HESI PN Medical-Surgical Test Bank 2026/2027 –
Practical/Vocational Nursing – Comprehensive NGN-Style
Competency Assessment with Detailed Practice Questions — 140
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area HESI PN Medical-Surgical Nursing
Description This comprehensive exam assesses the clinical reasoning, prioritization, and
application of evidence-based nursing care for adult patients with medical-surgical
conditions. It aligns with the latest NGN (Next Generation NCLEX) format,
requiring analysis of complex case scenarios, interpretation of clinical data, and
safe delegation. Content spans all major body systems, perioperative care,
oncology, fluid/electrolyte balance, and emergency nursing.
Expected Grade A+ (90% or higher)
Total Questions 140
Duration 3 hours
Learning Outcomes 1. Apply the nursing process to prioritize care for patients with acute and chronic
medical-surgical conditions.
2. Interpret clinical data (lab values, vital signs, diagnostic results) to detect
complications and guide interventions.
3. Differentiate between anticipated, nonessential, and contraindicated provider
prescriptions for complex patient scenarios.
4. Demonstrate safe delegation and interprofessional communication in the
medical-surgical setting.
Accreditation This exam meets the rigor and content standards for accredited US
practical/vocational nursing programs and prepares students for the HESI PN exit
exam and NCLEX-PN.
Page 1
,1. A patient with chronic heart failure is admitted with acute dyspnea, crackles up to
the scapulae, and a productive cough with pink-tinged sputum. The nurse notes the
patient has been nonadherent with the low-sodium diet and diuretic regimen. Which
intervention should the nurse implement first?
A. Administer intravenous furosemide 40 mg as prescribed.
B. Place the patient in high Fowler's position and apply supplemental oxygen.
C. Obtain a stat serum potassium level.
D. Notify the healthcare provider of the assessment findings.
Answer: B. Place the patient in high Fowler's position and apply supplemental
oxygen.
In acute pulmonary edema, the priority is to optimize oxygenation and reduce preload.
High Fowler's position decreases venous return and improves ventilation; oxygen
corrects hypoxemia. While diuretics are essential, positioning and oxygen are
immediate interventions to prevent respiratory failure.
2. A patient with a history of type 2 diabetes mellitus is admitted for elective
cholecystectomy. The nurse reviews the morning lab results: blood glucose 245
mg/dL, serum potassium 3.4 mEq/L, and hemoglobin A1c 8.2%. Which nursing
action is most appropriate?
A. Administer the prescribed oral hypoglycemic agent and proceed with surgery.
B. Notify the healthcare provider and anticipate postponement of surgery.
C. Administer potassium chloride intravenously as prescribed.
D. Give a bolus of regular insulin per sliding scale.
Answer: B. Notify the healthcare provider and anticipate postponement of surgery.
Elective surgery is typically postponed when blood glucose is >200 mg/dL and HbA1c is
elevated due to increased risk of infection, delayed wound healing, and metabolic
instability. The nurse should report findings to the provider; insulin and potassium
management may be needed but the priority is to recognize the need for glycemic
control before surgery.
Page 2
,3. A patient receiving continuous enteral tube feeding develops abdominal distention,
diarrhea, and a blood glucose of 180 mg/dL. The nurse suspects dumping syndrome.
Which intervention should the nurse implement?
A. Increase the infusion rate to clear the feeding tube.
B. Change to a hypotonic formula.
C. Administer an anti-diarrheal medication as prescribed.
D. Reduce the rate of the enteral feeding and monitor blood glucose.
Answer: D. Reduce the rate of the enteral feeding and monitor blood glucose.
Dumping syndrome results from rapid infusion of hypertonic feedings into the small
intestine, causing fluid shifts and hyperglycemia. Slowing the rate allows gradual
absorption and reduces symptoms. Increasing the rate or using hypotonic formula
would exacerbate the condition; anti-diarrheals are not first-line.
4. The nurse is caring for a patient with a chest tube connected to a water-seal
drainage system. During assessment, the nurse notes continuous bubbling in the
water-seal chamber. Which action should the nurse take?
A. Increase the suction pressure to resolve the bubbling.
B. Clamp the chest tube near the insertion site.
C. Check the entire system for an air leak.
D. Empty the drainage collection chamber.
Answer: C. Check the entire system for an air leak.
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse should
systematically check all connections and the chest tube insertion site for leaks.
Increasing suction may worsen the leak; clamping is dangerous and could cause tension
pneumothorax; emptying the chamber is unrelated.
Page 3
, 5. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with pneumonia. The arterial blood gas (ABG) results on room air: pH
7.32, PaCO2 58 mm Hg, PaO2 55 mm Hg, HCO3- 28 mEq/L. Which acid-base
imbalance does the nurse identify?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis with respiratory compensation
Answer: B. Partially compensated respiratory acidosis
The pH is acidic (7.32), PaCO2 is elevated (58), indicating respiratory acidosis. The
HCO3- is elevated (28), suggesting renal compensation. Because the pH is still below
7.35, compensation is partial. Full compensation would return pH to normal. Metabolic
alkalosis would show elevated pH and HCO3-.
6. A patient is receiving a blood transfusion of packed red blood cells. Fifteen
minutes after the infusion begins, the patient reports chills and low back pain. The
nurse notes a temperature of 101.2°F (38.4°C). Which action should the nurse take
first?
A. Administer an antipyretic as prescribed.
B. Slow the transfusion rate and monitor vital signs.
C. Stop the transfusion immediately and maintain IV access with normal saline.
D. Notify the healthcare provider and the blood bank.
Answer: C. Stop the transfusion immediately and maintain IV access with normal
saline.
Chills, back pain, and fever are signs of a hemolytic transfusion reaction, which is a
medical emergency. The priority is to stop the transfusion to prevent further reaction,
then maintain IV access with normal saline. Antipyretics may be given later; slowing
the transfusion is incorrect; notifying the provider and blood bank is important but
secondary.
Page 4
Practical/Vocational Nursing – Comprehensive NGN-Style
Competency Assessment with Detailed Practice Questions — 140
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area HESI PN Medical-Surgical Nursing
Description This comprehensive exam assesses the clinical reasoning, prioritization, and
application of evidence-based nursing care for adult patients with medical-surgical
conditions. It aligns with the latest NGN (Next Generation NCLEX) format,
requiring analysis of complex case scenarios, interpretation of clinical data, and
safe delegation. Content spans all major body systems, perioperative care,
oncology, fluid/electrolyte balance, and emergency nursing.
Expected Grade A+ (90% or higher)
Total Questions 140
Duration 3 hours
Learning Outcomes 1. Apply the nursing process to prioritize care for patients with acute and chronic
medical-surgical conditions.
2. Interpret clinical data (lab values, vital signs, diagnostic results) to detect
complications and guide interventions.
3. Differentiate between anticipated, nonessential, and contraindicated provider
prescriptions for complex patient scenarios.
4. Demonstrate safe delegation and interprofessional communication in the
medical-surgical setting.
Accreditation This exam meets the rigor and content standards for accredited US
practical/vocational nursing programs and prepares students for the HESI PN exit
exam and NCLEX-PN.
Page 1
,1. A patient with chronic heart failure is admitted with acute dyspnea, crackles up to
the scapulae, and a productive cough with pink-tinged sputum. The nurse notes the
patient has been nonadherent with the low-sodium diet and diuretic regimen. Which
intervention should the nurse implement first?
A. Administer intravenous furosemide 40 mg as prescribed.
B. Place the patient in high Fowler's position and apply supplemental oxygen.
C. Obtain a stat serum potassium level.
D. Notify the healthcare provider of the assessment findings.
Answer: B. Place the patient in high Fowler's position and apply supplemental
oxygen.
In acute pulmonary edema, the priority is to optimize oxygenation and reduce preload.
High Fowler's position decreases venous return and improves ventilation; oxygen
corrects hypoxemia. While diuretics are essential, positioning and oxygen are
immediate interventions to prevent respiratory failure.
2. A patient with a history of type 2 diabetes mellitus is admitted for elective
cholecystectomy. The nurse reviews the morning lab results: blood glucose 245
mg/dL, serum potassium 3.4 mEq/L, and hemoglobin A1c 8.2%. Which nursing
action is most appropriate?
A. Administer the prescribed oral hypoglycemic agent and proceed with surgery.
B. Notify the healthcare provider and anticipate postponement of surgery.
C. Administer potassium chloride intravenously as prescribed.
D. Give a bolus of regular insulin per sliding scale.
Answer: B. Notify the healthcare provider and anticipate postponement of surgery.
Elective surgery is typically postponed when blood glucose is >200 mg/dL and HbA1c is
elevated due to increased risk of infection, delayed wound healing, and metabolic
instability. The nurse should report findings to the provider; insulin and potassium
management may be needed but the priority is to recognize the need for glycemic
control before surgery.
Page 2
,3. A patient receiving continuous enteral tube feeding develops abdominal distention,
diarrhea, and a blood glucose of 180 mg/dL. The nurse suspects dumping syndrome.
Which intervention should the nurse implement?
A. Increase the infusion rate to clear the feeding tube.
B. Change to a hypotonic formula.
C. Administer an anti-diarrheal medication as prescribed.
D. Reduce the rate of the enteral feeding and monitor blood glucose.
Answer: D. Reduce the rate of the enteral feeding and monitor blood glucose.
Dumping syndrome results from rapid infusion of hypertonic feedings into the small
intestine, causing fluid shifts and hyperglycemia. Slowing the rate allows gradual
absorption and reduces symptoms. Increasing the rate or using hypotonic formula
would exacerbate the condition; anti-diarrheals are not first-line.
4. The nurse is caring for a patient with a chest tube connected to a water-seal
drainage system. During assessment, the nurse notes continuous bubbling in the
water-seal chamber. Which action should the nurse take?
A. Increase the suction pressure to resolve the bubbling.
B. Clamp the chest tube near the insertion site.
C. Check the entire system for an air leak.
D. Empty the drainage collection chamber.
Answer: C. Check the entire system for an air leak.
Continuous bubbling in the water-seal chamber indicates an air leak. The nurse should
systematically check all connections and the chest tube insertion site for leaks.
Increasing suction may worsen the leak; clamping is dangerous and could cause tension
pneumothorax; emptying the chamber is unrelated.
Page 3
, 5. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with pneumonia. The arterial blood gas (ABG) results on room air: pH
7.32, PaCO2 58 mm Hg, PaO2 55 mm Hg, HCO3- 28 mEq/L. Which acid-base
imbalance does the nurse identify?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis with respiratory compensation
Answer: B. Partially compensated respiratory acidosis
The pH is acidic (7.32), PaCO2 is elevated (58), indicating respiratory acidosis. The
HCO3- is elevated (28), suggesting renal compensation. Because the pH is still below
7.35, compensation is partial. Full compensation would return pH to normal. Metabolic
alkalosis would show elevated pH and HCO3-.
6. A patient is receiving a blood transfusion of packed red blood cells. Fifteen
minutes after the infusion begins, the patient reports chills and low back pain. The
nurse notes a temperature of 101.2°F (38.4°C). Which action should the nurse take
first?
A. Administer an antipyretic as prescribed.
B. Slow the transfusion rate and monitor vital signs.
C. Stop the transfusion immediately and maintain IV access with normal saline.
D. Notify the healthcare provider and the blood bank.
Answer: C. Stop the transfusion immediately and maintain IV access with normal
saline.
Chills, back pain, and fever are signs of a hemolytic transfusion reaction, which is a
medical emergency. The priority is to stop the transfusion to prevent further reaction,
then maintain IV access with normal saline. Antipyretics may be given later; slowing
the transfusion is incorrect; notifying the provider and blood bank is important but
secondary.
Page 4
