2026/2027 HESI RN MEDICAL SURGICAL — VERSION 1 Page 1
2026/2027 HESI RN MEDICAL SURGICAL ALL 55
CORRECT ANSWERS VERSION 1
Comprehensive Medical-Surgical Nursing Examination | HESI RN & NCLEX-RN Blueprint | 2026/2027 Edition
Instructions: This examination contains 55 multiple-choice questions across 9 medical-surgical content areas. Each question
has ONE best answer. Cognitive level distribution: ~20% recall, ~50% application, ~30% analysis. Special inclusions: 10
priority-setting, 10 pharmacology, 5 laboratory-value questions are integrated throughout. The correct answer for each
question is marked *[CORRECT]* with the rationale provided immediately below.
Section 1: Cardiovascular Disorders
Q1: A 68-year-old male is admitted with suspected acute myocardial infarction (MI). He reports crushing
substernal chest pain rated 8/10 that radiates to the left jaw. Vital signs: BP 148/92, HR 104, RR 22, SpO2 94% on
room air. Which nursing action is the PRIORITY at this time?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes until pain is relieved.
B. Apply oxygen via nasal cannula at 2 L/min and obtain a 12-lead ECG.
C. Administer 325 mg chewable aspirin and initiate cardiac monitoring. *[CORRECT]*
D. Draw blood for troponin and CK-MB and establish two large-bore IV sites.
Correct Answer: C
Rationale: Aspirin 325 mg chewed inhibits platelet aggregation and reduces mortality in acute MI per ACS guidelines;
simultaneous cardiac monitoring detects lethal dysrhythmias early. Nitroglycerin is withheld until BP and recent
phosphodiesterase inhibitor use are confirmed; oxygen is reserved for SpO2 < 90%; lab draws and IV access are essential but
occur after the first antiplatelet/monitoring intervention.
Q2: A nurse on a telemetry unit is caring for four patients. Which patient should the nurse assess FIRST?
A. A patient with heart failure reporting dyspnea after walking to the bathroom.
B. A patient with atrial fibrillation whose heart rate is 118 and irregular.
C. A patient two days post-MI with new ST-segment elevation on lead V3. *[CORRECT]*
D. A patient on IV heparin for DVT with gum bleeding and epistaxis.
Correct Answer: C
Rationale: New ST-segment elevation two days post-MI suggests reinfarction or extension, a life-threatening emergency
requiring immediate provider notification and possible emergent catheterization; this is the priority. Atrial fibrillation with a
controlled rate of 118 is concerning but not immediately lethal; heart failure dyspnea on exertion and heparin-associated
bleeding warrant prompt action but are less acute than ongoing myocardial injury.
Q3: A patient with chronic heart failure is prescribed furosemide 40 mg IV twice daily. Which laboratory finding
requires IMMEDIATE provider notification?
A. Serum potassium 3.1 mEq/L. *[CORRECT]*
B. Serum sodium 134 mEq/L.
C. Serum magnesium 1.6 mEq/L.
D. Serum creatinine 1.3 mg/dL.
Correct Answer: A
Rationale: Serum potassium of 3.1 mEq/L (normal 3.5–5.0) places the patient at high risk for lethal ventricular dysrhythmias,
especially with concurrent loop diuretic therapy and underlying heart failure; the provider should be notified to add potassium
supplementation or hold the dose. Mild hyponatremia, borderline hypomagnesemia, and slightly elevated creatinine warrant
monitoring but are not immediately life-threatening.
HESI RN Medical-Surgical Exam Blueprint | NCLEX-RN Test Plan | For Educational Use
, 2026/2027 HESI RN MEDICAL SURGICAL — VERSION 1 Page 2
Q4: A patient receiving IV heparin for a pulmonary embolism has an aPTT of 110 seconds (control 30–40
seconds). The protocol calls for protamine sulfate. Which nursing action is correct when administering protamine?
A. Administer protamine 50 mg IV push over 1 minute to rapidly reverse heparin.
B. Administer protamine IV very slowly (over 1–10 minutes) and monitor for hypotension and
bradycardia. *[CORRECT]*
C. Stop the heparin infusion but wait 4 hours before giving protamine to avoid interaction.
D. Give protamine intramuscularly to reduce the risk of anaphylaxis.
Correct Answer: B
Rationale: Protamine sulfate neutralizes heparin but must be administered very slowly (no faster than 20 mg/min) because
rapid infusion causes histamine release, hypotension, bradycardia, and anaphylactoid reactions; the heparin infusion should
be stopped concurrently. IV push is contraindicated; waiting 4 hours defeats the purpose of reversal; IM administration is
ineffective and not recommended.
Q5: A 55-year-old female with a history of rheumatic heart disease is admitted with suspected infective
endocarditis. Blood cultures are pending. Which assessment finding is a classic Osler node presentation?
A. Painless erythematous lesions on the palms and soles.
B. Tender, pea-sized nodules on the pads of the fingers and toes. *[CORRECT]*
C. Splinter hemorrhages in the nail beds of multiple fingers.
D. Petechiae on the conjunctiva and oral mucosa.
Correct Answer: B
Rationale: Osler nodes are painful, pea-sized nodules on the pads of fingers and toes caused by immune complex deposition, a
classic finding in infective endocarditis. Janeway lesions (A) are painless erythematous macules on palms/soles; splinter
hemorrhages (C) and petechiae (D) are also associated but are not Osler nodes.
Q6: A patient with a history of hypertension and type 2 diabetes presents with a BP of 188/110 mmHg, severe
headache, and confusion. Which nursing action is the PRIORITY?
A. Administer the scheduled oral lisinopril 20 mg and recheck BP in 1 hour.
B. Place the patient in a quiet, dim room and lower the head of the bed.
C. Initiate continuous IV cardiac monitoring and prepare for IV antihypertensive infusion.
*[CORRECT]*
D. Encourage slow deep breathing and reassess blood pressure in 15 minutes.
Correct Answer: C
Rationale: The patient is exhibiting signs of hypertensive encephalopathy, a hypertensive emergency requiring immediate but
controlled BP reduction (by no more than 25% in the first hour) with a titratable IV agent such as nicardipine or labetalol;
cardiac monitoring is essential. Oral agents are too slow; lowering the head of the bed worsens cerebral pressure; breathing
exercises delay critical intervention.
Q7: A patient with chronic stable angina is prescribed a transdermal nitroglycerin patch. What teaching is MOST
important for the nurse to include?
A. Apply the patch at the same time each morning and remove it at bedtime for an 8–12 hour
nitrate-free interval. *[CORRECT]*
B. Cut the patch in half if headaches occur, and rotate application sites weekly.
C. Apply the patch only when chest pain occurs and remove it once pain subsides.
D. Place the patch on the same site daily for consistent absorption and effectiveness.
Correct Answer: A
Rationale: A daily 8–12 hour nitrate-free interval prevents tolerance and maintains therapeutic effect; the patch should be
applied in the morning and removed at bedtime. Cutting the patch destroys the delivery system; transdermal nitroglycerin is for
HESI RN Medical-Surgical Exam Blueprint | NCLEX-RN Test Plan | For Educational Use
2026/2027 HESI RN MEDICAL SURGICAL ALL 55
CORRECT ANSWERS VERSION 1
Comprehensive Medical-Surgical Nursing Examination | HESI RN & NCLEX-RN Blueprint | 2026/2027 Edition
Instructions: This examination contains 55 multiple-choice questions across 9 medical-surgical content areas. Each question
has ONE best answer. Cognitive level distribution: ~20% recall, ~50% application, ~30% analysis. Special inclusions: 10
priority-setting, 10 pharmacology, 5 laboratory-value questions are integrated throughout. The correct answer for each
question is marked *[CORRECT]* with the rationale provided immediately below.
Section 1: Cardiovascular Disorders
Q1: A 68-year-old male is admitted with suspected acute myocardial infarction (MI). He reports crushing
substernal chest pain rated 8/10 that radiates to the left jaw. Vital signs: BP 148/92, HR 104, RR 22, SpO2 94% on
room air. Which nursing action is the PRIORITY at this time?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes until pain is relieved.
B. Apply oxygen via nasal cannula at 2 L/min and obtain a 12-lead ECG.
C. Administer 325 mg chewable aspirin and initiate cardiac monitoring. *[CORRECT]*
D. Draw blood for troponin and CK-MB and establish two large-bore IV sites.
Correct Answer: C
Rationale: Aspirin 325 mg chewed inhibits platelet aggregation and reduces mortality in acute MI per ACS guidelines;
simultaneous cardiac monitoring detects lethal dysrhythmias early. Nitroglycerin is withheld until BP and recent
phosphodiesterase inhibitor use are confirmed; oxygen is reserved for SpO2 < 90%; lab draws and IV access are essential but
occur after the first antiplatelet/monitoring intervention.
Q2: A nurse on a telemetry unit is caring for four patients. Which patient should the nurse assess FIRST?
A. A patient with heart failure reporting dyspnea after walking to the bathroom.
B. A patient with atrial fibrillation whose heart rate is 118 and irregular.
C. A patient two days post-MI with new ST-segment elevation on lead V3. *[CORRECT]*
D. A patient on IV heparin for DVT with gum bleeding and epistaxis.
Correct Answer: C
Rationale: New ST-segment elevation two days post-MI suggests reinfarction or extension, a life-threatening emergency
requiring immediate provider notification and possible emergent catheterization; this is the priority. Atrial fibrillation with a
controlled rate of 118 is concerning but not immediately lethal; heart failure dyspnea on exertion and heparin-associated
bleeding warrant prompt action but are less acute than ongoing myocardial injury.
Q3: A patient with chronic heart failure is prescribed furosemide 40 mg IV twice daily. Which laboratory finding
requires IMMEDIATE provider notification?
A. Serum potassium 3.1 mEq/L. *[CORRECT]*
B. Serum sodium 134 mEq/L.
C. Serum magnesium 1.6 mEq/L.
D. Serum creatinine 1.3 mg/dL.
Correct Answer: A
Rationale: Serum potassium of 3.1 mEq/L (normal 3.5–5.0) places the patient at high risk for lethal ventricular dysrhythmias,
especially with concurrent loop diuretic therapy and underlying heart failure; the provider should be notified to add potassium
supplementation or hold the dose. Mild hyponatremia, borderline hypomagnesemia, and slightly elevated creatinine warrant
monitoring but are not immediately life-threatening.
HESI RN Medical-Surgical Exam Blueprint | NCLEX-RN Test Plan | For Educational Use
, 2026/2027 HESI RN MEDICAL SURGICAL — VERSION 1 Page 2
Q4: A patient receiving IV heparin for a pulmonary embolism has an aPTT of 110 seconds (control 30–40
seconds). The protocol calls for protamine sulfate. Which nursing action is correct when administering protamine?
A. Administer protamine 50 mg IV push over 1 minute to rapidly reverse heparin.
B. Administer protamine IV very slowly (over 1–10 minutes) and monitor for hypotension and
bradycardia. *[CORRECT]*
C. Stop the heparin infusion but wait 4 hours before giving protamine to avoid interaction.
D. Give protamine intramuscularly to reduce the risk of anaphylaxis.
Correct Answer: B
Rationale: Protamine sulfate neutralizes heparin but must be administered very slowly (no faster than 20 mg/min) because
rapid infusion causes histamine release, hypotension, bradycardia, and anaphylactoid reactions; the heparin infusion should
be stopped concurrently. IV push is contraindicated; waiting 4 hours defeats the purpose of reversal; IM administration is
ineffective and not recommended.
Q5: A 55-year-old female with a history of rheumatic heart disease is admitted with suspected infective
endocarditis. Blood cultures are pending. Which assessment finding is a classic Osler node presentation?
A. Painless erythematous lesions on the palms and soles.
B. Tender, pea-sized nodules on the pads of the fingers and toes. *[CORRECT]*
C. Splinter hemorrhages in the nail beds of multiple fingers.
D. Petechiae on the conjunctiva and oral mucosa.
Correct Answer: B
Rationale: Osler nodes are painful, pea-sized nodules on the pads of fingers and toes caused by immune complex deposition, a
classic finding in infective endocarditis. Janeway lesions (A) are painless erythematous macules on palms/soles; splinter
hemorrhages (C) and petechiae (D) are also associated but are not Osler nodes.
Q6: A patient with a history of hypertension and type 2 diabetes presents with a BP of 188/110 mmHg, severe
headache, and confusion. Which nursing action is the PRIORITY?
A. Administer the scheduled oral lisinopril 20 mg and recheck BP in 1 hour.
B. Place the patient in a quiet, dim room and lower the head of the bed.
C. Initiate continuous IV cardiac monitoring and prepare for IV antihypertensive infusion.
*[CORRECT]*
D. Encourage slow deep breathing and reassess blood pressure in 15 minutes.
Correct Answer: C
Rationale: The patient is exhibiting signs of hypertensive encephalopathy, a hypertensive emergency requiring immediate but
controlled BP reduction (by no more than 25% in the first hour) with a titratable IV agent such as nicardipine or labetalol;
cardiac monitoring is essential. Oral agents are too slow; lowering the head of the bed worsens cerebral pressure; breathing
exercises delay critical intervention.
Q7: A patient with chronic stable angina is prescribed a transdermal nitroglycerin patch. What teaching is MOST
important for the nurse to include?
A. Apply the patch at the same time each morning and remove it at bedtime for an 8–12 hour
nitrate-free interval. *[CORRECT]*
B. Cut the patch in half if headaches occur, and rotate application sites weekly.
C. Apply the patch only when chest pain occurs and remove it once pain subsides.
D. Place the patch on the same site daily for consistent absorption and effectiveness.
Correct Answer: A
Rationale: A daily 8–12 hour nitrate-free interval prevents tolerance and maintains therapeutic effect; the patch should be
applied in the morning and removed at bedtime. Cutting the patch destroys the delivery system; transdermal nitroglycerin is for
HESI RN Medical-Surgical Exam Blueprint | NCLEX-RN Test Plan | For Educational Use
