HESI Medical Surgical Nursing Review
2026/2027 Key Concepts & Test Tips
with 400+ NGN Practice Questions and
Verified Rationales Cardiovascular,
HESI Medical Surgical Nursing Review 2026/2027 Key |
Comprehensive Examination
HESI Medical Surgical Nursing Review 2026/2027 Key
Concepts & Test Tips with 400+ NGN Practice Questions and
Verified Rationales Cardiovascular, Respiratory, Endocrine,
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Review 2026/2027
Key Concepts & Test Tips with 400+ NGN Practice Questions
and Verified Rationales Cardiovascular, Respiratory,
Endocrine, Renal, GI, Neuro Disorders 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 set of assessment findings best indicates that the medication is
achieving its therapeutic effect?
A. Urine output 80 mL/hr, bilateral crackles clearing, weight loss of 1.2
kg in 24 hours
B. Serum potassium 3.2 mEq/L, urine output 30 mL/hr, increased thirst
C. Blood pressure 88/52 mm Hg, heart rate 112 bpm, urine output 120
mL/hr
D. Serum sodium 128 mEq/L, weight loss of 2.5 kg in 24 hours, dry
mucous membranes
Correct Answer: A - Urine output 80 mL/hr, bilateral crackles
clearing, weight loss of 1.2 kg in 24 hours
RATIONALE
Therapeutic furosemide effect is demonstrated by adequate diuresis,
resolution of pulmonary congestion, and gradual weight reduction.
Option B shows hypokalemia and oliguria, indicating adverse effects.
Option C shows hypotension and tachycardia, suggesting overdiuresis.
Option D shows hyponatremia and excessive fluid loss, indicating
dehydration.
Question 2
A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). Which laboratory finding would the nurse expect to see that
differentiates DKA from hyperosmolar hyperglycemic state (HHS)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg
C. Arterial pH <7.30 with positive serum ketones
D. Bicarbonate level >24 mEq/L
Correct Answer: C - Arterial pH <7.30 with positive serum
Page 2
,ketones
RATIONALE
DKA is characterized by metabolic acidosis (pH <7.30), positive
ketones, and bicarbonate <18 mEq/L. HHS typically presents with
profound hyperglycemia, higher osmolality, and minimal ketosis.
Options A and B are more characteristic of HHS. Option D is incorrect
because bicarbonate is low in DKA.
Question 3
A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of
6.8 mEq/L. Which intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Prepare for emergency hemodialysis
C. Administer calcium gluconate IV
D. Restrict dietary potassium and recheck in 4 hours
Correct Answer: C - Administer calcium gluconate IV
RATIONALE
Calcium gluconate is the priority to stabilize the myocardium and
prevent lethal arrhythmias in severe hyperkalemia. Kayexalate and
dietary restriction are slower acting. Emergency dialysis may be
needed but is not the immediate first action to protect the heart.
Question 4
A patient with cirrhosis and portal hypertension is admitted with hematemesis.
Which medication should the nurse expect to administer to reduce portal
pressure?
A. Propranolol
B. Octreotide
C. Lactulose
D. Spironolactone
Page 3
, Correct Answer: B - Octreotide
RATIONALE
Octreotide is a somatostatin analog that reduces splanchnic blood flow
and portal pressure in acute variceal bleeding. Propranolol is used for
prophylaxis but not acute management. Lactulose treats hepatic
encephalopathy. Spironolactone manages ascites.
Question 5
A patient with a traumatic brain injury has an intracranial pressure (ICP)
monitor reading of 22 mm Hg. Which nursing action is most appropriate?
A. Elevate the head of the bed to 30 degrees
B. Perform endotracheal suctioning to clear secretions
C. Administer a bolus of 0.9% sodium chloride
D. Cluster nursing care to allow rest periods
Correct Answer: A - Elevate the head of the bed to 30 degrees
RATIONALE
Elevating the head of the bed to 30 degrees promotes venous drainage
and reduces ICP. Suctioning can increase ICP. Fluid boluses may
worsen cerebral edema. Clustering care may increase ICP; instead,
care should be spaced to allow rest.
Question 6
A patient with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which ventilator setting is most consistent with lung-protective
ventilation?
A. Tidal volume 10 mL/kg of predicted body weight
B. Positive end-expiratory pressure (PEEP) 5 cm H2O
C. Tidal volume 6 mL/kg of predicted body weight
D. Peak inspiratory pressure 45 cm H2O
Correct Answer: C - Tidal volume 6 mL/kg of predicted body
Page 4
2026/2027 Key Concepts & Test Tips
with 400+ NGN Practice Questions and
Verified Rationales Cardiovascular,
HESI Medical Surgical Nursing Review 2026/2027 Key |
Comprehensive Examination
HESI Medical Surgical Nursing Review 2026/2027 Key
Concepts & Test Tips with 400+ NGN Practice Questions and
Verified Rationales Cardiovascular, Respiratory, Endocrine,
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Review 2026/2027
Key Concepts & Test Tips with 400+ NGN Practice Questions
and Verified Rationales Cardiovascular, Respiratory,
Endocrine, Renal, GI, Neuro Disorders 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 set of assessment findings best indicates that the medication is
achieving its therapeutic effect?
A. Urine output 80 mL/hr, bilateral crackles clearing, weight loss of 1.2
kg in 24 hours
B. Serum potassium 3.2 mEq/L, urine output 30 mL/hr, increased thirst
C. Blood pressure 88/52 mm Hg, heart rate 112 bpm, urine output 120
mL/hr
D. Serum sodium 128 mEq/L, weight loss of 2.5 kg in 24 hours, dry
mucous membranes
Correct Answer: A - Urine output 80 mL/hr, bilateral crackles
clearing, weight loss of 1.2 kg in 24 hours
RATIONALE
Therapeutic furosemide effect is demonstrated by adequate diuresis,
resolution of pulmonary congestion, and gradual weight reduction.
Option B shows hypokalemia and oliguria, indicating adverse effects.
Option C shows hypotension and tachycardia, suggesting overdiuresis.
Option D shows hyponatremia and excessive fluid loss, indicating
dehydration.
Question 2
A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). Which laboratory finding would the nurse expect to see that
differentiates DKA from hyperosmolar hyperglycemic state (HHS)?
A. Blood glucose >600 mg/dL
B. Serum osmolality >320 mOsm/kg
C. Arterial pH <7.30 with positive serum ketones
D. Bicarbonate level >24 mEq/L
Correct Answer: C - Arterial pH <7.30 with positive serum
Page 2
,ketones
RATIONALE
DKA is characterized by metabolic acidosis (pH <7.30), positive
ketones, and bicarbonate <18 mEq/L. HHS typically presents with
profound hyperglycemia, higher osmolality, and minimal ketosis.
Options A and B are more characteristic of HHS. Option D is incorrect
because bicarbonate is low in DKA.
Question 3
A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of
6.8 mEq/L. Which intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Prepare for emergency hemodialysis
C. Administer calcium gluconate IV
D. Restrict dietary potassium and recheck in 4 hours
Correct Answer: C - Administer calcium gluconate IV
RATIONALE
Calcium gluconate is the priority to stabilize the myocardium and
prevent lethal arrhythmias in severe hyperkalemia. Kayexalate and
dietary restriction are slower acting. Emergency dialysis may be
needed but is not the immediate first action to protect the heart.
Question 4
A patient with cirrhosis and portal hypertension is admitted with hematemesis.
Which medication should the nurse expect to administer to reduce portal
pressure?
A. Propranolol
B. Octreotide
C. Lactulose
D. Spironolactone
Page 3
, Correct Answer: B - Octreotide
RATIONALE
Octreotide is a somatostatin analog that reduces splanchnic blood flow
and portal pressure in acute variceal bleeding. Propranolol is used for
prophylaxis but not acute management. Lactulose treats hepatic
encephalopathy. Spironolactone manages ascites.
Question 5
A patient with a traumatic brain injury has an intracranial pressure (ICP)
monitor reading of 22 mm Hg. Which nursing action is most appropriate?
A. Elevate the head of the bed to 30 degrees
B. Perform endotracheal suctioning to clear secretions
C. Administer a bolus of 0.9% sodium chloride
D. Cluster nursing care to allow rest periods
Correct Answer: A - Elevate the head of the bed to 30 degrees
RATIONALE
Elevating the head of the bed to 30 degrees promotes venous drainage
and reduces ICP. Suctioning can increase ICP. Fluid boluses may
worsen cerebral edema. Clustering care may increase ICP; instead,
care should be spaced to allow rest.
Question 6
A patient with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which ventilator setting is most consistent with lung-protective
ventilation?
A. Tidal volume 10 mL/kg of predicted body weight
B. Positive end-expiratory pressure (PEEP) 5 cm H2O
C. Tidal volume 6 mL/kg of predicted body weight
D. Peak inspiratory pressure 45 cm H2O
Correct Answer: C - Tidal volume 6 mL/kg of predicted body
Page 4
