HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
HESI PN MED-SURG EXAM 2026
Actual Questions and Answers () — Verified Answers
A Comprehensive Practical Nursing Medical-Surgical Examination Aligned with 2026–2027 HESI PN
Standards, NCLEX-PN Competencies, and Evidence-Based Practice Guidelines
100 Questions • 10 Sections • Cardiovascular • Respiratory • GI • Renal/GU • Endocrine • Neurological •
Musculoskeletal/Integumentary • Hematologic/Immunologic/Oncologic • Perioperative • Integrated Clinical Judgment
Section 1: Cardiovascular Disorders
Q1: A 68-year-old client with heart failure reports waking up gasping for breath in the middle of the night and
uses three pillows to sleep. Which assessment finding is most consistent with left-sided heart failure?
A. Jugular vein distention and dependent edema
B. Hepatomegaly and right upper quadrant pain
C. Crackles in the lung bases and an S3 gallop [CORRECT]
D. Weight gain of 4 pounds and abdominal ascites
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to the left ventricle's inability to effectively pump blood
forward, leading to fluid backing up into the lungs. Classic manifestations include paroxysmal nocturnal dyspnea, orthopnea,
crackles (rales) at the lung bases, a third heart sound (S3 gallop), cough, fatigue, and tachycardia. Options A, B, and D
describe right-sided heart failure, where backup occurs in the systemic venous system producing JVD, hepatomegaly, ascites,
and dependent peripheral edema. Recognizing left versus right-sided findings is essential for accurate HESI PN prioritization.
Q2: A client with heart failure is prescribed furosemide 40 mg IV daily. Which laboratory value requires the
nurse to withhold the medication and notify the provider immediately?
A. Serum sodium 135 mEq/L
B. Serum potassium 3.0 mEq/L [CORRECT]
C. Serum creatinine 1.1 mg/dL
D. Blood urea nitrogen 18 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss through the distal tubule. A potassium of 3.0
mEq/L (normal 3.5–5.0) indicates hypokalemia, which predisposes the client to life-threatening dysrhythmias, especially
digoxin toxicity if the client is also taking digoxin. The nurse must hold the dose and notify the provider for potassium
replacement before administering the diuretic. Sodium of 135, creatinine of 1.1, and BUN of 18 are all within or near normal
limits and do not require holding the medication. This question tests application of pharmacologic safety principles in heart
failure management.
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,HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q3: A client taking digoxin 0.25 mg daily for heart failure reports nausea, vomiting, and seeing yellow-green
halos around lights. The apical pulse is 52 beats per minute. Which action should the practical nurse take first?
A. Administer the next dose of digoxin as scheduled
B. Withhold digoxin and notify the healthcare provider [CORRECT]
C. Document the findings and continue monitoring
D. Administer an antiemetic for the nausea
Correct Answer: B
Rationale: The client is exhibiting classic signs of digoxin toxicity: gastrointestinal symptoms (anorexia, nausea, vomiting),
visual disturbances (yellow-green halos), and bradycardia (pulse <60 bpm). The therapeutic digoxin range is 0.8–2.0 ng/mL.
The priority action is to withhold the medication and notify the provider, who may order a serum digoxin level, potassium
level (hypokalemia potentiates toxicity), and possibly digoxin immune Fab (Digibind) as the antidote for severe toxicity.
Administering the next dose would worsen toxicity, and simply documenting or giving an antiemetic delays critical
intervention.
Q4: The nurse is teaching a client with heart failure about dietary modifications. Which statement by the client
indicates that teaching has been effective?
A. "I should consume no more than 4 grams of sodium per day."
B. "I will limit my daily fluid intake to 1.5 to 2 liters." [CORRECT]
C. "I should drink at least 3 liters of water to stay hydrated."
D. "I can use a salt substitute instead of regular table salt."
Correct Answer: B
Rationale: Clients with heart failure are typically placed on a sodium restriction of 2 g/day and a fluid restriction of 1.5–2
L/day to prevent volume overload and exacerbations. Fluid restriction reduces cardiac workload and prevents pulmonary
congestion. Option A is incorrect because the sodium limit is 2 g, not 4 g. Option C would worsen fluid overload. Option D is
dangerous because many salt substitutes contain potassium chloride, which can cause hyperkalemia—especially dangerous in
clients taking ACE inhibitors or ARBs. Daily weights (reporting a 2–3 lb gain in one day or 5 lb in a week) should also be
reinforced.
Q5: A 58-year-old client is admitted with hypertensive crisis. Blood pressure is 188/114 mmHg, and the client
reports a severe headache and confusion. Which IV medication should the nurse anticipate being prescribed?
A. Oral losartan
B. IV labetalol [CORRECT]
C. Sublingual nitroglycerin
D. Oral hydrochlorothiazide
Correct Answer: B
Rationale: Hypertensive crisis is defined as a blood pressure >180/120 mmHg with target organ damage (brain, heart,
kidneys). IV antihypertensives such as labetalol, nicardipine, or sodium nitroprusside are used to lower BP gradually (by no
more than 25% in the first hour) to prevent ischemic stroke or organ hypoperfusion. Oral medications (options A and D) act
too slowly for this emergency. Sublingual nitroglycerin (option C) is used for angina, not hypertensive crisis, and has a short
duration of action. The nurse must also continuously monitor neurologic status, urine output, and ECG for end-organ effects.
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,HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q6: A client with primary hypertension is being discharged with a new prescription for lisinopril 10 mg daily.
Which instruction is most important for the nurse to include in discharge teaching?
A. Take the medication at bedtime to prevent dizziness.
B. Report a persistent dry cough to the healthcare provider. [CORRECT]
C. Increase dietary potassium-rich foods such as bananas.
D. Avoid grapefruit juice while taking this medication.
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that can cause a persistent dry cough in up to 20% of clients due to bradykinin
accumulation in the lungs. While not life-threatening, the cough often warrants switching to an ARB (such as losartan).
Clients should report this side effect rather than discontinue the drug abruptly. Option A is unnecessary; ACE inhibitors are
usually taken in the morning. Option C is dangerous because ACE inhibitors can cause potassium retention (hyperkalemia), so
potassium intake should not be increased. Option D applies to certain calcium channel blockers and statins, not ACE
inhibitors.
Q7: A client arrives at the emergency department reporting chest pressure that started 30 minutes ago while at
rest, radiating to the left arm, with diaphoresis and nausea. Which action should the nurse take first?
A. Administer sublingual nitroglycerin 0.4 mg
B. Apply oxygen at 2 L/min via nasal cannula [CORRECT]
C. Obtain a 12-lead electrocardiogram
D. Administer aspirin 325 mg chewable
Correct Answer: B
Rationale: Using the ABC priority framework, airway and breathing take precedence. The client is experiencing symptoms
of acute coronary syndrome (likely unstable angina or MI). Oxygen should be applied first if SpO2 is below 94% or there is
respiratory distress, although routine oxygen for normoxic clients is no longer recommended. After stabilizing oxygenation,
the nurse would obtain a 12-lead ECG (within 10 minutes of arrival), administer aspirin 162–325 mg chewable to inhibit
platelet aggregation, and give nitroglycerin for pain. Cardiac biomarkers (troponin, CK-MB) are also drawn. This question
tests prioritization within the ACS protocol (MONA — Morphine, Oxygen, Nitroglycerin, Aspirin).
Q8: A client is receiving IV heparin for treatment of a deep vein thrombosis (DVT). The client's aPTT is 110
seconds (control 35 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate
B. Document the finding; the value is therapeutic
C. Stop the infusion and notify the healthcare provider [CORRECT]
D. Administer protamine sulfate as an antidote
Correct Answer: C
Rationale: The therapeutic range for heparin is 1.5–2.5 times the control aPTT, which would be approximately 52–88
seconds for a control of 35. An aPTT of 110 seconds is above the therapeutic range and indicates a bleeding risk. The nurse
should stop the infusion immediately and notify the provider for a dose adjustment. Option A would worsen the situation.
Option B is incorrect because the value is not therapeutic—it is supratherapeutic. Option D (protamine sulfate) is the antidote
for heparin, but it is reserved for significant bleeding or markedly elevated aPTT with active hemorrhage, not simply an
elevated value without symptoms.
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, HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q9: A client with a DVT is being transitioned from IV heparin to oral warfarin. The client asks, "Why do I
have to take two blood thinners at the same time?" What is the nurse's best response?
A. "Warfarin takes 3 to 5 days to reach its full therapeutic effect." [CORRECT]
B. "Heparin and warfarin work together to prevent all clot formation."
C. "You only need to take warfarin once your INR is below 1.0."
D. "The two medications prevent different types of blood clots."
Correct Answer: A
Rationale: Warfarin inhibits synthesis of vitamin K–dependent clotting factors (II, VII, IX, X), but it takes 3–5 days to
achieve therapeutic effect. During this overlap period, heparin provides immediate anticoagulation while warfarin builds to
therapeutic levels. Heparin is discontinued once the INR reaches the therapeutic range (2.0–3.0 for VTE). Option B is
incorrect—they do not work synergistically; they have different mechanisms. Option C is wrong because the INR goal is 2–3,
not below 1. Option D is incorrect; both prevent similar clots but through different mechanisms and timeframes.
Q10: A client is admitted with new-onset atrial fibrillation. The heart rate is 142 beats per minute and
irregularly irregular, and no P waves are visible on the ECG. Which complication is the client at greatest risk
for?
A. Cardiac tamponade
B. Pulmonary embolism
C. Ischemic stroke [CORRECT]
D. Ventricular fibrillation
Correct Answer: C
Rationale: In atrial fibrillation, the atria quiver rather than contract effectively, causing blood to pool in the atria (especially
the left atrial appendage) and form thrombi. These clots can embolize to the brain, causing an ischemic stroke. Clients are
typically anticoagulated with warfarin (INR 2–3) or a DOAC to reduce stroke risk. Rate control is achieved with
beta-blockers, calcium channel blockers, or digoxin; rhythm control may involve amiodarone or cardioversion. Options A, B,
and D are not the primary complications of atrial fibrillation. The irregularly irregular rhythm and absent P waves are
hallmark ECG findings.
Q11: A client on the telemetry unit suddenly becomes unresponsive. The monitor shows ventricular fibrillation.
Which action should the nurse take first?
A. Administer IV epinephrine 1 mg
B. Defibrillate at 200 joules (biphasic)
C. Begin chest compressions at 100–120 per minute [CORRECT]
D. Administer IV amiodarone 300 mg
Correct Answer: C
Rationale: Ventricular fibrillation is a shockable rhythm, but per the current ACLS algorithm, the nurse should immediately
call for help, begin high-quality CPR (compressions at 100–120/min, depth 2–2.4 inches), and defibrillate as soon as the
defibrillator is available. If the nurse is alone, the order is: call for help → start CPR → defibrillate. Option B (defibrillation)
is the definitive treatment, but CPR must be initiated immediately to maintain perfusion while the defibrillator is being
retrieved. Epinephrine (option A) and amiodarone (option D) are given after the first shock during CPR cycles. This question
tests prioritization in a code situation.
Page 4 | HESI PN Medical-Surgical Exam 2026 | Confidential Study Resource
HESI PN MED-SURG EXAM 2026
Actual Questions and Answers () — Verified Answers
A Comprehensive Practical Nursing Medical-Surgical Examination Aligned with 2026–2027 HESI PN
Standards, NCLEX-PN Competencies, and Evidence-Based Practice Guidelines
100 Questions • 10 Sections • Cardiovascular • Respiratory • GI • Renal/GU • Endocrine • Neurological •
Musculoskeletal/Integumentary • Hematologic/Immunologic/Oncologic • Perioperative • Integrated Clinical Judgment
Section 1: Cardiovascular Disorders
Q1: A 68-year-old client with heart failure reports waking up gasping for breath in the middle of the night and
uses three pillows to sleep. Which assessment finding is most consistent with left-sided heart failure?
A. Jugular vein distention and dependent edema
B. Hepatomegaly and right upper quadrant pain
C. Crackles in the lung bases and an S3 gallop [CORRECT]
D. Weight gain of 4 pounds and abdominal ascites
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to the left ventricle's inability to effectively pump blood
forward, leading to fluid backing up into the lungs. Classic manifestations include paroxysmal nocturnal dyspnea, orthopnea,
crackles (rales) at the lung bases, a third heart sound (S3 gallop), cough, fatigue, and tachycardia. Options A, B, and D
describe right-sided heart failure, where backup occurs in the systemic venous system producing JVD, hepatomegaly, ascites,
and dependent peripheral edema. Recognizing left versus right-sided findings is essential for accurate HESI PN prioritization.
Q2: A client with heart failure is prescribed furosemide 40 mg IV daily. Which laboratory value requires the
nurse to withhold the medication and notify the provider immediately?
A. Serum sodium 135 mEq/L
B. Serum potassium 3.0 mEq/L [CORRECT]
C. Serum creatinine 1.1 mg/dL
D. Blood urea nitrogen 18 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium loss through the distal tubule. A potassium of 3.0
mEq/L (normal 3.5–5.0) indicates hypokalemia, which predisposes the client to life-threatening dysrhythmias, especially
digoxin toxicity if the client is also taking digoxin. The nurse must hold the dose and notify the provider for potassium
replacement before administering the diuretic. Sodium of 135, creatinine of 1.1, and BUN of 18 are all within or near normal
limits and do not require holding the medication. This question tests application of pharmacologic safety principles in heart
failure management.
Page 1 | HESI PN Medical-Surgical Exam 2026 | Confidential Study Resource
,HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q3: A client taking digoxin 0.25 mg daily for heart failure reports nausea, vomiting, and seeing yellow-green
halos around lights. The apical pulse is 52 beats per minute. Which action should the practical nurse take first?
A. Administer the next dose of digoxin as scheduled
B. Withhold digoxin and notify the healthcare provider [CORRECT]
C. Document the findings and continue monitoring
D. Administer an antiemetic for the nausea
Correct Answer: B
Rationale: The client is exhibiting classic signs of digoxin toxicity: gastrointestinal symptoms (anorexia, nausea, vomiting),
visual disturbances (yellow-green halos), and bradycardia (pulse <60 bpm). The therapeutic digoxin range is 0.8–2.0 ng/mL.
The priority action is to withhold the medication and notify the provider, who may order a serum digoxin level, potassium
level (hypokalemia potentiates toxicity), and possibly digoxin immune Fab (Digibind) as the antidote for severe toxicity.
Administering the next dose would worsen toxicity, and simply documenting or giving an antiemetic delays critical
intervention.
Q4: The nurse is teaching a client with heart failure about dietary modifications. Which statement by the client
indicates that teaching has been effective?
A. "I should consume no more than 4 grams of sodium per day."
B. "I will limit my daily fluid intake to 1.5 to 2 liters." [CORRECT]
C. "I should drink at least 3 liters of water to stay hydrated."
D. "I can use a salt substitute instead of regular table salt."
Correct Answer: B
Rationale: Clients with heart failure are typically placed on a sodium restriction of 2 g/day and a fluid restriction of 1.5–2
L/day to prevent volume overload and exacerbations. Fluid restriction reduces cardiac workload and prevents pulmonary
congestion. Option A is incorrect because the sodium limit is 2 g, not 4 g. Option C would worsen fluid overload. Option D is
dangerous because many salt substitutes contain potassium chloride, which can cause hyperkalemia—especially dangerous in
clients taking ACE inhibitors or ARBs. Daily weights (reporting a 2–3 lb gain in one day or 5 lb in a week) should also be
reinforced.
Q5: A 58-year-old client is admitted with hypertensive crisis. Blood pressure is 188/114 mmHg, and the client
reports a severe headache and confusion. Which IV medication should the nurse anticipate being prescribed?
A. Oral losartan
B. IV labetalol [CORRECT]
C. Sublingual nitroglycerin
D. Oral hydrochlorothiazide
Correct Answer: B
Rationale: Hypertensive crisis is defined as a blood pressure >180/120 mmHg with target organ damage (brain, heart,
kidneys). IV antihypertensives such as labetalol, nicardipine, or sodium nitroprusside are used to lower BP gradually (by no
more than 25% in the first hour) to prevent ischemic stroke or organ hypoperfusion. Oral medications (options A and D) act
too slowly for this emergency. Sublingual nitroglycerin (option C) is used for angina, not hypertensive crisis, and has a short
duration of action. The nurse must also continuously monitor neurologic status, urine output, and ECG for end-organ effects.
Page 2 | HESI PN Medical-Surgical Exam 2026 | Confidential Study Resource
,HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q6: A client with primary hypertension is being discharged with a new prescription for lisinopril 10 mg daily.
Which instruction is most important for the nurse to include in discharge teaching?
A. Take the medication at bedtime to prevent dizziness.
B. Report a persistent dry cough to the healthcare provider. [CORRECT]
C. Increase dietary potassium-rich foods such as bananas.
D. Avoid grapefruit juice while taking this medication.
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that can cause a persistent dry cough in up to 20% of clients due to bradykinin
accumulation in the lungs. While not life-threatening, the cough often warrants switching to an ARB (such as losartan).
Clients should report this side effect rather than discontinue the drug abruptly. Option A is unnecessary; ACE inhibitors are
usually taken in the morning. Option C is dangerous because ACE inhibitors can cause potassium retention (hyperkalemia), so
potassium intake should not be increased. Option D applies to certain calcium channel blockers and statins, not ACE
inhibitors.
Q7: A client arrives at the emergency department reporting chest pressure that started 30 minutes ago while at
rest, radiating to the left arm, with diaphoresis and nausea. Which action should the nurse take first?
A. Administer sublingual nitroglycerin 0.4 mg
B. Apply oxygen at 2 L/min via nasal cannula [CORRECT]
C. Obtain a 12-lead electrocardiogram
D. Administer aspirin 325 mg chewable
Correct Answer: B
Rationale: Using the ABC priority framework, airway and breathing take precedence. The client is experiencing symptoms
of acute coronary syndrome (likely unstable angina or MI). Oxygen should be applied first if SpO2 is below 94% or there is
respiratory distress, although routine oxygen for normoxic clients is no longer recommended. After stabilizing oxygenation,
the nurse would obtain a 12-lead ECG (within 10 minutes of arrival), administer aspirin 162–325 mg chewable to inhibit
platelet aggregation, and give nitroglycerin for pain. Cardiac biomarkers (troponin, CK-MB) are also drawn. This question
tests prioritization within the ACS protocol (MONA — Morphine, Oxygen, Nitroglycerin, Aspirin).
Q8: A client is receiving IV heparin for treatment of a deep vein thrombosis (DVT). The client's aPTT is 110
seconds (control 35 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate
B. Document the finding; the value is therapeutic
C. Stop the infusion and notify the healthcare provider [CORRECT]
D. Administer protamine sulfate as an antidote
Correct Answer: C
Rationale: The therapeutic range for heparin is 1.5–2.5 times the control aPTT, which would be approximately 52–88
seconds for a control of 35. An aPTT of 110 seconds is above the therapeutic range and indicates a bleeding risk. The nurse
should stop the infusion immediately and notify the provider for a dose adjustment. Option A would worsen the situation.
Option B is incorrect because the value is not therapeutic—it is supratherapeutic. Option D (protamine sulfate) is the antidote
for heparin, but it is reserved for significant bleeding or markedly elevated aPTT with active hemorrhage, not simply an
elevated value without symptoms.
Page 3 | HESI PN Medical-Surgical Exam 2026 | Confidential Study Resource
, HESI PN MED-SURG EXAM 2026 — Actual Questions and Answers (2026/2027) Verified Answers | A+ Graded
Q9: A client with a DVT is being transitioned from IV heparin to oral warfarin. The client asks, "Why do I
have to take two blood thinners at the same time?" What is the nurse's best response?
A. "Warfarin takes 3 to 5 days to reach its full therapeutic effect." [CORRECT]
B. "Heparin and warfarin work together to prevent all clot formation."
C. "You only need to take warfarin once your INR is below 1.0."
D. "The two medications prevent different types of blood clots."
Correct Answer: A
Rationale: Warfarin inhibits synthesis of vitamin K–dependent clotting factors (II, VII, IX, X), but it takes 3–5 days to
achieve therapeutic effect. During this overlap period, heparin provides immediate anticoagulation while warfarin builds to
therapeutic levels. Heparin is discontinued once the INR reaches the therapeutic range (2.0–3.0 for VTE). Option B is
incorrect—they do not work synergistically; they have different mechanisms. Option C is wrong because the INR goal is 2–3,
not below 1. Option D is incorrect; both prevent similar clots but through different mechanisms and timeframes.
Q10: A client is admitted with new-onset atrial fibrillation. The heart rate is 142 beats per minute and
irregularly irregular, and no P waves are visible on the ECG. Which complication is the client at greatest risk
for?
A. Cardiac tamponade
B. Pulmonary embolism
C. Ischemic stroke [CORRECT]
D. Ventricular fibrillation
Correct Answer: C
Rationale: In atrial fibrillation, the atria quiver rather than contract effectively, causing blood to pool in the atria (especially
the left atrial appendage) and form thrombi. These clots can embolize to the brain, causing an ischemic stroke. Clients are
typically anticoagulated with warfarin (INR 2–3) or a DOAC to reduce stroke risk. Rate control is achieved with
beta-blockers, calcium channel blockers, or digoxin; rhythm control may involve amiodarone or cardioversion. Options A, B,
and D are not the primary complications of atrial fibrillation. The irregularly irregular rhythm and absent P waves are
hallmark ECG findings.
Q11: A client on the telemetry unit suddenly becomes unresponsive. The monitor shows ventricular fibrillation.
Which action should the nurse take first?
A. Administer IV epinephrine 1 mg
B. Defibrillate at 200 joules (biphasic)
C. Begin chest compressions at 100–120 per minute [CORRECT]
D. Administer IV amiodarone 300 mg
Correct Answer: C
Rationale: Ventricular fibrillation is a shockable rhythm, but per the current ACLS algorithm, the nurse should immediately
call for help, begin high-quality CPR (compressions at 100–120/min, depth 2–2.4 inches), and defibrillate as soon as the
defibrillator is available. If the nurse is alone, the order is: call for help → start CPR → defibrillate. Option B (defibrillation)
is the definitive treatment, but CPR must be initiated immediately to maintain perfusion while the defibrillator is being
retrieved. Epinephrine (option A) and amiodarone (option D) are given after the first shock during CPR cycles. This question
tests prioritization in a code situation.
Page 4 | HESI PN Medical-Surgical Exam 2026 | Confidential Study Resource
