2026/2027 HESI RN MEDICAL-SURGICAL EXAM — VERSION 1 All 55 Correct Answers
2026/2027 HESI RN MEDICAL-SURGICAL EXAM
VERSION 1 — ALL 55 CORRECT ANSWERS
Comprehensive Medical-Surgical Nursing Examination | Aligned with 2026-2027 HESI RN Content Revisions
Total Questions: 55 Cognitive Distribution: 25% Recall / 55% Application / 20% Analysis
Question Format: 4-Option Multiple Choice (A-D) Style: 75% Scenario-Based / 25% Direct Recall
Passing Standard: HESI RN Exit Exam Benchmarks Time Allocation: Approx. 90 seconds per item
EXAM INSTRUCTIONS: Read each question stem carefully and select the ONE best response from options A
through D. Each item includes a detailed rationale that explains why the correct answer is correct and why each
distractor is incorrect, incorporating pathophysiology, prioritization principles (ABCs, Maslow's Hierarchy, Nursing
Process ADPIE), pharmacology, safety, and evidence-based nursing interventions. Use this document for
self-assessment, content review, and remediation across all six HESI Medical-Surgical content domains. Question
difficulty and distractor design mirror HESI RN examination pitfalls including medication side-effect confusion,
complication misidentification, and prioritization errors.
SECTION 1: CARDIOVASCULAR SYSTEM DISORDERS
Hypertension, Coronary Artery Disease, Heart Failure, Dysrhythmias, and Peripheral Vascular Disease — Questions 1
through 12
Q1: A 58-year-old male presents to the emergency department with a blood pressure of 214/128 mmHg, severe
occipital headache, confusion, and blurred vision. Which nursing intervention is the HIGHEST priority?
A. Administer sublingual nitroglycerin 0.4 mg PRN for chest discomfort.
B. Place the client in Trendelenburg position to enhance cerebral perfusion.
C. Initiate continuous IV access and prepare for IV antihypertensive infusion (e.g., nicardipine).
[CORRECT]
D. Encourage oral fluid intake to prevent dehydration and orthostatic hypotension.
Correct Answer: C
Rationale: This client presents with a hypertensive emergency (BP >180/120 plus target-organ damage evidenced by
neurologic symptoms — headache, confusion, blurred vision). The priority is IV access and a titratable IV antihypertensive
such as nicardipine to reduce BP by no more than 25% in the first hour to prevent ischemic stroke or renal injury from overly
rapid reduction. Sublingual nitroglycerin is for angina, not hypertensive emergency; Trendelenburg increases intracranial
pressure and worsens cerebral edema; oral fluids are contraindicated in acute neurologic emergencies.
HESI RN Medical-Surgical Nursing Exam Preparation Page 1
,2026/2027 HESI RN MEDICAL-SURGICAL EXAM — VERSION 1 All 55 Correct Answers
Q2: A 64-year-old female is admitted with chest pain. Troponin I is drawn at 0 hours, 3 hours, and 6 hours.
Which troponin finding most reliably confirms acute myocardial infarction?
A. A single troponin I of 0.05 ng/mL drawn at onset of chest pain.
B. A rise and/or fall of troponin I values with at least one value above the 99th percentile URL.
[CORRECT]
C. A troponin I value of 0.02 ng/mL at 6 hours that is unchanged from baseline.
D. A single troponin I value of 0.10 ng/mL drawn 12 hours after symptom onset.
Correct Answer: B
Rationale: Per the Fourth Universal Definition of MI (2023, updated guidance carried into 2026 HESI revisions), acute MI is
diagnosed by a detectable rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference
limit, accompanied by symptoms, ECG changes, or imaging evidence of ischemia. A single isolated value — even at 12
hours — does not establish acute injury without the dynamic change pattern. Stable low values suggest chronic elevation
from renal disease or other causes, not acute infarction.
Q3: A client with left-sided heart failure reports increasing dyspnea, orthopnea, and a nocturnal cough
productive of pink, frothy sputum. Which assessment finding should the nurse anticipate as MOST consistent
with pulmonary edema?
A. Bilateral crackles that begin in the dependent lung bases and progress upwardly. [CORRECT]
B. Wheezing localized to the upper lobes with a prolonged inspiratory phase.
C. Pleural friction rub heard best at the right lower lobe posteriorly.
D. Absent breath sounds unilaterally with tracheal deviation to the unaffected side.
Correct Answer: A
Rationale: Left ventricular failure produces backward congestion into the pulmonary vasculature, causing fluid to leak into
alveoli starting in the dependent bases (where hydrostatic pressure is highest) and ascending as edema worsens. Bilateral
basilar crackles are the hallmark auscultatory finding. Wheezing suggests bronchospasm; friction rub indicates pleural
inflammation; absent breath sounds with tracheal deviation signals pneumothorax — a different emergency entirely.
Q4: A client with heart failure is receiving digoxin 0.25 mg PO daily and furosemide 40 mg PO BID. The
morning digoxin level is 2.8 ng/mL (therapeutic 0.5-2.0). Potassium is 3.1 mEq/L. Which finding is the
EARLIEST indicator of digoxin toxicity the nurse should monitor?
A. Yellow-tinged vision (xanthopsia) and anorexia. [CORRECT]
B. Sudden, severe chest pain radiating to the left arm.
C. Bounding peripheral pulses with a systolic blood pressure of 180/95.
D. Profuse diaphoresis with pallor and loss of consciousness.
Correct Answer: A
Rationale: Hypokalemia (K+ 3.1) potentiates digoxin toxicity by increasing myocardial binding of the drug. Early classic
signs include gastrointestinal symptoms (anorexia, nausea, vomiting) and visual disturbances — specifically yellow-green
halos or xanthopsia. The therapeutic range is 0.5–2.0 ng/mL; this client's level of 2.8 is toxic. Cardiac dysrhythmias
(premature ventricular contractions, bradycardia) are later, life-threatening manifestations. The other listed findings are not
digoxin toxicity presentations.
HESI RN Medical-Surgical Nursing Exam Preparation Page 2
, 2026/2027 HESI RN MEDICAL-SURGICAL EXAM — VERSION 1 All 55 Correct Answers
Q5: A client with chronic atrial fibrillation is being discharged on warfarin 5 mg PO daily. The INR target
range is 2.0-3.0. Today's INR is 2.6. Which discharge instruction is MOST critical for the nurse to reinforce?
A. Increase intake of spinach, kale, and broccoli to maintain vascular health.
B. Use a soft-bristle toothbrush and an electric razor, and report any dark, tarry stools immediately.
[CORRECT]
C. Discontinue the medication if bruising appears, then notify the provider within 1 week.
D. Take ibuprofen 400 mg PO every 6 hours for headache instead of acetaminophen.
Correct Answer: B
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, so the priority teaching is bleeding precautions: soft
toothbrush, electric razor, avoid contact sports, and report signs of GI bleeding (melena, coffee-ground emesis). Spinach,
kale, and broccoli are high in vitamin K and should be consumed in consistent amounts — not increased — to avoid
antagonizing warfarin. The client should never self-discontinue warfarin. NSAIDs like ibuprofen potentiate bleeding risk and
are contraindicated; acetaminophen at therapeutic doses is preferred for mild analgesia.
Q6: The monitor technician alerts the nurse that a post-MI client in the CCU has suddenly developed a
rhythm with wide QRS complexes (>0.14 sec) at a rate of 180/min, with no discernible P waves. The client is
awake but lightheaded. What is the PRIORITY nursing action?
A. Administer adenosine 6 mg IV rapid push followed by a 20 mL saline flush.
B. Synchronize and deliver a 100-joule biphasic synchronized cardioversion. [CORRECT]
C. Defibrillate immediately at 200 joules biphasic and begin CPR.
D. Administer amiodarone 150 mg IV over 10 minutes and reassess.
Correct Answer: B
Rationale: The client has monomorphic ventricular tachycardia with a pulse but is symptomatic (lightheadedness indicates
hemodynamic compromise). The ACLS priority is synchronized cardioversion. Adenosine is contraindicated for
wide-complex tachycardia (it can degenerate VT into VF). Defibrillation is reserved for pulseless VT/VF or unstable rhythms
where synchronization is impossible. Amiodarone is appropriate for STABLE VT in a hemodynamically stable client, not for
one with symptoms.
Q7: A 67-year-old male smoker has chronic peripheral arterial disease (PAD) of the lower extremities. Which
assessment finding is the MOST characteristic of arterial versus venous insufficiency?
A. Dependent rubor, pallor on elevation, absent or diminished posterior tibial and dorsalis pedis pulses.
[CORRECT]
B. Brown hyperpigmentation around the ankles with 2+ pitting edema and warm skin.
C. Ulceration at the medial malleolus with shallow, irregular edges and moderate exudate.
D. Aching pain that worsens at the end of the day and is relieved by elevating the legs.
Correct Answer: A
Rationale: PAD produces the classic arterial triad: pallor on elevation, dependent rubor (redness when legs are dependent),
and absent/diminished peripheral pulses due to occlusive atherosclerotic disease. Pain is intermittent claudication that
worsens with activity and improves with rest. The other findings describe venous insufficiency: hyperpigmentation
(hemosiderin deposition), edema, warm skin, and medial malleolar ulcers (venous stasis ulcers) with pain relieved by
elevation.
HESI RN Medical-Surgical Nursing Exam Preparation Page 3
2026/2027 HESI RN MEDICAL-SURGICAL EXAM
VERSION 1 — ALL 55 CORRECT ANSWERS
Comprehensive Medical-Surgical Nursing Examination | Aligned with 2026-2027 HESI RN Content Revisions
Total Questions: 55 Cognitive Distribution: 25% Recall / 55% Application / 20% Analysis
Question Format: 4-Option Multiple Choice (A-D) Style: 75% Scenario-Based / 25% Direct Recall
Passing Standard: HESI RN Exit Exam Benchmarks Time Allocation: Approx. 90 seconds per item
EXAM INSTRUCTIONS: Read each question stem carefully and select the ONE best response from options A
through D. Each item includes a detailed rationale that explains why the correct answer is correct and why each
distractor is incorrect, incorporating pathophysiology, prioritization principles (ABCs, Maslow's Hierarchy, Nursing
Process ADPIE), pharmacology, safety, and evidence-based nursing interventions. Use this document for
self-assessment, content review, and remediation across all six HESI Medical-Surgical content domains. Question
difficulty and distractor design mirror HESI RN examination pitfalls including medication side-effect confusion,
complication misidentification, and prioritization errors.
SECTION 1: CARDIOVASCULAR SYSTEM DISORDERS
Hypertension, Coronary Artery Disease, Heart Failure, Dysrhythmias, and Peripheral Vascular Disease — Questions 1
through 12
Q1: A 58-year-old male presents to the emergency department with a blood pressure of 214/128 mmHg, severe
occipital headache, confusion, and blurred vision. Which nursing intervention is the HIGHEST priority?
A. Administer sublingual nitroglycerin 0.4 mg PRN for chest discomfort.
B. Place the client in Trendelenburg position to enhance cerebral perfusion.
C. Initiate continuous IV access and prepare for IV antihypertensive infusion (e.g., nicardipine).
[CORRECT]
D. Encourage oral fluid intake to prevent dehydration and orthostatic hypotension.
Correct Answer: C
Rationale: This client presents with a hypertensive emergency (BP >180/120 plus target-organ damage evidenced by
neurologic symptoms — headache, confusion, blurred vision). The priority is IV access and a titratable IV antihypertensive
such as nicardipine to reduce BP by no more than 25% in the first hour to prevent ischemic stroke or renal injury from overly
rapid reduction. Sublingual nitroglycerin is for angina, not hypertensive emergency; Trendelenburg increases intracranial
pressure and worsens cerebral edema; oral fluids are contraindicated in acute neurologic emergencies.
HESI RN Medical-Surgical Nursing Exam Preparation Page 1
,2026/2027 HESI RN MEDICAL-SURGICAL EXAM — VERSION 1 All 55 Correct Answers
Q2: A 64-year-old female is admitted with chest pain. Troponin I is drawn at 0 hours, 3 hours, and 6 hours.
Which troponin finding most reliably confirms acute myocardial infarction?
A. A single troponin I of 0.05 ng/mL drawn at onset of chest pain.
B. A rise and/or fall of troponin I values with at least one value above the 99th percentile URL.
[CORRECT]
C. A troponin I value of 0.02 ng/mL at 6 hours that is unchanged from baseline.
D. A single troponin I value of 0.10 ng/mL drawn 12 hours after symptom onset.
Correct Answer: B
Rationale: Per the Fourth Universal Definition of MI (2023, updated guidance carried into 2026 HESI revisions), acute MI is
diagnosed by a detectable rise and/or fall in cardiac troponin with at least one value above the 99th percentile upper reference
limit, accompanied by symptoms, ECG changes, or imaging evidence of ischemia. A single isolated value — even at 12
hours — does not establish acute injury without the dynamic change pattern. Stable low values suggest chronic elevation
from renal disease or other causes, not acute infarction.
Q3: A client with left-sided heart failure reports increasing dyspnea, orthopnea, and a nocturnal cough
productive of pink, frothy sputum. Which assessment finding should the nurse anticipate as MOST consistent
with pulmonary edema?
A. Bilateral crackles that begin in the dependent lung bases and progress upwardly. [CORRECT]
B. Wheezing localized to the upper lobes with a prolonged inspiratory phase.
C. Pleural friction rub heard best at the right lower lobe posteriorly.
D. Absent breath sounds unilaterally with tracheal deviation to the unaffected side.
Correct Answer: A
Rationale: Left ventricular failure produces backward congestion into the pulmonary vasculature, causing fluid to leak into
alveoli starting in the dependent bases (where hydrostatic pressure is highest) and ascending as edema worsens. Bilateral
basilar crackles are the hallmark auscultatory finding. Wheezing suggests bronchospasm; friction rub indicates pleural
inflammation; absent breath sounds with tracheal deviation signals pneumothorax — a different emergency entirely.
Q4: A client with heart failure is receiving digoxin 0.25 mg PO daily and furosemide 40 mg PO BID. The
morning digoxin level is 2.8 ng/mL (therapeutic 0.5-2.0). Potassium is 3.1 mEq/L. Which finding is the
EARLIEST indicator of digoxin toxicity the nurse should monitor?
A. Yellow-tinged vision (xanthopsia) and anorexia. [CORRECT]
B. Sudden, severe chest pain radiating to the left arm.
C. Bounding peripheral pulses with a systolic blood pressure of 180/95.
D. Profuse diaphoresis with pallor and loss of consciousness.
Correct Answer: A
Rationale: Hypokalemia (K+ 3.1) potentiates digoxin toxicity by increasing myocardial binding of the drug. Early classic
signs include gastrointestinal symptoms (anorexia, nausea, vomiting) and visual disturbances — specifically yellow-green
halos or xanthopsia. The therapeutic range is 0.5–2.0 ng/mL; this client's level of 2.8 is toxic. Cardiac dysrhythmias
(premature ventricular contractions, bradycardia) are later, life-threatening manifestations. The other listed findings are not
digoxin toxicity presentations.
HESI RN Medical-Surgical Nursing Exam Preparation Page 2
, 2026/2027 HESI RN MEDICAL-SURGICAL EXAM — VERSION 1 All 55 Correct Answers
Q5: A client with chronic atrial fibrillation is being discharged on warfarin 5 mg PO daily. The INR target
range is 2.0-3.0. Today's INR is 2.6. Which discharge instruction is MOST critical for the nurse to reinforce?
A. Increase intake of spinach, kale, and broccoli to maintain vascular health.
B. Use a soft-bristle toothbrush and an electric razor, and report any dark, tarry stools immediately.
[CORRECT]
C. Discontinue the medication if bruising appears, then notify the provider within 1 week.
D. Take ibuprofen 400 mg PO every 6 hours for headache instead of acetaminophen.
Correct Answer: B
Rationale: Warfarin inhibits vitamin K–dependent clotting factors, so the priority teaching is bleeding precautions: soft
toothbrush, electric razor, avoid contact sports, and report signs of GI bleeding (melena, coffee-ground emesis). Spinach,
kale, and broccoli are high in vitamin K and should be consumed in consistent amounts — not increased — to avoid
antagonizing warfarin. The client should never self-discontinue warfarin. NSAIDs like ibuprofen potentiate bleeding risk and
are contraindicated; acetaminophen at therapeutic doses is preferred for mild analgesia.
Q6: The monitor technician alerts the nurse that a post-MI client in the CCU has suddenly developed a
rhythm with wide QRS complexes (>0.14 sec) at a rate of 180/min, with no discernible P waves. The client is
awake but lightheaded. What is the PRIORITY nursing action?
A. Administer adenosine 6 mg IV rapid push followed by a 20 mL saline flush.
B. Synchronize and deliver a 100-joule biphasic synchronized cardioversion. [CORRECT]
C. Defibrillate immediately at 200 joules biphasic and begin CPR.
D. Administer amiodarone 150 mg IV over 10 minutes and reassess.
Correct Answer: B
Rationale: The client has monomorphic ventricular tachycardia with a pulse but is symptomatic (lightheadedness indicates
hemodynamic compromise). The ACLS priority is synchronized cardioversion. Adenosine is contraindicated for
wide-complex tachycardia (it can degenerate VT into VF). Defibrillation is reserved for pulseless VT/VF or unstable rhythms
where synchronization is impossible. Amiodarone is appropriate for STABLE VT in a hemodynamically stable client, not for
one with symptoms.
Q7: A 67-year-old male smoker has chronic peripheral arterial disease (PAD) of the lower extremities. Which
assessment finding is the MOST characteristic of arterial versus venous insufficiency?
A. Dependent rubor, pallor on elevation, absent or diminished posterior tibial and dorsalis pedis pulses.
[CORRECT]
B. Brown hyperpigmentation around the ankles with 2+ pitting edema and warm skin.
C. Ulceration at the medial malleolus with shallow, irregular edges and moderate exudate.
D. Aching pain that worsens at the end of the day and is relieved by elevating the legs.
Correct Answer: A
Rationale: PAD produces the classic arterial triad: pallor on elevation, dependent rubor (redness when legs are dependent),
and absent/diminished peripheral pulses due to occlusive atherosclerotic disease. Pain is intermittent claudication that
worsens with activity and improves with rest. The other findings describe venous insufficiency: hyperpigmentation
(hemosiderin deposition), edema, warm skin, and medial malleolar ulcers (venous stasis ulcers) with pain relieved by
elevation.
HESI RN Medical-Surgical Nursing Exam Preparation Page 3
