HESI RN Advanced Medical-
Surgical Exam | Updated Scenario-
Based Questions | 2025/2026
Edition
Section 1: Introduction
Tailored for advanced learners, this guide includes complex, case-based questions
that simulate critical decision-making in high-acuity environments.
Covers multi-system failure, emergency interventions, sepsis, shock, critical care
protocols, and post-op complications.
Updated for 2025/2026 and professor-verified, this A+ graded exam prep is
designed for advanced med-surg readiness.
Section 2: Exam Questions and Answers
Format:
• Numbered scenario-based multiple-choice questions
• Each item includes four answer options
• Correct answer highlighted in luminous green
• Rationales provided to explain advanced medical-surgical concepts and critical
thinking
1. A 55-year-old patient post-coronary artery bypass graft (CABG) develops chest
pain and shortness of breath. Vital signs: BP 90/60 mmHg, HR 110 bpm, RR
28/min, SpO2 88%. What is the nurse’s priority action?
A) Administer morphine for pain
B) Apply oxygen and notify the surgeon
C) Increase IV fluids
D) Prepare for discharge
Correct Answer: B) Apply oxygen and notify the surgeon
Rationale: Low SpO2 and vital signs suggest a cardiac or pulmonary complication
(e.g., graft failure), requiring immediate oxygen and surgical evaluation.
2. A patient with sepsis has a temperature of 39.5°C, HR 120 bpm, and BP 88/50
mmHg. Which intervention is most urgent?
A) Administer broad-spectrum antibiotics
B) Apply a cooling blanket
C) Initiate fluid resuscitation
D) Obtain a chest X-ray
Correct Answer: C) Initiate fluid resuscitation
Rationale: Hypotension in sepsis indicates septic shock; fluid resuscitation is the first
step to restore perfusion per 2025/2026 protocols.
, 3. A 62-year-old patient in hypovolemic shock post-trauma has cool, clammy skin
and a weak pulse. What is the nurse’s next action?
A) Administer a vasopressor
B) Transfuse packed red blood cells
C) Monitor urine output
D) Elevate the legs
Correct Answer: D) Elevate the legs
Rationale: Leg elevation improves venous return and perfusion until definitive
treatment (e.g., fluids, blood) is available.
4. A patient with multi-system failure (renal and respiratory) has a pH of 7.25,
PaCO2 50 mmHg, and HCO3 18 mEq/L. What condition is indicated?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Combined respiratory and metabolic acidosis
D) Metabolic alkalosis
Correct Answer: C) Combined respiratory and metabolic acidosis
Rationale: Low pH with elevated PaCO2 (respiratory) and low HCO3 (metabolic)
indicate dual acid-base imbalances.
5. A post-op patient develops sudden dyspnea and tachycardia 2 days after a total
hip replacement. What should the nurse suspect?
A) Pneumonia
B) Pulmonary embolism
C) Wound infection
D) Urinary retention
Correct Answer: B) Pulmonary embolism
Rationale: Dyspnea and tachycardia post-surgery suggest a PE, a life-threatening
complication requiring urgent action.
6. A patient in the ICU with ARDS has a PaO2 of 55 mmHg on 100% oxygen.
What is the nurse’s priority?
A) Increase PEEP settings
B) Administer a diuretic
C) Encourage ambulation
D) Reduce oxygen flow
Correct Answer: A) Increase PEEP settings
Rationale: Low PaO2 despite high oxygen indicates severe hypoxemia; increasing
PEEP improves alveolar recruitment.
7. A patient with a GI bleed has a hemoglobin of 7 g/dL and HR 110 bpm. What
should the nurse do first?
A) Prepare for endoscopy
B) Transfuse packed red blood cells
C) Administer an antacid
D) Check vital signs again
Correct Answer: B) Transfuse packed red blood cells
Rationale: Severe anemia with tachycardia requires immediate transfusion to restore
oxygen-carrying capacity.
8. A patient with acute pancreatitis has severe abdominal pain and nausea. Which
order should the nurse question?
A) NPO status
B) IV fluids
C) Morphine administration
Surgical Exam | Updated Scenario-
Based Questions | 2025/2026
Edition
Section 1: Introduction
Tailored for advanced learners, this guide includes complex, case-based questions
that simulate critical decision-making in high-acuity environments.
Covers multi-system failure, emergency interventions, sepsis, shock, critical care
protocols, and post-op complications.
Updated for 2025/2026 and professor-verified, this A+ graded exam prep is
designed for advanced med-surg readiness.
Section 2: Exam Questions and Answers
Format:
• Numbered scenario-based multiple-choice questions
• Each item includes four answer options
• Correct answer highlighted in luminous green
• Rationales provided to explain advanced medical-surgical concepts and critical
thinking
1. A 55-year-old patient post-coronary artery bypass graft (CABG) develops chest
pain and shortness of breath. Vital signs: BP 90/60 mmHg, HR 110 bpm, RR
28/min, SpO2 88%. What is the nurse’s priority action?
A) Administer morphine for pain
B) Apply oxygen and notify the surgeon
C) Increase IV fluids
D) Prepare for discharge
Correct Answer: B) Apply oxygen and notify the surgeon
Rationale: Low SpO2 and vital signs suggest a cardiac or pulmonary complication
(e.g., graft failure), requiring immediate oxygen and surgical evaluation.
2. A patient with sepsis has a temperature of 39.5°C, HR 120 bpm, and BP 88/50
mmHg. Which intervention is most urgent?
A) Administer broad-spectrum antibiotics
B) Apply a cooling blanket
C) Initiate fluid resuscitation
D) Obtain a chest X-ray
Correct Answer: C) Initiate fluid resuscitation
Rationale: Hypotension in sepsis indicates septic shock; fluid resuscitation is the first
step to restore perfusion per 2025/2026 protocols.
, 3. A 62-year-old patient in hypovolemic shock post-trauma has cool, clammy skin
and a weak pulse. What is the nurse’s next action?
A) Administer a vasopressor
B) Transfuse packed red blood cells
C) Monitor urine output
D) Elevate the legs
Correct Answer: D) Elevate the legs
Rationale: Leg elevation improves venous return and perfusion until definitive
treatment (e.g., fluids, blood) is available.
4. A patient with multi-system failure (renal and respiratory) has a pH of 7.25,
PaCO2 50 mmHg, and HCO3 18 mEq/L. What condition is indicated?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Combined respiratory and metabolic acidosis
D) Metabolic alkalosis
Correct Answer: C) Combined respiratory and metabolic acidosis
Rationale: Low pH with elevated PaCO2 (respiratory) and low HCO3 (metabolic)
indicate dual acid-base imbalances.
5. A post-op patient develops sudden dyspnea and tachycardia 2 days after a total
hip replacement. What should the nurse suspect?
A) Pneumonia
B) Pulmonary embolism
C) Wound infection
D) Urinary retention
Correct Answer: B) Pulmonary embolism
Rationale: Dyspnea and tachycardia post-surgery suggest a PE, a life-threatening
complication requiring urgent action.
6. A patient in the ICU with ARDS has a PaO2 of 55 mmHg on 100% oxygen.
What is the nurse’s priority?
A) Increase PEEP settings
B) Administer a diuretic
C) Encourage ambulation
D) Reduce oxygen flow
Correct Answer: A) Increase PEEP settings
Rationale: Low PaO2 despite high oxygen indicates severe hypoxemia; increasing
PEEP improves alveolar recruitment.
7. A patient with a GI bleed has a hemoglobin of 7 g/dL and HR 110 bpm. What
should the nurse do first?
A) Prepare for endoscopy
B) Transfuse packed red blood cells
C) Administer an antacid
D) Check vital signs again
Correct Answer: B) Transfuse packed red blood cells
Rationale: Severe anemia with tachycardia requires immediate transfusion to restore
oxygen-carrying capacity.
8. A patient with acute pancreatitis has severe abdominal pain and nausea. Which
order should the nurse question?
A) NPO status
B) IV fluids
C) Morphine administration
