HESI PN Medical-Surgical Test Bank
Official NGN Competency Assessment
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PERIOPERATIVE & INTEGUMENTARY DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client is on postoperative day 3 after an open cholecystectomy. While getting
out of bed, the client calls out that something "gave way" at the incision site. The PN finds
the wound edges separated with loops of intestine visible.
A. Cover the exposed viscera with sterile saline-soaked dressings and notify the RN
immediately. ✓ CORRECT
B. Apply a sterile dry gauze dressing tightly over the wound to prevent further exposure.
C. Push the protruding intestine back into the abdominal cavity using sterile gloves.
D. Place the client in a left lateral position and administer the prescribed analgesic.
Correct Answer: A
Rationale: Covering exposed viscera with sterile saline-soaked dressings prevents tissue
desiccation and infection while maintaining a sterile field until surgical intervention. Pushing
the intestine back into the cavity introduces bacteria and risks perforation, and a dry dressing
will adhere to the tissue and cause further damage. Evisceration is a surgical emergency that
requires immediate RN notification and preparation for the operating room.
Question 2 of 50
A 54-year-old client is scheduled for a total knee replacement in 5 days and takes warfarin 5
mg daily for atrial fibrillation. During the preoperative clinic visit, the PN reviews the
medication list with the client.
A. Instruct the client to stop the warfarin immediately and resume it the evening after surgery.
,B. Tell the client to contact the surgeon's office for specific instructions about stopping the
warfarin. ✓ CORRECT
C. Advise the client to take the usual dose of warfarin the morning of surgery with a sip of
water.
D. Suggest the client switch to aspirin 81 mg daily until the day of surgery.
Correct Answer: B
Rationale: The surgeon must provide individualized instructions for anticoagulant
management based on the client's thromboembolic risk and planned procedure. The PN does
not independently discontinue anticoagulants, as premature stopping increases clotting risk
and continuing it increases bleeding risk. This response respects the PN scope of practice
while ensuring client safety through appropriate provider communication.
Question 3 of 50
A 32-year-old client is admitted 2 hours after sustaining partial-thickness burns to 35% of the
total body surface area from a house fire. The PN is monitoring the client during the initial
fluid resuscitation phase.
A. Assess the client's blood glucose every 30 minutes to evaluate metabolic response.
B. Monitor the client's hourly urine output and expect it to remain below 20 mL/hr during the
first 8 hours.
C. Evaluate the client's hourly urine output and report an output below 30 mL/hr to the RN. ✓
CORRECT
D. Check the client's weight every 4 hours to determine the effectiveness of fluid
replacement.
Correct Answer: C
Rationale: Hourly urine output is the primary indicator of adequate fluid resuscitation in burn
injuries, with an expected range of 30 to 50 mL per hour for adults. An output below 30 mL/hr
signals inadequate perfusion and requires immediate intervention to prevent acute kidney
injury. Blood glucose monitoring is not the priority during initial resuscitation, and weights
fluctuate with edema rather than reflecting real-time perfusion status.
Question 4 of 50
An 82-year-old client with limited mobility has a 3 cm by 2 cm wound over the right ischial
tuberosity. The PN observes a shallow open ulcer with a red-pink wound bed and no slough or
bruising present.
A. Document this as a Stage 3 pressure injury because the skin is fully broken.
B. Stage this as a Stage 1 pressure injury with partial-thickness skin loss.
C. Classify this as an unstageable pressure injury due to the wound bed appearance.
D. Identify this as a Stage 2 pressure injury with partial-thickness skin loss. ✓ CORRECT
, Correct Answer: D
Rationale: A Stage 2 pressure injury presents as partial-thickness skin loss with a visible
red-pink wound bed and no slough or bruising, which matches this description exactly. Stage
1 involves intact skin with non-blanchable erythema, while Stage 3 involves full-thickness
skin loss with visible subcutaneous fat. Accurate staging guides treatment selection and
determines reimbursement and quality metrics.
Question 5 of 50
A 45-year-old client is 6 hours postoperative after a total thyroidectomy. The PN enters the
room and notices the client is restless, has a respiratory rate of 28, and is making
high-pitched inspiratory sounds.
A. Stay with the client, call for the RN immediately, and keep emergency airway equipment
nearby. ✓ CORRECT
B. Offer the client a sip of water to soothe the throat and reduce the respiratory effort.
C. Reposition the client to a high-Fowler's position and wait to see if the breathing improves.
D. Administer the prescribed PRN morphine to decrease the client's anxiety and respiratory
rate.
Correct Answer: A
Rationale: Restlessness and stridor after thyroidectomy indicate possible tracheal
compression from a neck hematoma, which is a life-threatening airway emergency requiring
immediate RN and provider notification. Morphine would depress respirations further, and
waiting to observe could allow complete airway obstruction to develop. The PN must stay
with the client while mobilizing emergency resources.
Question 6 of 50
During a sterile dressing change for a postoperative abdominal wound, the PN accidentally
touches the sterile field with an ungloved hand.
A. Continue the procedure quickly since the wound is already colonized with bacteria.
B. Discard the contaminated supplies, wash hands, and set up a new sterile field. ✓ CORRECT
C. Pour additional sterile saline over the area touched to rinse away contamination.
D. Apply sterile gloves over the ungloved hand and continue with the dressing change.
Correct Answer: B
Rationale: Any break in surgical asepsis requires discarding all contaminated supplies and
establishing a new sterile field to prevent introducing pathogens into the wound. Sterility
cannot be restored by pouring saline or adding gloves over a contaminated hand, and
assuming colonization justifies poor technique places the client at risk for surgical site
infection. This standard protects all clients regardless of wound status.
Official NGN Competency Assessment
Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PERIOPERATIVE & INTEGUMENTARY DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client is on postoperative day 3 after an open cholecystectomy. While getting
out of bed, the client calls out that something "gave way" at the incision site. The PN finds
the wound edges separated with loops of intestine visible.
A. Cover the exposed viscera with sterile saline-soaked dressings and notify the RN
immediately. ✓ CORRECT
B. Apply a sterile dry gauze dressing tightly over the wound to prevent further exposure.
C. Push the protruding intestine back into the abdominal cavity using sterile gloves.
D. Place the client in a left lateral position and administer the prescribed analgesic.
Correct Answer: A
Rationale: Covering exposed viscera with sterile saline-soaked dressings prevents tissue
desiccation and infection while maintaining a sterile field until surgical intervention. Pushing
the intestine back into the cavity introduces bacteria and risks perforation, and a dry dressing
will adhere to the tissue and cause further damage. Evisceration is a surgical emergency that
requires immediate RN notification and preparation for the operating room.
Question 2 of 50
A 54-year-old client is scheduled for a total knee replacement in 5 days and takes warfarin 5
mg daily for atrial fibrillation. During the preoperative clinic visit, the PN reviews the
medication list with the client.
A. Instruct the client to stop the warfarin immediately and resume it the evening after surgery.
,B. Tell the client to contact the surgeon's office for specific instructions about stopping the
warfarin. ✓ CORRECT
C. Advise the client to take the usual dose of warfarin the morning of surgery with a sip of
water.
D. Suggest the client switch to aspirin 81 mg daily until the day of surgery.
Correct Answer: B
Rationale: The surgeon must provide individualized instructions for anticoagulant
management based on the client's thromboembolic risk and planned procedure. The PN does
not independently discontinue anticoagulants, as premature stopping increases clotting risk
and continuing it increases bleeding risk. This response respects the PN scope of practice
while ensuring client safety through appropriate provider communication.
Question 3 of 50
A 32-year-old client is admitted 2 hours after sustaining partial-thickness burns to 35% of the
total body surface area from a house fire. The PN is monitoring the client during the initial
fluid resuscitation phase.
A. Assess the client's blood glucose every 30 minutes to evaluate metabolic response.
B. Monitor the client's hourly urine output and expect it to remain below 20 mL/hr during the
first 8 hours.
C. Evaluate the client's hourly urine output and report an output below 30 mL/hr to the RN. ✓
CORRECT
D. Check the client's weight every 4 hours to determine the effectiveness of fluid
replacement.
Correct Answer: C
Rationale: Hourly urine output is the primary indicator of adequate fluid resuscitation in burn
injuries, with an expected range of 30 to 50 mL per hour for adults. An output below 30 mL/hr
signals inadequate perfusion and requires immediate intervention to prevent acute kidney
injury. Blood glucose monitoring is not the priority during initial resuscitation, and weights
fluctuate with edema rather than reflecting real-time perfusion status.
Question 4 of 50
An 82-year-old client with limited mobility has a 3 cm by 2 cm wound over the right ischial
tuberosity. The PN observes a shallow open ulcer with a red-pink wound bed and no slough or
bruising present.
A. Document this as a Stage 3 pressure injury because the skin is fully broken.
B. Stage this as a Stage 1 pressure injury with partial-thickness skin loss.
C. Classify this as an unstageable pressure injury due to the wound bed appearance.
D. Identify this as a Stage 2 pressure injury with partial-thickness skin loss. ✓ CORRECT
, Correct Answer: D
Rationale: A Stage 2 pressure injury presents as partial-thickness skin loss with a visible
red-pink wound bed and no slough or bruising, which matches this description exactly. Stage
1 involves intact skin with non-blanchable erythema, while Stage 3 involves full-thickness
skin loss with visible subcutaneous fat. Accurate staging guides treatment selection and
determines reimbursement and quality metrics.
Question 5 of 50
A 45-year-old client is 6 hours postoperative after a total thyroidectomy. The PN enters the
room and notices the client is restless, has a respiratory rate of 28, and is making
high-pitched inspiratory sounds.
A. Stay with the client, call for the RN immediately, and keep emergency airway equipment
nearby. ✓ CORRECT
B. Offer the client a sip of water to soothe the throat and reduce the respiratory effort.
C. Reposition the client to a high-Fowler's position and wait to see if the breathing improves.
D. Administer the prescribed PRN morphine to decrease the client's anxiety and respiratory
rate.
Correct Answer: A
Rationale: Restlessness and stridor after thyroidectomy indicate possible tracheal
compression from a neck hematoma, which is a life-threatening airway emergency requiring
immediate RN and provider notification. Morphine would depress respirations further, and
waiting to observe could allow complete airway obstruction to develop. The PN must stay
with the client while mobilizing emergency resources.
Question 6 of 50
During a sterile dressing change for a postoperative abdominal wound, the PN accidentally
touches the sterile field with an ungloved hand.
A. Continue the procedure quickly since the wound is already colonized with bacteria.
B. Discard the contaminated supplies, wash hands, and set up a new sterile field. ✓ CORRECT
C. Pour additional sterile saline over the area touched to rinse away contamination.
D. Apply sterile gloves over the ungloved hand and continue with the dressing change.
Correct Answer: B
Rationale: Any break in surgical asepsis requires discarding all contaminated supplies and
establishing a new sterile field to prevent introducing pathogens into the wound. Sterility
cannot be restored by pouring saline or adding gloves over a contaminated hand, and
assuming colonization justifies poor technique places the client at risk for surgical site
infection. This standard protects all clients regardless of wound status.
