HESI PN Medical-Surgical NGN Exam 2026/2027 | HESI PN
Med-Surg Study Guide & Practice Test | HESI PN Medical
Surgical NGN Exam Prep, Practice Questions & Detailed
Rationales | NGN Case Studies, Clinical Judgment,
Cardiovascular, Respiratory, Neurological, Gastrointestinal,
Endocrine, Renal & Musculoskeletal Nursing
Question 1: A practical nurse is reinforcing discharge instructions to a client
following a transurethral resection of the prostate. Which statement by the
client indicates a need for further teaching?
A. "I will avoid lifting heavy objects for at least two weeks."
B. "I should expect my urine to remain bright red for several days."
C. "I will drink plenty of fluids to help flush my bladder."
D. "I will take stool softeners to prevent straining during bowel movements."
E. "I will call the provider if I cannot urinate."
CORRECT ANSWER: B. "I should expect my urine to remain bright red for several
days."
Rationale: Following TURP, the urine should progressively clear from pink-tinged
to clear over days to weeks. Bright red urine with clots indicates active
hemorrhage requiring immediate intervention. Avoiding heavy lifting prevents
bleeding, increased fluids promote bladder irrigation, stool softeners prevent
straining that could dislodge clots, and inability to void may signal clot retention
or stricture.
Question 2: A practical nurse is caring for a client who is one day postoperative
following a below-the-knee amputation. Which finding should the PN report
immediately to the registered nurse?
A. The client reports incisional pain rated 6/10.
B. There is a moderate amount of serosanguineous drainage on the dressing.
C. The client describes a sensation that the removed foot is itching.
D. The surgical dressing has saturated completely through with blood.
E. The client is reluctant to look at the surgical site.
CORRECT ANSWER: D. The surgical dressing has saturated completely through
with blood.
,Rationale: A saturated surgical dressing indicates active bleeding that may signal
hemorrhage from the surgical site. This requires immediate evaluation and
reinforcement of the dressing. Incisional pain, serosanguineous drainage,
phantom sensations, and reluctance to view the site are expected findings
following amputation.
Question 3: A practical nurse is collecting data from a client who has a new
prescription for levothyroxine. The PN should question the prescription if the
client has which pre-existing condition?
A. Type 2 diabetes mellitus
B. Untreated hyperthyroidism
C. Hypertension controlled with medication
D. Osteoarthritis
E. Chronic obstructive pulmonary disease
CORRECT ANSWER: B. Untreated hyperthyroidism
Rationale: Levothyroxine is a thyroid hormone replacement that would
exacerbate untreated hyperthyroidism, potentially precipitating thyroid storm.
Diabetes, controlled hypertension, osteoarthritis, and COPD are not absolute
contraindications, though thyroid replacement may affect glucose control and
cardiac function requiring monitoring.
Question 4: A practical nurse is assisting with the care of a client who has a
chest tube connected to a water-seal drainage system. The PN observes
continuous bubbling in the water-seal chamber. What is the most appropriate
interpretation of this finding?
A. The lung has fully re-expanded.
B. The suction is set appropriately.
C. There is an air leak in the system.
D. The chest tube is functioning normally.
E. The client has developed a pneumothorax.
CORRECT ANSWER: C. There is an air leak in the system.
Rationale: Intermittent bubbling in the water-seal chamber is expected during
exhalation or coughing in a client with pneumothorax. Continuous bubbling
,indicates an air leak in the drainage system, tubing connections, or insertion site.
The PN should assess the system from the client to the drainage unit to identify
the source.
Question 5: A practical nurse is reinforcing teaching to a client who is scheduled
for a colonoscopy. Which instruction should the PN include?
A. "You may eat a light breakfast on the morning of the procedure."
B. "Stop taking all blood pressure medications 24 hours before the procedure."
C. "You will need to drink a prescribed bowel preparation solution the evening
before."
D. "The procedure will require a general anesthetic."
E. "You can resume your normal diet immediately after the procedure."
CORRECT ANSWER: C. "You will need to drink a prescribed bowel preparation
solution the evening before."
Rationale: A colonoscopy requires a clear bowel for adequate visualization,
achieved through a prescribed bowel preparation solution consumed the evening
before and sometimes the morning of the procedure. The client must remain NPO
after midnight, blood pressure medications are typically continued, moderate
sedation is used rather than general anesthesia, and diet advances gradually after
the procedure.
Question 6: A practical nurse is caring for a client who has an arteriovenous
fistula in the left arm for hemodialysis. Which action by the PN indicates a need
for further education?
A. Palpating the thrill of the fistula.
B. Auscultating the bruit of the fistula.
C. Taking blood pressure in the left arm.
D. Checking the radial pulse in the left arm.
E. Instructing the client to avoid sleeping on the left arm.
CORRECT ANSWER: C. Taking blood pressure in the left arm.
Rationale: Blood pressure measurement in the arm with an AV fistula can
compress the fistula, impair blood flow, and lead to thrombosis. Palpating the
, thrill, auscultating the bruit, checking the distal pulse, and protecting the arm
from pressure are all appropriate care measures for fistula preservation.
Question 7: A practical nurse is caring for a client who has a new diagnosis of
type 1 diabetes mellitus. The client asks what causes this condition. Which
response by the PN is accurate?
A. "It results from the body's cells becoming resistant to insulin."
B. "It occurs when the pancreas stops producing insulin due to autoimmune
destruction."
C. "It is caused by excessive sugar intake over many years."
D. "It develops when the liver produces too much glucose."
E. "It is primarily caused by obesity and sedentary lifestyle."
CORRECT ANSWER: B. "It occurs when the pancreas stops producing insulin due
to autoimmune destruction."
Rationale: Type 1 diabetes mellitus results from autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency. Type 2 diabetes
involves insulin resistance and relative deficiency, is associated with obesity and
lifestyle factors, and involves excessive hepatic glucose production.
Question 8: A practical nurse is collecting data from a client who is receiving a
blood transfusion. Fifteen minutes after the infusion begins, the client reports
chills and flank pain. The PN notes the client's temperature has risen and urine
is dark. What action should the PN take first?
A. Slow the transfusion rate.
B. Administer prescribed antipyretic.
C. Stop the transfusion immediately.
D. Obtain a urine specimen.
E. Notify the blood bank.
CORRECT ANSWER: C. Stop the transfusion immediately.
Rationale: Chills, flank pain, fever, and dark urine are manifestations of an acute
hemolytic transfusion reaction, which can be life-threatening. The first action is to
stop the transfusion immediately to prevent further infusion of incompatible
Med-Surg Study Guide & Practice Test | HESI PN Medical
Surgical NGN Exam Prep, Practice Questions & Detailed
Rationales | NGN Case Studies, Clinical Judgment,
Cardiovascular, Respiratory, Neurological, Gastrointestinal,
Endocrine, Renal & Musculoskeletal Nursing
Question 1: A practical nurse is reinforcing discharge instructions to a client
following a transurethral resection of the prostate. Which statement by the
client indicates a need for further teaching?
A. "I will avoid lifting heavy objects for at least two weeks."
B. "I should expect my urine to remain bright red for several days."
C. "I will drink plenty of fluids to help flush my bladder."
D. "I will take stool softeners to prevent straining during bowel movements."
E. "I will call the provider if I cannot urinate."
CORRECT ANSWER: B. "I should expect my urine to remain bright red for several
days."
Rationale: Following TURP, the urine should progressively clear from pink-tinged
to clear over days to weeks. Bright red urine with clots indicates active
hemorrhage requiring immediate intervention. Avoiding heavy lifting prevents
bleeding, increased fluids promote bladder irrigation, stool softeners prevent
straining that could dislodge clots, and inability to void may signal clot retention
or stricture.
Question 2: A practical nurse is caring for a client who is one day postoperative
following a below-the-knee amputation. Which finding should the PN report
immediately to the registered nurse?
A. The client reports incisional pain rated 6/10.
B. There is a moderate amount of serosanguineous drainage on the dressing.
C. The client describes a sensation that the removed foot is itching.
D. The surgical dressing has saturated completely through with blood.
E. The client is reluctant to look at the surgical site.
CORRECT ANSWER: D. The surgical dressing has saturated completely through
with blood.
,Rationale: A saturated surgical dressing indicates active bleeding that may signal
hemorrhage from the surgical site. This requires immediate evaluation and
reinforcement of the dressing. Incisional pain, serosanguineous drainage,
phantom sensations, and reluctance to view the site are expected findings
following amputation.
Question 3: A practical nurse is collecting data from a client who has a new
prescription for levothyroxine. The PN should question the prescription if the
client has which pre-existing condition?
A. Type 2 diabetes mellitus
B. Untreated hyperthyroidism
C. Hypertension controlled with medication
D. Osteoarthritis
E. Chronic obstructive pulmonary disease
CORRECT ANSWER: B. Untreated hyperthyroidism
Rationale: Levothyroxine is a thyroid hormone replacement that would
exacerbate untreated hyperthyroidism, potentially precipitating thyroid storm.
Diabetes, controlled hypertension, osteoarthritis, and COPD are not absolute
contraindications, though thyroid replacement may affect glucose control and
cardiac function requiring monitoring.
Question 4: A practical nurse is assisting with the care of a client who has a
chest tube connected to a water-seal drainage system. The PN observes
continuous bubbling in the water-seal chamber. What is the most appropriate
interpretation of this finding?
A. The lung has fully re-expanded.
B. The suction is set appropriately.
C. There is an air leak in the system.
D. The chest tube is functioning normally.
E. The client has developed a pneumothorax.
CORRECT ANSWER: C. There is an air leak in the system.
Rationale: Intermittent bubbling in the water-seal chamber is expected during
exhalation or coughing in a client with pneumothorax. Continuous bubbling
,indicates an air leak in the drainage system, tubing connections, or insertion site.
The PN should assess the system from the client to the drainage unit to identify
the source.
Question 5: A practical nurse is reinforcing teaching to a client who is scheduled
for a colonoscopy. Which instruction should the PN include?
A. "You may eat a light breakfast on the morning of the procedure."
B. "Stop taking all blood pressure medications 24 hours before the procedure."
C. "You will need to drink a prescribed bowel preparation solution the evening
before."
D. "The procedure will require a general anesthetic."
E. "You can resume your normal diet immediately after the procedure."
CORRECT ANSWER: C. "You will need to drink a prescribed bowel preparation
solution the evening before."
Rationale: A colonoscopy requires a clear bowel for adequate visualization,
achieved through a prescribed bowel preparation solution consumed the evening
before and sometimes the morning of the procedure. The client must remain NPO
after midnight, blood pressure medications are typically continued, moderate
sedation is used rather than general anesthesia, and diet advances gradually after
the procedure.
Question 6: A practical nurse is caring for a client who has an arteriovenous
fistula in the left arm for hemodialysis. Which action by the PN indicates a need
for further education?
A. Palpating the thrill of the fistula.
B. Auscultating the bruit of the fistula.
C. Taking blood pressure in the left arm.
D. Checking the radial pulse in the left arm.
E. Instructing the client to avoid sleeping on the left arm.
CORRECT ANSWER: C. Taking blood pressure in the left arm.
Rationale: Blood pressure measurement in the arm with an AV fistula can
compress the fistula, impair blood flow, and lead to thrombosis. Palpating the
, thrill, auscultating the bruit, checking the distal pulse, and protecting the arm
from pressure are all appropriate care measures for fistula preservation.
Question 7: A practical nurse is caring for a client who has a new diagnosis of
type 1 diabetes mellitus. The client asks what causes this condition. Which
response by the PN is accurate?
A. "It results from the body's cells becoming resistant to insulin."
B. "It occurs when the pancreas stops producing insulin due to autoimmune
destruction."
C. "It is caused by excessive sugar intake over many years."
D. "It develops when the liver produces too much glucose."
E. "It is primarily caused by obesity and sedentary lifestyle."
CORRECT ANSWER: B. "It occurs when the pancreas stops producing insulin due
to autoimmune destruction."
Rationale: Type 1 diabetes mellitus results from autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency. Type 2 diabetes
involves insulin resistance and relative deficiency, is associated with obesity and
lifestyle factors, and involves excessive hepatic glucose production.
Question 8: A practical nurse is collecting data from a client who is receiving a
blood transfusion. Fifteen minutes after the infusion begins, the client reports
chills and flank pain. The PN notes the client's temperature has risen and urine
is dark. What action should the PN take first?
A. Slow the transfusion rate.
B. Administer prescribed antipyretic.
C. Stop the transfusion immediately.
D. Obtain a urine specimen.
E. Notify the blood bank.
CORRECT ANSWER: C. Stop the transfusion immediately.
Rationale: Chills, flank pain, fever, and dark urine are manifestations of an acute
hemolytic transfusion reaction, which can be life-threatening. The first action is to
stop the transfusion immediately to prevent further infusion of incompatible
