HESI PN Medical-Surgical 2026 Test Bank
Medical Surgical HESI Exit 2026/2027 Test Bank
Real Exam Questions and Correct Answers
200 Questions | Verified Answers & Detailed Rationales
Aligned with 2026-2027 HESI PN Exit Exam Blueprint
Comprehensive coverage reflecting the HESI PN Exit Examination's medical-surgical emphasis and NCLEX-PN test plan standards
Section Topic Q Range
S1 Perioperative Nursing Care Q1-Q20
S2 Cardiovascular and Hematologic Disorders Q21-Q40
S3 Respiratory Disorders Q41-Q60
S4 Neurological Disorders Q61-Q78
S5 Renal and Urinary Disorders Q79-Q96
S6 Gastrointestinal and Hepatic Disorders Q97-Q116
S7 Endocrine Disorders Q117-Q134
S8 Musculoskeletal and Integumentary Disorders Q135-Q152
S9 Cancer Care and Oncologic Emergencies Q153-Q170
S10 Emergency, Critical Care, and Multisystem Disorders Q171-Q200
10 Sections | 200 Questions | Cognitive Levels: 30% Recall, 50% Application, 20% Analysis
Question Style: 80% Scenario-Based, 20% Direct Recall with Calculation Integration
, HESI PN Medical-Surgical 2026 Test Bank
200 Real Exam Questions with Verified Answers and Detailed Rationales
About this Test Bank: This comprehensive 200-question practice test bank mirrors the content domains of the HESI PN Exit Examination
Medical-Surgical blueprint and the NCLEX-PN test plan. Questions span ten major body-system sections covering perioperative nursing care,
cardiovascular/hematologic disorders, respiratory, neurologic, renal/urinary, gastrointestinal/hepatic, endocrine, musculoskeletal/integumentary,
cancer care, and emergency/critical care nursing. Each question emphasizes practical nurse (PN) scope of practice, clinical judgment, and integration
of pharmacologic, laboratory, and patient education principles.
Cognitive Level Distribution: 30% Recall | 50% Application | 20% Analysis
Question Style: 80% Scenario-Based | 20% Direct Recall with Calculation Integration
Aligned with: 2026-2027 HESI PN Exit Examination Blueprint | NCLEX-PN Test Plan
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, & Postoperative Management
Q1 [Periop]: A client scheduled for a cholecystectomy asks the PN to explain the surgical procedure in detail because the surgeon did
not fully explain it. What is the PN's most appropriate response?
A. I will notify the surgeon so they can answer your questions before you sign the consent. [CORRECT]
B. I will explain the procedure to you using this preoperative teaching booklet.
C. You can sign the consent now and ask questions after surgery.
D. Just sign the form; the surgeon already explained everything.
Correct Answer: A — I will notify the surgeon so they can answer your questions before you sign the consent.
Rationale: Informed consent requires the surgeon (or qualified provider performing the procedure) to explain the risks, benefits, and alternatives. The PN
may witness the signature but cannot obtain consent or explain the procedure in detail. Options B, C, and D violate informed consent principles or exceed
PN scope.
Q2 [Periop]: A client is scheduled for an inguinal hernia repair at 0800. The PN reinforces preoperative NPO instructions. Which
statement by the client indicates teaching was effective?
A. I can eat a light breakfast at 0600 if I take my medications.
B. I can drink clear liquids until 0600 on the morning of surgery. [CORRECT]
C. I can chew gum to moisten my mouth until I leave for surgery.
D. I can have coffee with cream up to 4 hours before surgery.
Correct Answer: B — I can drink clear liquids until 0600 on the morning of surgery.
Rationale: Current ASA fasting guidelines allow clear liquids up to 2 hours before anesthesia induction; for an 0800 case, clear liquids may be taken until
0600. A light meal is allowed up to 6 hours and fatty foods up to 8 hours before. Chewing gum, hard candy, and coffee with milk are not permitted the
morning of surgery due to gastric stimulation and aspiration risk.
Q3 [Periop]: A client is scheduled for a colonoscopy. The PN reinforces instructions for the bowel preparation. Which statement by the
client indicates the need for further teaching?
A. I will drink the polyethylene glycol solution as prescribed even if it tastes unpleasant.
B. I will stop taking my warfarin three days before the procedure as my provider directed.
C. I can eat a regular breakfast the morning of the procedure. [CORRECT]
D. I will stay near a bathroom after starting the prep solution.
Correct Answer: C — I can eat a regular breakfast the morning of the procedure.
Rationale: Bowel prep requires clear liquids the day before and NPO status for at least 4-6 hours before the procedure. A regular breakfast would
compromise bowel visualization and increase aspiration risk. Polyethylene glycol intake, warfarin hold per provider direction, and proximity to a bathroom
all reflect correct understanding.
,HESI PN Medical-Surgical 2026 Test Bank | Medical Surgical HESI Exit Real Exam Questions | Verified Answers
Q4 [Periop]: A PN is preparing a sterile field for a dressing change. Which action by the PN maintains surgical
asepsis?
A. Turning away from the sterile field briefly to reach for additional supplies.
B. Pouring sterile solution from a height of 12 inches above the field.
C. Keeping the sterile field open and unattended for short periods.
D. Holding sterile gloved hands above waist level and in front of the body. [CORRECT]
Correct Answer: D — Holding sterile gloved hands above waist level and in front of the body.
Rationale: The PN should keep sterile gloved hands above waist level and in front of the body to maintain sterility. Turning away
from the field, pouring from a height (which increases splashing and contamination risk), and leaving the field unattended all violate
surgical asepsis principles and increase the risk of surgical site infection.
Q5 [Periop]: A PN is collecting preoperative data on a client scheduled for total hip arthroplasty. Which laboratory
value should the PN report to the RN/provider immediately?
A. Hemoglobin 14.0 g/dL.
B. Potassium 5.8 mEq/L. [CORRECT]
C. Platelets 200,000/mm3.
D. Sodium 138 mEq/L.
Correct Answer: B — Potassium 5.8 mEq/L.
Rationale: Potassium 5.8 mEq/L is above the normal range (3.5-5.0) and increases the risk of cardiac dysrhythmias under anesthesia;
surgery may be delayed until corrected. Hemoglobin 14.0, platelets 200,000, and sodium 138 are within normal limits. PN scope
includes data collection and reporting of critical findings to the RN/provider.
Q6 [Periop]: A client with a history of gastroesophageal reflux disease (GERD) is scheduled for abdominal surgery.
Which intraoperative position increases the client's risk of aspiration?
A. Trendelenburg (head-down tilt). [CORRECT]
B. Supine with head of bed flat.
C. Lithotomy position.
D. Reverse Trendelenburg (head-up tilt).
Correct Answer: A — Trendelenburg (head-down tilt).
Rationale: Trendelenburg position tilts the head down, promoting gastric reflux and aspiration in clients with GERD. Reverse
Trendelenburg (head-up) is preferred to reduce reflux risk. Supine flat and lithotomy positions are less likely to cause aspiration
than Trendelenburg in a client with GERD.
Q7 [Periop]: A postoperative client on the first evening after surgery has a temperature of 37.5 C (99.5 F), pulse
96/min, RR 20/min, and BP 116/72 mmHg. The PN auscultates diminished breath sounds at the right base. The
client has not used the incentive spirometer since returning from PACU. What is the PN's priority action?
A. Administer supplemental oxygen at 2 L/min via nasal cannula.
B. Notify the surgeon and request a STAT chest x-ray.
C. Administer prescribed acetaminophen for the low-grade fever.
D. Assist the client to use the incentive spirometer every 1-2 hours while awake. [CORRECT]
Correct Answer: D — Assist the client to use the incentive spirometer every 1-2 hours while awake.
Rationale: Atelectasis is the most common postoperative complication on POD 1-2. The priority action is to encourage incentive
spirometer use every 1-2 hours while awake to expand alveoli and treat atelectasis. Oxygen alone treats hypoxemia without
correcting the cause. A low-grade fever on POD 1 does not require acetaminophen or STAT imaging unless higher or worsening.
Page 3 | HESI PN Medical-Surgical Test Bank
, HESI PN Medical-Surgical 2026 Test Bank | Medical Surgical HESI Exit Real Exam Questions | Verified Answers
Q8 [Periop]: A client 4 hours postop from abdominal surgery has 200 mL of bright red blood in the Jackson-Pratt
drain over the last hour. The client's BP is 96/60 mmHg, pulse 118/min, and the client is anxious. What is the PN's
first action?
A. Check the surgical dressing and estimate additional blood loss.
B. Place the client in Trendelenburg position.
C. Apply oxygen at 2 L/min and notify the RN/surgeon immediately. [CORRECT]
D. Increase the IV fluid rate to 150 mL/hr to maintain blood pressure.
Correct Answer: C — Apply oxygen at 2 L/min and notify the RN/surgeon immediately.
Rationale: Bright red drainage >100 mL/hr with hypotension and tachycardia indicates active hemorrhage and shock. The PN's first
action is to apply oxygen to improve tissue perfusion and immediately notify the RN/surgeon for IV fluid/blood orders. PN scope
does not permit independent changes to IV rates. Trendelenburg is contraindicated due to aspiration risk.
Q9 [Periop]: A client is 5 days postop from an abdominal surgery. The PN notes the incisional edges are red, warm,
and tender with a small amount of purulent yellow-green drainage. The client's temperature is 38.5 C (101.3 F).
What is the PN's best action?
A. Document the findings and continue to monitor.
B. Apply warm compresses to reduce inflammation.
C. Administer acetaminophen for the fever.
D. Notify the RN/surgeon and prepare for wound culture. [CORRECT]
Correct Answer: D — Notify the RN/surgeon and prepare for wound culture.
Rationale: Redness, warmth, tenderness, purulent drainage, and fever on POD 5-7 are classic signs of wound infection. The PN
should notify the RN/surgeon and prepare for wound culture and antibiotic therapy. Documentation alone is insufficient, warm
compresses do not treat infection, and antipyretics do not address the underlying infection.
Q10 [Periop]: Which action should the PN include in the plan for a postoperative client to prevent deep vein
thrombosis (DVT)?
A. Encourage ankle pumps every 1-2 hours while awake. [CORRECT]
B. Place a pillow under the knees when in bed.
C. Keep the client on strict bedrest for the first 48 hours.
D. Massage the legs if calf pain develops.
Correct Answer: A — Encourage ankle pumps every 1-2 hours while awake.
Rationale: Ankle pumps promote venous return and prevent venous stasis, reducing DVT risk. Pillows under the knees impede
venous return. Early ambulation is encouraged rather than strict bedrest. Massaging calf pain is contraindicated because it may
dislodge a clot and cause pulmonary embolism.
Q11 [Periop]: A postoperative client suddenly reports chest pain and shortness of breath. The client is tachypneic,
tachycardic, and appears anxious. The PN notes oxygen saturation 88% on room air. What is the PN's priority
action?
A. Encourage the client to cough and deep breathe.
B. Place the client supine with legs elevated.
C. Raise the head of the bed and apply oxygen at 4 L/min. [CORRECT]
D. Administer prescribed morphine for chest pain.
Correct Answer: C — Raise the head of the bed and apply oxygen at 4 L/min.
Rationale: Sudden chest pain, dyspnea, hypoxemia, tachycardia, and anxiety in a postoperative client suggest pulmonary embolism.
The PN's priority is to raise the head of the bed to ease breathing and apply oxygen to address hypoxemia (ABC priority).
Cough/deep breathe is inappropriate for PE. Supine worsens breathing. Morphine follows oxygen and notification.
Page 4 | HESI PN Medical-Surgical Test Bank
Medical Surgical HESI Exit 2026/2027 Test Bank
Real Exam Questions and Correct Answers
200 Questions | Verified Answers & Detailed Rationales
Aligned with 2026-2027 HESI PN Exit Exam Blueprint
Comprehensive coverage reflecting the HESI PN Exit Examination's medical-surgical emphasis and NCLEX-PN test plan standards
Section Topic Q Range
S1 Perioperative Nursing Care Q1-Q20
S2 Cardiovascular and Hematologic Disorders Q21-Q40
S3 Respiratory Disorders Q41-Q60
S4 Neurological Disorders Q61-Q78
S5 Renal and Urinary Disorders Q79-Q96
S6 Gastrointestinal and Hepatic Disorders Q97-Q116
S7 Endocrine Disorders Q117-Q134
S8 Musculoskeletal and Integumentary Disorders Q135-Q152
S9 Cancer Care and Oncologic Emergencies Q153-Q170
S10 Emergency, Critical Care, and Multisystem Disorders Q171-Q200
10 Sections | 200 Questions | Cognitive Levels: 30% Recall, 50% Application, 20% Analysis
Question Style: 80% Scenario-Based, 20% Direct Recall with Calculation Integration
, HESI PN Medical-Surgical 2026 Test Bank
200 Real Exam Questions with Verified Answers and Detailed Rationales
About this Test Bank: This comprehensive 200-question practice test bank mirrors the content domains of the HESI PN Exit Examination
Medical-Surgical blueprint and the NCLEX-PN test plan. Questions span ten major body-system sections covering perioperative nursing care,
cardiovascular/hematologic disorders, respiratory, neurologic, renal/urinary, gastrointestinal/hepatic, endocrine, musculoskeletal/integumentary,
cancer care, and emergency/critical care nursing. Each question emphasizes practical nurse (PN) scope of practice, clinical judgment, and integration
of pharmacologic, laboratory, and patient education principles.
Cognitive Level Distribution: 30% Recall | 50% Application | 20% Analysis
Question Style: 80% Scenario-Based | 20% Direct Recall with Calculation Integration
Aligned with: 2026-2027 HESI PN Exit Examination Blueprint | NCLEX-PN Test Plan
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, & Postoperative Management
Q1 [Periop]: A client scheduled for a cholecystectomy asks the PN to explain the surgical procedure in detail because the surgeon did
not fully explain it. What is the PN's most appropriate response?
A. I will notify the surgeon so they can answer your questions before you sign the consent. [CORRECT]
B. I will explain the procedure to you using this preoperative teaching booklet.
C. You can sign the consent now and ask questions after surgery.
D. Just sign the form; the surgeon already explained everything.
Correct Answer: A — I will notify the surgeon so they can answer your questions before you sign the consent.
Rationale: Informed consent requires the surgeon (or qualified provider performing the procedure) to explain the risks, benefits, and alternatives. The PN
may witness the signature but cannot obtain consent or explain the procedure in detail. Options B, C, and D violate informed consent principles or exceed
PN scope.
Q2 [Periop]: A client is scheduled for an inguinal hernia repair at 0800. The PN reinforces preoperative NPO instructions. Which
statement by the client indicates teaching was effective?
A. I can eat a light breakfast at 0600 if I take my medications.
B. I can drink clear liquids until 0600 on the morning of surgery. [CORRECT]
C. I can chew gum to moisten my mouth until I leave for surgery.
D. I can have coffee with cream up to 4 hours before surgery.
Correct Answer: B — I can drink clear liquids until 0600 on the morning of surgery.
Rationale: Current ASA fasting guidelines allow clear liquids up to 2 hours before anesthesia induction; for an 0800 case, clear liquids may be taken until
0600. A light meal is allowed up to 6 hours and fatty foods up to 8 hours before. Chewing gum, hard candy, and coffee with milk are not permitted the
morning of surgery due to gastric stimulation and aspiration risk.
Q3 [Periop]: A client is scheduled for a colonoscopy. The PN reinforces instructions for the bowel preparation. Which statement by the
client indicates the need for further teaching?
A. I will drink the polyethylene glycol solution as prescribed even if it tastes unpleasant.
B. I will stop taking my warfarin three days before the procedure as my provider directed.
C. I can eat a regular breakfast the morning of the procedure. [CORRECT]
D. I will stay near a bathroom after starting the prep solution.
Correct Answer: C — I can eat a regular breakfast the morning of the procedure.
Rationale: Bowel prep requires clear liquids the day before and NPO status for at least 4-6 hours before the procedure. A regular breakfast would
compromise bowel visualization and increase aspiration risk. Polyethylene glycol intake, warfarin hold per provider direction, and proximity to a bathroom
all reflect correct understanding.
,HESI PN Medical-Surgical 2026 Test Bank | Medical Surgical HESI Exit Real Exam Questions | Verified Answers
Q4 [Periop]: A PN is preparing a sterile field for a dressing change. Which action by the PN maintains surgical
asepsis?
A. Turning away from the sterile field briefly to reach for additional supplies.
B. Pouring sterile solution from a height of 12 inches above the field.
C. Keeping the sterile field open and unattended for short periods.
D. Holding sterile gloved hands above waist level and in front of the body. [CORRECT]
Correct Answer: D — Holding sterile gloved hands above waist level and in front of the body.
Rationale: The PN should keep sterile gloved hands above waist level and in front of the body to maintain sterility. Turning away
from the field, pouring from a height (which increases splashing and contamination risk), and leaving the field unattended all violate
surgical asepsis principles and increase the risk of surgical site infection.
Q5 [Periop]: A PN is collecting preoperative data on a client scheduled for total hip arthroplasty. Which laboratory
value should the PN report to the RN/provider immediately?
A. Hemoglobin 14.0 g/dL.
B. Potassium 5.8 mEq/L. [CORRECT]
C. Platelets 200,000/mm3.
D. Sodium 138 mEq/L.
Correct Answer: B — Potassium 5.8 mEq/L.
Rationale: Potassium 5.8 mEq/L is above the normal range (3.5-5.0) and increases the risk of cardiac dysrhythmias under anesthesia;
surgery may be delayed until corrected. Hemoglobin 14.0, platelets 200,000, and sodium 138 are within normal limits. PN scope
includes data collection and reporting of critical findings to the RN/provider.
Q6 [Periop]: A client with a history of gastroesophageal reflux disease (GERD) is scheduled for abdominal surgery.
Which intraoperative position increases the client's risk of aspiration?
A. Trendelenburg (head-down tilt). [CORRECT]
B. Supine with head of bed flat.
C. Lithotomy position.
D. Reverse Trendelenburg (head-up tilt).
Correct Answer: A — Trendelenburg (head-down tilt).
Rationale: Trendelenburg position tilts the head down, promoting gastric reflux and aspiration in clients with GERD. Reverse
Trendelenburg (head-up) is preferred to reduce reflux risk. Supine flat and lithotomy positions are less likely to cause aspiration
than Trendelenburg in a client with GERD.
Q7 [Periop]: A postoperative client on the first evening after surgery has a temperature of 37.5 C (99.5 F), pulse
96/min, RR 20/min, and BP 116/72 mmHg. The PN auscultates diminished breath sounds at the right base. The
client has not used the incentive spirometer since returning from PACU. What is the PN's priority action?
A. Administer supplemental oxygen at 2 L/min via nasal cannula.
B. Notify the surgeon and request a STAT chest x-ray.
C. Administer prescribed acetaminophen for the low-grade fever.
D. Assist the client to use the incentive spirometer every 1-2 hours while awake. [CORRECT]
Correct Answer: D — Assist the client to use the incentive spirometer every 1-2 hours while awake.
Rationale: Atelectasis is the most common postoperative complication on POD 1-2. The priority action is to encourage incentive
spirometer use every 1-2 hours while awake to expand alveoli and treat atelectasis. Oxygen alone treats hypoxemia without
correcting the cause. A low-grade fever on POD 1 does not require acetaminophen or STAT imaging unless higher or worsening.
Page 3 | HESI PN Medical-Surgical Test Bank
, HESI PN Medical-Surgical 2026 Test Bank | Medical Surgical HESI Exit Real Exam Questions | Verified Answers
Q8 [Periop]: A client 4 hours postop from abdominal surgery has 200 mL of bright red blood in the Jackson-Pratt
drain over the last hour. The client's BP is 96/60 mmHg, pulse 118/min, and the client is anxious. What is the PN's
first action?
A. Check the surgical dressing and estimate additional blood loss.
B. Place the client in Trendelenburg position.
C. Apply oxygen at 2 L/min and notify the RN/surgeon immediately. [CORRECT]
D. Increase the IV fluid rate to 150 mL/hr to maintain blood pressure.
Correct Answer: C — Apply oxygen at 2 L/min and notify the RN/surgeon immediately.
Rationale: Bright red drainage >100 mL/hr with hypotension and tachycardia indicates active hemorrhage and shock. The PN's first
action is to apply oxygen to improve tissue perfusion and immediately notify the RN/surgeon for IV fluid/blood orders. PN scope
does not permit independent changes to IV rates. Trendelenburg is contraindicated due to aspiration risk.
Q9 [Periop]: A client is 5 days postop from an abdominal surgery. The PN notes the incisional edges are red, warm,
and tender with a small amount of purulent yellow-green drainage. The client's temperature is 38.5 C (101.3 F).
What is the PN's best action?
A. Document the findings and continue to monitor.
B. Apply warm compresses to reduce inflammation.
C. Administer acetaminophen for the fever.
D. Notify the RN/surgeon and prepare for wound culture. [CORRECT]
Correct Answer: D — Notify the RN/surgeon and prepare for wound culture.
Rationale: Redness, warmth, tenderness, purulent drainage, and fever on POD 5-7 are classic signs of wound infection. The PN
should notify the RN/surgeon and prepare for wound culture and antibiotic therapy. Documentation alone is insufficient, warm
compresses do not treat infection, and antipyretics do not address the underlying infection.
Q10 [Periop]: Which action should the PN include in the plan for a postoperative client to prevent deep vein
thrombosis (DVT)?
A. Encourage ankle pumps every 1-2 hours while awake. [CORRECT]
B. Place a pillow under the knees when in bed.
C. Keep the client on strict bedrest for the first 48 hours.
D. Massage the legs if calf pain develops.
Correct Answer: A — Encourage ankle pumps every 1-2 hours while awake.
Rationale: Ankle pumps promote venous return and prevent venous stasis, reducing DVT risk. Pillows under the knees impede
venous return. Early ambulation is encouraged rather than strict bedrest. Massaging calf pain is contraindicated because it may
dislodge a clot and cause pulmonary embolism.
Q11 [Periop]: A postoperative client suddenly reports chest pain and shortness of breath. The client is tachypneic,
tachycardic, and appears anxious. The PN notes oxygen saturation 88% on room air. What is the PN's priority
action?
A. Encourage the client to cough and deep breathe.
B. Place the client supine with legs elevated.
C. Raise the head of the bed and apply oxygen at 4 L/min. [CORRECT]
D. Administer prescribed morphine for chest pain.
Correct Answer: C — Raise the head of the bed and apply oxygen at 4 L/min.
Rationale: Sudden chest pain, dyspnea, hypoxemia, tachycardia, and anxiety in a postoperative client suggest pulmonary embolism.
The PN's priority is to raise the head of the bed to ease breathing and apply oxygen to address hypoxemia (ABC priority).
Cough/deep breathe is inappropriate for PE. Supine worsens breathing. Morphine follows oxygen and notification.
Page 4 | HESI PN Medical-Surgical Test Bank
