HESI MEDICAL-SURGICAL NURSING PRACTICE
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This rigorous practice examination is designed for nursing students and graduate
nurses preparing for the HESI Medical-Surgical Nursing specialty exam, NCLEX-RN®
medical-surgical content, or advanced clinical competency assessments. The 100-
question test encompasses adult health, perioperative care, critical care,
emergency management, and chronic disease nursing across all major body
systems. Each item reflects the high cognitive complexity expected of a competent
medical-surgical nurse, integrating pathophysiology, pharmacology, clinical
reasoning, patient safety, and evidence-based practice. The questions emphasize
analysis of laboratory data, interpretation of hemodynamic waveforms, titration
of high-alert medications, prioritization of care in unstable conditions, and
application of infection control and quality improvement principles. Use this
comprehensive review to self-assess your mastery of medical-surgical nursing and
to strengthen your decision-making skills for safe, effective, and compassionate
patient care in acute and community settings. This 2026–2027 edition is updated
with the most current clinical guidelines and standards.
Table of Contents
I. Cardiovascular and Hemodynamic Nursing
II. Respiratory and Mechanical Ventilation
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal, Hepatic, and Biliary Nursing
V. Renal and Genitourinary Nursing
VI. Neurological and Neurosensory Nursing
VII. Musculoskeletal and Integumentary Nursing
VIII. Oncology and Hematology
IX. Perioperative and Post-Anesthesia Nursing
,X. Infectious Disease and Sepsis Management
XI. Emergency, Trauma, and Disaster Nursing
1. A client is admitted with acute decompensated heart failure. The
pulmonary artery catheter reveals a cardiac index of 1.8 L/min/m²,
pulmonary artery wedge pressure (PAWP) of 28 mm Hg, and systemic
vascular resistance (SVR) of 2100 dynes/sec/cm⁻⁵. Which hemodynamic
profile do these findings represent?
A) Hyperdynamic shock with low afterload
B) Cardiogenic shock with elevated filling pressures
C) Hypovolemic shock with compensatory vasoconstriction
D) Septic shock with high cardiac output and low SVR
Correct Answer: B
Cardiac index <2.2 L/min/m², PAWP >18 mm Hg, and SVR >1500 dynes/sec/cm⁻⁵
characterize cardiogenic shock with poor pump function and compensatory
vasoconstriction. Hyperdynamic shock (A, D) presents with high cardiac index and
low SVR. Hypovolemic shock (C) typically shows low PAWP.
2. A client on mechanical ventilation has an FiO₂ of 0.60 and an arterial blood
gas showing PaO₂ 58 mm Hg, PaCO₂ 38 mm Hg, pH 7.39. The calculated P/F
ratio is 96. What intervention should the nurse prepare for next?
A) Increase positive end-expiratory pressure (PEEP) by 2 cm H₂O
B) Switch to high-frequency oscillatory ventilation
C) Administer sodium bicarbonate for metabolic acidosis
D) Suction the endotracheal tube to clear mucus plug
Correct Answer: A
P/F ratio <100 indicates severe ARDS requiring lung-protective ventilation with
increased PEEP to improve oxygenation. High-frequency ventilation (B) may be
considered later if refractory. ABG shows adequate ventilation (PaCO₂ normal), so
no plug (D). No acidosis (C).
, 3. A nurse is titrating a norepinephrine infusion for a client with septic shock
to maintain a mean arterial pressure (MAP) ≥65 mm Hg. The current MAP is
58 mm Hg on 0.2 mcg/kg/min. The provider’s order reads: “Increase by
0.05 mcg/kg/min every 5 minutes to target MAP 65.” The client’s weight is
70 kg. The infusion concentration is 8 mg in 250 mL D5W. At what rate
(mL/hr) is the nurse currently infusing? (Round to the nearest whole
number.)
A) 10 mL/hr
B) 18 mL/hr
C) 26 mL/hr
D) 35 mL/hr
Correct Answer: C
First, calculate the concentration: 8 mg = 8000 mcg in 250 mL → 32 mcg/mL.
Current dose: 0.2 mcg/kg/min x 70 kg = 14 mcg/min. Infusion rate: 14 mcg/min ÷
32 mcg/mL = 0.4375 mL/min x 60 = 26.25 mL/hr, rounded to 26 mL/hr. Option A,
B, D are miscalculations.
4. A client with Cushing’s syndrome is admitted for adrenalectomy. Which
postoperative laboratory value demands the nurse’s immediate attention?
A) Serum glucose 180 mg/dL
B) Serum potassium 3.8 mEq/L
C) Serum sodium 150 mEq/L
D) Serum cortisol 2 mcg/dL (low)
Correct Answer: D
After adrenalectomy, sudden drop in cortisol can cause adrenal crisis, a life-
threatening emergency requiring immediate administration of IV hydrocortisone.
Hyperglycemia (A) and mild hypernatremia (C) are expected but not immediately
lethal. Potassium (B) is within normal limits.
5. A client with cirrhosis develops increasing confusion, a serum ammonia of
180 mcg/dL, and asterixis. The provider orders lactulose 30 mL PO every
hour until two soft stools are produced. After the first dose, the client has
watery diarrhea and cramping. What is the nurse’s best action?
, A) Hold the next dose and notify the provider
B) Continue the hourly lactulose as prescribed
C) Administer loperamide to control diarrhea
D) Decrease lactulose to 15 mL every 2 hours without an order
Correct Answer: A
The goal is 2–3 soft stools/day; watery diarrhea indicates overmedication, which
can cause fluid/electrolyte imbalances and worsened encephalopathy. The nurse
should hold and notify. Continuing (B) or adjusting dose independently (D) is
unsafe. Loperamide (C) adds to constipation risk.
6. The telemetry nurse observes a rhythm with a rate of 40 bpm, no visible P
waves before the QRS complexes, and wide QRS intervals of 0.14 seconds.
The client is asymptomatic. What is the rhythm most likely?
A) Sinus bradycardia with first-degree AV block
B) Junctional escape rhythm with aberrancy
C) Idioventricular rhythm
D) Atrial fibrillation with slow ventricular response
Correct Answer: C
An idioventricular rhythm has a rate 20–40 bpm, no P waves, and wide QRS (>0.12
sec), indicating ventricular origin. Junctional escape (B) has narrow QRS. Sinus (A)
has P waves. Atrial fibrillation (D) is irregular with narrow QRS unless aberrancy.
7. A client with a 55% total body surface area burn is receiving fluid
resuscitation per the Parkland formula. In the first 8 hours, the urine output
averaged 15 mL/hr. The nurse should suspect which complication?
A) Acute tubular necrosis from inadequate resuscitation
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Hyperdynamic response with excessive cardiac output
D) Normal response to the burn injury
Correct Answer: A
Target urine output is 0.5–1 mL/kg/hr; 15 mL/hr is well below target for an
average adult, indicating inadequate renal perfusion and possible acute tubular
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
This rigorous practice examination is designed for nursing students and graduate
nurses preparing for the HESI Medical-Surgical Nursing specialty exam, NCLEX-RN®
medical-surgical content, or advanced clinical competency assessments. The 100-
question test encompasses adult health, perioperative care, critical care,
emergency management, and chronic disease nursing across all major body
systems. Each item reflects the high cognitive complexity expected of a competent
medical-surgical nurse, integrating pathophysiology, pharmacology, clinical
reasoning, patient safety, and evidence-based practice. The questions emphasize
analysis of laboratory data, interpretation of hemodynamic waveforms, titration
of high-alert medications, prioritization of care in unstable conditions, and
application of infection control and quality improvement principles. Use this
comprehensive review to self-assess your mastery of medical-surgical nursing and
to strengthen your decision-making skills for safe, effective, and compassionate
patient care in acute and community settings. This 2026–2027 edition is updated
with the most current clinical guidelines and standards.
Table of Contents
I. Cardiovascular and Hemodynamic Nursing
II. Respiratory and Mechanical Ventilation
III. Endocrine and Metabolic Disorders
IV. Gastrointestinal, Hepatic, and Biliary Nursing
V. Renal and Genitourinary Nursing
VI. Neurological and Neurosensory Nursing
VII. Musculoskeletal and Integumentary Nursing
VIII. Oncology and Hematology
IX. Perioperative and Post-Anesthesia Nursing
,X. Infectious Disease and Sepsis Management
XI. Emergency, Trauma, and Disaster Nursing
1. A client is admitted with acute decompensated heart failure. The
pulmonary artery catheter reveals a cardiac index of 1.8 L/min/m²,
pulmonary artery wedge pressure (PAWP) of 28 mm Hg, and systemic
vascular resistance (SVR) of 2100 dynes/sec/cm⁻⁵. Which hemodynamic
profile do these findings represent?
A) Hyperdynamic shock with low afterload
B) Cardiogenic shock with elevated filling pressures
C) Hypovolemic shock with compensatory vasoconstriction
D) Septic shock with high cardiac output and low SVR
Correct Answer: B
Cardiac index <2.2 L/min/m², PAWP >18 mm Hg, and SVR >1500 dynes/sec/cm⁻⁵
characterize cardiogenic shock with poor pump function and compensatory
vasoconstriction. Hyperdynamic shock (A, D) presents with high cardiac index and
low SVR. Hypovolemic shock (C) typically shows low PAWP.
2. A client on mechanical ventilation has an FiO₂ of 0.60 and an arterial blood
gas showing PaO₂ 58 mm Hg, PaCO₂ 38 mm Hg, pH 7.39. The calculated P/F
ratio is 96. What intervention should the nurse prepare for next?
A) Increase positive end-expiratory pressure (PEEP) by 2 cm H₂O
B) Switch to high-frequency oscillatory ventilation
C) Administer sodium bicarbonate for metabolic acidosis
D) Suction the endotracheal tube to clear mucus plug
Correct Answer: A
P/F ratio <100 indicates severe ARDS requiring lung-protective ventilation with
increased PEEP to improve oxygenation. High-frequency ventilation (B) may be
considered later if refractory. ABG shows adequate ventilation (PaCO₂ normal), so
no plug (D). No acidosis (C).
, 3. A nurse is titrating a norepinephrine infusion for a client with septic shock
to maintain a mean arterial pressure (MAP) ≥65 mm Hg. The current MAP is
58 mm Hg on 0.2 mcg/kg/min. The provider’s order reads: “Increase by
0.05 mcg/kg/min every 5 minutes to target MAP 65.” The client’s weight is
70 kg. The infusion concentration is 8 mg in 250 mL D5W. At what rate
(mL/hr) is the nurse currently infusing? (Round to the nearest whole
number.)
A) 10 mL/hr
B) 18 mL/hr
C) 26 mL/hr
D) 35 mL/hr
Correct Answer: C
First, calculate the concentration: 8 mg = 8000 mcg in 250 mL → 32 mcg/mL.
Current dose: 0.2 mcg/kg/min x 70 kg = 14 mcg/min. Infusion rate: 14 mcg/min ÷
32 mcg/mL = 0.4375 mL/min x 60 = 26.25 mL/hr, rounded to 26 mL/hr. Option A,
B, D are miscalculations.
4. A client with Cushing’s syndrome is admitted for adrenalectomy. Which
postoperative laboratory value demands the nurse’s immediate attention?
A) Serum glucose 180 mg/dL
B) Serum potassium 3.8 mEq/L
C) Serum sodium 150 mEq/L
D) Serum cortisol 2 mcg/dL (low)
Correct Answer: D
After adrenalectomy, sudden drop in cortisol can cause adrenal crisis, a life-
threatening emergency requiring immediate administration of IV hydrocortisone.
Hyperglycemia (A) and mild hypernatremia (C) are expected but not immediately
lethal. Potassium (B) is within normal limits.
5. A client with cirrhosis develops increasing confusion, a serum ammonia of
180 mcg/dL, and asterixis. The provider orders lactulose 30 mL PO every
hour until two soft stools are produced. After the first dose, the client has
watery diarrhea and cramping. What is the nurse’s best action?
, A) Hold the next dose and notify the provider
B) Continue the hourly lactulose as prescribed
C) Administer loperamide to control diarrhea
D) Decrease lactulose to 15 mL every 2 hours without an order
Correct Answer: A
The goal is 2–3 soft stools/day; watery diarrhea indicates overmedication, which
can cause fluid/electrolyte imbalances and worsened encephalopathy. The nurse
should hold and notify. Continuing (B) or adjusting dose independently (D) is
unsafe. Loperamide (C) adds to constipation risk.
6. The telemetry nurse observes a rhythm with a rate of 40 bpm, no visible P
waves before the QRS complexes, and wide QRS intervals of 0.14 seconds.
The client is asymptomatic. What is the rhythm most likely?
A) Sinus bradycardia with first-degree AV block
B) Junctional escape rhythm with aberrancy
C) Idioventricular rhythm
D) Atrial fibrillation with slow ventricular response
Correct Answer: C
An idioventricular rhythm has a rate 20–40 bpm, no P waves, and wide QRS (>0.12
sec), indicating ventricular origin. Junctional escape (B) has narrow QRS. Sinus (A)
has P waves. Atrial fibrillation (D) is irregular with narrow QRS unless aberrancy.
7. A client with a 55% total body surface area burn is receiving fluid
resuscitation per the Parkland formula. In the first 8 hours, the urine output
averaged 15 mL/hr. The nurse should suspect which complication?
A) Acute tubular necrosis from inadequate resuscitation
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Hyperdynamic response with excessive cardiac output
D) Normal response to the burn injury
Correct Answer: A
Target urine output is 0.5–1 mL/kg/hr; 15 mL/hr is well below target for an
average adult, indicating inadequate renal perfusion and possible acute tubular
