HESI RN Med-Surg Exam 2026/2027:
200 Practice Questions and Answers
With Rationales | Elsevier Evolve
Clinical Judgment Instant Download
Question 1
A client with heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding requires the nurse to withhold the dose
and notify the provider?
A. Blood pressure 138/82 mmHg
B. Serum potassium 2.9 mEq/L
C. Urine output of 60 mL/hr
D. Heart rate 88 beats/min
Rationale: Furosemide is a loop diuretic that causes potassium loss.
A serum potassium of 2.9 mEq/L is critically low (normal 3.5–5.0
mEq/L) and places the client at risk for life-threatening
dysrhythmias. The dose should be withheld and the provider
notified. The other findings are within normal limits.
Question 2
A client is admitted with suspected acute pancreatitis. Which
laboratory finding best supports this diagnosis?
,A. Elevated serum lipase and amylase
B. Decreased serum calcium
C. Elevated AST and ALT
D. Decreased hemoglobin and hematocrit
Rationale: Elevated lipase and amylase are the hallmark diagnostic
findings in acute pancreatitis. While hypocalcemia can occur as a
complication (fat necrosis), it is not diagnostic. AST/ALT reflect liver
function, and low Hgb/Hct indicate anemia or bleeding.
Question 3
A nurse is caring for a client with a new ileostomy. Which finding
should be reported to the provider immediately?
A. Stoma is beefy red and moist
B. Stoma output of 1,500 mL in 24 hours
C. Small amount of serosanguineous drainage on the pouch
D. Client reports gas in the pouch
Rationale: An ileostomy output exceeding 1,000–1,200 mL/day
indicates excessive fluid and electrolyte loss, risking dehydration
and hypovolemia. This requires prompt notification. A beefy red
stoma is normal, minimal drainage is expected, and gas is common.
Question 4
A client with COPD has an oxygen saturation of 88% on room air.
Which oxygen delivery method is most appropriate?
,A. Venturi mask at 28%
B. Nasal cannula at 6 L/min
C. Simple face mask at 10 L/min
D. Nonrebreather mask at 15 L/min
Rationale: Clients with COPD are at risk for CO2 retention and
should receive controlled low-flow oxygen (88–92% SpO2 target). A
Venturi mask delivers a precise FiO2, making it the safest choice.
High-flow devices risk suppressing the hypoxic drive.
Question 5
A client is 24 hours post-abdominal surgery and reports sudden
shortness of breath and chest pain. Vital signs: HR 118, RR 28,
SpO2 89%. What is the nurse's priority action?
A. Reposition the client on the left side
B. Apply supplemental oxygen and notify the rapid response team
C. Administer the prescribed PRN morphine
D. Encourage the client to cough and deep breathe
Rationale: These findings suggest a pulmonary embolism, a life-
threatening postoperative complication. The priority is oxygenation
and rapid escalation of care. Positioning, analgesia, and breathing
exercises are secondary to stabilizing oxygenation and activating
the rapid response team.
, Question 6
A client with type 1 diabetes has a blood glucose of 48 mg/dL and
is conscious but confused. What is the nurse's first action?
A. Administer subcutaneous insulin
B. Give 15 g of a fast-acting carbohydrate orally
C. Start an IV and administer D50W
D. Recheck the blood glucose in 30 minutes
Rationale: For a conscious client with hypoglycemia, the first
intervention is oral intake of 15 g of rapid-acting carbohydrate (e.g.,
juice, glucose tablets), followed by rechecking glucose in 15
minutes. IV dextrose is reserved for unconscious clients or those
unable to swallow.
Question 7
A nurse is assessing a client with a suspected tension
pneumothorax. Which finding is most characteristic?
A. Bilateral crackles
B. Tracheal deviation away from the affected side
C. Bradycardia and hypertension
D. Increased breath sounds on the affected side
Rationale: Tension pneumothorax causes mediastinal shift,
manifesting as tracheal deviation away from the affected side,
along with severe dyspnea, hypotension, and absent breath sounds
on the affected side. It is a medical emergency requiring immediate
needle decompression.
200 Practice Questions and Answers
With Rationales | Elsevier Evolve
Clinical Judgment Instant Download
Question 1
A client with heart failure is prescribed furosemide 40 mg IV push.
Which assessment finding requires the nurse to withhold the dose
and notify the provider?
A. Blood pressure 138/82 mmHg
B. Serum potassium 2.9 mEq/L
C. Urine output of 60 mL/hr
D. Heart rate 88 beats/min
Rationale: Furosemide is a loop diuretic that causes potassium loss.
A serum potassium of 2.9 mEq/L is critically low (normal 3.5–5.0
mEq/L) and places the client at risk for life-threatening
dysrhythmias. The dose should be withheld and the provider
notified. The other findings are within normal limits.
Question 2
A client is admitted with suspected acute pancreatitis. Which
laboratory finding best supports this diagnosis?
,A. Elevated serum lipase and amylase
B. Decreased serum calcium
C. Elevated AST and ALT
D. Decreased hemoglobin and hematocrit
Rationale: Elevated lipase and amylase are the hallmark diagnostic
findings in acute pancreatitis. While hypocalcemia can occur as a
complication (fat necrosis), it is not diagnostic. AST/ALT reflect liver
function, and low Hgb/Hct indicate anemia or bleeding.
Question 3
A nurse is caring for a client with a new ileostomy. Which finding
should be reported to the provider immediately?
A. Stoma is beefy red and moist
B. Stoma output of 1,500 mL in 24 hours
C. Small amount of serosanguineous drainage on the pouch
D. Client reports gas in the pouch
Rationale: An ileostomy output exceeding 1,000–1,200 mL/day
indicates excessive fluid and electrolyte loss, risking dehydration
and hypovolemia. This requires prompt notification. A beefy red
stoma is normal, minimal drainage is expected, and gas is common.
Question 4
A client with COPD has an oxygen saturation of 88% on room air.
Which oxygen delivery method is most appropriate?
,A. Venturi mask at 28%
B. Nasal cannula at 6 L/min
C. Simple face mask at 10 L/min
D. Nonrebreather mask at 15 L/min
Rationale: Clients with COPD are at risk for CO2 retention and
should receive controlled low-flow oxygen (88–92% SpO2 target). A
Venturi mask delivers a precise FiO2, making it the safest choice.
High-flow devices risk suppressing the hypoxic drive.
Question 5
A client is 24 hours post-abdominal surgery and reports sudden
shortness of breath and chest pain. Vital signs: HR 118, RR 28,
SpO2 89%. What is the nurse's priority action?
A. Reposition the client on the left side
B. Apply supplemental oxygen and notify the rapid response team
C. Administer the prescribed PRN morphine
D. Encourage the client to cough and deep breathe
Rationale: These findings suggest a pulmonary embolism, a life-
threatening postoperative complication. The priority is oxygenation
and rapid escalation of care. Positioning, analgesia, and breathing
exercises are secondary to stabilizing oxygenation and activating
the rapid response team.
, Question 6
A client with type 1 diabetes has a blood glucose of 48 mg/dL and
is conscious but confused. What is the nurse's first action?
A. Administer subcutaneous insulin
B. Give 15 g of a fast-acting carbohydrate orally
C. Start an IV and administer D50W
D. Recheck the blood glucose in 30 minutes
Rationale: For a conscious client with hypoglycemia, the first
intervention is oral intake of 15 g of rapid-acting carbohydrate (e.g.,
juice, glucose tablets), followed by rechecking glucose in 15
minutes. IV dextrose is reserved for unconscious clients or those
unable to swallow.
Question 7
A nurse is assessing a client with a suspected tension
pneumothorax. Which finding is most characteristic?
A. Bilateral crackles
B. Tracheal deviation away from the affected side
C. Bradycardia and hypertension
D. Increased breath sounds on the affected side
Rationale: Tension pneumothorax causes mediastinal shift,
manifesting as tracheal deviation away from the affected side,
along with severe dyspnea, hypotension, and absent breath sounds
on the affected side. It is a medical emergency requiring immediate
needle decompression.
