HESI Med Surg Comprehensive
Practice Exam (Latest 2026/2027
Update) Complete Q&A with Verified
Answers and Detailed Rationales
HESI Med Surg Comprehensive Practice Exam (Latest |
Comprehensive Examination
HESI Med Surg Comprehensive Practice Exam (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier Medical Surgical Nursing
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Comprehensive Practice Exam
(Latest 2026/2027 Update) Complete Q&A with Verified
Answers and Detailed Rationales Evolve Elsevier Medical
Surgical Nursing Test Bank for RN Exit and Med Surg
Specialty A+ Graded. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
Which assessment finding most strongly indicates impending local anesthetic
systemic toxicity (LAST) after a peripheral nerve block?
A. Perioral numbness and tinnitus
B. Hypertension and tachycardia
C. Bradycardia and hypotension
D. Immediate loss of motor function
Correct Answer: A - Perioral numbness and tinnitus
RATIONALE
Early LAST presents with excitatory neurologic symptoms such as
perioral numbness, tinnitus, and metallic taste due to CNS stimulation.
Cardiovascular depression (bradycardia, hypotension) occurs later,
and hypertension/tachycardia are nonspecific. Loss of motor function
is expected, not toxic.
Question 2
When evaluating a patient with acute decompensated heart failure, which
combination of findings best supports cardiogenic pulmonary edema rather
than ARDS?
A. Elevated BNP, frothy pink sputum, S3 gallop
B. Normal BNP, bilateral infiltrates, fever
C. Low PAOP, refractory hypoxemia, normal CVP
D. High PAOP, unilateral infiltrates, purulent sputum
Correct Answer: A - Elevated BNP, frothy pink sputum, S3 gallop
RATIONALE
Cardiogenic pulmonary edema is characterized by elevated BNP,
frothy pink sputum, and an S3 gallop due to volume overload and left
ventricular dysfunction. ARDS typically has normal or low PAOP,
bilateral infiltrates, and no S3. Unilateral infiltrates suggest
pneumonia or other localized process.
Page 2
, Question 3
A patient with chronic kidney disease stage 4 is prescribed sodium polystyrene
sulfonate. Which concurrent medication poses the highest risk for serious
adverse effects?
A. Calcium acetate
B. Sorbitol
C. Lisinopril
D. Epoetin alfa
Correct Answer: B - Sorbitol
RATIONALE
Sodium polystyrene sulfonate combined with sorbitol can cause
intestinal necrosis, especially in patients with impaired motility or
CKD. Calcium acetate, lisinopril, and epoetin alfa do not have this
specific interaction. Sorbitol is often used as a laxative with the resin
but increases risk.
Question 4
Which intervention is the priority when a patient with a new tracheostomy
develops sudden respiratory distress, absent breath sounds on the left, and
subcutaneous emphysema?
A. Suction the tracheostomy
B. Auscultate lung sounds
C. Remove the tracheostomy tube
D. Prepare for chest tube insertion
Correct Answer: D - Prepare for chest tube insertion
Page 3
, RATIONALE
Unilateral absent breath sounds with subcutaneous emphysema after
tracheostomy suggests pneumothorax, requiring immediate chest tube
insertion. Suctioning and auscultation delay definitive treatment.
Removing the tracheostomy tube is not indicated and could worsen
the airway.
Question 5
A patient with acute pancreatitis has a serum calcium of 7.2 mg/dL. Which
pathophysiologic mechanism best explains this finding?
A. Increased calcitonin release
B. Saponification of calcium in peripancreatic fat
C. Vitamin D deficiency
D. Hyperparathyroidism
Correct Answer: B - Saponification of calcium in peripancreatic
fat
RATIONALE
In acute pancreatitis, lipase breaks down fat into fatty acids that bind
calcium (saponification), leading to hypocalcemia. This is a classic
sign of severe pancreatitis. Hyperparathyroidism would cause
hypercalcemia, and vitamin D deficiency is not the primary acute
mechanism.
Question 6
Which finding in a patient receiving a blood transfusion requires immediate
cessation of the transfusion and initiation of emergency protocols?
A. Temperature increase of 1.8°F (1°C) after 15 minutes
B. Mild urticaria and itching
C. Hemoglobinuria and flank pain
D. Blood pressure increase from 110/70 to 130/80
Correct Answer: C - Hemoglobinuria and flank pain
Page 4
Practice Exam (Latest 2026/2027
Update) Complete Q&A with Verified
Answers and Detailed Rationales
HESI Med Surg Comprehensive Practice Exam (Latest |
Comprehensive Examination
HESI Med Surg Comprehensive Practice Exam (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier Medical Surgical Nursing
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Comprehensive Practice Exam
(Latest 2026/2027 Update) Complete Q&A with Verified
Answers and Detailed Rationales Evolve Elsevier Medical
Surgical Nursing Test Bank for RN Exit and Med Surg
Specialty A+ Graded. Every item uses a focused exam stem,
four response options, a keyed response, and a clear rationale,
making it easier to understand the subject, spot distractors, and
build real exam confidence.
Page 1
, Question 1
Which assessment finding most strongly indicates impending local anesthetic
systemic toxicity (LAST) after a peripheral nerve block?
A. Perioral numbness and tinnitus
B. Hypertension and tachycardia
C. Bradycardia and hypotension
D. Immediate loss of motor function
Correct Answer: A - Perioral numbness and tinnitus
RATIONALE
Early LAST presents with excitatory neurologic symptoms such as
perioral numbness, tinnitus, and metallic taste due to CNS stimulation.
Cardiovascular depression (bradycardia, hypotension) occurs later,
and hypertension/tachycardia are nonspecific. Loss of motor function
is expected, not toxic.
Question 2
When evaluating a patient with acute decompensated heart failure, which
combination of findings best supports cardiogenic pulmonary edema rather
than ARDS?
A. Elevated BNP, frothy pink sputum, S3 gallop
B. Normal BNP, bilateral infiltrates, fever
C. Low PAOP, refractory hypoxemia, normal CVP
D. High PAOP, unilateral infiltrates, purulent sputum
Correct Answer: A - Elevated BNP, frothy pink sputum, S3 gallop
RATIONALE
Cardiogenic pulmonary edema is characterized by elevated BNP,
frothy pink sputum, and an S3 gallop due to volume overload and left
ventricular dysfunction. ARDS typically has normal or low PAOP,
bilateral infiltrates, and no S3. Unilateral infiltrates suggest
pneumonia or other localized process.
Page 2
, Question 3
A patient with chronic kidney disease stage 4 is prescribed sodium polystyrene
sulfonate. Which concurrent medication poses the highest risk for serious
adverse effects?
A. Calcium acetate
B. Sorbitol
C. Lisinopril
D. Epoetin alfa
Correct Answer: B - Sorbitol
RATIONALE
Sodium polystyrene sulfonate combined with sorbitol can cause
intestinal necrosis, especially in patients with impaired motility or
CKD. Calcium acetate, lisinopril, and epoetin alfa do not have this
specific interaction. Sorbitol is often used as a laxative with the resin
but increases risk.
Question 4
Which intervention is the priority when a patient with a new tracheostomy
develops sudden respiratory distress, absent breath sounds on the left, and
subcutaneous emphysema?
A. Suction the tracheostomy
B. Auscultate lung sounds
C. Remove the tracheostomy tube
D. Prepare for chest tube insertion
Correct Answer: D - Prepare for chest tube insertion
Page 3
, RATIONALE
Unilateral absent breath sounds with subcutaneous emphysema after
tracheostomy suggests pneumothorax, requiring immediate chest tube
insertion. Suctioning and auscultation delay definitive treatment.
Removing the tracheostomy tube is not indicated and could worsen
the airway.
Question 5
A patient with acute pancreatitis has a serum calcium of 7.2 mg/dL. Which
pathophysiologic mechanism best explains this finding?
A. Increased calcitonin release
B. Saponification of calcium in peripancreatic fat
C. Vitamin D deficiency
D. Hyperparathyroidism
Correct Answer: B - Saponification of calcium in peripancreatic
fat
RATIONALE
In acute pancreatitis, lipase breaks down fat into fatty acids that bind
calcium (saponification), leading to hypocalcemia. This is a classic
sign of severe pancreatitis. Hyperparathyroidism would cause
hypercalcemia, and vitamin D deficiency is not the primary acute
mechanism.
Question 6
Which finding in a patient receiving a blood transfusion requires immediate
cessation of the transfusion and initiation of emergency protocols?
A. Temperature increase of 1.8°F (1°C) after 15 minutes
B. Mild urticaria and itching
C. Hemoglobinuria and flank pain
D. Blood pressure increase from 110/70 to 130/80
Correct Answer: C - Hemoglobinuria and flank pain
Page 4
