HESI PN MED-SURG EXAM 2026 | PRACTICAL
NURSING MEDICAL-SURGICAL NURSING
STUDY GUIDE | VERIFIED QUESTIONS &
ANSWERS | COMPREHENSIVE EXAM PREP
WITH DETAILED RATIONALES
• This comprehensive 200-question HESI PN Med-Surg Exam prep guide mirrors the
structure and rigor of the actual exam, covering all major medical-surgical nursing
domains tested at the practical nursing level.
• Study by attempting each question independently before reviewing the correct
answer and EXPERT RATIONALE — use the detailed explanations to reinforce
clinical reasoning, not just memorization.
1. A nurse is caring for a client with heart failure who has dependent edema
and shortness of breath. Which position should the nurse place the client in
to best relieve dyspnea?
A. Supine with legs elevated
B. Prone with head turned to the side
C. Lateral recumbent with knees flexed
D. Trendelenburg position
E. High Fowler's position with legs dependent
✓ Correct Answer: E. High Fowler's position with legs dependent
EXPERT RATIONALE: High Fowler's position (60–90 degrees) promotes maximal
lung expansion by allowing the diaphragm to descend. Keeping legs dependent
reduces venous return to the heart, decreasing preload and relieving pulmonary
congestion in heart failure clients.
2. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which dietary instruction is the priority?
A. Increase intake of bananas and oranges
,B. Encourage consumption of dairy products
C. Avoid high-potassium foods such as potatoes and tomatoes
D. Increase fluid intake to flush excess potassium
E. Recommend a high-protein diet
✓ Correct Answer: C. Avoid high-potassium foods such as potatoes and
tomatoes EXPERT RATIONALE: Hyperkalemia (potassium >5.0 mEq/L) is
dangerous in CKD because the kidneys cannot excrete excess potassium.
Restricting high-potassium foods prevents life-threatening cardiac dysrhythmias.
Bananas and oranges are high in potassium and must be avoided.
3. A nurse is assessing a client who has been admitted with a suspected
myocardial infarction (MI). Which symptom is most commonly associated
with an acute MI?
A. Sharp, pleuritic chest pain that worsens with breathing
B. Crushing substernal chest pain radiating to the left arm and jaw
C. Burning epigastric pain relieved by antacids
D. Intermittent chest tightness relieved by rest
E. Right-sided chest pain with deep inspiration
✓ Correct Answer: B. Crushing substernal chest pain radiating to the left arm
and jaw EXPERT RATIONALE: Classic MI pain is described as crushing, squeezing,
or pressure-like, located substernally, and may radiate to the left arm, jaw, neck, or
back. It is not relieved by rest or nitroglycerin and is often accompanied by
diaphoresis, nausea, and shortness of breath.
4. A client is prescribed furosemide (Lasix) for hypertension. Which electrolyte
imbalance should the nurse monitor for most closely?
A. Hypernatremia
,B. Hypercalcemia
C. Hypermagnesemia
D. Hypokalemia
E. Hyperphosphatemia
✓ Correct Answer: D. Hypokalemia EXPERT RATIONALE: Furosemide is a loop
diuretic that causes potassium wasting through the kidneys. Hypokalemia (K+ <3.5
mEq/L) can cause life-threatening cardiac dysrhythmias. Nurses must monitor
potassium levels and encourage potassium-rich foods or supplements as ordered.
5. A nurse is caring for a postoperative client who has not voided in 8 hours.
The client reports lower abdominal pressure. What is the nurse's priority
action?
A. Encourage increased oral fluid intake
B. Administer a diuretic as prescribed
C. Perform a bladder scan to assess for urinary retention
D. Insert a urinary catheter immediately
E. Document findings and continue to monitor
✓ Correct Answer: C. Perform a bladder scan to assess for urinary retention
EXPERT RATIONALE: The nurse should first assess bladder volume using a bladder
scan before any intervention. If the scan reveals significant urinary retention
(typically >300–400 mL), catheterization may then be indicated. Assessment
precedes intervention in the nursing process.
6. A client with type 2 diabetes has a fasting blood glucose of 52 mg/dL and is
conscious and alert. What is the nurse's first action?
A. Administer 50% dextrose IV push
B. Call the physician immediately
, C. Give 15–20 grams of fast-acting carbohydrates orally
D. Administer glucagon intramuscularly
E. Recheck the glucose in 30 minutes without treatment
✓ Correct Answer: C. Give 15–20 grams of fast-acting carbohydrates orally
EXPERT RATIONALE: The conscious, alert client with mild hypoglycemia is treated
with the "Rule of 15" — 15 grams of fast-acting carbohydrates (glucose tablets,
orange juice, regular soda) orally. IV dextrose and glucagon are reserved for
unconscious or severely hypoglycemic clients.
7. A nurse is caring for a client on warfarin therapy. Which laboratory value is
used to monitor the therapeutic effect of warfarin?
A. Partial thromboplastin time (PTT)
B. Complete blood count (CBC)
C. Activated clotting time (ACT)
D. Prothrombin time/INR
E. Platelet count
✓ Correct Answer: D. Prothrombin time/INR EXPERT RATIONALE: Warfarin
affects the extrinsic coagulation pathway and is monitored using PT/INR. The
therapeutic INR range for most indications is 2.0–3.0. PTT monitors heparin
therapy. Platelet count monitors thrombocytopenia, not anticoagulation.
8. A client is admitted with acute pancreatitis. Which position will best relieve
the client's abdominal pain?
A. Supine with arms at the sides
B. Prone with a pillow under the abdomen
C. High Fowler's with legs straight
D. Knee-chest (fetal) position
NURSING MEDICAL-SURGICAL NURSING
STUDY GUIDE | VERIFIED QUESTIONS &
ANSWERS | COMPREHENSIVE EXAM PREP
WITH DETAILED RATIONALES
• This comprehensive 200-question HESI PN Med-Surg Exam prep guide mirrors the
structure and rigor of the actual exam, covering all major medical-surgical nursing
domains tested at the practical nursing level.
• Study by attempting each question independently before reviewing the correct
answer and EXPERT RATIONALE — use the detailed explanations to reinforce
clinical reasoning, not just memorization.
1. A nurse is caring for a client with heart failure who has dependent edema
and shortness of breath. Which position should the nurse place the client in
to best relieve dyspnea?
A. Supine with legs elevated
B. Prone with head turned to the side
C. Lateral recumbent with knees flexed
D. Trendelenburg position
E. High Fowler's position with legs dependent
✓ Correct Answer: E. High Fowler's position with legs dependent
EXPERT RATIONALE: High Fowler's position (60–90 degrees) promotes maximal
lung expansion by allowing the diaphragm to descend. Keeping legs dependent
reduces venous return to the heart, decreasing preload and relieving pulmonary
congestion in heart failure clients.
2. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which dietary instruction is the priority?
A. Increase intake of bananas and oranges
,B. Encourage consumption of dairy products
C. Avoid high-potassium foods such as potatoes and tomatoes
D. Increase fluid intake to flush excess potassium
E. Recommend a high-protein diet
✓ Correct Answer: C. Avoid high-potassium foods such as potatoes and
tomatoes EXPERT RATIONALE: Hyperkalemia (potassium >5.0 mEq/L) is
dangerous in CKD because the kidneys cannot excrete excess potassium.
Restricting high-potassium foods prevents life-threatening cardiac dysrhythmias.
Bananas and oranges are high in potassium and must be avoided.
3. A nurse is assessing a client who has been admitted with a suspected
myocardial infarction (MI). Which symptom is most commonly associated
with an acute MI?
A. Sharp, pleuritic chest pain that worsens with breathing
B. Crushing substernal chest pain radiating to the left arm and jaw
C. Burning epigastric pain relieved by antacids
D. Intermittent chest tightness relieved by rest
E. Right-sided chest pain with deep inspiration
✓ Correct Answer: B. Crushing substernal chest pain radiating to the left arm
and jaw EXPERT RATIONALE: Classic MI pain is described as crushing, squeezing,
or pressure-like, located substernally, and may radiate to the left arm, jaw, neck, or
back. It is not relieved by rest or nitroglycerin and is often accompanied by
diaphoresis, nausea, and shortness of breath.
4. A client is prescribed furosemide (Lasix) for hypertension. Which electrolyte
imbalance should the nurse monitor for most closely?
A. Hypernatremia
,B. Hypercalcemia
C. Hypermagnesemia
D. Hypokalemia
E. Hyperphosphatemia
✓ Correct Answer: D. Hypokalemia EXPERT RATIONALE: Furosemide is a loop
diuretic that causes potassium wasting through the kidneys. Hypokalemia (K+ <3.5
mEq/L) can cause life-threatening cardiac dysrhythmias. Nurses must monitor
potassium levels and encourage potassium-rich foods or supplements as ordered.
5. A nurse is caring for a postoperative client who has not voided in 8 hours.
The client reports lower abdominal pressure. What is the nurse's priority
action?
A. Encourage increased oral fluid intake
B. Administer a diuretic as prescribed
C. Perform a bladder scan to assess for urinary retention
D. Insert a urinary catheter immediately
E. Document findings and continue to monitor
✓ Correct Answer: C. Perform a bladder scan to assess for urinary retention
EXPERT RATIONALE: The nurse should first assess bladder volume using a bladder
scan before any intervention. If the scan reveals significant urinary retention
(typically >300–400 mL), catheterization may then be indicated. Assessment
precedes intervention in the nursing process.
6. A client with type 2 diabetes has a fasting blood glucose of 52 mg/dL and is
conscious and alert. What is the nurse's first action?
A. Administer 50% dextrose IV push
B. Call the physician immediately
, C. Give 15–20 grams of fast-acting carbohydrates orally
D. Administer glucagon intramuscularly
E. Recheck the glucose in 30 minutes without treatment
✓ Correct Answer: C. Give 15–20 grams of fast-acting carbohydrates orally
EXPERT RATIONALE: The conscious, alert client with mild hypoglycemia is treated
with the "Rule of 15" — 15 grams of fast-acting carbohydrates (glucose tablets,
orange juice, regular soda) orally. IV dextrose and glucagon are reserved for
unconscious or severely hypoglycemic clients.
7. A nurse is caring for a client on warfarin therapy. Which laboratory value is
used to monitor the therapeutic effect of warfarin?
A. Partial thromboplastin time (PTT)
B. Complete blood count (CBC)
C. Activated clotting time (ACT)
D. Prothrombin time/INR
E. Platelet count
✓ Correct Answer: D. Prothrombin time/INR EXPERT RATIONALE: Warfarin
affects the extrinsic coagulation pathway and is monitored using PT/INR. The
therapeutic INR range for most indications is 2.0–3.0. PTT monitors heparin
therapy. Platelet count monitors thrombocytopenia, not anticoagulation.
8. A client is admitted with acute pancreatitis. Which position will best relieve
the client's abdominal pain?
A. Supine with arms at the sides
B. Prone with a pillow under the abdomen
C. High Fowler's with legs straight
D. Knee-chest (fetal) position
