HESI RN Med Surge Practice Exam
(Latest 2026/2027 Update) Q&A with
Verified Answers and Detailed
Rationales Medical Surgical Nursing
HESI RN Med Surge Practice Exam (Latest | Comprehensive
Examination
HESI RN Med Surge Practice Exam (Latest 2026/2027
Update) Q&A with Verified Answers and Detailed Rationales
Medical Surgical Nursing for RN Exit Exam A+ Graded
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI RN Med Surge Practice Exam (Latest
2026/2027 Update) Q&A with Verified Answers and Detailed
Rationales Medical Surgical Nursing for RN Exit Exam A+
Graded Evolve Elsevier. 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 client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
The provider orders an IV insulin infusion at 0.1 units/kg/hr. The client weighs
80 kg. The pharmacy supplies regular insulin 100 units in 100 mL of 0.9%
NaCl. What is the correct infusion rate in mL/hr?
A. 0.8 mL/hr
B. 8 mL/hr
C. 80 mL/hr
D. 0.08 mL/hr
Correct Answer: B - 8 mL/hr
RATIONALE
Dose = 0.1 units/kg/hr × 80 kg = 8 units/hr. Concentration = 100
units/100 mL = 1 unit/mL, so 8 units/hr = 8 mL/hr. Distractors reflect
decimal errors or misinterpretation of concentration; option C would
deliver 80 units/hr, a tenfold overdose.
Question 2
A client with chronic kidney disease (CKD) stage 4 has the following labs: K+
6.2 mEq/L, Ca2+ 8.0 mg/dL, phosphate 6.5 mg/dL, PTH elevated. Which
intervention should the nurse anticipate as the priority?
A. Administer calcium acetate with meals
B. Administer IV regular insulin with 50% dextrose
C. Restrict dietary potassium to 40 mEq/day
D. Prepare for emergent hemodialysis
Correct Answer: B - Administer IV regular insulin with 50%
dextrose
Page 2
, RATIONALE
A serum potassium of 6.2 mEq/L with ECG changes risk requires
immediate intracellular shift; IV insulin with dextrose is the fastest
temporizing measure. Calcium acetate treats hyperphosphatemia but
does not lower potassium acutely; dietary restriction is too slow;
dialysis is indicated if refractory but is not the immediate first action
when insulin-dextrose is available.
Question 3
A client is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Stop the transfusion and maintain IV access with 0.9% NaCl
B. Administer acetaminophen and continue the transfusion
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
Correct Answer: A - Stop the transfusion and maintain IV access
with 0.9% NaCl
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction; the priority is to stop the transfusion immediately and keep
the IV line patent with normal saline via new tubing. Continuing or
slowing the transfusion worsens hemolysis; acetaminophen masks
symptoms; urine collection is secondary to stopping the transfusion.
Question 4
A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which ventilator strategy is most consistent with current
evidence-based practice?
A. Tidal volume 12 mL/kg of ideal body weight and low PEEP
B. Tidal volume 6 mL/kg of ideal body weight and PEEP titrated to
oxygenation
Page 3
, C. High tidal volume with permissive hypercapnia
D. Pressure support ventilation with minimal PEEP
Correct Answer: B - Tidal volume 6 mL/kg of ideal body weight
and PEEP titrated to oxygenation
RATIONALE
The ARDSNet protocol recommends low tidal volume (6 mL/kg
IBW) and adequate PEEP to prevent ventilator-induced lung injury
and improve oxygenation. High tidal volumes (12 mL/kg) increase
barotrauma and mortality; permissive hypercapnia is a consequence,
not a primary setting; pressure support is not the initial mode for
severe ARDS.
Question 5
A client is admitted with a suspected ischemic stroke and presents 2 hours after
symptom onset. Non-contrast CT of the head is negative for hemorrhage.
Which assessment finding would contraindicate administration of IV alteplase?
A. Blood pressure 178/98 mmHg
B. INR 1.1
C. Platelet count 210,000/mm³
D. Serum glucose 145 mg/dL
Correct Answer: A - Blood pressure 178/98 mmHg
RATIONALE
IV alteplase is contraindicated when blood pressure is >185/110
mmHg because of the risk of intracranial hemorrhage; it must be
lowered and stabilized before treatment. INR 1.1, normal platelets,
and glucose 145 mg/dL are not contraindications; glucose >400 mg/dL
would be, but 145 mg/dL is acceptable.
Page 4
(Latest 2026/2027 Update) Q&A with
Verified Answers and Detailed
Rationales Medical Surgical Nursing
HESI RN Med Surge Practice Exam (Latest | Comprehensive
Examination
HESI RN Med Surge Practice Exam (Latest 2026/2027
Update) Q&A with Verified Answers and Detailed Rationales
Medical Surgical Nursing for RN Exit Exam A+ Graded
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI RN Med Surge Practice Exam (Latest
2026/2027 Update) Q&A with Verified Answers and Detailed
Rationales Medical Surgical Nursing for RN Exit Exam A+
Graded Evolve Elsevier. 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 client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
The provider orders an IV insulin infusion at 0.1 units/kg/hr. The client weighs
80 kg. The pharmacy supplies regular insulin 100 units in 100 mL of 0.9%
NaCl. What is the correct infusion rate in mL/hr?
A. 0.8 mL/hr
B. 8 mL/hr
C. 80 mL/hr
D. 0.08 mL/hr
Correct Answer: B - 8 mL/hr
RATIONALE
Dose = 0.1 units/kg/hr × 80 kg = 8 units/hr. Concentration = 100
units/100 mL = 1 unit/mL, so 8 units/hr = 8 mL/hr. Distractors reflect
decimal errors or misinterpretation of concentration; option C would
deliver 80 units/hr, a tenfold overdose.
Question 2
A client with chronic kidney disease (CKD) stage 4 has the following labs: K+
6.2 mEq/L, Ca2+ 8.0 mg/dL, phosphate 6.5 mg/dL, PTH elevated. Which
intervention should the nurse anticipate as the priority?
A. Administer calcium acetate with meals
B. Administer IV regular insulin with 50% dextrose
C. Restrict dietary potassium to 40 mEq/day
D. Prepare for emergent hemodialysis
Correct Answer: B - Administer IV regular insulin with 50%
dextrose
Page 2
, RATIONALE
A serum potassium of 6.2 mEq/L with ECG changes risk requires
immediate intracellular shift; IV insulin with dextrose is the fastest
temporizing measure. Calcium acetate treats hyperphosphatemia but
does not lower potassium acutely; dietary restriction is too slow;
dialysis is indicated if refractory but is not the immediate first action
when insulin-dextrose is available.
Question 3
A client is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Stop the transfusion and maintain IV access with 0.9% NaCl
B. Administer acetaminophen and continue the transfusion
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
Correct Answer: A - Stop the transfusion and maintain IV access
with 0.9% NaCl
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction; the priority is to stop the transfusion immediately and keep
the IV line patent with normal saline via new tubing. Continuing or
slowing the transfusion worsens hemolysis; acetaminophen masks
symptoms; urine collection is secondary to stopping the transfusion.
Question 4
A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which ventilator strategy is most consistent with current
evidence-based practice?
A. Tidal volume 12 mL/kg of ideal body weight and low PEEP
B. Tidal volume 6 mL/kg of ideal body weight and PEEP titrated to
oxygenation
Page 3
, C. High tidal volume with permissive hypercapnia
D. Pressure support ventilation with minimal PEEP
Correct Answer: B - Tidal volume 6 mL/kg of ideal body weight
and PEEP titrated to oxygenation
RATIONALE
The ARDSNet protocol recommends low tidal volume (6 mL/kg
IBW) and adequate PEEP to prevent ventilator-induced lung injury
and improve oxygenation. High tidal volumes (12 mL/kg) increase
barotrauma and mortality; permissive hypercapnia is a consequence,
not a primary setting; pressure support is not the initial mode for
severe ARDS.
Question 5
A client is admitted with a suspected ischemic stroke and presents 2 hours after
symptom onset. Non-contrast CT of the head is negative for hemorrhage.
Which assessment finding would contraindicate administration of IV alteplase?
A. Blood pressure 178/98 mmHg
B. INR 1.1
C. Platelet count 210,000/mm³
D. Serum glucose 145 mg/dL
Correct Answer: A - Blood pressure 178/98 mmHg
RATIONALE
IV alteplase is contraindicated when blood pressure is >185/110
mmHg because of the risk of intracranial hemorrhage; it must be
lowered and stabilized before treatment. INR 1.1, normal platelets,
and glucose 145 mg/dL are not contraindications; glucose >400 mg/dL
would be, but 145 mg/dL is acceptable.
Page 4
