HESI MEDICAL SURGICAL NURSING EXAM 2026/2027
VERIFIED QUESTIONS AND CORRECT ANSWERS A+
GRADED
Medical-Surgical Nursing (HESI Exit Exam Focus) | Key Domains: Complex Multisystem Disorders,
Advanced Cardiac & Respiratory Care, Neurological & Sensory Emergencies, Renal & Endocrine
Management, Oncology & Immunologic Disorders, Perioperative & Trauma Care, and Gerontological
Considerations | Expert-Aligned Structure | Verified A+ Exam Format
Introduction
This structured HESI Medical-Surgical Nursing Exam for 2026/2027 provides a verified set of
high-level exam-style questions with A+-graded correct answers and rationales. It is designed to
rigorously prepare students for the medical-surgical component of the HESI exit exam, emphasizing
critical thinking, prioritization in complex scenarios, and management of high-acuity adult health
conditions.
Exam Structure:
• Verified A+ Exam Bank: (120 QUESTIONS)
Answer Format
All A+-graded correct answers must appear in bold and cyan blue, accompanied by concise
rationales explaining the complex pathophysiology, the priority nursing intervention based on
patient stability (e.g., addressing airway before pain), the interpretation of advanced diagnostic
data, the management of a life-threatening complication, and why alternative options are incorrect,
represent a lower priority, or would compromise patient safety in a medical-surgical setting.
,Verified A+ Questions (1–120)
1. A client with heart failure has crackles in the lung bases, +3 pitting edema, and dyspnea at rest.
The nurse notes an S3 heart sound. What is the priority nursing intervention?
A. Administer morphine sulfate
B. Elevate the legs
C. Administer furosemide IV as prescribed
D. Provide supplemental oxygen
Rationale (A+ Standard): The client is in acute decompensated heart failure with pulmonary and
systemic fluid overload. Furosemide, a loop diuretic, rapidly reduces preload by promoting diuresis,
directly addressing the underlying pathophysiology. While oxygen (D) supports oxygenation and
morphine (A) reduces anxiety and preload, diuresis is the definitive treatment for volume excess. Leg
elevation (B) would worsen pulmonary congestion. Per HESI prioritization, treating the cause (fluid
overload) takes precedence over symptomatic relief.
2. A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L and
peaked T waves on ECG. What is the nurse’s priority action?
A. Administer oral sodium polystyrene sulfonate (Kayexalate)
B. Restrict dietary potassium
, C. Administer calcium gluconate IV
D. Increase IV fluid rate with normal saline
Rationale (A+ Standard): Peaked T waves indicate hyperkalemia-induced myocardial irritability, which
can progress to ventricular fibrillation or asystole. Calcium gluconate IV stabilizes the cardiac membrane
within minutes, providing immediate protection against dysrhythmias. Kayexalate (A) eliminates
potassium but takes hours. Fluids (D) may worsen fluid overload in CKD. Per HESI cardiac emergency
protocols, cardiac stabilization precedes potassium-lowering measures.
3. A client 2 days post-op from a total hip arthroplasty suddenly becomes dyspneic, tachycardic, and
anxious. Arterial blood gas shows: pH 7.48, PaCO2 30 mm Hg, PaO2 62 mm Hg, HCO3 24 mEq/L.
What complication should the nurse suspect?
A. Myocardial infarction
B. Pneumonia
C. Pulmonary embolism
D. Atelectasis
Rationale (A+ Standard): The ABG reveals respiratory alkalosis (↑pH, ↓PaCO2) with
hypoxemia—classic for pulmonary embolism due to hyperventilation and impaired gas exchange.
Post-op hip surgery is a major risk factor for DVT/PE. MI (A) typically causes metabolic acidosis;
pneumonia (B) causes hypoxemia with possible respiratory acidosis; atelectasis (D) causes mild
hypoxemia but not alkalosis. HESI emphasizes recognizing PE in post-op clients with sudden respiratory
distress.
, 4. A client with a traumatic brain injury has an intracranial pressure (ICP) of 28 mm Hg. Which
intervention should the nurse implement first?
A. Administer acetaminophen for fever
B. Elevate the head of the bed to 15 degrees
C. Elevate the head of the bed to 30–45 degrees
D. Hyperventilate the client to a PaCO2 of 25 mm Hg
Rationale (A+ Standard): Elevating the HOB to 30–45 degrees promotes venous drainage from the
brain, reducing ICP. This is a first-line, non-invasive intervention per neurocritical care guidelines
emphasized in HESI. Hyperventilation (D) is reserved for acute herniation due to risk of cerebral
ischemia. Fever management (A) is important but secondary. A 15-degree elevation (B) is insufficient for
ICP control.
5. A client with type 1 diabetes presents with nausea, vomiting, abdominal pain, and Kussmaul
respirations. Blood glucose is 480 mg/dL, and serum ketones are positive. What is the priority
nursing action?
A. Administer subcutaneous insulin
B. Encourage oral fluids
C. Initiate IV regular insulin infusion
VERIFIED QUESTIONS AND CORRECT ANSWERS A+
GRADED
Medical-Surgical Nursing (HESI Exit Exam Focus) | Key Domains: Complex Multisystem Disorders,
Advanced Cardiac & Respiratory Care, Neurological & Sensory Emergencies, Renal & Endocrine
Management, Oncology & Immunologic Disorders, Perioperative & Trauma Care, and Gerontological
Considerations | Expert-Aligned Structure | Verified A+ Exam Format
Introduction
This structured HESI Medical-Surgical Nursing Exam for 2026/2027 provides a verified set of
high-level exam-style questions with A+-graded correct answers and rationales. It is designed to
rigorously prepare students for the medical-surgical component of the HESI exit exam, emphasizing
critical thinking, prioritization in complex scenarios, and management of high-acuity adult health
conditions.
Exam Structure:
• Verified A+ Exam Bank: (120 QUESTIONS)
Answer Format
All A+-graded correct answers must appear in bold and cyan blue, accompanied by concise
rationales explaining the complex pathophysiology, the priority nursing intervention based on
patient stability (e.g., addressing airway before pain), the interpretation of advanced diagnostic
data, the management of a life-threatening complication, and why alternative options are incorrect,
represent a lower priority, or would compromise patient safety in a medical-surgical setting.
,Verified A+ Questions (1–120)
1. A client with heart failure has crackles in the lung bases, +3 pitting edema, and dyspnea at rest.
The nurse notes an S3 heart sound. What is the priority nursing intervention?
A. Administer morphine sulfate
B. Elevate the legs
C. Administer furosemide IV as prescribed
D. Provide supplemental oxygen
Rationale (A+ Standard): The client is in acute decompensated heart failure with pulmonary and
systemic fluid overload. Furosemide, a loop diuretic, rapidly reduces preload by promoting diuresis,
directly addressing the underlying pathophysiology. While oxygen (D) supports oxygenation and
morphine (A) reduces anxiety and preload, diuresis is the definitive treatment for volume excess. Leg
elevation (B) would worsen pulmonary congestion. Per HESI prioritization, treating the cause (fluid
overload) takes precedence over symptomatic relief.
2. A client with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L and
peaked T waves on ECG. What is the nurse’s priority action?
A. Administer oral sodium polystyrene sulfonate (Kayexalate)
B. Restrict dietary potassium
, C. Administer calcium gluconate IV
D. Increase IV fluid rate with normal saline
Rationale (A+ Standard): Peaked T waves indicate hyperkalemia-induced myocardial irritability, which
can progress to ventricular fibrillation or asystole. Calcium gluconate IV stabilizes the cardiac membrane
within minutes, providing immediate protection against dysrhythmias. Kayexalate (A) eliminates
potassium but takes hours. Fluids (D) may worsen fluid overload in CKD. Per HESI cardiac emergency
protocols, cardiac stabilization precedes potassium-lowering measures.
3. A client 2 days post-op from a total hip arthroplasty suddenly becomes dyspneic, tachycardic, and
anxious. Arterial blood gas shows: pH 7.48, PaCO2 30 mm Hg, PaO2 62 mm Hg, HCO3 24 mEq/L.
What complication should the nurse suspect?
A. Myocardial infarction
B. Pneumonia
C. Pulmonary embolism
D. Atelectasis
Rationale (A+ Standard): The ABG reveals respiratory alkalosis (↑pH, ↓PaCO2) with
hypoxemia—classic for pulmonary embolism due to hyperventilation and impaired gas exchange.
Post-op hip surgery is a major risk factor for DVT/PE. MI (A) typically causes metabolic acidosis;
pneumonia (B) causes hypoxemia with possible respiratory acidosis; atelectasis (D) causes mild
hypoxemia but not alkalosis. HESI emphasizes recognizing PE in post-op clients with sudden respiratory
distress.
, 4. A client with a traumatic brain injury has an intracranial pressure (ICP) of 28 mm Hg. Which
intervention should the nurse implement first?
A. Administer acetaminophen for fever
B. Elevate the head of the bed to 15 degrees
C. Elevate the head of the bed to 30–45 degrees
D. Hyperventilate the client to a PaCO2 of 25 mm Hg
Rationale (A+ Standard): Elevating the HOB to 30–45 degrees promotes venous drainage from the
brain, reducing ICP. This is a first-line, non-invasive intervention per neurocritical care guidelines
emphasized in HESI. Hyperventilation (D) is reserved for acute herniation due to risk of cerebral
ischemia. Fever management (A) is important but secondary. A 15-degree elevation (B) is insufficient for
ICP control.
5. A client with type 1 diabetes presents with nausea, vomiting, abdominal pain, and Kussmaul
respirations. Blood glucose is 480 mg/dL, and serum ketones are positive. What is the priority
nursing action?
A. Administer subcutaneous insulin
B. Encourage oral fluids
C. Initiate IV regular insulin infusion
