HESI RN Medical-Surgical Nursing – 2025–2026 Review
(Next-Gen Focus) System-based med-surg concepts,
prioritization, clinical judgment, and NGN-style case
reasoning.
HESI RN Medical-Surgical Nursing – 2025–2026 Review (100 Q&A)
Cardiovascular System
1. A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
a) Weight loss of 1 kg since yesterday.
b) Serum potassium level of 3.0 mEq/L. ✓
c) Client reports increased urination.
d) Mild pitting edema in the lower extremities.
2. A client with an acute myocardial infarction (MI) develops third-degree heart block. Which
intervention should the nurse anticipate first?
a) Administer atropine IV.
b) Prepare for transcutaneous pacing. ✓
c) Insert a Foley catheter.
d) Increase the IV fluid rate.
3. The nurse is assessing a client with suspected infective endocarditis. Which finding is most
indicative of this condition?
a) Bilateral crackles in the lung bases.
b) A new, loud holosystolic murmur. ✓
c) Generalized muscle weakness.
d) Petechiae on the chest and abdomen.
4. A client with peripheral arterial disease (PAD) is being discharged. Which client statement
indicates a need for further teaching?
a) "I will use a heating pad on my feet if they feel cold at night." ✓
b) "I have purchased well-fitting, supportive shoes."
c) "I plan to walk for 30 minutes most days of the week."
d) "I will inspect my feet every day for any cuts or sores."
,5. When administering nitroprusside for a hypertensive crisis, the nurse must monitor for
which serious, potential adverse effect?
a) Hypernatremia
b) Cyanide toxicity ✓
c) Hyperglycemia
d) Metabolic alkalosis
6. A client with atrial fibrillation is scheduled for a cardioversion. What is the
nurse's priority action before the procedure?
a) Administer a sedative as ordered.
b) Ensure the client has been NPO.
c) Verify that anticoagulation therapy has been adequate. ✓
d) Obtain a signed informed consent.
Respiratory System
7. A client with COPD has a pH of 7.30, PaCO2 of 60 mm Hg, and HCO3 of 28 mEq/L. The nurse
interprets these results as:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis ✓
d) Respiratory alkalosis
8. A client is receiving a continuous heparin infusion for a pulmonary embolism. The activated
partial thromboplastin time (aPTT) is 95 seconds. The protocol specifies to hold the infusion
for an aPTT greater than 80 seconds. What is the nurse's next action?
a) Stop the heparin infusion and notify the healthcare provider. ✓
b) Increase the heparin rate as per the sliding scale.
c) Administer protamine sulfate immediately.
d) Re-draw the aPTT to confirm the result.
9. The nurse is caring for a client with a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. What is the most
appropriate initial action?
a) This is an expected finding; no action is needed.
b) Check all connections for an air leak. ✓
c) Clamp the chest tube immediately.
d) Increase the suction pressure.
,10. A client with lung cancer develops syndrome of inappropriate antidiuretic hormone
(SIADH). Which finding should the nurse expect?
a) Polyuria and hypernatremia
b) Oliguria and hyponatremia ✓
c) Hyperglycemia and polydipsia
d) Hypertension and hypokalemia
11. A post-lobectomy client's chest tube drainage suddenly increases to 200 mL/hour. What is
the nurse's priority action?
a) Milk the chest tube to ensure patency.
b) Assess the client's blood pressure and heart rate. ✓
c) Increase the suction pressure on the drainage system.
d) Document the finding as the only action.
12. The nurse is teaching a client with asthma about using a peak flow meter. The client's
"green zone" is 80-100% of their personal best. What does this zone indicate?
a) A medical alert; use rescue medication and seek help.
b) Caution; asthma is worsening.
c) Good control; continue current medications. ✓
d) The client is in respiratory failure.
Neurological System
13. A client is admitted with a suspected ischemic stroke. The nurse knows that the time
frame for administering recombinant tissue plasminogen activator (rt-PA) is within how many
hours of symptom onset?
a) 2 hours
b) 3 hours
c) 4.5 hours ✓
d) 6 hours
14. The nurse is assessing a client 2 hours after a craniotomy. Which finding
requires immediate intervention?
a) The client reports a headache.
b) The client is drowsy but arousable.
c) The client has a dilated pupil on one side. ✓
d) The dressing has a small amount of serous drainage.
, 15. A client with a C5 spinal cord injury develops a severe headache and profuse diaphoresis
above the level of injury. The nurse should first:
a) Administer an analgesic for the headache.
b) Check the client's blood pressure. ✓
c) Lower the head of the bed.
d) Place the client on a cooling blanket.
16. The nurse is caring for a client with meningitis. Which physician's order should the nurse
implement first?
a) Obtain blood cultures.
b) Administer the prescribed antibiotic. ✓
c) Start an IV of D5W.
d) Administer acetaminophen for a fever.
17. A client with Guillain-Barré syndrome is experiencing rapidly progressive ascending
muscle weakness. The nurse's priority assessment is:
a) Deep tendon reflexes.
b) Respiratory effort and vital capacity. ✓
c) Level of consciousness.
d) Bowel and bladder function.
18. A client with myasthenia gravis is experiencing increased muscle weakness. The nurse
should assess for which life-threatening complication?
a) Myasthenic crisis ✓
b) Thyroid storm
c) Neuroleptic malignant syndrome
d) Addisonian crisis
Gastrointestinal System
19. A client with cirrhosis has significant ascites. The nurse should monitor for which
complication related to a paracentesis?
a) Hypovolemic shock ✓
b) Hepatic encephalopathy
c) Esophageal varices
d) Spontaneous bacterial peritonitis
20. A client with acute pancreatitis has a nasogastric (NG) tube in place. The primary purpose
of the NG tube for this client is to:
(Next-Gen Focus) System-based med-surg concepts,
prioritization, clinical judgment, and NGN-style case
reasoning.
HESI RN Medical-Surgical Nursing – 2025–2026 Review (100 Q&A)
Cardiovascular System
1. A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
a) Weight loss of 1 kg since yesterday.
b) Serum potassium level of 3.0 mEq/L. ✓
c) Client reports increased urination.
d) Mild pitting edema in the lower extremities.
2. A client with an acute myocardial infarction (MI) develops third-degree heart block. Which
intervention should the nurse anticipate first?
a) Administer atropine IV.
b) Prepare for transcutaneous pacing. ✓
c) Insert a Foley catheter.
d) Increase the IV fluid rate.
3. The nurse is assessing a client with suspected infective endocarditis. Which finding is most
indicative of this condition?
a) Bilateral crackles in the lung bases.
b) A new, loud holosystolic murmur. ✓
c) Generalized muscle weakness.
d) Petechiae on the chest and abdomen.
4. A client with peripheral arterial disease (PAD) is being discharged. Which client statement
indicates a need for further teaching?
a) "I will use a heating pad on my feet if they feel cold at night." ✓
b) "I have purchased well-fitting, supportive shoes."
c) "I plan to walk for 30 minutes most days of the week."
d) "I will inspect my feet every day for any cuts or sores."
,5. When administering nitroprusside for a hypertensive crisis, the nurse must monitor for
which serious, potential adverse effect?
a) Hypernatremia
b) Cyanide toxicity ✓
c) Hyperglycemia
d) Metabolic alkalosis
6. A client with atrial fibrillation is scheduled for a cardioversion. What is the
nurse's priority action before the procedure?
a) Administer a sedative as ordered.
b) Ensure the client has been NPO.
c) Verify that anticoagulation therapy has been adequate. ✓
d) Obtain a signed informed consent.
Respiratory System
7. A client with COPD has a pH of 7.30, PaCO2 of 60 mm Hg, and HCO3 of 28 mEq/L. The nurse
interprets these results as:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis ✓
d) Respiratory alkalosis
8. A client is receiving a continuous heparin infusion for a pulmonary embolism. The activated
partial thromboplastin time (aPTT) is 95 seconds. The protocol specifies to hold the infusion
for an aPTT greater than 80 seconds. What is the nurse's next action?
a) Stop the heparin infusion and notify the healthcare provider. ✓
b) Increase the heparin rate as per the sliding scale.
c) Administer protamine sulfate immediately.
d) Re-draw the aPTT to confirm the result.
9. The nurse is caring for a client with a chest tube connected to a water-seal drainage system.
The nurse notes continuous bubbling in the water-seal chamber. What is the most
appropriate initial action?
a) This is an expected finding; no action is needed.
b) Check all connections for an air leak. ✓
c) Clamp the chest tube immediately.
d) Increase the suction pressure.
,10. A client with lung cancer develops syndrome of inappropriate antidiuretic hormone
(SIADH). Which finding should the nurse expect?
a) Polyuria and hypernatremia
b) Oliguria and hyponatremia ✓
c) Hyperglycemia and polydipsia
d) Hypertension and hypokalemia
11. A post-lobectomy client's chest tube drainage suddenly increases to 200 mL/hour. What is
the nurse's priority action?
a) Milk the chest tube to ensure patency.
b) Assess the client's blood pressure and heart rate. ✓
c) Increase the suction pressure on the drainage system.
d) Document the finding as the only action.
12. The nurse is teaching a client with asthma about using a peak flow meter. The client's
"green zone" is 80-100% of their personal best. What does this zone indicate?
a) A medical alert; use rescue medication and seek help.
b) Caution; asthma is worsening.
c) Good control; continue current medications. ✓
d) The client is in respiratory failure.
Neurological System
13. A client is admitted with a suspected ischemic stroke. The nurse knows that the time
frame for administering recombinant tissue plasminogen activator (rt-PA) is within how many
hours of symptom onset?
a) 2 hours
b) 3 hours
c) 4.5 hours ✓
d) 6 hours
14. The nurse is assessing a client 2 hours after a craniotomy. Which finding
requires immediate intervention?
a) The client reports a headache.
b) The client is drowsy but arousable.
c) The client has a dilated pupil on one side. ✓
d) The dressing has a small amount of serous drainage.
, 15. A client with a C5 spinal cord injury develops a severe headache and profuse diaphoresis
above the level of injury. The nurse should first:
a) Administer an analgesic for the headache.
b) Check the client's blood pressure. ✓
c) Lower the head of the bed.
d) Place the client on a cooling blanket.
16. The nurse is caring for a client with meningitis. Which physician's order should the nurse
implement first?
a) Obtain blood cultures.
b) Administer the prescribed antibiotic. ✓
c) Start an IV of D5W.
d) Administer acetaminophen for a fever.
17. A client with Guillain-Barré syndrome is experiencing rapidly progressive ascending
muscle weakness. The nurse's priority assessment is:
a) Deep tendon reflexes.
b) Respiratory effort and vital capacity. ✓
c) Level of consciousness.
d) Bowel and bladder function.
18. A client with myasthenia gravis is experiencing increased muscle weakness. The nurse
should assess for which life-threatening complication?
a) Myasthenic crisis ✓
b) Thyroid storm
c) Neuroleptic malignant syndrome
d) Addisonian crisis
Gastrointestinal System
19. A client with cirrhosis has significant ascites. The nurse should monitor for which
complication related to a paracentesis?
a) Hypovolemic shock ✓
b) Hepatic encephalopathy
c) Esophageal varices
d) Spontaneous bacterial peritonitis
20. A client with acute pancreatitis has a nasogastric (NG) tube in place. The primary purpose
of the NG tube for this client is to:
