HESI Med-Surg 2026/2027- 300 Verified Q&A | Med-Surg I & II
Ultimate Mastery Study Guide (Grade A+)
Ace your HESI Medical-Surgical nursing exam with this 2026/2027 Mastery Pack, featuring
over 250+ verified practice questions with detailed clinical rationales. This comprehensive guide
focuses on high-yield prioritization (ABCs), Next-Generation NCLEX (NGN) case study cues,
and critical nursing interventions for complex multi-system disorders. Designed for BSN
students, these materials bridge the gap between textbook theory and the high-stakes critical
thinking required for first-pass success on the HESI.
A patient with a history of heart failure is experiencing sudden onset of shortness of
breath and a "wet" cough. Which electrolyte imbalance is the nurse most
concerned about when initiating high-dose furosemide?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypophosphatemia
Answer: B. BROADWAY
Rationale: Furosemide is a loop diuretic that causes the kidneys to excrete
potassium. Low potassium (Hypokalemia) can lead to life-threatening cardiac
dysrhythmias and digoxin toxicity.
A patient is admitted with a serum sodium level of 112 mEq/L. What is the priority
nursing intervention?
A. Encourage oral fluid intake
B. Monitor for deep vein thrombosis
C. Initiate seizure precautions
D. Administer a 0.45% Sodium Chloride bolus
Answer: C. BROADWAY
Rationale: Severe hyponatremia (<120) causes cerebral edema, putting the
patient at extreme risk for seizures, coma, and death. Fluid restriction is usually
indicated, not increased intake.
The nurse is caring for a patient with a small bowel obstruction who has had a
nasogastric tube (NGT) to low intermittent suction for 3 days. Which acid-base
imbalance does the nurse anticipate?
, A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D. BROADWAY
Rationale: Gastric secretions are highly acidic. The loss of hydrogen ions through
NGT suctioning or vomiting causes the body to become more alkaline.
A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 52, HCO3 24. How
should the nurse interpret these results?
A. Respiratory Acidosis, uncompensated
B. Metabolic Acidosis, partially compensated
C. Respiratory Alkalosis, uncompensated
D. Metabolic Alkalosis, fully compensated
Answer: A. BROADWAY
Rationale: The pH is low (acidic), the CO2 is high (acidic), and the bicarbonate is
normal, indicating that the kidneys have not yet begun to compensate.
A patient with end-stage renal disease (ESRD) has a potassium level of 7.1 mEq/L.
Which medication should the nurse be prepared to administer first to stabilize the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Spironolactone
D. Regular Insulin and Dextrose
Answer: B. BROADWAY
Rationale: While Insulin/Dextrose and Kayexalate lower potassium, Calcium
Gluconate is the priority to protect the myocardium from the effects of
hyperkalemia and prevent cardiac arrest.
Cardiovascular System
A nurse is assessing a patient with right-sided heart failure. Which clinical manifestation
should the nurse expect?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular Venous Distension (JVD)
D. Pink frothy sputum
Answer: C. BROADWAY
,Rationale: Right-sided heart failure causes blood to back up into the systemic
circulation, leading to JVD, peripheral edema, and hepatomegaly. Pulmonary signs
indicate left-sided failure.
After a permanent pacemaker insertion, the nurse should provide which discharge
instruction to ensure lead stability?
A. Avoid all microwave ovens
B. Do not lift the arm on the surgical side above the head for 2 weeks
C. It is safe to undergo an MRI scheduled for next month
D. Resume vigorous contact sports immediately
Answer: B. BROADWAY
Rationale: Lifting the arm above the head can pull on or dislodge the newly placed
pacemaker leads before they are fully scarred into place.
Which lab value is the most specific indicator of an acute Myocardial Infarction (MI)?
A. CK-MB
B. Myoglobin
C. Troponin I
D. C-Reactive Protein (CRP)
Answer: C. BROADWAY
Rationale: Troponins are highly specific to cardiac muscle and remain elevated for up to
two weeks, making them the gold standard for MI diagnosis.
A patient with Peripheral Arterial Disease (PAD) reports severe pain in the legs while
walking that is relieved by rest. This is known as:
A. Raynaud’s phenomenon
B. Dependent rubor
C. Intermittent claudication
D. Phlebitis
Answer: C. BROADWAY
Rationale: Intermittent claudication is the hallmark sign of PAD, caused by muscle
ischemia during activity due to narrowed arteries.
A patient is receiving an IV Heparin infusion for a DVT. The nurse notes the patient’s
aPTT is 105 seconds (Control is 30). What is the nurse's priority action?
A. Increase the infusion rate
B. Stop the infusion and prepare Protamine Sulfate
C. Continue to monitor the patient
D. Administer Vitamin K
Answer: B. BROADWAY
, Rationale: The therapeutic range for aPTT is 1.5–2.5 times the control (approx. 45–75).
105 seconds is too high (bleeding risk). Protamine Sulfate is the specific antidote.
Respiratory System
A nurse is caring for a patient with a chest tube. The nurse notes continuous bubbling in
the water seal chamber. What does this indicate?
A. The lung has fully re-expanded
B. There is an air leak in the system
C. This is a normal finding during expiration
D. The suction is turned up too high
Answer: B. BROADWAY
Rationale: Bubbling in the water seal chamber should only be intermittent (when the
patient coughs or exhales). Continuous bubbling signifies a leak in the tubing or the
patient's pleural space.
What is the priority nursing intervention for a patient experiencing a Pulmonary
Embolism (PE)?
A. Administer oral anticoagulants
B. Apply a warm compress to the chest
C. Start a 12-lead EKG
D. Raise the head of the bed and apply Oxygen
Answer: D. BROADWAY
Rationale: Airway and Breathing (ABC) take priority. Elevating the HOB and giving O2
improves gas exchange and decreases the workload of the heart.
A patient with COPD is receiving oxygen via nasal cannula. Which oxygen saturation (
) range is the safest goal for this patient?
A. 95%–100%
B. 88%–92%
C. 70%–80%
D. 98%–100%
Answer: B. BROADWAY
Rationale: In chronic CO2 retainers, high levels of oxygen can suppress the
hypoxic drive to breathe. Maintaining a lower but safe range (88-92%) is
standard care.
A patient is 2 hours post-op from a bronchoscopy. Which assessment must the nurse
perform before allowing the patient to take a sip of water?
Ultimate Mastery Study Guide (Grade A+)
Ace your HESI Medical-Surgical nursing exam with this 2026/2027 Mastery Pack, featuring
over 250+ verified practice questions with detailed clinical rationales. This comprehensive guide
focuses on high-yield prioritization (ABCs), Next-Generation NCLEX (NGN) case study cues,
and critical nursing interventions for complex multi-system disorders. Designed for BSN
students, these materials bridge the gap between textbook theory and the high-stakes critical
thinking required for first-pass success on the HESI.
A patient with a history of heart failure is experiencing sudden onset of shortness of
breath and a "wet" cough. Which electrolyte imbalance is the nurse most
concerned about when initiating high-dose furosemide?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypophosphatemia
Answer: B. BROADWAY
Rationale: Furosemide is a loop diuretic that causes the kidneys to excrete
potassium. Low potassium (Hypokalemia) can lead to life-threatening cardiac
dysrhythmias and digoxin toxicity.
A patient is admitted with a serum sodium level of 112 mEq/L. What is the priority
nursing intervention?
A. Encourage oral fluid intake
B. Monitor for deep vein thrombosis
C. Initiate seizure precautions
D. Administer a 0.45% Sodium Chloride bolus
Answer: C. BROADWAY
Rationale: Severe hyponatremia (<120) causes cerebral edema, putting the
patient at extreme risk for seizures, coma, and death. Fluid restriction is usually
indicated, not increased intake.
The nurse is caring for a patient with a small bowel obstruction who has had a
nasogastric tube (NGT) to low intermittent suction for 3 days. Which acid-base
imbalance does the nurse anticipate?
, A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D. BROADWAY
Rationale: Gastric secretions are highly acidic. The loss of hydrogen ions through
NGT suctioning or vomiting causes the body to become more alkaline.
A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 52, HCO3 24. How
should the nurse interpret these results?
A. Respiratory Acidosis, uncompensated
B. Metabolic Acidosis, partially compensated
C. Respiratory Alkalosis, uncompensated
D. Metabolic Alkalosis, fully compensated
Answer: A. BROADWAY
Rationale: The pH is low (acidic), the CO2 is high (acidic), and the bicarbonate is
normal, indicating that the kidneys have not yet begun to compensate.
A patient with end-stage renal disease (ESRD) has a potassium level of 7.1 mEq/L.
Which medication should the nurse be prepared to administer first to stabilize the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Spironolactone
D. Regular Insulin and Dextrose
Answer: B. BROADWAY
Rationale: While Insulin/Dextrose and Kayexalate lower potassium, Calcium
Gluconate is the priority to protect the myocardium from the effects of
hyperkalemia and prevent cardiac arrest.
Cardiovascular System
A nurse is assessing a patient with right-sided heart failure. Which clinical manifestation
should the nurse expect?
A. Pulmonary crackles
B. Dyspnea on exertion
C. Jugular Venous Distension (JVD)
D. Pink frothy sputum
Answer: C. BROADWAY
,Rationale: Right-sided heart failure causes blood to back up into the systemic
circulation, leading to JVD, peripheral edema, and hepatomegaly. Pulmonary signs
indicate left-sided failure.
After a permanent pacemaker insertion, the nurse should provide which discharge
instruction to ensure lead stability?
A. Avoid all microwave ovens
B. Do not lift the arm on the surgical side above the head for 2 weeks
C. It is safe to undergo an MRI scheduled for next month
D. Resume vigorous contact sports immediately
Answer: B. BROADWAY
Rationale: Lifting the arm above the head can pull on or dislodge the newly placed
pacemaker leads before they are fully scarred into place.
Which lab value is the most specific indicator of an acute Myocardial Infarction (MI)?
A. CK-MB
B. Myoglobin
C. Troponin I
D. C-Reactive Protein (CRP)
Answer: C. BROADWAY
Rationale: Troponins are highly specific to cardiac muscle and remain elevated for up to
two weeks, making them the gold standard for MI diagnosis.
A patient with Peripheral Arterial Disease (PAD) reports severe pain in the legs while
walking that is relieved by rest. This is known as:
A. Raynaud’s phenomenon
B. Dependent rubor
C. Intermittent claudication
D. Phlebitis
Answer: C. BROADWAY
Rationale: Intermittent claudication is the hallmark sign of PAD, caused by muscle
ischemia during activity due to narrowed arteries.
A patient is receiving an IV Heparin infusion for a DVT. The nurse notes the patient’s
aPTT is 105 seconds (Control is 30). What is the nurse's priority action?
A. Increase the infusion rate
B. Stop the infusion and prepare Protamine Sulfate
C. Continue to monitor the patient
D. Administer Vitamin K
Answer: B. BROADWAY
, Rationale: The therapeutic range for aPTT is 1.5–2.5 times the control (approx. 45–75).
105 seconds is too high (bleeding risk). Protamine Sulfate is the specific antidote.
Respiratory System
A nurse is caring for a patient with a chest tube. The nurse notes continuous bubbling in
the water seal chamber. What does this indicate?
A. The lung has fully re-expanded
B. There is an air leak in the system
C. This is a normal finding during expiration
D. The suction is turned up too high
Answer: B. BROADWAY
Rationale: Bubbling in the water seal chamber should only be intermittent (when the
patient coughs or exhales). Continuous bubbling signifies a leak in the tubing or the
patient's pleural space.
What is the priority nursing intervention for a patient experiencing a Pulmonary
Embolism (PE)?
A. Administer oral anticoagulants
B. Apply a warm compress to the chest
C. Start a 12-lead EKG
D. Raise the head of the bed and apply Oxygen
Answer: D. BROADWAY
Rationale: Airway and Breathing (ABC) take priority. Elevating the HOB and giving O2
improves gas exchange and decreases the workload of the heart.
A patient with COPD is receiving oxygen via nasal cannula. Which oxygen saturation (
) range is the safest goal for this patient?
A. 95%–100%
B. 88%–92%
C. 70%–80%
D. 98%–100%
Answer: B. BROADWAY
Rationale: In chronic CO2 retainers, high levels of oxygen can suppress the
hypoxic drive to breathe. Maintaining a lower but safe range (88-92%) is
standard care.
A patient is 2 hours post-op from a bronchoscopy. Which assessment must the nurse
perform before allowing the patient to take a sip of water?
