NSG 233 Medical-Surgical Nursing II
HESI Actual Exam 2026/2027 | Verified
Questions
Higher Education Nursing Curriculum | Verified Q&A |
University-Level Nursing Students
Comprehensive 150-Question Original Actual Exam Set | 140 scored
and 10 unscored items | 2026/2027
Introduction
This 2026/2027 comprehensive 150-question actual exam set provides original Higher Education nursing
questions covering Cardiovascular and Respiratory Disorders, Gastrointestinal and Renal Disorders, Neurological
and Musculoskeletal Alterations, and Endocrine, Hematological, and Oncological Nursing Care. The set
represents 140 scored and 10 unscored items and is designed to reinforce official HESI Medical-Surgical Nursing
objectives for actual exam readiness and clinical proficiency by strengthening prioritization, pathophysiology,
medication safety, complication recognition, and evidence-based nursing interventions across acute and chronic
adult health conditions. Each item includes Verified Questions with concise rationales grounded in HESI Medical-
Surgical Nursing materials, evidence-based clinical guidelines, and current nursing standards of care.
Domain: Cardiovascular and Respiratory Disorders
1. A client with heart failure has severe dyspnea, pink frothy sputum, and crackles. Which position
is priority?
A. High Fowler position with legs dependent if tolerated
B. Flat supine with legs elevated
C. Prone with head lower than feet
D. Left side-lying with no oxygen assessment
Correct Answer: A
Rationale: Upright positioning reduces venous return and improves lung expansion during acute
pulmonary edema.
2. A client with chest pressure has ST elevation on the ECG monitor. Which action is priority?
A. Offer a full meal
B. Activate emergency cardiac response and obtain rapid provider-directed care
C. Delay until morning rounds
D. Encourage ambulation in the hallway
Correct Answer: B
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion requiring rapid
intervention.
3. Which finding is most concerning after femoral cardiac catheterization?
A. Mild bruising at insertion site
B. Client voids clear urine
C. Cool pale foot with diminished pedal pulse
D. Client reports hunger
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, Rationale: Decreased distal perfusion may indicate arterial compromise and requires immediate nursing
action.
4. Which laboratory value should be checked before administering digoxin?
A. Serum albumin only
B. Platelet count only
C. Urine specific gravity only
D. Potassium level
Correct Answer: D
Rationale: Hypokalemia increases digoxin toxicity risk and dysrhythmia potential.
5. A client receiving IV heparin reports sudden severe headache and weakness on one side. What
is the priority concern?
A. Intracranial bleeding
B. Expected medication effect
C. Mild dehydration
D. Stable therapeutic response
Correct Answer: A
Rationale: Heparin increases bleeding risk, and sudden neurologic change may signal hemorrhage.
6. Which instruction is appropriate for warfarin therapy?
A. Avoid all green vegetables forever
B. Maintain consistent vitamin K intake and report unusual bleeding
C. Double the dose after a missed dose
D. Stop INR monitoring when bruising is absent
Correct Answer: B
Rationale: Warfarin effect is influenced by vitamin K intake and requires monitoring for bleeding.
7. A client with atrial fibrillation is prescribed anticoagulation primarily to prevent which
complication?
A. Tension pneumothorax
B. Pancreatitis
C. Embolic stroke
D. Gastric ulcer
Correct Answer: C
Rationale: Atrial fibrillation can allow atrial clot formation with embolization to cerebral circulation.
8. Which sign suggests cardiogenic shock after myocardial infarction?
A. Warm skin with bounding pulse only
B. Isolated ankle itching
C. Localized abdominal rash
D. Hypotension with cool clammy skin and crackles
Correct Answer: D
Rationale: Pump failure reduces perfusion and can cause pulmonary congestion after myocardial injury.
9. A client has unilateral absent breath sounds, tracheal deviation, and hypotension after trauma.
What condition is suspected?
A. Tension pneumothorax
B. Simple bronchitis
C. Stable pleural effusion
D. Chronic sinusitis
Correct Answer: A
Rationale: Tension pneumothorax traps air under pressure, shifting mediastinal structures and impairing
circulation.
10. Which finding indicates worsening asthma requiring urgent action?
A. Mild wheeze after exercise with normal speech
B. Silent chest with increased work of breathing
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, C. Occasional dry cough only
D. Clear breath sounds and relaxed posture
Correct Answer: B
Rationale: A silent chest can indicate minimal airflow and impending respiratory failure.
11. Which oxygen device delivers a precise oxygen concentration?
A. Nasal cannula only
B. Simple gauze mask
C. Venturi mask
D. Room fan
Correct Answer: C
Rationale: A Venturi mask delivers a controlled fraction of inspired oxygen using entrainment ports.
12. A client with COPD becomes increasingly somnolent and has PaCO2 70 mm Hg. What is the
nurse’s priority interpretation?
A. The client is ready for discharge
B. The arterial gas is normal
C. The client needs unrestricted sedation
D. Ventilatory failure is developing
Correct Answer: D
Rationale: Rising carbon dioxide with decreased alertness indicates inadequate ventilation.
13. Which finding supports pneumonia rather than uncomplicated bronchitis?
A. Fever, focal crackles, and infiltrate on chest imaging
B. Clear lungs with mild throat irritation
C. Itchy eyes and sneezing
D. Normal temperature with no cough
Correct Answer: A
Rationale: Fever, focal lung findings, and infiltrate indicate parenchymal infection.
14. A client has sudden dyspnea, pleuritic chest pain, tachycardia, and low oxygen saturation after
surgery. What is most likely?
A. Otitis media
B. Pulmonary embolism
C. Gastroesophageal reflux
D. Tension headache
Correct Answer: B
Rationale: Postoperative immobility increases clot risk, and emboli commonly cause acute dyspnea and
pleuritic pain.
15. Which action helps prevent ventilator-associated pneumonia?
A. Keep client flat at all times
B. Avoid oral care
C. Elevate head of bed when not contraindicated
D. Disconnect ventilator tubing every hour
Correct Answer: C
Rationale: Head elevation reduces aspiration risk in mechanically ventilated clients.
16. Which chest tube observation suggests an air leak?
A. Gentle tidaling with respirations
B. Drainage system below chest level
C. Dressing dry and intact
D. Continuous bubbling in the water-seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates air entering the system or pleural
space.
17. What should the nurse do if a chest tube is accidentally pulled out?
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, A. Apply sterile occlusive dressing taped on three sides and notify the provider
B. Insert the tube back into the chest
C. Leave the site open to air
D. Raise the drainage unit above the chest
Correct Answer: A
Rationale: A three-sided occlusive dressing reduces air entry while allowing trapped air to escape.
18. A client with bacterial pneumonia develops confusion, hypotension, and rapid breathing.
Which complication is suspected?
A. Mild seasonal allergy
B. Sepsis
C. Stable recovery
D. Muscle strain
Correct Answer: B
Rationale: Infection plus altered mentation, hypotension, and tachypnea suggests systemic infection with
organ dysfunction.
19. Which symptom is characteristic of pericarditis?
A. Crushing pain relieved only by sleep
B. Pain limited to ankle motion
C. Sharp chest pain improved by sitting forward
D. Burning urination
Correct Answer: C
Rationale: Pericardial pain is often pleuritic and positional, improving when the client leans forward.
20. Which assessment finding is expected with right-sided heart failure?
A. Pink frothy sputum only
B. Absent bowel sounds
C. Fixed dilated pupils
D. Jugular venous distention and dependent edema
Correct Answer: D
Rationale: Right-sided failure causes systemic venous congestion, visible in neck veins and peripheral
edema.
21. Which rhythm requires immediate defibrillation if the client is pulseless?
A. Ventricular fibrillation
B. Sinus bradycardia with pulse
C. First-degree AV block
D. Normal sinus rhythm
Correct Answer: A
Rationale: Pulseless ventricular fibrillation is a shockable arrest rhythm requiring CPR and defibrillation.
22. Which finding suggests unstable tachycardia?
A. Normal blood pressure and no symptoms
B. Hypotension and altered mental status
C. Stable oxygen saturation and warm skin
D. Mild anxiety before discharge
Correct Answer: B
Rationale: Poor perfusion signs such as hypotension and altered mentation indicate instability.
23. Which medication should the nurse anticipate for symptomatic bradycardia per emergency
protocols?
A. Furosemide only
B. Warfarin
C. Atropine
D. Metformin
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
HESI Actual Exam 2026/2027 | Verified
Questions
Higher Education Nursing Curriculum | Verified Q&A |
University-Level Nursing Students
Comprehensive 150-Question Original Actual Exam Set | 140 scored
and 10 unscored items | 2026/2027
Introduction
This 2026/2027 comprehensive 150-question actual exam set provides original Higher Education nursing
questions covering Cardiovascular and Respiratory Disorders, Gastrointestinal and Renal Disorders, Neurological
and Musculoskeletal Alterations, and Endocrine, Hematological, and Oncological Nursing Care. The set
represents 140 scored and 10 unscored items and is designed to reinforce official HESI Medical-Surgical Nursing
objectives for actual exam readiness and clinical proficiency by strengthening prioritization, pathophysiology,
medication safety, complication recognition, and evidence-based nursing interventions across acute and chronic
adult health conditions. Each item includes Verified Questions with concise rationales grounded in HESI Medical-
Surgical Nursing materials, evidence-based clinical guidelines, and current nursing standards of care.
Domain: Cardiovascular and Respiratory Disorders
1. A client with heart failure has severe dyspnea, pink frothy sputum, and crackles. Which position
is priority?
A. High Fowler position with legs dependent if tolerated
B. Flat supine with legs elevated
C. Prone with head lower than feet
D. Left side-lying with no oxygen assessment
Correct Answer: A
Rationale: Upright positioning reduces venous return and improves lung expansion during acute
pulmonary edema.
2. A client with chest pressure has ST elevation on the ECG monitor. Which action is priority?
A. Offer a full meal
B. Activate emergency cardiac response and obtain rapid provider-directed care
C. Delay until morning rounds
D. Encourage ambulation in the hallway
Correct Answer: B
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion requiring rapid
intervention.
3. Which finding is most concerning after femoral cardiac catheterization?
A. Mild bruising at insertion site
B. Client voids clear urine
C. Cool pale foot with diminished pedal pulse
D. Client reports hunger
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, Rationale: Decreased distal perfusion may indicate arterial compromise and requires immediate nursing
action.
4. Which laboratory value should be checked before administering digoxin?
A. Serum albumin only
B. Platelet count only
C. Urine specific gravity only
D. Potassium level
Correct Answer: D
Rationale: Hypokalemia increases digoxin toxicity risk and dysrhythmia potential.
5. A client receiving IV heparin reports sudden severe headache and weakness on one side. What
is the priority concern?
A. Intracranial bleeding
B. Expected medication effect
C. Mild dehydration
D. Stable therapeutic response
Correct Answer: A
Rationale: Heparin increases bleeding risk, and sudden neurologic change may signal hemorrhage.
6. Which instruction is appropriate for warfarin therapy?
A. Avoid all green vegetables forever
B. Maintain consistent vitamin K intake and report unusual bleeding
C. Double the dose after a missed dose
D. Stop INR monitoring when bruising is absent
Correct Answer: B
Rationale: Warfarin effect is influenced by vitamin K intake and requires monitoring for bleeding.
7. A client with atrial fibrillation is prescribed anticoagulation primarily to prevent which
complication?
A. Tension pneumothorax
B. Pancreatitis
C. Embolic stroke
D. Gastric ulcer
Correct Answer: C
Rationale: Atrial fibrillation can allow atrial clot formation with embolization to cerebral circulation.
8. Which sign suggests cardiogenic shock after myocardial infarction?
A. Warm skin with bounding pulse only
B. Isolated ankle itching
C. Localized abdominal rash
D. Hypotension with cool clammy skin and crackles
Correct Answer: D
Rationale: Pump failure reduces perfusion and can cause pulmonary congestion after myocardial injury.
9. A client has unilateral absent breath sounds, tracheal deviation, and hypotension after trauma.
What condition is suspected?
A. Tension pneumothorax
B. Simple bronchitis
C. Stable pleural effusion
D. Chronic sinusitis
Correct Answer: A
Rationale: Tension pneumothorax traps air under pressure, shifting mediastinal structures and impairing
circulation.
10. Which finding indicates worsening asthma requiring urgent action?
A. Mild wheeze after exercise with normal speech
B. Silent chest with increased work of breathing
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, C. Occasional dry cough only
D. Clear breath sounds and relaxed posture
Correct Answer: B
Rationale: A silent chest can indicate minimal airflow and impending respiratory failure.
11. Which oxygen device delivers a precise oxygen concentration?
A. Nasal cannula only
B. Simple gauze mask
C. Venturi mask
D. Room fan
Correct Answer: C
Rationale: A Venturi mask delivers a controlled fraction of inspired oxygen using entrainment ports.
12. A client with COPD becomes increasingly somnolent and has PaCO2 70 mm Hg. What is the
nurse’s priority interpretation?
A. The client is ready for discharge
B. The arterial gas is normal
C. The client needs unrestricted sedation
D. Ventilatory failure is developing
Correct Answer: D
Rationale: Rising carbon dioxide with decreased alertness indicates inadequate ventilation.
13. Which finding supports pneumonia rather than uncomplicated bronchitis?
A. Fever, focal crackles, and infiltrate on chest imaging
B. Clear lungs with mild throat irritation
C. Itchy eyes and sneezing
D. Normal temperature with no cough
Correct Answer: A
Rationale: Fever, focal lung findings, and infiltrate indicate parenchymal infection.
14. A client has sudden dyspnea, pleuritic chest pain, tachycardia, and low oxygen saturation after
surgery. What is most likely?
A. Otitis media
B. Pulmonary embolism
C. Gastroesophageal reflux
D. Tension headache
Correct Answer: B
Rationale: Postoperative immobility increases clot risk, and emboli commonly cause acute dyspnea and
pleuritic pain.
15. Which action helps prevent ventilator-associated pneumonia?
A. Keep client flat at all times
B. Avoid oral care
C. Elevate head of bed when not contraindicated
D. Disconnect ventilator tubing every hour
Correct Answer: C
Rationale: Head elevation reduces aspiration risk in mechanically ventilated clients.
16. Which chest tube observation suggests an air leak?
A. Gentle tidaling with respirations
B. Drainage system below chest level
C. Dressing dry and intact
D. Continuous bubbling in the water-seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates air entering the system or pleural
space.
17. What should the nurse do if a chest tube is accidentally pulled out?
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
, A. Apply sterile occlusive dressing taped on three sides and notify the provider
B. Insert the tube back into the chest
C. Leave the site open to air
D. Raise the drainage unit above the chest
Correct Answer: A
Rationale: A three-sided occlusive dressing reduces air entry while allowing trapped air to escape.
18. A client with bacterial pneumonia develops confusion, hypotension, and rapid breathing.
Which complication is suspected?
A. Mild seasonal allergy
B. Sepsis
C. Stable recovery
D. Muscle strain
Correct Answer: B
Rationale: Infection plus altered mentation, hypotension, and tachypnea suggests systemic infection with
organ dysfunction.
19. Which symptom is characteristic of pericarditis?
A. Crushing pain relieved only by sleep
B. Pain limited to ankle motion
C. Sharp chest pain improved by sitting forward
D. Burning urination
Correct Answer: C
Rationale: Pericardial pain is often pleuritic and positional, improving when the client leans forward.
20. Which assessment finding is expected with right-sided heart failure?
A. Pink frothy sputum only
B. Absent bowel sounds
C. Fixed dilated pupils
D. Jugular venous distention and dependent edema
Correct Answer: D
Rationale: Right-sided failure causes systemic venous congestion, visible in neck veins and peripheral
edema.
21. Which rhythm requires immediate defibrillation if the client is pulseless?
A. Ventricular fibrillation
B. Sinus bradycardia with pulse
C. First-degree AV block
D. Normal sinus rhythm
Correct Answer: A
Rationale: Pulseless ventricular fibrillation is a shockable arrest rhythm requiring CPR and defibrillation.
22. Which finding suggests unstable tachycardia?
A. Normal blood pressure and no symptoms
B. Hypotension and altered mental status
C. Stable oxygen saturation and warm skin
D. Mild anxiety before discharge
Correct Answer: B
Rationale: Poor perfusion signs such as hypotension and altered mentation indicate instability.
23. Which medication should the nurse anticipate for symptomatic bradycardia per emergency
protocols?
A. Furosemide only
B. Warfarin
C. Atropine
D. Metformin
Correct Answer: C
NSG 233 Medical-Surgical Nursing II HESI Actual Exam 2026/2027 | Verified Questions
