NCLEX- RN NGN F ORMAT | VERIFIED ANSWERS
EDITION
HESI MED SURG
EXIT EXAM V1
A comprehensive 150-item exit examination spanning
twelve medical-surgical content domains, with verified
answers and detailed rationales for every question.
Aligned with the HESI Exit Exam Test Blueprint, the
NGN Clinical Judgment Measurement Model, and
2026/2027 Medical-Surgical Nursing Core
Competencies.
Medical-Surgical Nursing Core Competencies
Cardiovascular · Respiratory · Gastrointestinal · Renal · Neurological · Endocrine ·
Musculoskeletal · Hematological · Integumentary · Perioperative · Pharmacology ·
NGN Case Studies
VERSI ON 1 | 15 0 I TEMS | 2026-2027 ED I TI ON
,NCLEX- RN NGN F ORMAT | VERIFIED ANSWERS
EDITION
HESI MED SURG
EXIT EXAM V1
A comprehensive 150-item exit examination spanning
twelve medical-surgical content domains, with verified
answers and detailed rationales for every question.
Aligned with the HESI Exit Exam Test Blueprint, the
NGN Clinical Judgment Measurement Model, and
2026/2027 Medical-Surgical Nursing Core
Competencies.
Medical-Surgical Nursing Core Competencies
Cardiovascular · Respiratory · Gastrointestinal · Renal · Neurological · Endocrine ·
Musculoskeletal · Hematological · Integumentary · Perioperative · Pharmacology ·
NGN Case Studies
VERSI ON 1 | 15 0 I TEMS | 2026-2027 ED I TI ON
,HESI MED SURG EXIT EXAM V1 (2026/2027) 150 ITEMS | NGN FORMAT
HESI MED SURG EXIT EXAM V1 (2026/2027)
Practice Questions with Verified Answers | NGN Format
Total Items: 150 | Sections: 12 | Time Allotment: 180 Minutes | Cognitive Levels: 20% Recall / 40% Application / 40%
Analysis | Aligned with the HESI Exit Exam Test Blueprint and the NCLEX-RN (NGN) Measurement Model
About this practice bank: All 150 items are original NGN-style practice questions written to align with the HESI Exit Exam test
plan and the NCLEX-RN Clinical Judgment Measurement Model. This is an independent study resource - it is not affiliated with,
endorsed by, and does not contain proprietary content from, HESI/Elsevier or NCSBN. Each item carries a verified answer key
and a detailed rationale that applies HESI/NGN test-taking methodology.
Section 1: Cardiovascular Disorders
Q1. An adult client has a confirmed blood pressure of 152/94 mm Hg on three separate clinic visits. The
provider plans to begin lifestyle modification and medication therapy. Which nursing intervention is most
appropriate to include in the initial plan of care?
A. Schedule the client for an exercise treadmill stress test before starting any therapy
B. Instruct the client in the DASH eating plan, sodium restriction, regular physical activity, and home blood
pressure monitoring [CORRECT]
C. Place the client on complete bed rest for 24 hours and withhold all oral fluids
D. Prepare the client for admission to the intensive care unit for continuous intravenous antihypertensive
therapy
Correct Answer: B
Rationale: Stage 2 hypertension is managed initially with lifestyle modification (DASH diet, sodium restriction,
weight management, regular aerobic activity) plus pharmacologic therapy, along with home BP monitoring to
evaluate response. A stress test is not indicated solely on the basis of newly diagnosed hypertension. Complete bed
rest and IV therapy are reserved for hypertensive emergency, which this client does not have.
Q2. The nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent
with this condition?
A. Bilateral pitting ankle edema and jugular venous distention
B. Right upper quadrant tenderness with hepatomegaly
C. Bibasilar crackles, dyspnea on exertion, and orthopnea [CORRECT]
D. Ascites and peripheral venous stasis
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, producing crackles, dyspnea on exertion,
orthopnea, and paroxysmal nocturnal dyspnea. Ankle edema, jugular venous distention, hepatomegaly, and ascites
are manifestations of right-sided heart failure, in which blood backs up into the systemic venous circulation.
Medical-Surgical Nursing Core Competencies - 2026/2027 Edition 1
, HESI MED SURG EXIT EXAM V1 (2026/2027) 150 ITEMS | NGN FORMAT
Q3. A client is admitted to the emergency department with chest pain. Which laboratory result is the most
specific indicator of myocardial cell injury?
A. Serum myoglobin
B. Creatine kinase-MB (CK-MB) fraction
C. Cardiac troponin I [CORRECT]
D. Serum lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponin I is the most specific cardiac biomarker for myocardial injury; it begins to rise within 2
to 4 hours of injury and remains elevated for up to 10 days. CK-MB is cardiac-sensitive but less specific than
troponin, myoglobin is the earliest but least specific marker because it is also found in skeletal muscle, and LDH is a
nonspecific marker that is rarely used today.
Q4. The nurse is conducting a community health screening. Which client has the greatest number of
modifiable risk factors for coronary artery disease (CAD)?
A. A 62-year-old man whose father died of a myocardial infarction at age 50
B. A 48-year-old woman who smokes, is hypertensive, has an LDL of 170 mg/dL, and is sedentary
[CORRECT]
C. A 75-year-old man with a family history of hyperlipidemia
D. A 39-year-old woman of Asian descent with a body mass index of 21
Correct Answer: B
Rationale: Cigarette smoking, hypertension, hyperlipidemia, obesity, and physical inactivity are modifiable CAD
risk factors that can be altered through lifestyle change and treatment. A family history of early cardiac death,
advanced age, ethnicity, and gender are nonmodifiable factors, so the clients in the other options have risk factors
that cannot be changed by nursing intervention.
Q5. The nurse is teaching a client with heart failure about daily weight monitoring at home. Which statement
by the client indicates a correct understanding of the teaching?
A. I will weigh myself at a different time each day so I can see how my weight varies
B. I will report a weight gain of more than 2 pounds in one day or 5 pounds in one week [CORRECT]
C. I should expect to lose 1 to 2 pounds every day once my diuretic is started
D. I will weigh myself after dinner so the weight includes everything I ate that day
Correct Answer: B
Rationale: A gain of more than 2 pounds in one day or 5 pounds in one week signals fluid retention and worsening
heart failure and must be reported before symptoms such as dyspnea appear. Weights should be taken at the same
time each morning, after voiding and before breakfast, in similar clothing. Rapid intentional weight loss is not
expected with diuretics, and evening weights reflect daily food and fluid intake and are inaccurate for fluid-status
trending.
Medical-Surgical Nursing Core Competencies - 2026/2027 Edition 2
EDITION
HESI MED SURG
EXIT EXAM V1
A comprehensive 150-item exit examination spanning
twelve medical-surgical content domains, with verified
answers and detailed rationales for every question.
Aligned with the HESI Exit Exam Test Blueprint, the
NGN Clinical Judgment Measurement Model, and
2026/2027 Medical-Surgical Nursing Core
Competencies.
Medical-Surgical Nursing Core Competencies
Cardiovascular · Respiratory · Gastrointestinal · Renal · Neurological · Endocrine ·
Musculoskeletal · Hematological · Integumentary · Perioperative · Pharmacology ·
NGN Case Studies
VERSI ON 1 | 15 0 I TEMS | 2026-2027 ED I TI ON
,NCLEX- RN NGN F ORMAT | VERIFIED ANSWERS
EDITION
HESI MED SURG
EXIT EXAM V1
A comprehensive 150-item exit examination spanning
twelve medical-surgical content domains, with verified
answers and detailed rationales for every question.
Aligned with the HESI Exit Exam Test Blueprint, the
NGN Clinical Judgment Measurement Model, and
2026/2027 Medical-Surgical Nursing Core
Competencies.
Medical-Surgical Nursing Core Competencies
Cardiovascular · Respiratory · Gastrointestinal · Renal · Neurological · Endocrine ·
Musculoskeletal · Hematological · Integumentary · Perioperative · Pharmacology ·
NGN Case Studies
VERSI ON 1 | 15 0 I TEMS | 2026-2027 ED I TI ON
,HESI MED SURG EXIT EXAM V1 (2026/2027) 150 ITEMS | NGN FORMAT
HESI MED SURG EXIT EXAM V1 (2026/2027)
Practice Questions with Verified Answers | NGN Format
Total Items: 150 | Sections: 12 | Time Allotment: 180 Minutes | Cognitive Levels: 20% Recall / 40% Application / 40%
Analysis | Aligned with the HESI Exit Exam Test Blueprint and the NCLEX-RN (NGN) Measurement Model
About this practice bank: All 150 items are original NGN-style practice questions written to align with the HESI Exit Exam test
plan and the NCLEX-RN Clinical Judgment Measurement Model. This is an independent study resource - it is not affiliated with,
endorsed by, and does not contain proprietary content from, HESI/Elsevier or NCSBN. Each item carries a verified answer key
and a detailed rationale that applies HESI/NGN test-taking methodology.
Section 1: Cardiovascular Disorders
Q1. An adult client has a confirmed blood pressure of 152/94 mm Hg on three separate clinic visits. The
provider plans to begin lifestyle modification and medication therapy. Which nursing intervention is most
appropriate to include in the initial plan of care?
A. Schedule the client for an exercise treadmill stress test before starting any therapy
B. Instruct the client in the DASH eating plan, sodium restriction, regular physical activity, and home blood
pressure monitoring [CORRECT]
C. Place the client on complete bed rest for 24 hours and withhold all oral fluids
D. Prepare the client for admission to the intensive care unit for continuous intravenous antihypertensive
therapy
Correct Answer: B
Rationale: Stage 2 hypertension is managed initially with lifestyle modification (DASH diet, sodium restriction,
weight management, regular aerobic activity) plus pharmacologic therapy, along with home BP monitoring to
evaluate response. A stress test is not indicated solely on the basis of newly diagnosed hypertension. Complete bed
rest and IV therapy are reserved for hypertensive emergency, which this client does not have.
Q2. The nurse is assessing a client with left-sided heart failure. Which assessment finding is most consistent
with this condition?
A. Bilateral pitting ankle edema and jugular venous distention
B. Right upper quadrant tenderness with hepatomegaly
C. Bibasilar crackles, dyspnea on exertion, and orthopnea [CORRECT]
D. Ascites and peripheral venous stasis
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, producing crackles, dyspnea on exertion,
orthopnea, and paroxysmal nocturnal dyspnea. Ankle edema, jugular venous distention, hepatomegaly, and ascites
are manifestations of right-sided heart failure, in which blood backs up into the systemic venous circulation.
Medical-Surgical Nursing Core Competencies - 2026/2027 Edition 1
, HESI MED SURG EXIT EXAM V1 (2026/2027) 150 ITEMS | NGN FORMAT
Q3. A client is admitted to the emergency department with chest pain. Which laboratory result is the most
specific indicator of myocardial cell injury?
A. Serum myoglobin
B. Creatine kinase-MB (CK-MB) fraction
C. Cardiac troponin I [CORRECT]
D. Serum lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponin I is the most specific cardiac biomarker for myocardial injury; it begins to rise within 2
to 4 hours of injury and remains elevated for up to 10 days. CK-MB is cardiac-sensitive but less specific than
troponin, myoglobin is the earliest but least specific marker because it is also found in skeletal muscle, and LDH is a
nonspecific marker that is rarely used today.
Q4. The nurse is conducting a community health screening. Which client has the greatest number of
modifiable risk factors for coronary artery disease (CAD)?
A. A 62-year-old man whose father died of a myocardial infarction at age 50
B. A 48-year-old woman who smokes, is hypertensive, has an LDL of 170 mg/dL, and is sedentary
[CORRECT]
C. A 75-year-old man with a family history of hyperlipidemia
D. A 39-year-old woman of Asian descent with a body mass index of 21
Correct Answer: B
Rationale: Cigarette smoking, hypertension, hyperlipidemia, obesity, and physical inactivity are modifiable CAD
risk factors that can be altered through lifestyle change and treatment. A family history of early cardiac death,
advanced age, ethnicity, and gender are nonmodifiable factors, so the clients in the other options have risk factors
that cannot be changed by nursing intervention.
Q5. The nurse is teaching a client with heart failure about daily weight monitoring at home. Which statement
by the client indicates a correct understanding of the teaching?
A. I will weigh myself at a different time each day so I can see how my weight varies
B. I will report a weight gain of more than 2 pounds in one day or 5 pounds in one week [CORRECT]
C. I should expect to lose 1 to 2 pounds every day once my diuretic is started
D. I will weigh myself after dinner so the weight includes everything I ate that day
Correct Answer: B
Rationale: A gain of more than 2 pounds in one day or 5 pounds in one week signals fluid retention and worsening
heart failure and must be reported before symptoms such as dyspnea appear. Weights should be taken at the same
time each morning, after voiding and before breakfast, in similar clothing. Rapid intentional weight loss is not
expected with diuretics, and evening weights reflect daily food and fluid intake and are inaccurate for fluid-status
trending.
Medical-Surgical Nursing Core Competencies - 2026/2027 Edition 2
