HESI Med-Surg Next Gen Exam Questions and Answers
2026/2027 | Complete Medical Surgical Nursing Study Guide
250 original HESI/NGN-style medical-surgical nursing practice questions with answers and concise rationales. These are not
leaked or verbatim HESI/Elsevier exam items; they are original questions modeled on high-yield medical-surgical and
clinical-judgment concepts. HESI is an Elsevier product.
Clinical anatomy reference: heart chambers and major vessels.
Clinical anatomy reference: lungs and central airway.
Clinical data reference: representative ECG waveform.
Question 1 • Cardiovascular • Core
A client with acute chest pressure is diaphoretic and nauseated. Which action is priority?
• Pulmonary crackles
Page 1
, • Intermittent claudication relieved by rest
■ Obtain a 12-lead ECG promptly
• New oxygen saturation of 86%
Answer: Obtain a 12-lead ECG promptly
Rationale: Chest pressure with autonomic symptoms may indicate acute coronary syndrome; rapid ECG helps identify STEMI/NSTEMI.
Question 2 • Cardiovascular • Core
Which finding is most concerning in a client receiving digoxin?
■ New visual halos with an apical pulse of 52/min
• Decreased potassium
• Low sodium with individualized fluid guidance
• New oxygen saturation of 86%
Answer: New visual halos with an apical pulse of 52/min
Rationale: Bradycardia and visual disturbances are classic toxicity cues and require holding the drug and notifying the provider.
Question 3 • Cardiovascular • Core
Which instruction is most important for a client taking sublingual nitroglycerin?
• Intermittent claudication relieved by rest
• New visual halos with an apical pulse of 52/min
■ Sit down before taking the dose
• Low sodium with individualized fluid guidance
Answer: Sit down before taking the dose
Rationale: Nitroglycerin can cause hypotension; sitting reduces the risk of injury from syncope.
Question 4 • Cardiovascular • Core
A client with heart failure has crackles and worsening dyspnea. Which finding should the nurse report first?
• Pulmonary crackles
• Sit down before taking the dose
■ New oxygen saturation of 86%
• Obtain a 12-lead ECG promptly
Answer: New oxygen saturation of 86%
Rationale: Hypoxemia is an immediate threat and signals worsening pulmonary congestion.
Question 5 • Cardiovascular • Core
Which diet is most appropriate for a client with heart failure?
• Obtain a 12-lead ECG promptly
• Obtain a 12-lead ECG promptly
• Expanding groin hematoma
■ Low sodium with individualized fluid guidance
Answer: Low sodium with individualized fluid guidance
Rationale: Sodium restriction reduces fluid retention; fluid limits depend on severity and provider orders.
Question 6 • Cardiovascular • Core
A client taking furosemide should be monitored closely for which laboratory change?
• New visual halos with an apical pulse of 52/min
• New visual halos with an apical pulse of 52/min
Page 2
, • Intermittent claudication relieved by rest
■ Decreased potassium
Answer: Decreased potassium
Rationale: Loop diuretics increase urinary potassium loss and can cause hypokalemia.
Question 7 • Cardiovascular • Core
Which assessment finding is expected with left-sided heart failure?
■ Pulmonary crackles
• INR
• New visual halos with an apical pulse of 52/min
• Intermittent claudication relieved by rest
Answer: Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary venous congestion and interstitial/alveolar fluid.
Question 8 • Cardiovascular • Core
Which finding is most consistent with peripheral arterial disease?
• Expanding groin hematoma
• INR
• Obtain a 12-lead ECG promptly
■ Intermittent claudication relieved by rest
Answer: Intermittent claudication relieved by rest
Rationale: Arterial insufficiency causes exertional ischemic pain that improves when demand decreases.
Question 9 • Cardiovascular • Core
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is used to monitor therapy?
■ INR
• Expanding groin hematoma
• Intermittent claudication relieved by rest
• Sit down before taking the dose
Answer: INR
Rationale: Warfarin dosing is titrated using the international normalized ratio.
Question 10 • Cardiovascular • Core
Which assessment finding after femoral cardiac catheterization requires immediate action?
■ Expanding groin hematoma
• Sit down before taking the dose
• New visual halos with an apical pulse of 52/min
• Low sodium with individualized fluid guidance
Answer: Expanding groin hematoma
Rationale: An enlarging hematoma may indicate significant bleeding at the access site.
Question 11 • Respiratory • Core
Which position best improves ventilation in a client with severe dyspnea?
• Rinse the mouth after each use
■ High-Fowler position
• Prepare for immediate decompression
Page 3
, • Prepare for immediate decompression
Answer: High-Fowler position
Rationale: Upright positioning improves diaphragmatic expansion and reduces work of breathing.
Question 12 • Respiratory • Core
A client with COPD is receiving oxygen. Which finding requires close monitoring?
• Assess the system for an air leak
■ Increasing somnolence with rising PaCO2
• High-Fowler position
• Silent chest with increasing fatigue
Answer: Increasing somnolence with rising PaCO2
Rationale: Some chronic CO2 retainers can worsen hypercapnia; declining mental status is a danger sign.
Question 13 • Respiratory • Core
Which finding is most characteristic of a pneumothorax?
• Use an incentive spirometer regularly
• Assess the system for an air leak
■ Sudden unilateral absent breath sounds
• Sudden dyspnea with pleuritic chest pain
Answer: Sudden unilateral absent breath sounds
Rationale: Air in the pleural space can collapse the lung and eliminate breath sounds on the affected side.
Question 14 • Respiratory • Core
A client with a chest tube suddenly has continuous bubbling in the water-seal chamber. What should the
nurse do first?
• High-Fowler position
• High-Fowler position
■ Assess the system for an air leak
• Increasing somnolence with rising PaCO2
Answer: Assess the system for an air leak
Rationale: Continuous bubbling usually suggests an air leak somewhere in the system.
Question 15 • Respiratory • Core
Which intervention helps prevent postoperative atelectasis?
■ Use an incentive spirometer regularly
• Sudden unilateral absent breath sounds
• Rinse the mouth after each use
• Increasing somnolence with rising PaCO2
Answer: Use an incentive spirometer regularly
Rationale: Deep breathing and incentive spirometry promote alveolar expansion.
Question 16 • Respiratory • Core
A client with pulmonary embolism most commonly presents with which finding?
• pH 7.28, PaCO2 55 mm Hg
• Rinse the mouth after each use
• Assess the system for an air leak
Page 4
2026/2027 | Complete Medical Surgical Nursing Study Guide
250 original HESI/NGN-style medical-surgical nursing practice questions with answers and concise rationales. These are not
leaked or verbatim HESI/Elsevier exam items; they are original questions modeled on high-yield medical-surgical and
clinical-judgment concepts. HESI is an Elsevier product.
Clinical anatomy reference: heart chambers and major vessels.
Clinical anatomy reference: lungs and central airway.
Clinical data reference: representative ECG waveform.
Question 1 • Cardiovascular • Core
A client with acute chest pressure is diaphoretic and nauseated. Which action is priority?
• Pulmonary crackles
Page 1
, • Intermittent claudication relieved by rest
■ Obtain a 12-lead ECG promptly
• New oxygen saturation of 86%
Answer: Obtain a 12-lead ECG promptly
Rationale: Chest pressure with autonomic symptoms may indicate acute coronary syndrome; rapid ECG helps identify STEMI/NSTEMI.
Question 2 • Cardiovascular • Core
Which finding is most concerning in a client receiving digoxin?
■ New visual halos with an apical pulse of 52/min
• Decreased potassium
• Low sodium with individualized fluid guidance
• New oxygen saturation of 86%
Answer: New visual halos with an apical pulse of 52/min
Rationale: Bradycardia and visual disturbances are classic toxicity cues and require holding the drug and notifying the provider.
Question 3 • Cardiovascular • Core
Which instruction is most important for a client taking sublingual nitroglycerin?
• Intermittent claudication relieved by rest
• New visual halos with an apical pulse of 52/min
■ Sit down before taking the dose
• Low sodium with individualized fluid guidance
Answer: Sit down before taking the dose
Rationale: Nitroglycerin can cause hypotension; sitting reduces the risk of injury from syncope.
Question 4 • Cardiovascular • Core
A client with heart failure has crackles and worsening dyspnea. Which finding should the nurse report first?
• Pulmonary crackles
• Sit down before taking the dose
■ New oxygen saturation of 86%
• Obtain a 12-lead ECG promptly
Answer: New oxygen saturation of 86%
Rationale: Hypoxemia is an immediate threat and signals worsening pulmonary congestion.
Question 5 • Cardiovascular • Core
Which diet is most appropriate for a client with heart failure?
• Obtain a 12-lead ECG promptly
• Obtain a 12-lead ECG promptly
• Expanding groin hematoma
■ Low sodium with individualized fluid guidance
Answer: Low sodium with individualized fluid guidance
Rationale: Sodium restriction reduces fluid retention; fluid limits depend on severity and provider orders.
Question 6 • Cardiovascular • Core
A client taking furosemide should be monitored closely for which laboratory change?
• New visual halos with an apical pulse of 52/min
• New visual halos with an apical pulse of 52/min
Page 2
, • Intermittent claudication relieved by rest
■ Decreased potassium
Answer: Decreased potassium
Rationale: Loop diuretics increase urinary potassium loss and can cause hypokalemia.
Question 7 • Cardiovascular • Core
Which assessment finding is expected with left-sided heart failure?
■ Pulmonary crackles
• INR
• New visual halos with an apical pulse of 52/min
• Intermittent claudication relieved by rest
Answer: Pulmonary crackles
Rationale: Left ventricular failure causes pulmonary venous congestion and interstitial/alveolar fluid.
Question 8 • Cardiovascular • Core
Which finding is most consistent with peripheral arterial disease?
• Expanding groin hematoma
• INR
• Obtain a 12-lead ECG promptly
■ Intermittent claudication relieved by rest
Answer: Intermittent claudication relieved by rest
Rationale: Arterial insufficiency causes exertional ischemic pain that improves when demand decreases.
Question 9 • Cardiovascular • Core
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is used to monitor therapy?
■ INR
• Expanding groin hematoma
• Intermittent claudication relieved by rest
• Sit down before taking the dose
Answer: INR
Rationale: Warfarin dosing is titrated using the international normalized ratio.
Question 10 • Cardiovascular • Core
Which assessment finding after femoral cardiac catheterization requires immediate action?
■ Expanding groin hematoma
• Sit down before taking the dose
• New visual halos with an apical pulse of 52/min
• Low sodium with individualized fluid guidance
Answer: Expanding groin hematoma
Rationale: An enlarging hematoma may indicate significant bleeding at the access site.
Question 11 • Respiratory • Core
Which position best improves ventilation in a client with severe dyspnea?
• Rinse the mouth after each use
■ High-Fowler position
• Prepare for immediate decompression
Page 3
, • Prepare for immediate decompression
Answer: High-Fowler position
Rationale: Upright positioning improves diaphragmatic expansion and reduces work of breathing.
Question 12 • Respiratory • Core
A client with COPD is receiving oxygen. Which finding requires close monitoring?
• Assess the system for an air leak
■ Increasing somnolence with rising PaCO2
• High-Fowler position
• Silent chest with increasing fatigue
Answer: Increasing somnolence with rising PaCO2
Rationale: Some chronic CO2 retainers can worsen hypercapnia; declining mental status is a danger sign.
Question 13 • Respiratory • Core
Which finding is most characteristic of a pneumothorax?
• Use an incentive spirometer regularly
• Assess the system for an air leak
■ Sudden unilateral absent breath sounds
• Sudden dyspnea with pleuritic chest pain
Answer: Sudden unilateral absent breath sounds
Rationale: Air in the pleural space can collapse the lung and eliminate breath sounds on the affected side.
Question 14 • Respiratory • Core
A client with a chest tube suddenly has continuous bubbling in the water-seal chamber. What should the
nurse do first?
• High-Fowler position
• High-Fowler position
■ Assess the system for an air leak
• Increasing somnolence with rising PaCO2
Answer: Assess the system for an air leak
Rationale: Continuous bubbling usually suggests an air leak somewhere in the system.
Question 15 • Respiratory • Core
Which intervention helps prevent postoperative atelectasis?
■ Use an incentive spirometer regularly
• Sudden unilateral absent breath sounds
• Rinse the mouth after each use
• Increasing somnolence with rising PaCO2
Answer: Use an incentive spirometer regularly
Rationale: Deep breathing and incentive spirometry promote alveolar expansion.
Question 16 • Respiratory • Core
A client with pulmonary embolism most commonly presents with which finding?
• pH 7.28, PaCO2 55 mm Hg
• Rinse the mouth after each use
• Assess the system for an air leak
Page 4
