HESI RN MEDICAL-SURGICAL NURSING EXAM
COMPREHENSIVE REVIEW 2026/2027 –
QUESTIONS AND ANSWERS | 100% VERIFIED |
DETAILED RATIONALES – PASS GUARANTEED
– A+ GRADED
Core Domains
Cardiovascular Disorders and Emergency Management
Respiratory Disorders and Mechanical Ventilation
Neurological Disorders and Increased Intracranial Pressure
Gastrointestinal and Renal Disorders
Endocrine and Musculoskeletal Disorders
Perioperative Care and Postoperative Complications
Fluid, Electrolyte, and Acid-Base Balance
Infection Control, Safety, and Prioritization
Introduction
This comprehensive examination review assesses the critical knowledge and
clinical judgment required for successful performance on the HESI RN Medical-
Surgical Nursing Exam. It evaluates competency in patient assessment, nursing
interventions, priority setting, and application of evidence-based practice across
diverse adult health conditions. The examination employs multiple-choice and
scenario-based questions that mirror the actual HESI format and difficulty,
requiring candidates to analyze complex clinical situations, prioritize
interventions, and demonstrate sound clinical reasoning. Content is aligned with
the 2026/2027 HESI test plan and current clinical practice guidelines. Success on
this examination demonstrates readiness for professional medical-surgical nursing
practice and confirms mastery of essential competencies for NCLEX-RN success.
,SECTION ONE: QUESTIONS 1–100
1. A patient with chronic heart failure is admitted with worsening shortness of
breath and 3 kg weight gain over 5 days. Which assessment finding is most
concerning for the nurse?
A. Heart rate of 92 beats/min
B. Oxygen saturation of 88% on room air
C. Bilateral crackles in lower lung fields
D. Blood pressure of 138/82 mmHg
Correct answer B. Oxygen saturation of 88% on room air
RATIONALE: Oxygen saturation below 90% indicates hypoxemia and
impaired gas exchange, which is a life-threatening priority in heart failure patients
with fluid overload. Airway and breathing concerns always take priority over other
findings .
2. A patient is admitted with symptoms of a myocardial infarction (MI).
Which medication is the priority to administer?
A. Morphine
B. Aspirin
C. Meperidine
D. Nitroglycerin
Correct answer B. Aspirin
RATIONALE: Aspirin is the priority because it works as an antiplatelet to stop
clot formation, which is crucial in the early management of an MI. While
Morphine and Nitroglycerin are also part of the MONA protocol, aspirin is often
the first line to reduce mortality.
,3. The nurse is assessing a client who reports recent chest pain. Which client
statement most strongly suggests angina pectoris?
A. "The pain lasted about 45 minutes."
B. "The pain resolved after I ate a sandwich."
C. "The pain got worse when I took a deep breath."
D. "The pain occurred while I was mowing the lawn."
Correct answer D. "The pain occurred while I was mowing the lawn."
RATIONALE: Angina pectoris is typically triggered by physical exertion,
such as mowing the lawn, and is relieved by rest. Pain that lasts 45 minutes,
resolves with food, or worsens with deep breathing suggests other etiologies.
4. A patient with a history of angina reports experiencing chest pain at rest
that is not relieved by nitroglycerin. This is best described as:
A. Stable angina
B. Unstable angina
C. Variant angina
D. Silent ischemia
Correct answer B. Unstable angina
RATIONALE: Unstable angina is unpredictable, can occur at rest, and
indicates a more serious condition that may precede a myocardial infarction. Stable
angina is typically triggered by exertion and relieved by rest or nitroglycerin.
5. Which term refers to preinfarction angina?
A. Stable angina
B. Unstable angina
C. Variant angina
D. Silent ischemia
, Correct answer B. Unstable angina
RATIONALE: Unstable angina is often referred to as preinfarction angina
because it indicates a high risk of progressing to myocardial infarction. It is
characterized by chest pain that occurs at rest, is severe, or is unrelieved by
nitroglycerin.
6. Which finding in a client who has just arrived in the cardiac intensive care
unit after having coronary artery bypass grafting (CABG) requires the most
rapid action by the nurse?
A. The serum potassium level is 3.1 mEq/L.
B. Blood pressure 110/70 mmHg.
C. Heart rate 90 beats/minute.
D. Urine output 40 mL/hour.
Correct answer A. The serum potassium level is 3.1 mEq/L.
RATIONALE: Hypokalemia (potassium 3.1 mEq/L) predisposes the patient to
dysrhythmias, especially after cardiac surgery. This requires rapid correction to
prevent life-threatening arrhythmias.
7. A client has a prescription for sublingual nitroglycerin tablets. Which
technique will the nurse teach the client to use?
A. Place the pill under the tongue and let it dissolve.
B. Swallow the pill with a full glass of water.
C. Chew the pill thoroughly before swallowing.
D. Place the pill on top of the tongue.
Correct answer A. Place the pill under the tongue and let it dissolve.
RATIONALE: Sublingual nitroglycerin must be placed under the tongue and
allowed to dissolve completely. This route provides rapid absorption into the
bloodstream. Swallowing or chewing would reduce effectiveness.
COMPREHENSIVE REVIEW 2026/2027 –
QUESTIONS AND ANSWERS | 100% VERIFIED |
DETAILED RATIONALES – PASS GUARANTEED
– A+ GRADED
Core Domains
Cardiovascular Disorders and Emergency Management
Respiratory Disorders and Mechanical Ventilation
Neurological Disorders and Increased Intracranial Pressure
Gastrointestinal and Renal Disorders
Endocrine and Musculoskeletal Disorders
Perioperative Care and Postoperative Complications
Fluid, Electrolyte, and Acid-Base Balance
Infection Control, Safety, and Prioritization
Introduction
This comprehensive examination review assesses the critical knowledge and
clinical judgment required for successful performance on the HESI RN Medical-
Surgical Nursing Exam. It evaluates competency in patient assessment, nursing
interventions, priority setting, and application of evidence-based practice across
diverse adult health conditions. The examination employs multiple-choice and
scenario-based questions that mirror the actual HESI format and difficulty,
requiring candidates to analyze complex clinical situations, prioritize
interventions, and demonstrate sound clinical reasoning. Content is aligned with
the 2026/2027 HESI test plan and current clinical practice guidelines. Success on
this examination demonstrates readiness for professional medical-surgical nursing
practice and confirms mastery of essential competencies for NCLEX-RN success.
,SECTION ONE: QUESTIONS 1–100
1. A patient with chronic heart failure is admitted with worsening shortness of
breath and 3 kg weight gain over 5 days. Which assessment finding is most
concerning for the nurse?
A. Heart rate of 92 beats/min
B. Oxygen saturation of 88% on room air
C. Bilateral crackles in lower lung fields
D. Blood pressure of 138/82 mmHg
Correct answer B. Oxygen saturation of 88% on room air
RATIONALE: Oxygen saturation below 90% indicates hypoxemia and
impaired gas exchange, which is a life-threatening priority in heart failure patients
with fluid overload. Airway and breathing concerns always take priority over other
findings .
2. A patient is admitted with symptoms of a myocardial infarction (MI).
Which medication is the priority to administer?
A. Morphine
B. Aspirin
C. Meperidine
D. Nitroglycerin
Correct answer B. Aspirin
RATIONALE: Aspirin is the priority because it works as an antiplatelet to stop
clot formation, which is crucial in the early management of an MI. While
Morphine and Nitroglycerin are also part of the MONA protocol, aspirin is often
the first line to reduce mortality.
,3. The nurse is assessing a client who reports recent chest pain. Which client
statement most strongly suggests angina pectoris?
A. "The pain lasted about 45 minutes."
B. "The pain resolved after I ate a sandwich."
C. "The pain got worse when I took a deep breath."
D. "The pain occurred while I was mowing the lawn."
Correct answer D. "The pain occurred while I was mowing the lawn."
RATIONALE: Angina pectoris is typically triggered by physical exertion,
such as mowing the lawn, and is relieved by rest. Pain that lasts 45 minutes,
resolves with food, or worsens with deep breathing suggests other etiologies.
4. A patient with a history of angina reports experiencing chest pain at rest
that is not relieved by nitroglycerin. This is best described as:
A. Stable angina
B. Unstable angina
C. Variant angina
D. Silent ischemia
Correct answer B. Unstable angina
RATIONALE: Unstable angina is unpredictable, can occur at rest, and
indicates a more serious condition that may precede a myocardial infarction. Stable
angina is typically triggered by exertion and relieved by rest or nitroglycerin.
5. Which term refers to preinfarction angina?
A. Stable angina
B. Unstable angina
C. Variant angina
D. Silent ischemia
, Correct answer B. Unstable angina
RATIONALE: Unstable angina is often referred to as preinfarction angina
because it indicates a high risk of progressing to myocardial infarction. It is
characterized by chest pain that occurs at rest, is severe, or is unrelieved by
nitroglycerin.
6. Which finding in a client who has just arrived in the cardiac intensive care
unit after having coronary artery bypass grafting (CABG) requires the most
rapid action by the nurse?
A. The serum potassium level is 3.1 mEq/L.
B. Blood pressure 110/70 mmHg.
C. Heart rate 90 beats/minute.
D. Urine output 40 mL/hour.
Correct answer A. The serum potassium level is 3.1 mEq/L.
RATIONALE: Hypokalemia (potassium 3.1 mEq/L) predisposes the patient to
dysrhythmias, especially after cardiac surgery. This requires rapid correction to
prevent life-threatening arrhythmias.
7. A client has a prescription for sublingual nitroglycerin tablets. Which
technique will the nurse teach the client to use?
A. Place the pill under the tongue and let it dissolve.
B. Swallow the pill with a full glass of water.
C. Chew the pill thoroughly before swallowing.
D. Place the pill on top of the tongue.
Correct answer A. Place the pill under the tongue and let it dissolve.
RATIONALE: Sublingual nitroglycerin must be placed under the tongue and
allowed to dissolve completely. This route provides rapid absorption into the
bloodstream. Swallowing or chewing would reduce effectiveness.
