HESI Med Surg Exam (Latest
2026/2027 Update) Complete Practice
Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier
HESI Med Surg Exam (Latest 2026/2027 Update) | Comprehensive
Examination
HESI Med Surg Exam (Latest 2026/2027 Update) Complete
Practice Q&A with Verified Answers and Detailed Rationales
Evolve Elsevier Medical Surgical Nursing Test Bank for RN
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Exam (Latest 2026/2027 Update)
Complete Practice Q&A with Verified Answers and Detailed
Rationales Evolve Elsevier Medical Surgical Nursing Test Bank
for RN Exit and Specialty Exams A+ Graded. Every item uses a
focused exam stem, four response options, a keyed response,
and a clear rationale, making it easier to understand the
subject, spot distractors, and build real exam confidence.
Page 1
, Question 1
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, when it appears alongside a serum potassium of 3.1
mEq/L, most urgently requires immediate nursing intervention?
A. Blood pressure 102/64 mm Hg with a heart rate of 92/min
B. New-onset frequent premature ventricular contractions on the
telemetry monitor
C. Urine output of 1200 mL over the past 8 hours
D. Report of increased thirst and dry oral mucous membranes
Correct Answer: B - New-onset frequent premature ventricular
contractions on the telemetry monitor
RATIONALE
Hypokalemia from loop diuretics predisposes to ventricular
dysrhythmias; new PVCs signal cardiac irritability requiring
immediate intervention. Hypotension, diuresis, and thirst are expected
effects of diuresis and are less immediately life-threatening than
dysrhythmias.
Question 2
Which arterial blood gas pattern is most consistent with a patient experiencing
an acute exacerbation of COPD with CO2 retention and compensatory
metabolic response?
A. pH 7.48, PaCO2 30 mm Hg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L
C. pH 7.36, PaCO2 55 mm Hg, HCO3 31 mEq/L
D. pH 7.50, PaCO2 42 mm Hg, HCO3 34 mEq/L
Correct Answer: C - pH 7.36, PaCO2 55 mm Hg, HCO3 31
mEq/L
Page 2
, RATIONALE
Chronic CO2 retention triggers renal bicarbonate retention; a
near-normal pH with elevated PaCO2 and elevated HCO3 indicates
compensated respiratory acidosis. Option B shows uncompensated
respiratory acidosis, and options A and D reflect alkalotic states
inconsistent with CO2 retention.
Question 3
A patient with type 1 diabetes is admitted with diabetic ketoacidosis. After
initiating an insulin infusion, which parameter must be monitored most
frequently to prevent a life-threatening complication?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: A - Serum potassium
RATIONALE
Insulin drives potassium intracellularly, causing rapid hypokalemia
and potential cardiac dysrhythmias; potassium must be monitored
hourly and replaced as needed. Sodium, calcium, and magnesium
shifts are not the primary acute risk during DKA treatment.
Question 4
A patient with a new ileostomy has a high-output stoma (>1500 mL/day).
Which nursing action is most appropriate to prevent fluid and electrolyte
imbalance?
A. Encourage a high-fiber diet to thicken output
B. Restrict oral fluids to 1000 mL/day
C. Monitor serum potassium and sodium and replace losses
D. Administer a bulk-forming laxative to reduce output
Page 3
, Correct Answer: C - Monitor serum potassium and sodium and
replace losses
RATIONALE
High-output ileostomies cause loss of sodium, potassium, and water;
monitoring and replacing electrolytes is essential. Fiber and laxatives
would worsen output, and fluid restriction risks dehydration.
Question 5
Following a motor vehicle crash, a patient has a suspected cervical spine
injury. Which action should the nurse take first to maintain airway patency
while protecting the spinal cord?
A. Perform a head-tilt, chin-lift maneuver
B. Apply a cervical collar and perform a jaw-thrust maneuver
C. Insert an oropharyngeal airway immediately
D. Place the patient in a supine position with a pillow under the head
Correct Answer: B - Apply a cervical collar and perform a
jaw-thrust maneuver
RATIONALE
The jaw-thrust with cervical stabilization opens the airway without
extending the neck, preventing further spinal cord injury.
Head-tilt/chin-lift and pillow placement can exacerbate cervical
damage; an OPA may be used after stabilization but is not the first
step.
Question 6
A patient receiving heparin infusion has an aPTT of 95 seconds (control 30
seconds). Which action should the nurse anticipate?
A. Increase the heparin infusion rate
B. Administer vitamin K
C. Hold the heparin and prepare to administer protamine sulfate
Page 4
2026/2027 Update) Complete Practice
Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier
HESI Med Surg Exam (Latest 2026/2027 Update) | Comprehensive
Examination
HESI Med Surg Exam (Latest 2026/2027 Update) Complete
Practice Q&A with Verified Answers and Detailed Rationales
Evolve Elsevier Medical Surgical Nursing Test Bank for RN
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Exam (Latest 2026/2027 Update)
Complete Practice Q&A with Verified Answers and Detailed
Rationales Evolve Elsevier Medical Surgical Nursing Test Bank
for RN Exit and Specialty Exams A+ Graded. Every item uses a
focused exam stem, four response options, a keyed response,
and a clear rationale, making it easier to understand the
subject, spot distractors, and build real exam confidence.
Page 1
, Question 1
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, when it appears alongside a serum potassium of 3.1
mEq/L, most urgently requires immediate nursing intervention?
A. Blood pressure 102/64 mm Hg with a heart rate of 92/min
B. New-onset frequent premature ventricular contractions on the
telemetry monitor
C. Urine output of 1200 mL over the past 8 hours
D. Report of increased thirst and dry oral mucous membranes
Correct Answer: B - New-onset frequent premature ventricular
contractions on the telemetry monitor
RATIONALE
Hypokalemia from loop diuretics predisposes to ventricular
dysrhythmias; new PVCs signal cardiac irritability requiring
immediate intervention. Hypotension, diuresis, and thirst are expected
effects of diuresis and are less immediately life-threatening than
dysrhythmias.
Question 2
Which arterial blood gas pattern is most consistent with a patient experiencing
an acute exacerbation of COPD with CO2 retention and compensatory
metabolic response?
A. pH 7.48, PaCO2 30 mm Hg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L
C. pH 7.36, PaCO2 55 mm Hg, HCO3 31 mEq/L
D. pH 7.50, PaCO2 42 mm Hg, HCO3 34 mEq/L
Correct Answer: C - pH 7.36, PaCO2 55 mm Hg, HCO3 31
mEq/L
Page 2
, RATIONALE
Chronic CO2 retention triggers renal bicarbonate retention; a
near-normal pH with elevated PaCO2 and elevated HCO3 indicates
compensated respiratory acidosis. Option B shows uncompensated
respiratory acidosis, and options A and D reflect alkalotic states
inconsistent with CO2 retention.
Question 3
A patient with type 1 diabetes is admitted with diabetic ketoacidosis. After
initiating an insulin infusion, which parameter must be monitored most
frequently to prevent a life-threatening complication?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: A - Serum potassium
RATIONALE
Insulin drives potassium intracellularly, causing rapid hypokalemia
and potential cardiac dysrhythmias; potassium must be monitored
hourly and replaced as needed. Sodium, calcium, and magnesium
shifts are not the primary acute risk during DKA treatment.
Question 4
A patient with a new ileostomy has a high-output stoma (>1500 mL/day).
Which nursing action is most appropriate to prevent fluid and electrolyte
imbalance?
A. Encourage a high-fiber diet to thicken output
B. Restrict oral fluids to 1000 mL/day
C. Monitor serum potassium and sodium and replace losses
D. Administer a bulk-forming laxative to reduce output
Page 3
, Correct Answer: C - Monitor serum potassium and sodium and
replace losses
RATIONALE
High-output ileostomies cause loss of sodium, potassium, and water;
monitoring and replacing electrolytes is essential. Fiber and laxatives
would worsen output, and fluid restriction risks dehydration.
Question 5
Following a motor vehicle crash, a patient has a suspected cervical spine
injury. Which action should the nurse take first to maintain airway patency
while protecting the spinal cord?
A. Perform a head-tilt, chin-lift maneuver
B. Apply a cervical collar and perform a jaw-thrust maneuver
C. Insert an oropharyngeal airway immediately
D. Place the patient in a supine position with a pillow under the head
Correct Answer: B - Apply a cervical collar and perform a
jaw-thrust maneuver
RATIONALE
The jaw-thrust with cervical stabilization opens the airway without
extending the neck, preventing further spinal cord injury.
Head-tilt/chin-lift and pillow placement can exacerbate cervical
damage; an OPA may be used after stabilization but is not the first
step.
Question 6
A patient receiving heparin infusion has an aPTT of 95 seconds (control 30
seconds). Which action should the nurse anticipate?
A. Increase the heparin infusion rate
B. Administer vitamin K
C. Hold the heparin and prepare to administer protamine sulfate
Page 4
