1|Page
HESI MED-SURG II ORIGINAL
PRACTICE EXAM [QUESTIONS 1-100]
AND ANSWERS UPDATED 2026/2027 |
DETAILED RATIONALES
INTRODUCTION
HESI Medical-Surgical II is an advanced nursing assessment designed to evaluate a student's
ability to apply medical-surgical knowledge to complex patient-care situations. Preparation
requires more than memorizing disease definitions: students must recognize clinical
deterioration, interpret assessment findings and laboratory results, prioritize nursing
interventions, evaluate treatment responses, administer medications safely, and apply clinical
judgment. Elsevier identifies Medical-Surgical as one of its HESI RN specialty examinations,
while its HESI medical-surgical case studies incorporate physiological and psychosocial
alterations together with management, pharmacology, and nursing concepts. (Evolve)
This original practice bank is designed for nursing students preparing for a Medical-Surgical II
examination. The questions emphasize difficult, scenario-based application rather than simple
recall. Each item contains four answer choices, one best answer, and a detailed rationale
explaining the clinical reasoning behind the answer and why the alternatives are less appropriate.
The material should be used as a study and clinical-reasoning resource rather than as a
representation of confidential Elsevier examination content or a guarantee of examination
performance.
CONTENT AREA OVERVIEW
Suggested
Content Area Questions Key Topics
Weight
Heart failure, ACS, dysrhythmias,
Cardiovascular Disorders 1–15 15%
hypertension, shock, vascular disorders
COPD, asthma, pneumonia, PE,
Respiratory Disorders 16–28 13%
respiratory failure, chest tubes
Stroke, seizures, increased ICP, spinal
Neurologic Disorders 29–40 12%
cord injury, neurologic emergencies
AKI, CKD, dialysis, electrolyte
Renal & Urinary Disorders 41–50 10%
disturbances, urinary disorders
Endocrine & Metabolic Diabetes, thyroid disorders, adrenal
51–60 10%
Disorders disorders, metabolic emergencies
Gastrointestinal & Hepatic GI bleeding, pancreatitis, cirrhosis,
61–70 10%
Disorders hepatitis, bowel disorders
,2|Page
Suggested
Content Area Questions Key Topics
Weight
Hematologic & Oncologic Anemia, transfusion reactions,
71–78 8%
Disorders neutropenia, cancer complications
Musculoskeletal & Fractures, burns, compartment
79–84 6%
Integumentary Disorders syndrome, pressure injuries
Sepsis, septic shock, infection control,
Infection & Sepsis 85–90 6%
antimicrobial therapy
Perioperative & Critical- Postoperative complications,
91–95 5%
Care Concepts hemodynamics, ventilatory support
Pharmacology, Safety & High-alert medications, prioritization,
96–100 5%
Clinical Judgment delegation, adverse effects
QUESTIONS 1–100
Cardiovascular Disorders
Q1:
A client with acute decompensated heart failure has received IV furosemide. Two hours later, the
client reports severe muscle weakness and palpitations. The cardiac monitor shows frequent
premature ventricular contractions. Which laboratory result should the nurse anticipate?
A) Sodium 138 mEq/L
B) Potassium 2.9 mEq/L
C) Calcium 9.4 mg/dL
D) Magnesium 2.1 mg/dL
Rationale: The correct answer is B because aggressive loop-diuretic therapy can cause
significant potassium loss. Hypokalemia increases myocardial irritability and can produce
premature ventricular contractions and potentially dangerous dysrhythmias. Option A is a
normal sodium concentration and does not explain the ventricular ectopy. Option C represents a
normal calcium level. Option D represents a normal magnesium concentration. The combination
of diuretic therapy, weakness, palpitations, and ventricular ectopy makes hypokalemia the
priority concern.
Q2:
A client with an acute myocardial infarction suddenly develops severe dyspnea, pink frothy
sputum, bilateral crackles, and an oxygen saturation of 82%. Which intervention should the nurse
implement first?
,3|Page
A) Obtain a 12-lead ECG
B) Position the client upright and administer supplemental oxygen
C) Administer the prescribed oral beta blocker
D) Encourage the client to increase oral fluid intake
Rationale: The correct answer is B because the findings indicate acute pulmonary edema with
severe hypoxemia. Positioning upright improves lung expansion and decreases venous return,
while supplemental oxygen addresses the immediate oxygenation problem. Option A is important
but should not delay correction of severe hypoxemia. Option C is not the first intervention for
acute pulmonary edema and may worsen instability depending on the client's hemodynamic
status. Option D would increase intravascular volume and potentially worsen pulmonary
congestion.
Q3:
A client receiving IV heparin for an acute pulmonary embolism develops sudden severe
headache and confusion. Which action is the nurse's priority?
A) Reassess the client in 30 minutes
B) Administer the next dose of heparin
C) Stop the heparin infusion and notify the provider immediately
D) Encourage oral fluids
Rationale: The correct answer is C because sudden severe headache and altered mental status
during anticoagulant therapy may indicate intracranial bleeding. Continuing heparin could
worsen hemorrhage. Option A delays evaluation of a potentially life-threatening complication.
Option B could increase bleeding. Option D does not address the suspected intracranial event.
Q4:
A client with heart failure has gained 2.5 kg over the past three days and reports increasing
orthopnea. Which assessment finding requires the most immediate intervention?
A) Mild bilateral ankle edema
B) Heart rate of 96/min
C) Blood pressure of 142/88 mm Hg
D) Oxygen saturation of 84% with new crackles
Rationale: The correct answer is D because severe hypoxemia with new pulmonary crackles
suggests worsening pulmonary congestion and possible acute pulmonary edema. Immediate
respiratory support is required. Option A is consistent with fluid retention but is less immediately
life-threatening. Option B is only mildly elevated. Option C represents hypertension but does not
indicate the same degree of immediate compromise.
Q5:
, 4|Page
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most important
for evaluating therapeutic anticoagulation?
A) aPTT
B) INR
C) Troponin
D) CK-MB
Rationale: The correct answer is B because the INR is used to monitor warfarin therapy. Option
A is primarily used to monitor unfractionated heparin. Options C and D are cardiac biomarkers
used to evaluate myocardial injury rather than warfarin effectiveness.
Q6:
A client receiving digoxin for heart failure reports nausea, weakness, and seeing yellow-green
halos around lights. Which finding should the nurse recognize as most concerning?
A) Respiratory rate 18/min
B) Blood pressure 126/74 mm Hg
C) Heart rate 48/min
D) Temperature 37.0°C
Rationale: The correct answer is C because bradycardia can accompany digoxin toxicity. The
gastrointestinal and visual changes are also classic toxicity findings. Option A is normal. Option
B is acceptable. Option D is normal. The combination of suspected toxicity and marked
bradycardia requires prompt intervention.
Q7:
A client with peripheral arterial disease reports severe calf pain when walking that resolves after
resting. Which instruction should the nurse provide?
A) Elevate the legs above heart level frequently
B) Participate in a structured walking program as prescribed
C) Apply heating pads directly to the lower legs
D) Wear tightly fitted compression stockings continuously
Rationale: The correct answer is B because supervised or structured walking can improve
functional circulation and walking distance in peripheral arterial disease. Option A can further
decrease arterial perfusion. Option C creates a burn risk because arterial insufficiency can
impair sensation and healing. Option D may be inappropriate in significant arterial disease
because excessive compression can reduce arterial blood flow.
Q8:
HESI MED-SURG II ORIGINAL
PRACTICE EXAM [QUESTIONS 1-100]
AND ANSWERS UPDATED 2026/2027 |
DETAILED RATIONALES
INTRODUCTION
HESI Medical-Surgical II is an advanced nursing assessment designed to evaluate a student's
ability to apply medical-surgical knowledge to complex patient-care situations. Preparation
requires more than memorizing disease definitions: students must recognize clinical
deterioration, interpret assessment findings and laboratory results, prioritize nursing
interventions, evaluate treatment responses, administer medications safely, and apply clinical
judgment. Elsevier identifies Medical-Surgical as one of its HESI RN specialty examinations,
while its HESI medical-surgical case studies incorporate physiological and psychosocial
alterations together with management, pharmacology, and nursing concepts. (Evolve)
This original practice bank is designed for nursing students preparing for a Medical-Surgical II
examination. The questions emphasize difficult, scenario-based application rather than simple
recall. Each item contains four answer choices, one best answer, and a detailed rationale
explaining the clinical reasoning behind the answer and why the alternatives are less appropriate.
The material should be used as a study and clinical-reasoning resource rather than as a
representation of confidential Elsevier examination content or a guarantee of examination
performance.
CONTENT AREA OVERVIEW
Suggested
Content Area Questions Key Topics
Weight
Heart failure, ACS, dysrhythmias,
Cardiovascular Disorders 1–15 15%
hypertension, shock, vascular disorders
COPD, asthma, pneumonia, PE,
Respiratory Disorders 16–28 13%
respiratory failure, chest tubes
Stroke, seizures, increased ICP, spinal
Neurologic Disorders 29–40 12%
cord injury, neurologic emergencies
AKI, CKD, dialysis, electrolyte
Renal & Urinary Disorders 41–50 10%
disturbances, urinary disorders
Endocrine & Metabolic Diabetes, thyroid disorders, adrenal
51–60 10%
Disorders disorders, metabolic emergencies
Gastrointestinal & Hepatic GI bleeding, pancreatitis, cirrhosis,
61–70 10%
Disorders hepatitis, bowel disorders
,2|Page
Suggested
Content Area Questions Key Topics
Weight
Hematologic & Oncologic Anemia, transfusion reactions,
71–78 8%
Disorders neutropenia, cancer complications
Musculoskeletal & Fractures, burns, compartment
79–84 6%
Integumentary Disorders syndrome, pressure injuries
Sepsis, septic shock, infection control,
Infection & Sepsis 85–90 6%
antimicrobial therapy
Perioperative & Critical- Postoperative complications,
91–95 5%
Care Concepts hemodynamics, ventilatory support
Pharmacology, Safety & High-alert medications, prioritization,
96–100 5%
Clinical Judgment delegation, adverse effects
QUESTIONS 1–100
Cardiovascular Disorders
Q1:
A client with acute decompensated heart failure has received IV furosemide. Two hours later, the
client reports severe muscle weakness and palpitations. The cardiac monitor shows frequent
premature ventricular contractions. Which laboratory result should the nurse anticipate?
A) Sodium 138 mEq/L
B) Potassium 2.9 mEq/L
C) Calcium 9.4 mg/dL
D) Magnesium 2.1 mg/dL
Rationale: The correct answer is B because aggressive loop-diuretic therapy can cause
significant potassium loss. Hypokalemia increases myocardial irritability and can produce
premature ventricular contractions and potentially dangerous dysrhythmias. Option A is a
normal sodium concentration and does not explain the ventricular ectopy. Option C represents a
normal calcium level. Option D represents a normal magnesium concentration. The combination
of diuretic therapy, weakness, palpitations, and ventricular ectopy makes hypokalemia the
priority concern.
Q2:
A client with an acute myocardial infarction suddenly develops severe dyspnea, pink frothy
sputum, bilateral crackles, and an oxygen saturation of 82%. Which intervention should the nurse
implement first?
,3|Page
A) Obtain a 12-lead ECG
B) Position the client upright and administer supplemental oxygen
C) Administer the prescribed oral beta blocker
D) Encourage the client to increase oral fluid intake
Rationale: The correct answer is B because the findings indicate acute pulmonary edema with
severe hypoxemia. Positioning upright improves lung expansion and decreases venous return,
while supplemental oxygen addresses the immediate oxygenation problem. Option A is important
but should not delay correction of severe hypoxemia. Option C is not the first intervention for
acute pulmonary edema and may worsen instability depending on the client's hemodynamic
status. Option D would increase intravascular volume and potentially worsen pulmonary
congestion.
Q3:
A client receiving IV heparin for an acute pulmonary embolism develops sudden severe
headache and confusion. Which action is the nurse's priority?
A) Reassess the client in 30 minutes
B) Administer the next dose of heparin
C) Stop the heparin infusion and notify the provider immediately
D) Encourage oral fluids
Rationale: The correct answer is C because sudden severe headache and altered mental status
during anticoagulant therapy may indicate intracranial bleeding. Continuing heparin could
worsen hemorrhage. Option A delays evaluation of a potentially life-threatening complication.
Option B could increase bleeding. Option D does not address the suspected intracranial event.
Q4:
A client with heart failure has gained 2.5 kg over the past three days and reports increasing
orthopnea. Which assessment finding requires the most immediate intervention?
A) Mild bilateral ankle edema
B) Heart rate of 96/min
C) Blood pressure of 142/88 mm Hg
D) Oxygen saturation of 84% with new crackles
Rationale: The correct answer is D because severe hypoxemia with new pulmonary crackles
suggests worsening pulmonary congestion and possible acute pulmonary edema. Immediate
respiratory support is required. Option A is consistent with fluid retention but is less immediately
life-threatening. Option B is only mildly elevated. Option C represents hypertension but does not
indicate the same degree of immediate compromise.
Q5:
, 4|Page
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most important
for evaluating therapeutic anticoagulation?
A) aPTT
B) INR
C) Troponin
D) CK-MB
Rationale: The correct answer is B because the INR is used to monitor warfarin therapy. Option
A is primarily used to monitor unfractionated heparin. Options C and D are cardiac biomarkers
used to evaluate myocardial injury rather than warfarin effectiveness.
Q6:
A client receiving digoxin for heart failure reports nausea, weakness, and seeing yellow-green
halos around lights. Which finding should the nurse recognize as most concerning?
A) Respiratory rate 18/min
B) Blood pressure 126/74 mm Hg
C) Heart rate 48/min
D) Temperature 37.0°C
Rationale: The correct answer is C because bradycardia can accompany digoxin toxicity. The
gastrointestinal and visual changes are also classic toxicity findings. Option A is normal. Option
B is acceptable. Option D is normal. The combination of suspected toxicity and marked
bradycardia requires prompt intervention.
Q7:
A client with peripheral arterial disease reports severe calf pain when walking that resolves after
resting. Which instruction should the nurse provide?
A) Elevate the legs above heart level frequently
B) Participate in a structured walking program as prescribed
C) Apply heating pads directly to the lower legs
D) Wear tightly fitted compression stockings continuously
Rationale: The correct answer is B because supervised or structured walking can improve
functional circulation and walking distance in peripheral arterial disease. Option A can further
decrease arterial perfusion. Option C creates a burn risk because arterial insufficiency can
impair sensation and healing. Option D may be inappropriate in significant arterial disease
because excessive compression can reduce arterial blood flow.
Q8:
