1
HESI Med Surg Exit Exam V1 ACTUAL
EXAM 2026/2027 | Verified Questions
and Answers with Rationales |
Guaranteed Pass - A+ Graded
1. Traditional MCQ – Cardiovascular
A 68-year-old man with a history of HTN and DM is admitted with chest
pain. Vital signs: BP 88/50, HR 118, RR 26, SpO₂ 89% RA. 12-lead
shows ST elevation in II, III, aVF with reciprocal depression in aVL. He
is diaphoretic and confused. Which action is priority before calling the
provider?
A. Start high-flow O₂ via NRB
B. Insert a 14-gauge IV in the AC
C. Administer sublingual nitroglycerin
D. Obtain a stat bedside troponin
Correct Answer: A
Rationale: Hypoxemia and cardiogenic shock require immediate
oxygenation; airway/breathing come first.
Critical Thinking Key: In ACS with shock, ABC is always first—
oxygenate, then access, then meds.
2. Select All That Apply – Respiratory
A 55-year-old woman with COPD Gold III is receiving BiPAP for
hypercapnic encephalopathy. Which assessment findings indicate the
,2
BiPAP is effective? (Select three.)
☐ pH 7.25 → 7.38
☐ PaCO₂ 65 → 48 mm Hg (ABG)
☐ Respiratory rate 32 → 22/min
☐ Accessory muscle use present
☐ Patient reports dyspnea 8/10 → 3/10
Correct Answers: pH 7.25→7.38, PaCO₂ 65→48, RR 32→22
Rationale: Objective improvement in gas exchange and work of
breathing confirms efficacy; accessory muscles should decrease, not
remain.
3. Ordered Response – Endocrine
Place the nursing actions in order for a patient admitted with DKA who
has just arrived to the ICU.
A. Start insulin infusion 0.1 unit/kg/hr
B. Obtain ABG and serum ketones
C. Begin 0.9 % saline 20 mL/kg bolus
D. Insert 2 large-bore IVs
E. Connect to cardiac monitor
Correct Order: D → E → B → C → A
Rationale: Access and monitoring first, labs next, fluids before insulin
to prevent precipitous drop in osmolality.
4. Traditional MCQ – Renal/Fluid
A patient with cirrhosis develops abdominal distention and weight gain
of 3 kg in 5 days. Serum creatinine rises from 0.9 to 1.5 mg/dL. Urine
, 3
Na⁺ is 8 mEq/L. Which diagnosis best explains these findings?
A. Prerenal azotemia from over-diuresis
B. Hepatorenal syndrome (HRS)
C. Acute tubular necrosis
D. Spontaneous bacterial peritonitis
Correct Answer: B
Rationale: Low urine sodium, rising creatinine, and ascites = HRS; no
evidence of infection or ATN (casts, FeNa >1 %).
5. Traditional MCQ – Neurological
A 72-year-old woman with AFib suddenly cannot speak or move her
right arm. Last known normal 45 min ago. Vital signs stable. Which
initial action is priority?
A. Obtain CT without contrast
B. Check blood glucose
C. Administer aspirin 324 mg
D. Start heparin drip
Correct Answer: B
Rationale: Rule out hypoglycemia as a stroke mimic before imaging;
takes <1 min and prevents inappropriate thrombolysis.
6. Traditional MCQ – Hematology/Oncology
A patient receiving cisplatin develops tinnitus and a 20 % drop in
creatinine clearance. Which intervention is priority?
A. Reduce next dose by 25 %
B. Switch to carboplatin
HESI Med Surg Exit Exam V1 ACTUAL
EXAM 2026/2027 | Verified Questions
and Answers with Rationales |
Guaranteed Pass - A+ Graded
1. Traditional MCQ – Cardiovascular
A 68-year-old man with a history of HTN and DM is admitted with chest
pain. Vital signs: BP 88/50, HR 118, RR 26, SpO₂ 89% RA. 12-lead
shows ST elevation in II, III, aVF with reciprocal depression in aVL. He
is diaphoretic and confused. Which action is priority before calling the
provider?
A. Start high-flow O₂ via NRB
B. Insert a 14-gauge IV in the AC
C. Administer sublingual nitroglycerin
D. Obtain a stat bedside troponin
Correct Answer: A
Rationale: Hypoxemia and cardiogenic shock require immediate
oxygenation; airway/breathing come first.
Critical Thinking Key: In ACS with shock, ABC is always first—
oxygenate, then access, then meds.
2. Select All That Apply – Respiratory
A 55-year-old woman with COPD Gold III is receiving BiPAP for
hypercapnic encephalopathy. Which assessment findings indicate the
,2
BiPAP is effective? (Select three.)
☐ pH 7.25 → 7.38
☐ PaCO₂ 65 → 48 mm Hg (ABG)
☐ Respiratory rate 32 → 22/min
☐ Accessory muscle use present
☐ Patient reports dyspnea 8/10 → 3/10
Correct Answers: pH 7.25→7.38, PaCO₂ 65→48, RR 32→22
Rationale: Objective improvement in gas exchange and work of
breathing confirms efficacy; accessory muscles should decrease, not
remain.
3. Ordered Response – Endocrine
Place the nursing actions in order for a patient admitted with DKA who
has just arrived to the ICU.
A. Start insulin infusion 0.1 unit/kg/hr
B. Obtain ABG and serum ketones
C. Begin 0.9 % saline 20 mL/kg bolus
D. Insert 2 large-bore IVs
E. Connect to cardiac monitor
Correct Order: D → E → B → C → A
Rationale: Access and monitoring first, labs next, fluids before insulin
to prevent precipitous drop in osmolality.
4. Traditional MCQ – Renal/Fluid
A patient with cirrhosis develops abdominal distention and weight gain
of 3 kg in 5 days. Serum creatinine rises from 0.9 to 1.5 mg/dL. Urine
, 3
Na⁺ is 8 mEq/L. Which diagnosis best explains these findings?
A. Prerenal azotemia from over-diuresis
B. Hepatorenal syndrome (HRS)
C. Acute tubular necrosis
D. Spontaneous bacterial peritonitis
Correct Answer: B
Rationale: Low urine sodium, rising creatinine, and ascites = HRS; no
evidence of infection or ATN (casts, FeNa >1 %).
5. Traditional MCQ – Neurological
A 72-year-old woman with AFib suddenly cannot speak or move her
right arm. Last known normal 45 min ago. Vital signs stable. Which
initial action is priority?
A. Obtain CT without contrast
B. Check blood glucose
C. Administer aspirin 324 mg
D. Start heparin drip
Correct Answer: B
Rationale: Rule out hypoglycemia as a stroke mimic before imaging;
takes <1 min and prevents inappropriate thrombolysis.
6. Traditional MCQ – Hematology/Oncology
A patient receiving cisplatin develops tinnitus and a 20 % drop in
creatinine clearance. Which intervention is priority?
A. Reduce next dose by 25 %
B. Switch to carboplatin
