated.
Q8.
Client with PAD reports intermittent claudication after two blocks. Best teaching?
A. Walk to the point of pain, rest, then continue to promote collateral circulation.
B. Avoid all walking.
C. Keep legs elevated above heart level.
D. Apply heating pads to calves.
Correct Answer: A
Rationale:
Supervised walking programs improve collateral circulation in PAD.
Q9.
Client on heparin infusion has aPTT 95 s (therapeutic 60-80). Action?
A. Notify provider and anticipate decrease in heparin rate.
B. Continue current rate.
C. Stop infusion and give protamine immediately.
D. Increase rate by 200 units/hour.
Correct Answer: A
Rationale:
aPTT above therapeutic range increases bleeding risk; reduce rate per protocol.
Q10.
After first dose of lisinopril the client develops lip and tongue swelling with dyspnea. First action?
A. Call rapid response and prepare epinephrine as ordered.
B. Reassure that mild swelling is expected.
C. Give next dose with food.
D. Document and reassess in 30 minutes.
Correct Answer: A
Rationale:
Angioedema is life-threatening; airway support and epinephrine are required.
, Q11.
Four hours post-CABG chest-tube drainage suddenly rises from 40 mL/h to 180 mL in one hour; BP 88/50. Priority?
A. Notify surgeon of possible postoperative hemorrhage.
B. Strip the chest tube vigorously.
C. Raise HOB to high Fowler.
D. Give fluid bolus and reassess in 15 min.
Correct Answer: A
Rationale:
Sudden high output with hypotension suggests surgical bleeding requiring prompt intervention.
Q12.
Client on spironolactone has K 5.6 mEq/L, creatinine 1.4. Action?
A. Hold spironolactone and notify provider of elevated potassium.
B. Give dose as ordered.
C. Encourage bananas and orange juice.
D. Increase the dose.
Correct Answer: A
Rationale:
Spironolactone is potassium-sparing; K 5.6 warrants holding the dose.
Q13.
Client with acute decompensated HF on CPAP. Finding indicating effectiveness?
A. Decreased respiratory rate and improved oxygen saturation.
B. Increased JVP and worsening edema.
C. BP rising to 180/110.
D. Increased anxiety only.
Correct Answer: A
Rationale:
CPAP reduces preload/afterload; lower work of breathing and higher SpO2 confirm benefit.
Q14.
Client with permanent pacemaker has HR 48 and failure to capture; dizzy. Priority?
A. Prepare temporary transcutaneous pacing and notify cardiologist.
B. Instruct Valsalva maneuver.
C. Give atropine 1 mg IV only.
D. Increase lower rate limit without orders.
Correct Answer: A
Rationale:
Failure to capture with symptomatic bradycardia requires temporary pacing support.
Q15.
IV nitroglycerin infusion; BP drops from 140/82 to 86/50. First action?
A. Stop or reduce the infusion per protocol and notify provider.
B. Place in Trendelenburg and continue rate.
C. Give 1 L fluid bolus without order.
D. Increase infusion rate.
Correct Answer: A
Rationale:
Significant hypotension from nitroglycerin requires immediate reduction or cessation.
Q16.
Client with infective endocarditis has new murmur, left-flank pain, and hematuria. Suspect?
A. Septic embolization to the kidney.
B. Acute MI from coronary embolism.
C. Pulmonary embolism from right-sided vegetation.
D. Hepatic abscess only.
Correct Answer: A
Rationale:
Left-sided vegetations embolize systemically; flank pain + hematuria suggest renal embolus.
