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2026 HESI RN Medical-Surgical Exams – NGN Nursing
Questions, 2026 HESI Exit Med surg Exam Prep (Guarantee
Pass)
1. A patient with heart failure is receiving furosemide 40 mg IV. Which
assessment finding indicates a therapeutic response?
A) Decreased urine output
B) Increased crackles in lung bases
C) Weight loss of 1 kg in 24 hours
D) Increased peripheral edema
Answer: C – Weight loss of 1 kg in 24 hours
Explanation: Furosemide is a loop diuretic that promotes fluid excretion. Weight
loss of 1 kg in 24 hours indicates fluid removal. Increased crackles/edema and
decreased urine output indicate worsening failure.
2. A patient with chronic obstructive pulmonary disease (COPD) is started on
oxygen at 2 L/min via nasal cannula. The patient's SpO₂ increases from 85% to
94%. Which finding indicates the need to reduce oxygen flow?
A) Respiratory rate decreases from 24 to 16
B) Patient becomes drowsy with a respiratory rate of 10
C) Patient reports feeling better
D) ABG shows PaO₂ 85 mm Hg
Answer: B – Patient becomes drowsy with a respiratory rate of 10
Explanation: In COPD patients with chronic CO₂ retention, high oxygen can
suppress hypoxic drive, causing respiratory depression. Drowsiness and
bradypnea are signs of CO₂ narcosis; oxygen flow should be reduced.
pg. 1
,2
3. A patient with type 1 diabetes has a blood glucose of 580 mg/dL and is
lethargic. The nurse notes Kussmaul respirations and a fruity breath odor. What
is the priority nursing action?
A) Administer oral glucose
B) Start an IV and infuse normal saline as prescribed
C) Give insulin subcutaneously
D) Administer glucagon IM
Answer: B – Start an IV and infuse normal saline as prescribed
Explanation: The patient is in diabetic ketoacidosis (DKA). The priority is fluid
resuscitation with isotonic saline to restore perfusion before insulin therapy. Oral
glucose and glucagon are for hypoglycemia.
4. A patient with cirrhosis is admitted with ascites and esophageal varices.
Which finding indicates a medical emergency?
A) Serum ammonia 85 mcg/dL
B) Hematemesis
C) Peripheral edema
D) Asterixis
Answer: B – Hematemesis
Explanation: Hematemesis (vomiting blood) indicates variceal bleeding, a life-
threatening complication of cirrhosis. This requires immediate intervention.
Ammonia elevation and asterixis indicate hepatic encephalopathy; edema is
expected.
5. A patient has a chest tube after a pneumothorax. The nurse notes continuous
bubbling in the water seal chamber. What does this indicate?
A) Normal function
B) An air leak
C) The tube is occluded
D) The lung has re-expanded
pg. 2
,3
Answer: B – An air leak
Explanation: Continuous bubbling in the water seal chamber indicates an air leak
in the system or from the patient's lung. Intermittent bubbling with exhalation
may be normal in early pneumothorax; continuous is abnormal.
6. A patient is receiving a blood transfusion and develops chills, fever, and flank
pain. What is the priority action?
A) Slow the transfusion and reassess
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen
D) Notify the blood bank only
Answer: B – Stop the transfusion and infuse normal saline
Explanation: Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction. The transfusion must be stopped immediately, normal saline infused to
maintain IV access, and the provider/blood bank notified.
7. A patient with a myocardial infarction has a new onset of a holosystolic
murmur at the apex. What complication should the nurse suspect?
A) Ventricular aneurysm
B) Papillary muscle rupture
C) Pericarditis
D) Atrial septal defect
Answer: B – Papillary muscle rupture
Explanation: Papillary muscle rupture, a complication of MI, causes acute mitral
regurgitation, manifesting as a new holosystolic murmur at the apex. It can lead
to cardiogenic shock.
8. A patient with acute pancreatitis reports severe epigastric pain radiating to
the back. Which laboratory finding is most specific?
pg. 3
, 4
A) Elevated amylase
B) Elevated lipase
C) Elevated AST
D) Elevated alkaline phosphatase
Answer: B – Elevated lipase
Explanation: Lipase is more specific and sensitive than amylase for acute
pancreatitis. Lipase remains elevated longer.
9. A patient with a head injury has a decreasing level of consciousness and a
fixed, dilated pupil on the right. What is the priority action?
A) Administer a sedative
B) Notify the provider immediately and prepare for possible herniation
C) Place the patient in Trendelenburg
D) Reassess in 30 minutes
Answer: B – Notify the provider immediately and prepare for possible
herniation
Explanation: A fixed, dilated pupil with decreased LOC indicates increased
intracranial pressure and possible uncal herniation. This is an emergency requiring
immediate intervention.
10. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG finding should the nurse expect?
A) Prominent U waves
B) Peaked T waves and widened QRS
C) Prolonged QT
D) ST depression
Answer: B – Peaked T waves and widened QRS
Explanation: Hyperkalemia causes peaked T waves, widened QRS, and eventually
sine wave. U waves are seen in hypokalemia. This is a life-threatening emergency.
pg. 4
2026 HESI RN Medical-Surgical Exams – NGN Nursing
Questions, 2026 HESI Exit Med surg Exam Prep (Guarantee
Pass)
1. A patient with heart failure is receiving furosemide 40 mg IV. Which
assessment finding indicates a therapeutic response?
A) Decreased urine output
B) Increased crackles in lung bases
C) Weight loss of 1 kg in 24 hours
D) Increased peripheral edema
Answer: C – Weight loss of 1 kg in 24 hours
Explanation: Furosemide is a loop diuretic that promotes fluid excretion. Weight
loss of 1 kg in 24 hours indicates fluid removal. Increased crackles/edema and
decreased urine output indicate worsening failure.
2. A patient with chronic obstructive pulmonary disease (COPD) is started on
oxygen at 2 L/min via nasal cannula. The patient's SpO₂ increases from 85% to
94%. Which finding indicates the need to reduce oxygen flow?
A) Respiratory rate decreases from 24 to 16
B) Patient becomes drowsy with a respiratory rate of 10
C) Patient reports feeling better
D) ABG shows PaO₂ 85 mm Hg
Answer: B – Patient becomes drowsy with a respiratory rate of 10
Explanation: In COPD patients with chronic CO₂ retention, high oxygen can
suppress hypoxic drive, causing respiratory depression. Drowsiness and
bradypnea are signs of CO₂ narcosis; oxygen flow should be reduced.
pg. 1
,2
3. A patient with type 1 diabetes has a blood glucose of 580 mg/dL and is
lethargic. The nurse notes Kussmaul respirations and a fruity breath odor. What
is the priority nursing action?
A) Administer oral glucose
B) Start an IV and infuse normal saline as prescribed
C) Give insulin subcutaneously
D) Administer glucagon IM
Answer: B – Start an IV and infuse normal saline as prescribed
Explanation: The patient is in diabetic ketoacidosis (DKA). The priority is fluid
resuscitation with isotonic saline to restore perfusion before insulin therapy. Oral
glucose and glucagon are for hypoglycemia.
4. A patient with cirrhosis is admitted with ascites and esophageal varices.
Which finding indicates a medical emergency?
A) Serum ammonia 85 mcg/dL
B) Hematemesis
C) Peripheral edema
D) Asterixis
Answer: B – Hematemesis
Explanation: Hematemesis (vomiting blood) indicates variceal bleeding, a life-
threatening complication of cirrhosis. This requires immediate intervention.
Ammonia elevation and asterixis indicate hepatic encephalopathy; edema is
expected.
5. A patient has a chest tube after a pneumothorax. The nurse notes continuous
bubbling in the water seal chamber. What does this indicate?
A) Normal function
B) An air leak
C) The tube is occluded
D) The lung has re-expanded
pg. 2
,3
Answer: B – An air leak
Explanation: Continuous bubbling in the water seal chamber indicates an air leak
in the system or from the patient's lung. Intermittent bubbling with exhalation
may be normal in early pneumothorax; continuous is abnormal.
6. A patient is receiving a blood transfusion and develops chills, fever, and flank
pain. What is the priority action?
A) Slow the transfusion and reassess
B) Stop the transfusion and infuse normal saline
C) Administer acetaminophen
D) Notify the blood bank only
Answer: B – Stop the transfusion and infuse normal saline
Explanation: Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction. The transfusion must be stopped immediately, normal saline infused to
maintain IV access, and the provider/blood bank notified.
7. A patient with a myocardial infarction has a new onset of a holosystolic
murmur at the apex. What complication should the nurse suspect?
A) Ventricular aneurysm
B) Papillary muscle rupture
C) Pericarditis
D) Atrial septal defect
Answer: B – Papillary muscle rupture
Explanation: Papillary muscle rupture, a complication of MI, causes acute mitral
regurgitation, manifesting as a new holosystolic murmur at the apex. It can lead
to cardiogenic shock.
8. A patient with acute pancreatitis reports severe epigastric pain radiating to
the back. Which laboratory finding is most specific?
pg. 3
, 4
A) Elevated amylase
B) Elevated lipase
C) Elevated AST
D) Elevated alkaline phosphatase
Answer: B – Elevated lipase
Explanation: Lipase is more specific and sensitive than amylase for acute
pancreatitis. Lipase remains elevated longer.
9. A patient with a head injury has a decreasing level of consciousness and a
fixed, dilated pupil on the right. What is the priority action?
A) Administer a sedative
B) Notify the provider immediately and prepare for possible herniation
C) Place the patient in Trendelenburg
D) Reassess in 30 minutes
Answer: B – Notify the provider immediately and prepare for possible
herniation
Explanation: A fixed, dilated pupil with decreased LOC indicates increased
intracranial pressure and possible uncal herniation. This is an emergency requiring
immediate intervention.
10. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG finding should the nurse expect?
A) Prominent U waves
B) Peaked T waves and widened QRS
C) Prolonged QT
D) ST depression
Answer: B – Peaked T waves and widened QRS
Explanation: Hyperkalemia causes peaked T waves, widened QRS, and eventually
sine wave. U waves are seen in hypokalemia. This is a life-threatening emergency.
pg. 4
