2026 HESI RN MEDICAL-SURGICAL EXAMS – NGN NURSING
QUESTIONS, 2026 HESI EXIT MED-SURG EXAM PREP
(GUARANTEE PASS)
CORE DOMAINS
Cardiovascular Disorders
Respiratory Disorders
Neurological Disorders
Endocrine & Metabolic Disorders
Gastrointestinal, Hepatic & Renal Disorders
Perioperative Care & Prioritization
INTRODUCTION
This comprehensive practice examination is designed for nursing students
preparing for the 2026 HESI RN Medical-Surgical Exam and the HESI Exit
Exam. It contains 50 Next Generation NCLEX (NGN)-style questions
aligned with the current HESI blueprint and the NCSBN Clinical Judgment
Measurement Model. Content covers cardiovascular, respiratory,
neurological, endocrine, gastrointestinal, hepatic, renal, and perioperative
nursing, with emphasis on prioritization, clinical judgment, and safety. Each
question includes a detailed rationale grounded in evidence-based practice.
This assessment prepares candidates for the rigor of the HESI Med-Surg
examination and real-world clinical practice.
SECTION ONE: CARDIOVASCULAR DISORDERS (QUESTIONS 1–15)
1. A 62-year-old male with a history of hypertension and
hyperlipidemia presents to the ED with 30 minutes of substernal chest
pressure radiating to his left arm, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads II, III, and aVF. What is the
priority nursing action?
A. Administer sublingual nitroglycerin
B. Activate the cardiac catheterization lab for primary PCI
C. Obtain a 12-lead ECG
D. Start oxygen therapy
, B. Activate the cardiac catheterization lab for primary PCI
RATIONALE: ST-segment elevation in the inferior leads (II, III, aVF)
indicates an acute inferior STEMI. Time to reperfusion is critical; activating
the cath lab for primary percutaneous coronary intervention (PCI) within 90
minutes of first medical contact is the gold standard for STEMI
management. Nitroglycerin may be administered if the patient is
hemodynamically stable and has no contraindications, but it is not the
priority intervention over reperfusion. A 12-lead ECG has already been
obtained and interpreted. Oxygen therapy should be titrated to maintain
SpO₂ > 90%, but it is not the priority.
2. A client with heart failure is started on carvedilol. Which finding
would require the nurse to hold the medication and notify the
healthcare provider?
A. Heart rate 68 bpm
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
B. Systolic BP 86 mmHg
RATIONALE: Carvedilol is a beta-blocker that can worsen hypotension.
The medication should be held if the systolic blood pressure is < 90 mmHg
or signs of shock are present. Hypotension can reduce cardiac perfusion
and worsen heart failure. Beta-blockers should also be held if the heart rate
is < 60 bpm, but a heart rate of 68 bpm is within acceptable limits. A
respiratory rate of 20 breaths/min is normal. Weight gain of 0.5 kg should
be monitored but does not warrant holding the medication.
3. A client with atrial fibrillation and a ventricular rate of 128 beats/min
has a new prescription for metoprolol. The nurse knows this
medication is primarily used for which purpose in this client?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
, B. To control the ventricular rate
RATIONALE: Metoprolol is a beta-blocker that slows conduction
through the AV node, thereby controlling the ventricular rate in atrial
fibrillation. Rate control is the first-line approach for many patients with
atrial fibrillation, particularly those who are hemodynamically stable.
4. A client with heart failure reports increased shortness of breath and
notices a 3-pound weight gain over 2 days. Which nursing
intervention is the PRIORITY?
A. Restrict fluid intake to 1500 mL/day
B. Assess the client for jugular venous distension
C. Assess current weight and compare with baseline
D. Administer the prescribed diuretic
D. Administer the prescribed diuretic
RATIONALE: The 3-pound weight gain in 2 days indicates fluid
retention requiring immediate intervention. Administering the prescribed
diuretic addresses the fluid overload directly. While all options are
appropriate nursing actions, administering the diuretic takes priority
because it treats the underlying problem of fluid retention causing the
increased shortness of breath and weight gain.
5. A nurse is caring for a client with atrial fibrillation. Which finding
requires IMMEDIATE intervention by the nurse?
A. Heart rate of 98 bpm with an irregularly irregular rhythm
B. Blood pressure of 110/70 mmHg
C. Sudden onset of left-sided weakness and slurred speech
D. Client reports feeling fatigued during ambulation
C. Sudden onset of left-sided weakness and slurred speech
RATIONALE: Sudden onset of left-sided weakness and slurred speech
suggests an embolic stroke, a life-threatening complication of atrial
fibrillation. Atrial fibrillation increases thromboembolism risk due to stasis of
blood in the atria, and this finding requires immediate notification of the
healthcare provider and emergency intervention.
QUESTIONS, 2026 HESI EXIT MED-SURG EXAM PREP
(GUARANTEE PASS)
CORE DOMAINS
Cardiovascular Disorders
Respiratory Disorders
Neurological Disorders
Endocrine & Metabolic Disorders
Gastrointestinal, Hepatic & Renal Disorders
Perioperative Care & Prioritization
INTRODUCTION
This comprehensive practice examination is designed for nursing students
preparing for the 2026 HESI RN Medical-Surgical Exam and the HESI Exit
Exam. It contains 50 Next Generation NCLEX (NGN)-style questions
aligned with the current HESI blueprint and the NCSBN Clinical Judgment
Measurement Model. Content covers cardiovascular, respiratory,
neurological, endocrine, gastrointestinal, hepatic, renal, and perioperative
nursing, with emphasis on prioritization, clinical judgment, and safety. Each
question includes a detailed rationale grounded in evidence-based practice.
This assessment prepares candidates for the rigor of the HESI Med-Surg
examination and real-world clinical practice.
SECTION ONE: CARDIOVASCULAR DISORDERS (QUESTIONS 1–15)
1. A 62-year-old male with a history of hypertension and
hyperlipidemia presents to the ED with 30 minutes of substernal chest
pressure radiating to his left arm, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads II, III, and aVF. What is the
priority nursing action?
A. Administer sublingual nitroglycerin
B. Activate the cardiac catheterization lab for primary PCI
C. Obtain a 12-lead ECG
D. Start oxygen therapy
, B. Activate the cardiac catheterization lab for primary PCI
RATIONALE: ST-segment elevation in the inferior leads (II, III, aVF)
indicates an acute inferior STEMI. Time to reperfusion is critical; activating
the cath lab for primary percutaneous coronary intervention (PCI) within 90
minutes of first medical contact is the gold standard for STEMI
management. Nitroglycerin may be administered if the patient is
hemodynamically stable and has no contraindications, but it is not the
priority intervention over reperfusion. A 12-lead ECG has already been
obtained and interpreted. Oxygen therapy should be titrated to maintain
SpO₂ > 90%, but it is not the priority.
2. A client with heart failure is started on carvedilol. Which finding
would require the nurse to hold the medication and notify the
healthcare provider?
A. Heart rate 68 bpm
B. Systolic BP 86 mmHg
C. Respiratory rate 20 breaths/min
D. Weight gain 0.5 kg
B. Systolic BP 86 mmHg
RATIONALE: Carvedilol is a beta-blocker that can worsen hypotension.
The medication should be held if the systolic blood pressure is < 90 mmHg
or signs of shock are present. Hypotension can reduce cardiac perfusion
and worsen heart failure. Beta-blockers should also be held if the heart rate
is < 60 bpm, but a heart rate of 68 bpm is within acceptable limits. A
respiratory rate of 20 breaths/min is normal. Weight gain of 0.5 kg should
be monitored but does not warrant holding the medication.
3. A client with atrial fibrillation and a ventricular rate of 128 beats/min
has a new prescription for metoprolol. The nurse knows this
medication is primarily used for which purpose in this client?
A. To convert the rhythm to normal sinus
B. To control the ventricular rate
C. To prevent stroke
D. To increase cardiac contractility
, B. To control the ventricular rate
RATIONALE: Metoprolol is a beta-blocker that slows conduction
through the AV node, thereby controlling the ventricular rate in atrial
fibrillation. Rate control is the first-line approach for many patients with
atrial fibrillation, particularly those who are hemodynamically stable.
4. A client with heart failure reports increased shortness of breath and
notices a 3-pound weight gain over 2 days. Which nursing
intervention is the PRIORITY?
A. Restrict fluid intake to 1500 mL/day
B. Assess the client for jugular venous distension
C. Assess current weight and compare with baseline
D. Administer the prescribed diuretic
D. Administer the prescribed diuretic
RATIONALE: The 3-pound weight gain in 2 days indicates fluid
retention requiring immediate intervention. Administering the prescribed
diuretic addresses the fluid overload directly. While all options are
appropriate nursing actions, administering the diuretic takes priority
because it treats the underlying problem of fluid retention causing the
increased shortness of breath and weight gain.
5. A nurse is caring for a client with atrial fibrillation. Which finding
requires IMMEDIATE intervention by the nurse?
A. Heart rate of 98 bpm with an irregularly irregular rhythm
B. Blood pressure of 110/70 mmHg
C. Sudden onset of left-sided weakness and slurred speech
D. Client reports feeling fatigued during ambulation
C. Sudden onset of left-sided weakness and slurred speech
RATIONALE: Sudden onset of left-sided weakness and slurred speech
suggests an embolic stroke, a life-threatening complication of atrial
fibrillation. Atrial fibrillation increases thromboembolism risk due to stasis of
blood in the atria, and this finding requires immediate notification of the
healthcare provider and emergency intervention.
