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
1. A client with acute decompensated heart failure is receiving dobutamine. Which
hemodynamic parameter best indicates the drug is achieving its intended effect?
A) Decrease in pulmonary artery wedge pressure
B) Increase in central venous pressure
C) Decrease in systemic vascular resistance
D) Increase in cardiac index
Correct Answer: D
Dobutamine is a positive inotrope that increases cardiac output, reflected by an increase in
cardiac index. A decrease in PAWP may be secondary but is not the primary therapeutic goal.
CVP may decrease as stroke volume improves. SVR is more affected by vasodilators.
2. A client with COPD develops confusion, asterixis, and a bounding pulse. ABG on 2 L/min
oxygen: pH 7.31, PaCO₂ 68 mm Hg, HCO₃⁻ 34 mEq/L. Which interpretation is correct?
A) Chronic respiratory acidosis with acute hypoxemia
B) Acute respiratory acidosis with incomplete renal compensation
C) Fully compensated respiratory acidosis with superimposed metabolic alkalosis
D) Acute-on-chronic respiratory acidosis
Correct Answer: D
The pH is acidotic (7.31) despite elevated HCO₃⁻, indicating an acute increase in PaCO₂ on top of
chronic retention. The elevated bicarbonate reflects chronic compensation, making the
interpretation acute-on-chronic respiratory acidosis. Option A misses the acute component.
Option B would show lower bicarbonate. Option C requires normal pH.
3. After a total thyroidectomy, a client reports tingling around the mouth and has a positive
Chvostek’s sign. Which intravenous replacement should the nurse anticipate?
A) Magnesium sulfate
B) Calcium gluconate
, C) Potassium chloride
D) Sodium bicarbonate
Correct Answer: B
Tingling and Chvostek’s sign indicate hypocalcemia due to possible parathyroid removal or
injury. IV calcium gluconate is needed to prevent tetany. Magnesium, potassium, and
bicarbonate do not directly treat hypocalcemia.
4. A client with cirrhosis and esophageal varices presents with brisk, bright red
hematemesis. BP 88/52 mm Hg, HR 118 bpm. Which intervention should the nurse
anticipate first?
A) Prepare for endoscopic variceal ligation
B) Start an octreotide infusion
C) Insert a Sengstaken-Blakemore tube
D) Administer IV vasopressin and nitroglycerin
Correct Answer: B
Octreotide reduces portal pressure and is first-line pharmacotherapy for acute variceal bleeding,
along with volume resuscitation. Endoscopic ligation follows stabilization. Balloon tamponade is
a rescue therapy. Vasopressin is less preferred due to ischemic side effects.
5. The nurse receives a client from the OR after a transsphenoidal hypophysectomy. Which
finding requires the most immediate action?
A) Urine output of 250 mL/hr for two consecutive hours
B) Clear drainage on the nasal drip pad that tests positive for glucose
C) Serum sodium of 148 mEq/L
D) Report of mild frontal headache
Correct Answer: B
Clear nasal drainage positive for glucose is cerebrospinal fluid (CSF), indicating a possible CSF
leak and risk of meningitis. This takes priority over diabetes insipidus, hypernatremia, or
headache.
6. An 84-year-old client with community-acquired pneumonia has a CURB-65 score of 3.
What does this score indicate?
A) Outpatient oral antibiotic therapy is safe
B) Consider outpatient management with close follow-up
C) The client requires intensive care unit admission
D) The client should be hospitalized for intravenous antibiotics
Correct Answer: D
A CURB-65 score of 3 indicates severe pneumonia with significant mortality risk, requiring
,inpatient management and usually IV antibiotics. ICU admission is considered for scores of 4–5.
Outpatient treatment is for scores of 0–1.
7. A client is preparing to receive a unit of packed red blood cells. Fifteen minutes into the
infusion, the client develops a temperature of 100.6°F (38.1°C) and chills but no flank
pain, dyspnea, or urticaria. What is the most appropriate nursing action?
A) Stop the transfusion and administer diphenhydramine
B) Slow the infusion and reassess in 15 minutes
C) Continue the infusion and monitor for worsening symptoms
D) Stop the transfusion, administer an antipyretic, and restart slowly
Correct Answer: D
A febrile nonhemolytic reaction presents with fever and chills. The infusion should be stopped,
the provider notified, and an antipyretic administered. Restarting slowly may be ordered after
ruling out hemolytic reaction. Diphenhydramine is for allergic reactions. Slowing without
stopping is unsafe.
8. Which of the following clients is at highest risk for developing a pulmonary embolism?
A) A 40-year-old on oral contraceptives after an open cholecystectomy
B) A 72-year-old with a hip fracture immobilized for 48 hours
C) A 35-year-old with a lower leg cast and a history of smoking
D) A 65-year-old with atrial fibrillation not on anticoagulation
Correct Answer: A
The combination of major abdominal surgery, oral contraceptives, and immobility places this
client at very high risk per Virchow’s triad. The hip fracture carries risk but without a
hypercoagulable state. Atrial fibrillation causes embolic stroke, not typically PE. Smoking is a
lesser risk.
9. A client has a serum potassium of 2.9 mEq/L. The nurse notes a prolonged QT interval
and a U wave on the ECG. The provider orders IV potassium chloride. Which action is
essential during administration?
A) Infuse the dose over 10 minutes via a peripheral line
B) Administer the drug undiluted via a central venous catheter
C) Use an infusion pump and verify the concentration does not exceed the
recommended rate
D) Give the potassium by rapid IV push to correct the deficit quickly
Correct Answer: C
IV potassium must be diluted and infused slowly using an infusion pump to prevent fatal
, hyperkalemia and cardiac arrest. Rapid infusion, undiluted administration, and IV push are never
safe.
10. A client with renal failure develops tetany, paresthesia, and carpopedal spasm. Calcium
7.8 mg/dL, phosphorus 6.0 mg/dL. Which treatment should the nurse anticipate?
A) Intravenous calcium chloride and oral phosphate binders
B) Oral calcium carbonate and a thiazide diuretic
C) Intravenous magnesium sulfate and a loop diuretic
D) Oral calcitriol and a potassium-sparing diuretic
Correct Answer: A
Hypocalcemia with hyperphosphatemia in renal failure is treated with IV calcium for acute
symptoms and phosphate binders with meals to lower phosphorus. Calcitriol addresses vitamin
D deficiency but is not the immediate treatment for tetany. Loop diuretics increase calcium
excretion. Thiazides reduce calcium excretion but do not lower phosphate.
11. A client is monitoring a client receiving a heparin infusion. The aPTT is 90 seconds
(control 30 seconds). The provider’s order states to maintain aPTT at 1.5–2.5 times
control. What should the nurse do?
A) Increase the infusion rate by 2 units/kg/hr
B) Decrease the infusion rate per protocol and recheck aPTT
C) Stop the heparin and administer protamine sulfate
D) Continue the current rate; the aPTT is within target range
Correct Answer: B
The aPTT of 90 seconds is three times control (90/30 = 3), which is supratherapeutic. The
infusion should be decreased according to the titration nomogram. Protamine is for bleeding.
Continuing or increasing increases bleeding risk.
12. A client with ARDS is being ventilated with low tidal volumes (6 mL/kg ideal body
weight). ABG shows pH 7.25, PaCO₂ 60 mm Hg. What is the nurse’s interpretation of this
strategy?
A) Permissive hypercapnia is an expected consequence of lung-protective ventilation
B) The tidal volume is too low and must be increased to normalize the pH
C) The ventilator settings are causing a tension pneumothorax
D) The client is hyperventilating and needs sedation
Correct Answer: A
Low tidal volume ventilation in ARDS may cause a rise in PaCO₂, but it is tolerated (permissive
hypercapnia) to reduce ventilator-induced lung injury. Increasing tidal volumes would contradict
the protective strategy. Tension pneumothorax would cause sudden decompensation.
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A client with acute decompensated heart failure is receiving dobutamine. Which
hemodynamic parameter best indicates the drug is achieving its intended effect?
A) Decrease in pulmonary artery wedge pressure
B) Increase in central venous pressure
C) Decrease in systemic vascular resistance
D) Increase in cardiac index
Correct Answer: D
Dobutamine is a positive inotrope that increases cardiac output, reflected by an increase in
cardiac index. A decrease in PAWP may be secondary but is not the primary therapeutic goal.
CVP may decrease as stroke volume improves. SVR is more affected by vasodilators.
2. A client with COPD develops confusion, asterixis, and a bounding pulse. ABG on 2 L/min
oxygen: pH 7.31, PaCO₂ 68 mm Hg, HCO₃⁻ 34 mEq/L. Which interpretation is correct?
A) Chronic respiratory acidosis with acute hypoxemia
B) Acute respiratory acidosis with incomplete renal compensation
C) Fully compensated respiratory acidosis with superimposed metabolic alkalosis
D) Acute-on-chronic respiratory acidosis
Correct Answer: D
The pH is acidotic (7.31) despite elevated HCO₃⁻, indicating an acute increase in PaCO₂ on top of
chronic retention. The elevated bicarbonate reflects chronic compensation, making the
interpretation acute-on-chronic respiratory acidosis. Option A misses the acute component.
Option B would show lower bicarbonate. Option C requires normal pH.
3. After a total thyroidectomy, a client reports tingling around the mouth and has a positive
Chvostek’s sign. Which intravenous replacement should the nurse anticipate?
A) Magnesium sulfate
B) Calcium gluconate
, C) Potassium chloride
D) Sodium bicarbonate
Correct Answer: B
Tingling and Chvostek’s sign indicate hypocalcemia due to possible parathyroid removal or
injury. IV calcium gluconate is needed to prevent tetany. Magnesium, potassium, and
bicarbonate do not directly treat hypocalcemia.
4. A client with cirrhosis and esophageal varices presents with brisk, bright red
hematemesis. BP 88/52 mm Hg, HR 118 bpm. Which intervention should the nurse
anticipate first?
A) Prepare for endoscopic variceal ligation
B) Start an octreotide infusion
C) Insert a Sengstaken-Blakemore tube
D) Administer IV vasopressin and nitroglycerin
Correct Answer: B
Octreotide reduces portal pressure and is first-line pharmacotherapy for acute variceal bleeding,
along with volume resuscitation. Endoscopic ligation follows stabilization. Balloon tamponade is
a rescue therapy. Vasopressin is less preferred due to ischemic side effects.
5. The nurse receives a client from the OR after a transsphenoidal hypophysectomy. Which
finding requires the most immediate action?
A) Urine output of 250 mL/hr for two consecutive hours
B) Clear drainage on the nasal drip pad that tests positive for glucose
C) Serum sodium of 148 mEq/L
D) Report of mild frontal headache
Correct Answer: B
Clear nasal drainage positive for glucose is cerebrospinal fluid (CSF), indicating a possible CSF
leak and risk of meningitis. This takes priority over diabetes insipidus, hypernatremia, or
headache.
6. An 84-year-old client with community-acquired pneumonia has a CURB-65 score of 3.
What does this score indicate?
A) Outpatient oral antibiotic therapy is safe
B) Consider outpatient management with close follow-up
C) The client requires intensive care unit admission
D) The client should be hospitalized for intravenous antibiotics
Correct Answer: D
A CURB-65 score of 3 indicates severe pneumonia with significant mortality risk, requiring
,inpatient management and usually IV antibiotics. ICU admission is considered for scores of 4–5.
Outpatient treatment is for scores of 0–1.
7. A client is preparing to receive a unit of packed red blood cells. Fifteen minutes into the
infusion, the client develops a temperature of 100.6°F (38.1°C) and chills but no flank
pain, dyspnea, or urticaria. What is the most appropriate nursing action?
A) Stop the transfusion and administer diphenhydramine
B) Slow the infusion and reassess in 15 minutes
C) Continue the infusion and monitor for worsening symptoms
D) Stop the transfusion, administer an antipyretic, and restart slowly
Correct Answer: D
A febrile nonhemolytic reaction presents with fever and chills. The infusion should be stopped,
the provider notified, and an antipyretic administered. Restarting slowly may be ordered after
ruling out hemolytic reaction. Diphenhydramine is for allergic reactions. Slowing without
stopping is unsafe.
8. Which of the following clients is at highest risk for developing a pulmonary embolism?
A) A 40-year-old on oral contraceptives after an open cholecystectomy
B) A 72-year-old with a hip fracture immobilized for 48 hours
C) A 35-year-old with a lower leg cast and a history of smoking
D) A 65-year-old with atrial fibrillation not on anticoagulation
Correct Answer: A
The combination of major abdominal surgery, oral contraceptives, and immobility places this
client at very high risk per Virchow’s triad. The hip fracture carries risk but without a
hypercoagulable state. Atrial fibrillation causes embolic stroke, not typically PE. Smoking is a
lesser risk.
9. A client has a serum potassium of 2.9 mEq/L. The nurse notes a prolonged QT interval
and a U wave on the ECG. The provider orders IV potassium chloride. Which action is
essential during administration?
A) Infuse the dose over 10 minutes via a peripheral line
B) Administer the drug undiluted via a central venous catheter
C) Use an infusion pump and verify the concentration does not exceed the
recommended rate
D) Give the potassium by rapid IV push to correct the deficit quickly
Correct Answer: C
IV potassium must be diluted and infused slowly using an infusion pump to prevent fatal
, hyperkalemia and cardiac arrest. Rapid infusion, undiluted administration, and IV push are never
safe.
10. A client with renal failure develops tetany, paresthesia, and carpopedal spasm. Calcium
7.8 mg/dL, phosphorus 6.0 mg/dL. Which treatment should the nurse anticipate?
A) Intravenous calcium chloride and oral phosphate binders
B) Oral calcium carbonate and a thiazide diuretic
C) Intravenous magnesium sulfate and a loop diuretic
D) Oral calcitriol and a potassium-sparing diuretic
Correct Answer: A
Hypocalcemia with hyperphosphatemia in renal failure is treated with IV calcium for acute
symptoms and phosphate binders with meals to lower phosphorus. Calcitriol addresses vitamin
D deficiency but is not the immediate treatment for tetany. Loop diuretics increase calcium
excretion. Thiazides reduce calcium excretion but do not lower phosphate.
11. A client is monitoring a client receiving a heparin infusion. The aPTT is 90 seconds
(control 30 seconds). The provider’s order states to maintain aPTT at 1.5–2.5 times
control. What should the nurse do?
A) Increase the infusion rate by 2 units/kg/hr
B) Decrease the infusion rate per protocol and recheck aPTT
C) Stop the heparin and administer protamine sulfate
D) Continue the current rate; the aPTT is within target range
Correct Answer: B
The aPTT of 90 seconds is three times control (90/30 = 3), which is supratherapeutic. The
infusion should be decreased according to the titration nomogram. Protamine is for bleeding.
Continuing or increasing increases bleeding risk.
12. A client with ARDS is being ventilated with low tidal volumes (6 mL/kg ideal body
weight). ABG shows pH 7.25, PaCO₂ 60 mm Hg. What is the nurse’s interpretation of this
strategy?
A) Permissive hypercapnia is an expected consequence of lung-protective ventilation
B) The tidal volume is too low and must be increased to normalize the pH
C) The ventilator settings are causing a tension pneumothorax
D) The client is hyperventilating and needs sedation
Correct Answer: A
Low tidal volume ventilation in ARDS may cause a rise in PaCO₂, but it is tolerated (permissive
hypercapnia) to reduce ventilator-induced lung injury. Increasing tidal volumes would contradict
the protective strategy. Tension pneumothorax would cause sudden decompensation.
