HESI PN MEDSURG EXAM
SIMULATION 2025/2026
Screen-Format Practice with Visual Data
Q1 [IMAGE: Medication Administration Record (MAR) - Excerpt]
Copy
-------------------------------------------------
MAR - Unit 4B | Patient: J. Martinez | DOB: 03/15/1962
-------------------------------------------------
0900 □ Metoprolol 50 mg PO Daily
□ Furosemide 40 mg PO Daily
□ Potassium Chloride 20 mEq PO Daily
-------------------------------------------------
The PN is preparing the 0900 medications. The patient reports, "My heart is racing." The PN
checks the apical pulse and finds it to be 52 bpm. What is the PRIORITY action?
A. Administer the furosemide and potassium only
B. Hold the metoprolol and notify the RN [CORRECT]
C. Give all medications as ordered
D. Check the blood pressure before giving metoprolol
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that slows heart rate. The order parameters typically
require holding if HR <60 bpm. PN scope: PNs can administer medications but must hold and
notify the RN when vital signs are outside ordered parameters. The MAR does not show
specific hold parameters, so the PN must use clinical judgment (52 bpm is bradycardic) and
notify the RN. Distractor A is incorrect—furosemide and potassium do not address the
bradycardia, and the PN cannot independently decide to withhold other meds. Distractor C is
dangerous—giving a beta-blocker with a pulse of 52 could worsen bradycardia. Distractor D
delays necessary intervention; the pulse is already known to be low.
,Q2 [SCREENSHOT: Vital Sign Monitor Display]
Copy
┌─────────────────────────────────────┐
│ [LIVE VITALS] 08:15 AM │
│ │
│ ♥ HR: 128 bpm │
│ BP: 88/50 mmHg │
│ ♠ SpO2: 89% (Room Air) │
│ Resp: 28 /min │
│ Temp: 38.9°C (102.0°F) │
│ │
│ [ALARM: SpO2 Low] │
└─────────────────────────────────────┘
The PN enters the room and sees these vital signs on the monitor. What is the FIRST action?
A. Document the vital signs in the electronic record
B. Increase the IV flow rate
C. Apply supplemental oxygen and notify the RN [CORRECT]
D. Check the patient's blood glucose
Correct Answer: C
Rationale: The Pediatric Assessment Triangle (adapted for adults) prioritizes: Appearance,
Work of Breathing, Circulation. Here: SpO2 89% (hypoxemia), tachycardia (128), hypotension
(88/50), fever. This suggests sepsis with respiratory compromise. PN scope: PNs can apply
oxygen per protocol and must notify the RN immediately for unstable patients. Distractor A
delays critical intervention. Distractor B requires an RN order—PNs cannot independently
adjust IV rates for hemodynamic instability. Distractor D is unrelated to the immediate life
threats (hypoxemia, hypotension).
Q3 [IMAGE: IV Bag Label]
Copy
┌────────────────────────────────────────┐
│ 0.9% Sodium Chloride (Normal Saline) │
│ 1000 mL │
│ Start Time: 0600 │
│ Rate: 125 mL/hr (via pump) │
,│ Additive: KCl 20 mEq │
│ │
│ [WARNING: Potassium >10 mEq/hr │
│ requires cardiac monitoring] │
└────────────────────────────────────────┘
The PN is reviewing this IV order. What is the MOST important assessment before starting
this infusion?
A. Verify the IV site is patent
B. Ensure cardiac monitoring is available [CORRECT]
C. Check the patient's weight
D. Assess urine output for the last 8 hours
Correct Answer: B
Rationale: The label shows KCl 20 mEq in 1000 mL at 125 mL/hr. Infusion rate: 125 mL/hr
means the bag runs over 8 hours (1000 ÷ 125 = 8). Potassium delivery: 20 mEq ÷ 8 hours =
2.5 mEq/hr, which is below the 10 mEq/hr warning threshold. However, the principle is that
PNs must verify safety parameters for high-alert medications. If the rate were faster or
concentration higher, cardiac monitoring would be required. The question tests recognition
that KCl is a high-alert medication requiring safety verification. Distractor A is necessary but
not the priority safety check. Distractor C is relevant for dosing but this is a standard
concentration. Distractor D is important for potassium administration but not the immediate
safety priority.
Q4 [DRAG & DROP - Ordered Response]
[INTERFACE: Drag steps to the correct sequence]
The PN is assisting with sterile dressing change for a post-op abdominal wound. Place the
following actions in the correct order.
Available Steps:
● Remove old dressing using clean gloves
● Assess wound appearance and drainage
● Perform hand hygiene
● Apply sterile gloves
● Clean wound from center outward with sterile saline
● Apply new sterile dressing
, Correct Sequence: 3, 1, 2, 4, 5, 6
Rationale: Hand hygiene (3) always first. Remove old dressing (1) with clean gloves—this is
dirty work. Assess wound (2) before touching with sterile supplies. Sterile gloves (4) donned
after assessment to maintain sterility. Clean wound (5) from least contaminated (center) to
most (periphery). Apply dressing (6). This follows surgical asepsis principles and prevents
cross-contamination.
Q5 [SCREENSHOT: Intake & Output Record - 12 Hour Shift (0700-1900)]
Copy
┌─────────────────────────────────────────┐
│ INTAKE & OUTPUT RECORD │
│ Patient: R. Thompson | Room 412 │
├─────────────────────────────────────────┤
│ INTAKE: │
│ IV D5W 1000 mL (started 0700) │
│ IV Piggyback antibiotics 200 mL │
│ Oral fluids: 450 mL │
│ Ice chips: 1 cup (estimated 120 mL) │
├─────────────────────────────────────────┤
│ OUTPUT: │
│ Urine: 850 mL (Foley to gravity) │
│ NG suction: 400 mL │
│ Wound drainage: 50 mL │
│ Emesis: 200 mL │
└─────────────────────────────────────────┘
What is the patient's 12-hour fluid balance?
A. +270 mL
B. +470 mL [CORRECT]
C. +670 mL
D. +870 mL
Correct Answer: B (+470 mL)
Rationale: Intake calculation: IV D5W 1000 mL + IVPB 200 mL + PO 450 mL + ice chips 120
mL = 1770 mL. Note: Ice chips are calculated at half volume (60 mL) in some protocols, but
standard is full volume for I&O. Output calculation: Urine 850 mL + NG suction 400 mL +
wound drainage 50 mL + emesis 200 mL = 1500 mL. Balance: 1770 - 1500 = +270 mL? Let me
SIMULATION 2025/2026
Screen-Format Practice with Visual Data
Q1 [IMAGE: Medication Administration Record (MAR) - Excerpt]
Copy
-------------------------------------------------
MAR - Unit 4B | Patient: J. Martinez | DOB: 03/15/1962
-------------------------------------------------
0900 □ Metoprolol 50 mg PO Daily
□ Furosemide 40 mg PO Daily
□ Potassium Chloride 20 mEq PO Daily
-------------------------------------------------
The PN is preparing the 0900 medications. The patient reports, "My heart is racing." The PN
checks the apical pulse and finds it to be 52 bpm. What is the PRIORITY action?
A. Administer the furosemide and potassium only
B. Hold the metoprolol and notify the RN [CORRECT]
C. Give all medications as ordered
D. Check the blood pressure before giving metoprolol
Correct Answer: B
Rationale: Metoprolol is a beta-blocker that slows heart rate. The order parameters typically
require holding if HR <60 bpm. PN scope: PNs can administer medications but must hold and
notify the RN when vital signs are outside ordered parameters. The MAR does not show
specific hold parameters, so the PN must use clinical judgment (52 bpm is bradycardic) and
notify the RN. Distractor A is incorrect—furosemide and potassium do not address the
bradycardia, and the PN cannot independently decide to withhold other meds. Distractor C is
dangerous—giving a beta-blocker with a pulse of 52 could worsen bradycardia. Distractor D
delays necessary intervention; the pulse is already known to be low.
,Q2 [SCREENSHOT: Vital Sign Monitor Display]
Copy
┌─────────────────────────────────────┐
│ [LIVE VITALS] 08:15 AM │
│ │
│ ♥ HR: 128 bpm │
│ BP: 88/50 mmHg │
│ ♠ SpO2: 89% (Room Air) │
│ Resp: 28 /min │
│ Temp: 38.9°C (102.0°F) │
│ │
│ [ALARM: SpO2 Low] │
└─────────────────────────────────────┘
The PN enters the room and sees these vital signs on the monitor. What is the FIRST action?
A. Document the vital signs in the electronic record
B. Increase the IV flow rate
C. Apply supplemental oxygen and notify the RN [CORRECT]
D. Check the patient's blood glucose
Correct Answer: C
Rationale: The Pediatric Assessment Triangle (adapted for adults) prioritizes: Appearance,
Work of Breathing, Circulation. Here: SpO2 89% (hypoxemia), tachycardia (128), hypotension
(88/50), fever. This suggests sepsis with respiratory compromise. PN scope: PNs can apply
oxygen per protocol and must notify the RN immediately for unstable patients. Distractor A
delays critical intervention. Distractor B requires an RN order—PNs cannot independently
adjust IV rates for hemodynamic instability. Distractor D is unrelated to the immediate life
threats (hypoxemia, hypotension).
Q3 [IMAGE: IV Bag Label]
Copy
┌────────────────────────────────────────┐
│ 0.9% Sodium Chloride (Normal Saline) │
│ 1000 mL │
│ Start Time: 0600 │
│ Rate: 125 mL/hr (via pump) │
,│ Additive: KCl 20 mEq │
│ │
│ [WARNING: Potassium >10 mEq/hr │
│ requires cardiac monitoring] │
└────────────────────────────────────────┘
The PN is reviewing this IV order. What is the MOST important assessment before starting
this infusion?
A. Verify the IV site is patent
B. Ensure cardiac monitoring is available [CORRECT]
C. Check the patient's weight
D. Assess urine output for the last 8 hours
Correct Answer: B
Rationale: The label shows KCl 20 mEq in 1000 mL at 125 mL/hr. Infusion rate: 125 mL/hr
means the bag runs over 8 hours (1000 ÷ 125 = 8). Potassium delivery: 20 mEq ÷ 8 hours =
2.5 mEq/hr, which is below the 10 mEq/hr warning threshold. However, the principle is that
PNs must verify safety parameters for high-alert medications. If the rate were faster or
concentration higher, cardiac monitoring would be required. The question tests recognition
that KCl is a high-alert medication requiring safety verification. Distractor A is necessary but
not the priority safety check. Distractor C is relevant for dosing but this is a standard
concentration. Distractor D is important for potassium administration but not the immediate
safety priority.
Q4 [DRAG & DROP - Ordered Response]
[INTERFACE: Drag steps to the correct sequence]
The PN is assisting with sterile dressing change for a post-op abdominal wound. Place the
following actions in the correct order.
Available Steps:
● Remove old dressing using clean gloves
● Assess wound appearance and drainage
● Perform hand hygiene
● Apply sterile gloves
● Clean wound from center outward with sterile saline
● Apply new sterile dressing
, Correct Sequence: 3, 1, 2, 4, 5, 6
Rationale: Hand hygiene (3) always first. Remove old dressing (1) with clean gloves—this is
dirty work. Assess wound (2) before touching with sterile supplies. Sterile gloves (4) donned
after assessment to maintain sterility. Clean wound (5) from least contaminated (center) to
most (periphery). Apply dressing (6). This follows surgical asepsis principles and prevents
cross-contamination.
Q5 [SCREENSHOT: Intake & Output Record - 12 Hour Shift (0700-1900)]
Copy
┌─────────────────────────────────────────┐
│ INTAKE & OUTPUT RECORD │
│ Patient: R. Thompson | Room 412 │
├─────────────────────────────────────────┤
│ INTAKE: │
│ IV D5W 1000 mL (started 0700) │
│ IV Piggyback antibiotics 200 mL │
│ Oral fluids: 450 mL │
│ Ice chips: 1 cup (estimated 120 mL) │
├─────────────────────────────────────────┤
│ OUTPUT: │
│ Urine: 850 mL (Foley to gravity) │
│ NG suction: 400 mL │
│ Wound drainage: 50 mL │
│ Emesis: 200 mL │
└─────────────────────────────────────────┘
What is the patient's 12-hour fluid balance?
A. +270 mL
B. +470 mL [CORRECT]
C. +670 mL
D. +870 mL
Correct Answer: B (+470 mL)
Rationale: Intake calculation: IV D5W 1000 mL + IVPB 200 mL + PO 450 mL + ice chips 120
mL = 1770 mL. Note: Ice chips are calculated at half volume (60 mL) in some protocols, but
standard is full volume for I&O. Output calculation: Urine 850 mL + NG suction 400 mL +
wound drainage 50 mL + emesis 200 mL = 1500 mL. Balance: 1770 - 1500 = +270 mL? Let me
